Broken heart Syndrome is an increasingly reported syndrome characteriz
ed by transient apical or midventricular left ventricular dysfunction that mimics myocardial infarction (MI), but in the absence of significant coronary artery disease.
CLINICAL PRESENTATION — The clinical presentation of stress-induced cardiomyopathy is similar to that of an acute MI, usually with ST elevation . The most common presenting symptom is acute substernal chest pain, but some patients present with dyspnea, shock, or electrocardiographic abnormalities.
The range of findings from these reports is illustrated by the following:
Electrocardiographic abnormalities are the most common finding. ST segment elevation was present in 82 percent of patients (208 of 255) in the systematic review. Among these patients, ST elevations were most common in the anterior precordial leads (82 percent or 172 of 205 patients). Additional ECG abnormalities have also been described, including ST segment depression, T wave inversion, QT interval prolongation, and abnormal Q waves are also seen in some patients.
Cardiac biomarkers are frequently elevated. However, the enzyme elevations are typically mild, which is inconsistent with the often severe hemodynamic compromise. In the systematic review, among studies that measured cardiac troponins or creatine kinase MB, these levels were elevated in 86 and 74 percent of patients, respectively.
Left ventriculography or echocardiography usually show the characteristic apical ballooning with akinesis or dyskinesis of the apical one-half to two-thirds of the LV . Overall systolic function is reduced, and the reported average LVEF has ranged from 20 to 49 percent. In separate reports of ten other cases, ballooning has involved the middle or basal portions of the left ventricle but not the apical segment . No obvious mechanism for this difference in location has been identified.
In the systematic review, transient LVOT obstruction was reported in 16 percent of the patients (21 of 133) who underwent left ventriculography. In some cases, this is accompanied by systolic anterior motion of the mitral valve, similar to that seen in hypertrophic cardiomyopathy.
Reversible perfusion abnormalities in the left ventricular apex have been documented, while
magnetic resonance imaging typically shows mid and apical LV segmental wall motion abnormalities, often in multiple coronary territories without delayed hyperenhancement of involved regions.
Diagnosis — The diagnosis of stress-induced cardiomyopathy should be suspected in postmenopausal women who present with an acute coronary syndrome after intense psychologic stress in whom the clinical manifestations and ECG abnormalities are out of proportion to the degree of elevation in cardiac enzymes.
Left ventricular apical ballooning or midventricular hypokinesis is usually seen on left ventriculography or echocardiography. In a minority of cases (40 percent in one report), transient left ventricular hypokinesis is midventricular ("atypical") rather than apical ("typical) .
Coronary angiography, by definition, reveals no critical coronary lesions. However, in addition to stress-induced cardiomyopathy, a number of other syndromes have been associated with ST segment changes in the absence of significant coronary artery disease, including cardiac syndrome X, variant (Prinzmetal's) angina, and cocaine abuse.
The systematic review cited above proposed the following four diagnostic criteria, all of which must be met :
1- Transient akinesis or dyskinesis of the apical and midventricular segments in association with regional wall motion abnormalities that extend beyond the distribution of a single epicardial vessel
2- Absence on angiography of obstructive coronary artery disease or evidence of acute plaque rupture
3- New ST segment elevation or T wave inversion on the ECG
4- Absence of recent significant head trauma, intracranial bleeding, pheochromocytoma , myocarditis, or hypertrophic cardiomyopathy .
There are no standard treatment guidelines for treating broken heart syndrome. Treatment is similar to treatment for a heart attack until the diagnosis is clear. Most people stay in the hospital while they recover.
Once it's clear that broken heart syndrome is the cause of your symptoms, your doctor will likely prescribe heart medications for you to take while you're in the hospital, such as angiotensin-converting enzyme (ACE) inhibitors, beta blockers or diuretics. These medications help reduce the workload on your heart while you recover and may help prevent further attacks. Many patients make a full recovery within one to two months.
Procedures that are often used to treat a heart attack, such as balloon angioplasty and stent placement, or even surgery, are not helpful in treating broken heart syndrome. These procedures treat blocked arteries, which are not the cause of broken heart syndrome. However, coronary angiography is often used to diagnose exactly what's the cause of the chest pain.
·Leukocyte Alkaline Phosphatase – decreased in CML,
increased or normal in Leukemoid Reaction which is 50,000 WBC.
·Homocystinuria (similar to Marfan’s) – deficiency of
Cystathione Synthase. Tx with Pyridoxine Supplements (B6)
·Ring Enhanced Lesions – Toxoplasmosis, Seizures
·Dihydrobiopterin Reductase – Cofactor for Both
Phenylalanine Hydroxylase and Tyrosine Hydroxylase.
·Osteoblasts convert to Osteocytes – osteocytes are
connected by Gap Junctions.
·Lecithinase – alpha toxin, produced by C. Perfringes
and has an ability to degrade Lecithin, main component of Phospholipid Membrane
·Terminal Bronchioles – lined by ciliated simple
·Nipple Retraction – in Breast Cancer is usually due to
infiltration of Cooper’s Ligament by Cancer.
·Prepatellar Bursa – commonly seen in roofers,
carpenters, people who are kneeling all the time.
·Acute Myelogenous Leukemia – is associated with
t(15,17), where gene for Retinoic Acid is transferred from Ch. 17 to Ch. 15
·Sarcoidosis – presents with increased number of CD4 +
·Calcitonin – released from Parafollicular cells of
Thyroid, in response to increasing levels of calcium. It promotes calcium
absorption by the bone and reducing calcium absorption by the intestines and
thus decreasing the levels of circulating calcium
·NSAIDS - are the primary cause of papillary necrosis
and chronic interstitial nephritis
·Increased levels of Calcium, Phosphate and Oxalate –
promote salt formation and thus stones
·Increased levels of Citrate and High Fluid Intake –
prevent salt formation
·Cell Mediated Immune Response – stimulates production
of Interferon Gamma, Tumor Necrosis Factor Beta and IL 12 which in turn induces
cytotoxic T cell response and eliminated intracellular organism such as
·Listeria Monocytogenes – Gram Positive Rod which
produces Very Narrow Beta Hemolysis Zone on Sheep Blood Agar and exhibits Tumbling
Motility and the only Gram Positive Organism that produces LPS endotoxin (which
is normally found in Gram -)
·Succinylcholine – depolarizing NMJ blocker and usually
elicits a fast response within 60 seconds and lasts for 10 minutes.
·Bethanechol – muscarinic agonist that improves bladder
motility in post operative patients
·Oxybutinin – antimuscarinic agonist that is used in
patients with urinary incontinence
·Motor Innervation of the Tongue – provided by
Hypoglossal Nerve (12), except for palatoglossus which is innervated by Vagus
·Sensation of the Tongue – Anterior 2/3 is Mandibular
Branch of Trigeminal Nerve, Posterior 1/3 is by Glossopharyngeal Nerve (9).
·Gustatory Innervation of the Tongue – Anterior 2/3 is
Chorda Tympani by Facial Nerve, Posterior 1/3 is by Glossopharyngeal Nerve.
·Hypercalcemia in Sarcoidosis – is by macrophages
activated Vitamin D, which is extrarenally produced, it will in turn suppress
·Myocardial Infarction – is the most common cause of Death
in Diabetic Patients.
·Carbamazepine – blocks Voltage Gated Na Channels in
Cortical Neurons, and is used in Trigeminal Neuralgia. Causes Bone Marrow
Suppression and increase in ADH will cause SIADH.
·Ethosuximide – blocks T-type Calcium Channels and decreases
Calcium current in Thalamic Neurons, used for Absence Seizures.
·Type 2 Diabetes – Amyloid Deposition in the Pancreatic
·Type 1 Diabetes – beta cells are destroyed by T
Lymphocytes, look for Infection
·Von Hippel Lindau - autosomal dominant disorder
characterized by cerebellar hemangioblastomas, clear cell carcinomas and
pheochromocytomas. All patients have a deletion of VHL gene on Chromosome 3b.
·Acyclovir – can cause crystalline nephropathy if
hydration is not provided.
·In CO poisoning – PO2 is normal, % Saturation of
Oxygen is decreased, because CO competes with O for Heme Sites, Oxygen Content
·In Anemia - PO2 is normal, % Saturation of Oxygen is
Normal, Oxygen Content is decreased
·In Polycythemia – PO2 is normal, % Saturation of
Oxygen is Normal, Oxygen content in the blood is Increased.
·Foscarnet – is a pyrophosphate analog and can chelate
Calcium, it will also cause Magnesium excretion and thus the side effects are
Hypocalcemia and Hypomagnesemia and thus there will be Seizures in patients
·In Restrictive Lung Diseases – high expiratory flow
rates occur despite Low Lung Volumes, and that is due to Increased Elastic
Recoil Pressure and Increased Radial Traction on the airways.
·Henoch Schonlein Purpura – leukocytoclastic vasculitis
due to deposition of IgA immune complexes and presents with low extremity
purpura, abdominal pain, arthralgia and renal involvement.
·Lymphogranuloma Venerium – is caused by Chlamydia
Trachomatis, and will present with painful vesicular lesions.
·Acute Salicylate Overdose – at first there is a
Respiratory Alkalosis, because salicylates stimulate medullar respiratory
center and cause hyperventilation. Metabolic Acidosis occurs due to
accumulation of acids, and thus it’s a mixture of Respiratory Alkalosis (low
PCO2) and Metabolic Acidosis (low plasma HCO3)
·Prevention of Reinfection with Influenza –
anti-hemagglutinin IgG antibodies in the blood and anti-IgA antibodies in the
mucus and nasopharynx.
·Estrogen – will increase TBG levels, by reducing its
destruction and thus will increase T4 levels. So expect patients on Hormone
Therapy to have increased T4 levels.
·Acanthosis Nigricans – Benign Form is associated with
Insulin Dependent Diabetes and Malignant Form is usually due to underlying GI
·Nucleoside Analogs – Acyclovir, Gancyclovir,
Valacyclovir are nucleotide analogs that need to be converted into a
Monophosphate Form by Herpes Viral Kinases – Thymidine Kinases.
·Cidofovir – is already a Nucleoside Monophosphate and
thus doesn’t need to be converted to monophosphate and only needs to be
converted into an active Triphosphate Form.
·Neuraminidase Inhibitors – prevent Virion Release from
infected cells with Hemophilis Influenza.
·Amantadine – inhibits uncoating and disassembly of
Influenza A Toxin after it has entered the cell.
·Ribosomal RNA – is synthesized in Nucleolus. It’s the
proteins that are synthesized in RER.
·+ Trandelenburg Test – checks for damage to Superior
Gluteal Nerve that innervates Gluteus Medius and Minimus.
·Newborn born to Diabetic Mothers – will present with
Hypoglycemia and most of the times they present with Macrosomia, Transposition
of Great Vessels, Renal Agenesis, Rectal Atresia. Hypogycemia is due to Beta
Cell Hyperplasia, and not because Insulin has crossed the Placenta, because it
doesn’t. Thus when glucose crosses placenta into fetal blood, the response of
the fetus will be Beta Cell Hyperplasia.
·In Cyanide poisoning – Amyl Nitrite is the antidote,
because Nitrites increase formation of Methemoglobin, and Methemoglobin has an
increased affinity for Cyanide. Sodium Thiosulfate also is used in Cyanide
Poisoning which will form Thyocyanite which is less toxic.
·Recall Bias – when patients are selected who suffered
an adverse effect and they are more likely to recall previous risk factors.
·Selection Bias – is when patients are selected by
providers based on their severity of the disease. For Example: severely ill
patients are more likely to enroll in cancer trials.
·P. Aeruginosa – non-lactose fermenting (gram –) Rod
and is the cause of UTI in patients with Indwelling Urinary Catheters as well
as patients on Respirators.
·Injections into gluteal region – must be targeted into
Superior Gluteal Region, to avoid injury to sciatic or gluteal nerves.
·Foscarnet – is a pyrophosphate analog and does not
need to be converted intracellularly to monophosphate form by viral Thymidine
Kinase. Its side effects include Hypocalcemia, Hypmagnesemia and thus
·Cushing’s Syndrome – is usually caused by exogenous
administration of Glucocorticoids. Thus the Adrenal Cortex will appear shrunken
·Sand Paper Like Rash – Actinic Keratosis, that appears
as crusted lesion on Sun Exposed Areas in elderly, it may turn into Cutaneous
·Mycobacteria – that grows as Serpentine Cords, usually
·Adrenal Crisis – will present with shock syndromes in
combination with Hyponatremia, Hyperkalemia and Hypoglycemia, and presence of
nuchal rigidity, fever, rash and vomiting suggests Neisseria Meningitidis
Infection caused Waterhouse Friedrichsen Syndrome, where there is an Adrenal
·Primary Mineralocorticoid Excess – can be due to tumor
of Zona Glomerulosa, which will cause Hypokalemia, Bicarbonate Retention and Sodium
Retention. Which will in turn decrease Renin.
·Cushing Syndrome – primary work up will include
Dexamethasone Suppression Test. Where Cortisol Levels would not be suppressed
due to endogenous Cushing Syndrome causing Pituitary Adenoma.
·In Anorrhexia – levels of fat drop below normal and
this will in turn decrease pulsatile release of GnRH.
·Acid Fast Stain – stains mycolic acid and at first its
placed into Carbolfuchsin and then will be treated with Hydrochloric Acid and
·SnRNP (snurps) – are involved in the process of
removing RNA introns during Synthesis and thus are necessary for synthesis of
·Competent Patients – have the right not to find out
about their diagnosis, if they don’t want to.
·Beta Lactamase Inhibitors – Clavulinic Acid, Sulbactam
and Tazobactam will inhibit destruction of Beta Lactam Ring of Penicillins.
·Abciximab – inhibits binding of Glycoprotein IIb/IIIa
·Glanzmann Thrombasthenia – is a deficiency of IIb/IIIa
glycoprotein on platelet surfaces.
·Leukotrienes – are synthesized by eosinophils,
basophils in asthmatics
·Histamine – bronchoconstrictor and is released by mast
·Methacholine Challenge – cholinergic muscarinic
agonist used in testing for asthma
·Valproic Acid – if taken during pregnancy, increases
the risk of Neural Tube Defects.
·Test for Temporal Arteritis – first thing to look at
is Erythrocyte Sedimentation Rate. If it’s elevated (>100) then the positive
·PrP – has an α - helical structure and is usually
found in Creutzfeld Jacob Disease, where there is a Spongiform Transformation
of Gray Matter. Spongiform is because the abnormal protein accumulates in
Vacuoles and will form a Sponge Like surface.
·Subacute Sclerosing Encephalitis – complication of
Measles Virus in children and adolescents. Usually found in type of Measles
Virus that has an M-antigen missing.
·Multiple Sclerosis – will present with visual changes,
painful eye movements and there will be Demyelination of Axons, but Never a
Loss of Neurons, Axon Disruption or Astrocyte Degeneration.
·Herpes Encephalitis – usually a complication of HSV 1
virus in children and will involve Temporal Lobe Encephalitis.
·Meningitis caused by E.coli – usually will involve a
K-1 Viral Capsule that will be infectious. E.coli will grow Pink Colonies on
·Transfused Blood – will contain citrate, that is used
to prevent clotting of the blood, but in patients who are transfused with large
amounts of blood, it will cause Hypocalcemia, because it chelates Calcium.
·Fanconi Anemia – patients will present with DNA
exonuclease deficiency, and will be similar mechanism to Xeroderma Pigmentosum.
·Warfarin Therapy – Gamma Carboxylate protein C and S
(which are Natural Anti Coagulants), and in patients with Protein C deficiency,
there will be an extreme risk of Thrombosis.
·Clopidogrel and Ticlopidine – are ADP antagonists and
will act by blocking interaction of Ligands with Platelet Receptors. Patients
on Ticlopidine, will have Neutropenia and Mouth Ulcers as a side effect!!!!!
·Cilostazol and Dypyridamole – decrease
Phosphodiasterase and thus increase cAMP.
·RANK Receptor/RANK Ligand – are essential for
formation and differentiation of Osteoclasts. Hypoestrogenic state (Low
Estrogen) will increase RANK and thus will cause an increase in Osteoclasts and
thus in Increased Bone Resorption.
·Vacuoles formed in CJ Prion Disease – are
accumulations of Alpha Helical Protein that became abnormal and these
accumulations will form Spongeform Encephalitis and we will see PrP proteins in
·C-peptide – can be used as a marker for Endogenous
secretion of Insulin by β-pancreatic cells. Glyburide which is a SulfonylUrea
will increase the rate of Insulin Secretion and Levels of C-peptide in Type II
·Patients with MS after Hot Showers – will experience
Extreme Fatigue after taking a Hot Shower, because the Heat will Decrease the
Speed of Axonal Transport.
·M-CSF and RANK receptors – are present on Osteoclasts.
Macrophage –Colony Stimulating Factor and RANK are present in Osteoclasts.
·E.Coli causing UTI – will express Fimbriae, which are
Fimbrial Antigens, which are used for adhesion to Uroepithelial Cells.
·Brunner’s Glands in Duodenum – which are unique to
Duodenum, will secrete Alkaline Mucous into the ducts.
·Cilostazol and Dipyridamole – will decrease the
activity of Platelet Phosphodiesterase and thus will increase cAMP. Also they
will cause Vasodilation of Arterioles. Used in Peripheral Artery Disease –
·Ankylosing Spondylitis – are associated with HLA B-27,
which are TYPE I HLA class.
·Type II HLA Class are antigens that contain DR, DP and
·Ethosuximide – blocks T-type Calcium channels that
trigger and sustain rhythmical burst discharges in thalamic neurons.
·Phenytoin – blocks Na channels and thus decreases the
firing of neurons
·Valproic Acid – blocks NMDA receptors and affects K
·Benzodiazepines – can cause daytime drowsiness and
increase the risk of Falls in Elderly.
·Meckel’s Diverticulum – remnant of omphalomesenteric
duct (vitelling duct) and is a true diverticulum, that consists of all the
layers of the intestinal wall (mucosa, submucosa and muscularis)
·Power of a study – 1-percentage where it fails. So if
the data fails 20% of the time, then .8 is a power of study.
·Acute Rejection - occurs within weeks of
transplantation and primarily mediated by host T-lymphocytes that act against
donor MHC antigens. To prevent, administer Calcineurin Inhibitor such as
·Cricopharyngeal Muscle Dysfunction – caused by
diminished relaxation of pharyngeal muscles during swallowing. Usually occurs
in elderly, where they present with coughing, choking and recurrent aspiration.
·Doxyrubicin – anthracycline chemotherapeutic agent
will form free radicals in myocardium. The side effect is cardiac fibrosis,
which will present with Dilated Cardiomyopathy.
·Phospholipase C - forms IP3 and DAG from
phospholipids. And IP3 causes an increase in intracellular calcium, which then
activates Protein Kinase C.
·Lactase Deficient Patients - will present with a
Normal Intestinal Mucosa.
·Polycystic Ovarian Disease Patients – will benefit
from therapy with Clomiphene, which is an estrogen receptor antagonist and will
increase the release of GnRH and stimulates ovulation. Because in PCOS the
patients’ ovaries will secrete estrogen which will feedback inhibit GnRH, and
in treatment with Clomiphene, these receptors will be suppressed and thus GnRH
will secrete estrogens and induce ovulation.
·Nimodipine – Calcium Channel Blocker, used in surgery
on Subarachnoid Hemorrhage to prevent cerebral vasospasm.
·Aspergillosis – occurs in Old Lung Cavities. It will
grow as a Fungus Ball and will present in old cavities caused by TB,
Sarcoidosis or Emphysema. Patients with Asthma may have a hypersensitivity
reaction to Aspergillus.
·Erosions of Gastric Mucosa - are called erosions
because they do not penetrate Muscularis Mucosa, when they do, then it’s called
·Candida Albicans – will inoculate into serum at 37
degrees for 3 hours will lead to formation of Hyphae from Yeast.
·Mitral Valve Prolapse – the most common cardiac
abnormality that predisposes to native Valve Bacterial Endocarditis.
·Majority of Free Water – will be reabsorbed in the
Proximal Tubule, regardless of the patient’s Hydration Status.
·Alpha 1 antitrypsin deficiency – should be suspected
in all patients with premature onset (<50 years old) of Chronic Bronchitis,
Emphysema and Dyspnea. History of Neonatal Hepatitis with Cholestasis will
heighten the suspicion of A1AT deficiency!!!
·PCO2 – is the most potent Cerebral Vasodilator.
Patients with COPD will usually have low PO2 and High PCO2 and thus will
present with Increased Cerebral Circulation.
·Aortic Regurgitation – will present with Widened Pulse
Pressure and the patients will have Head Bobbing.
·Achondroplasia – the most common defect in these
patients is the mutation of Fibroblast Growth Factor Receptor (FGFR-3) at the
epiphyseal growth plate and the cells that are affected are Chondrocytes.
·Trigeminal Neuralgia – is commonly due to V2 and V3
nerves of CNV and will be treated by Carbamazepine.
·Acute Necrotizing Pancreatitis – Major Risk Factor for
Adult Onset Respiratory Distress Syndrome. Thus patients will have an elevated
Amylase and Lipase.
·Abetalipoproteinemia – is an inherited inability to
synthesize apolipoprotein B, which is a component of Chylomicrons. Thus Lipids
will accumulate in the Intestinal Epithelium, because they can’t be transported
·Resting Membrane Potential – is normally about -70 mV
and is due to Potassium Efflux and Sodium Influx.
·Valproate – is preferred in patients with Combined
Absence Seizures and Tonic Clonic, not Ehtosuximide which is only for Absence
·Cystinuria – is due to defect in renal tubules, which
fails to absorb amino acid Cysteine. To test for this, we do Cyanide test which
detects Sulfhydryl Groups and will detect presence of Cystine.
·Poststreptococcal Glomerulonephritis – will have
granular deposits of IgG, IgM and C3 in the mesangium and basement membrane.
·Stapedius Muscle – innervated by Stapedius Nerve,
which is a branch of CNVII. Paralysis of Stapedius Muscle will cause
Hyperacusis. Ipsilateral Hyperacusis is usually seen in Bell’s Palsy, which is
a peripheral facial nerve palsy.
·Hyperacute Rejection – that occurs immediately due to
Preformed Antibodies within the recipient. This is a Type II Hypersensitivity
·Patients with Mitral Stenosis – might have an Opening
Snap, which usually follows S2 heart sound.
·VSD – is usually heard at Left Midsternal Border and
produces a Holosystolic Murmur.
·Fixed Wide Splitting – is present in patients with
Atrial Septal Defect. Which is a fixed wide splitting of S2.
·Phrenic Nerve – which innervates diaphragm, arises
·Clubbed Fingers – patients will usually have
Bronchiectasis or other Lung Diseases.
·Uroporphyrynogen Synthase – is an enzyme deficient in
patients with Porphyria.
·Patients with Coronary Thrombi – will have a high
activity of Metalloproteinases in the clot and this will predispose to
·Colchicine – inhibits Leukocyte Migration and
Phagocytosis by Blocking Tubulin Polymerization. The side effects are Nausea
and Diarrhea, should not be used in Renal Insufficiency Patients or Elderly.
·Children with Measles – will benefit from therapy with
Vitamin A. Defficiency of vitamin A, will include xerophthalmia, night
blindness, keratomalacia and corneal perforation.
·Strep Viridans – will be present after Dental Surgery,
and will use Dextrans as substrates to facilitate adherence of Strep Viridans
·Inhaled Anesthetics – will vasodilate Cerebral
Vasculature, but will depress the blood flow in Liver, Kidneys, Heart.
·TCA Patients Cause of Death – is usually due to
Arrhythmia which is precipitated by Blocking of Fast Sodium Channels in
patients who overdose on Tricyclic Anti Depressants, which normally inhibit
reuptake of Norepinephrine and Serotonin.
·Imipramine – which is a TCA, will precipitate episodes
of Mania in patients who are depressed.
·Malignant Hyperthermia – usually occurs after
inhalation anesthetics were used and is treated with Dantrolene, which
Ryanodine Receptors and will inhibit the release of Calcium into a cytoplasm.
·Nafcillin or Methicillin – resistance is due to
alteration of Penicillin Binding Protein. Which will alter the Binding of Penicillin
and thus cause Resistance.
·Enteropeptidase Deficiency – will decrease conversion
of Trypsinogen to Trypsin in Intestines, which will present with diarrhea,
growth retardation and hypoproteinemia.
·Lymphedema in Post Mastectomy Patients – will predispose
to development of Lymphangiosarcoma of Lymphatic Channels, will occur 10 years
after the surgery.
·Natural Killer Cells – are responsible for killing if
MHC I cells fail to respond. NK cells are CD16 and CD56, and do not require
Thymus for Maturation. They are activated by IL 12
·Sickle Cell Patient – with HbA of 60% and Hb S of 40%
will not develop painful crises, due to a high number of Hb A, but will be
protected from Plasmodium Falciparum.
·QT Prolongation – will result from mutation of K channel
protein that contributes to delayed current of cardiac action potential.
·Wegener Granulomatosis – will present with Crescents
on Light Microscopy.
·Decidualization of endometrium – is seen in pregnancy,
it’s just another name for a change in the endometrium with gestation
·Perchlorate, Pretechnetate – are used to pretreat
people with Thyroid Problems, they will block iodide absorption via competitive
·Adenosine Deaminase – deficient in SCID and Adenosine
accumulates and is toxic to T-lymphocytes.
·Hydroxylation of Lysine to Proline – occurs in RER and
requires Vitamin C.
·Bone Specific Alkaline Phosphatase – is indicative of
·Tartrase Resistant Acid Phosphatase, Hydroxyproline
and Deoxypyridinoline – indicative of Osteoclastic Activity.
·Glucocoricoid Therapy – number 1 cause for Adrenal
·Atherosclerosis – predisposes to Abdominal Aortic
·Hypertension – risk factor for development of Aortic
·Abdominal Pain due to Pancreatitis – is the presenting
sign of patients with Hypertriglyceridimea, where there are eleveated levels of
·Hepatitis B Infection – will fill up the cytoplasm
with spheres and tubules containing HbSAg, which gives it eosinophilic ground
·Hepatitis C Infection – will form lymphoid
accumulation in the portal tracts and cause focal areas of macrovesicular
·Haloperidol – the drug associated with the side effect
of Neuroleptic Malignant Syndrome, which presents with confusion and muscle
·Glucocorticoids – are preferred as a short term
therapy for Rheumatoid Arthritis, and Methotrexate is used for Moderate to
Severe Rheumatoid Arthritis.
·Neuronal Damage – will present with Gliosis, due to
the death of Astrocytes.
·Calcium Channel Blockers – will present with Bilateral
Ankle Swelling and Flushing as a Side Effect.
·α Ketoacid Dehydrogenase – is usually deficient in
Maple Syrup Disease and the treatment is to avoid Branched Chain Amino Acids,
such as Isoleucine, Leucine and Valine.
·Goodpasture’s Syndrome – presents with Linear Deposits
·Minimal Change Disease – presents in children with
Selective Albumin Loss Proteinuria.
·Fetal HbF – contains Gamma Globin instead of Beta
·Thiazolidinediones (Pioglitazone, Rosiglitazone) – you
must check for Liver Function Tests, due to increased risk of Hepatotoxicity.
·Annular Pancreas – present due to Abnormal Migration
of Ventral Pancreatic Bud.
·Congenital Bicuspid Aortic Valve – presents with
Calcification and will cause Aortic Stenosis later on in Life.
·Bupropion – doesn’t have Sexual Dysfunction Side
Effects and is an excellent choice opposed to SSRIs
·Major Basic Protein – secreted by Eosinophils
functions to kill Helminths
·Adult Pneumovax – is an Unconjugated Polysaccharide
·Primary Pulmonary Hypertension – is usually due to
idiopathic dysfunction of Pulmonary Artery Endothelium
·ATP – is a regulatory stimulus that acts to stimulate
KATP Channels in Insulin Producing Pancreatic Beta Cells.
·Brown Pigment Stones – results in the release of
β-glucuronidase by injured hepatocytes.
·S. Pneumonia – is able to undergo transformation on
the agar, if combined with another bacteria
·E.Coli – is unable to undergo Pilus Mediated Transfer
of DNA Conjugation.
·Strep. VIridans – produce Dextrans from Glucose to
·Congenital Toxoplasmosis – presents with
Hydrocephalus, Intracranial Calcifications and Chorioretinits.
·Coccidiomycosis – produces Spherules in the Lung
·Systemic Macrocytosis – abnormal proliferation of mast
cells and increased histamine secretion. Gastric Hypersecretion will be seen in
Macrocytosis, due to increased production of Gastric Acid by Parietal Cells.
·Treatment with Statins – will increase LDL Receptor
·Neural Tube Defects – will present with increased
Alpha Fetoprotein and Increased Acetylcholinesterase
·Minimal Alveolar Concentration MAC – best measure of
potency of an inhaled anesthetics.
·MHC Class I Molecule – consists of a Heavy Chain and a
Beta 2 Microglobulin
·Lactase Deficiency – will present with Increased Stool
Osmotic Gap, Increased Breath Hydrogen and Decreased Stool pH.
·Pathogenesis of Crohn’s Disease – presents with
activity of TH1 cells, which will increase production of IL-2 and Interferon
Gamma and thus increase production of Macrophages and thus Granuloma Formation.
·Leuprolide – GnRH Agonist, will at first cause a
Transient Increase and then Decrease in Testosterone and DHT.
·Factor V Leiden Mutation – causes Factor Va resistance
to Inactivation by Activated Protein C, patients will present with Atypical
·Legionnaire’s Disease – caused by Legionella Pneumonia
causes disease in smokers, with diarrhea, headache and confusion
·DDAVP (Desmopressin) – increases vWF release from the
·S 4 – causes an extra sound before S 1 and that is due
to a stiff ventricle
·Second Generation (Atypical) Anti Psychotics -
Clozapine, Risperidone, Olanzapine and Quietiapine are used for positive and
·Echinococcus – usually causes cysts in the liver, that
if are ruptured, may cause Anaphylaxis.
·Cyanotic Spells – where a patient will strain himself
to vasoconstrict and thus reverse RàL shunt, are seen in Tetrallogy of Fallot.
·Diastolic Failure – will cause an increase only in
EDVP, where a Systolic will increase both ES and EDVP.
·Benign Glomus Tumor – glomangioma, can produce a
tender cyanotic nodule under the nail, and the cells that caused this are
involved in Thermoregulation.
·Morphine – opioid agonist, that works on Potassium Channel
·Negative Predictive Value – the probability of being
free of disease, if the result is negative.
·Small Cell Carcinoma – shows evidence of
·Potassium Iodide – is added to decrease the uptake of
thyroid by the thyroid gland in Hyperthyroid Patients.
·PTU – propylthiouracil, blocks the enzyme Thyroid
Peroxidase, and thus decreases the formation of Thyroid Hormone.
·Ventricular Hypertrophy – as well as volume overload
can induce formation of ANP and BNP from ventricular myocytes and induce
diuresis and natriuresis.
·Selegeline – an inhibitor of MAO Type B receptors, in
patients treated for Parkinson it can protect from damaging of dopaminergic
neurons. Treatment with Selegeline and Amantadine is a First Step in management
of Parkinson Patients, after all the options are tried, only then we administer
·COX 2 Inhibitors – do not affect platelet function,
because it’s mostly under COX 1 control.
·Maple Syrup Urine Disease – defect in α-ketoacid
dehydrogenase, which requires 5 cofactors (Thiamine Pyrophosphate, FAD, NAD and
Coenzyme Q) similar to Pyruvate Dehydrogenase.
·Rupture of Myocardium – is the most common
complication of AMI 3-7 days later. Hypotension, Increased Jugular Vein
Distention and Muffled Heart Sounds are the signs.
·Dietary Energy – 9 kCal per gram of Fat, 4 kCal per
gram of Carbs and Protein and 7 kCal per gram of Ethanol.
·Hepatitis A Virus – can be inactivated by boiling for
1 minute at 85 degrees, treating with Formaldehyde and Bleach.
·QT Prolongation – is usually caused by Potassium
Channel Blockers, Amiodarone is a Potassium Channel Blocker that doesn’t
predispose to Torsades de Pointes.
·Areas of Metaplasia – may be present in the duodenal
ulcers created by H. Pylori Infection.
·Complications of CF – in US, usually are
CardioRespiratory Symptoms, such as Pneumonia, Bronchiectasis, Cor Pulmonale
and Obstructive Pulmonary Disease.
·Standard Deviation – 68% is in the range of 1 SD, 95%
are in the range of 2 SD and 99.7 % contain 3 SD’s
·Increased Osteoid Matrix – is a complication of
·Macrophages loaded with PAS Positive granules – are
usually seen in Whipple Disease, if there are signs of Malabsorption in middle
·Lipofuscin – is an accumulation of Lipid Peroxidation
accumulating in aging cells.
·Elevated Serum Alpha Fetoprotein – is usually present
in Hepatocellular Carcinoma (Hepatoma)
·Complication of CREST – earliest damage is seen in
small vessels, where it causes intimal thickening
·Damage to Posterior Hypophysis – will causes Diabetes
Insipidus only for a short period of time.
·Damage to Hypothalamic Nuclei – will cause a long term
Diabetes Insipidus, not the transient that is seen with damage to Posterior
·Tolcapone – is a COMT Inhibitor, which serves to
prolong the availability of Levodopa in Parkinson Patients. Check for Liver
Enzymes when administering
·Elastin’s ability to recoil when stretched – is due to
Lysyl Hydroxylase crosslinking
·Mitral Valve Prolapse – is the most common
predisposition to Valve Bacterial Endocarditis.
·Cerebellar Tumor in a Child – is most likely a
Medulloblastoma or Pilocytic Astrocytoma, medulloblastomas are always solid and
Astrocytoma are solid and cystic.
·Renal Cell Carcinomas – are usually associated with
Von Hippel Lindau and deletion of VHL gene on Chromosome 3p.
·Patients with splenic rupture – are usually
susceptible to bacterial infections, such as S. Pneumonia, H.Influenzae and N.
·Ergonovine – is an ergot alkaloid that constricts
vascular smooth muscle by stimulating alpha adrenergic and serotonergic
receptors and thus it can cause a Coronary Vasospasm.
·N-Acetylcysteine – works by cleaving Disulfide Bonds
within Mucus Glycoproteins and thus Loosening the Mucus.
·Vitamin E Defficiency – the most notable changes are
seen in Nervous System, where there is a degeneration of Spinocerebellar
Tracts, dorsal columns and peripheral nerves, which is similar to Friedrich’s
·Pulmonary Effect of Vagus Stimulation – is
bronchoconstriction, which will increase the work of breathing, mucus
production and airway resistance.
·V. Cholera – does not survive well in Acidic pH. So
any condition that causes achlorhydia will cause V. Cholera to proliferate.
·During Recovery from ATN – patients tend to develop
Hypokalemia, due to high volume, hypotonic urine.
·Mutation in CFTR gene – in CF patients will cause an
abnormal folding of a protein and will result in degradation of a protein
before it reaches the cell surface.
·Cavernous Hemangioma – is the most common benign tumor
of the liver, which on microscopy presents with blood filled vascular spaces
·Avitaminosis of Vitamin A – may cause a squamous
epithelial metaplasia of Pancreatic exocrine ducts, seen in patients with CF
·Coccidioides Immites – presents with spherules on
microscopy and it looks like berries.
·Aspiration Pneumonia – is usually seen in alcoholics,
seizures, old age, poor oral hygiene, the agents usually aspirated are Fusobacterium,
·Thiopental – is an anesthetic and will cause a
paralysis, further on it will dissolve into the Skeletal Muscle Tissue.
·Tetrallogy of Fallot, Transpostion of Great Vessels
and Truncus Arteriosus – can be caused by an abnormal migration of Neural Crest
·Inhalation Anesthetics – can cause a massive Hepatic
Necrosis, due to Halothane Exposure, where Halothane Metabolites produce
autoantibodies against Hepatocytes.
·Thioridazine – anti psychotic causes Retinal Deposits
(Retinitis Pigmentosa). Chlorpromazine usually causes Corneal Deposits.
·N-AcetylCysteine – provides Sulfhydryl groups and thus
binds the toxic metabolites of Acetaminophen, and also it is useful in
loosening the mucus plugs in CF patients, where it breaks sulfide bonds by
providing Sulfhydryl groups.
·Amyotrophic Lateral Sclerosis – causes loss of neurons
in Anterior Horn (LMN Lesion) where it causes muscle weakness and atrophy.
Demyelination of Lateral Corticospinal Tract (UMN Lesion) will cause spasticity
·Nitrates and High Blood Pressure – nitrates cause
vasodilation and Reflex Tachycardia kicks in when the body senses the drop in
BP, so to avoid Tachycardia, you must administer Beta Blockers.
·Loss of Contractility of a Muscle – usually occurs
within 60 seconds of Ischemia and Lactate will accumulate.
·ACE Inhibitors – may produce Angioedema
·Symptoms of Raynaud Phenomenon – are usually treated
with Calcium Channel Blockers.
·Hemiballismus – associated with wild flinging of
extremities on 1 side of the body indicates damage to Subthalamic Nucleus,
usually due to a Lacunar Stroke.
·Menopause – is associated with increased levels of
·Busprione – is a first line treatment of Generalized
Anxiety Disorder and usually takes 2 or more weeks to show full effect.
·Primary Oocytes – are arrested in Prophase of Meiosis
I, and remain there until puberty. At puberty, it starts Meiosis II and gets
arrested until fertilization in Metaphase of Meiosis II.
·Classical Conditioning – is when a person has a
reaction to a stimulus, like White Coat Anxiety, where White Coat is a
Conditioned Stimulus for Anxiety.
·Left Atrial Enlargement – can impinge Left Recurrent
Laryngeal Nerve and cause Hoarseness
·Amiodarone – Class III Anti Arrhythmic and can cause
Thyroid Dysfunction (it’s 40% Iodine by Weight), Corneal Deposits, Blue Skin
Discoloration, Pulmonary Fibrosis or Liver Dysfunction.
·Mutation with FAS gene – impairs CTL to delete self
reacting T-Lymphocytes and thus can cause an auto-infection of different
organs, such as seen in SLE.
·VPL – receives input from Spinothalamic and is a relay
for Pain, Temperature, Proprioception.
·VPM – is a relay for Gustatory Pathways
·Lateral Geniculate Body – pathway for Vision
·Medial Geniculate Body – pathway for Auditory.
·Olfactory – doesn’t have a relay through the Thalamus.
·Glycoprotein in Whipple’s Disease – stains well with
PAS and is resistant to Diastase. It stains Red with PAS and is an excellent
way to diagnose Whipple’s
·HIV + Patients – often undergo reactivation of EBV
·Absolute Risk Reduction = Event Rate in Placebo
(25/1000 = 2.5%) – Event Rate in Treatment (10/1000=1%) Thus it’s equal to 1.5%
·Number Needed to Treat = 1/ARR NNT= 1/0.015=0.66 or
·Aflatoxin – present in different Molds of Grain, cause
a mutation of G to T of p53 Gene and will cause Hepatocellular Carcinoma.
Usually seen in Asian Countries.
·Methacholine Challenge – can be used in patients to
diagnose Asthma, since it’s a Muscarinic Cholinergic Agonist, it will increase
Bronchial Smooth Muscle Contraction and Mucus Production.
·Etanercept – Alpha Tumor Necrosis Factor Antagonist,
and is used in treatment of Severe Rheumatoid Arthritis, especially in patients
who failed Methotrexate Therapy.
·Check for PPD, since it causes Reactivation of
·Woolsorter’s Disease – is caused by Bacillis
Anthracis, and has a structure where it has D-Glutamate instead of
·COX 2 Enzyme in Colon Cancers – increased expression
of COX 2 enzyme, has been seen in Colon Adenocarcinomas and Polyposis, so
prevention with NSAIDS has been useful
·Fexofenadine – Second Generation Anti Histamine that
causes minimal sedation
·Mucor Rhizopus Infection – causes fungus in
Ketoacidosis Diabetic Patients and must be Biopsied to Diagnose. It branches at
90 degree angles and Aspergillosis at 45 degrees
·Lamotrigine – anticonvulsant used in Refractory
Partial Seizures and has been shown to cause a Hypersensitivity Rash as a Side
·Prolactinomas – associated with increased production
of Prolactin will suppress GnRH and thus causes Osteoporosis by decreasing
levels of Estrogen.
·Atherosclerotic Plaque – exresses increased number of
PDGF and causes adherence of Platelets to it and thus increasing Intimal
·Intususseption – usually seen in children less than 2
years of age and are presented with a mass in the abdomen, poor feeding and
Currant Jelly Stool
·NSAID in Acute Gout – are the first line of treatment
in patients presenting with Acute Attacks of Gout, Glucocorticoids are used as
a first line of treatment in Elderly Patients or those with Renal Failure.
·Loss of Nissl Substance in Neurons – indicates an
Irreversible Damage to a Neuron
·Left Sided Colon Cancers – usually present with
Obstruction Type of Symptoms, where Right Sided Colon Cancers present with Iron
Deficiency Anemia, since they tend to bleed.
·Mutation of K-Ras gene – usually causes an increase in
Growth of Colonic Polyp.
·Mutation in APC Gene – usually causes Adenomatous
·Mutation of p53 gene – usually causes a Malignant
Transformation of Adenomatous Polyps.
·Odds Ratio – is calculated from formula OR=ad/bc
·Relative Risk – is [a(a+c)]/[b(b+d)]
·Incomplete closure of Caudal Region – of abdomen, will
cause extrophy of the bladder or cloaca extrophy
·Fibrates and Bile Resins – will increase cholesterol
content of bile and increase the risk of gallstones. Fibrates are drugs like
Gemfibrozil and Bile Resins are Cholestyramine
·Extracellular Propeptidases – cleave disulfide rich
extensions from procollagen molecule and thus will form triple helix.
·Niacin – decreases synthesis of triglycerides and
VLDL, by suppressing the release of fatty acids from peripheral tissue. Side
Effects are flushing, which can be prevented by administration of Aspirin.
·Shiga Like Toxin – produced by E.Coli are identical in
structure to Shigella Toxin, work by inhibiting 60S subunit of ribosomal
protein and thus preventing protein synthesis
·Toxic Shock Syndrome – has superantigen, which
interacts with MHC complex on antigen presenting cells and T-lymphocytes and
they cause widespread of activation of T cells with release of IL-2 from
T-cells, IL-1 and TNF from macrophages.
·Hepatitis D antigen – must be coated by external coat
HBsAg antigen of Hepatitis B Virus.
·Blastomycosis – can cause a pulmonary disease in
immunocompromised patients, where Aspergillus may cause aspergillosis in old
cavities created by TB etc.
·Methotrexate – inhibits dihydrofolate reductase and
side effects include stomatitis (mouth ulcers) and hepatotoxicity.
·Biopsy in Hirschprung Disease – must include the
submucosa of the narrow part, because usually submucosa and myenteric plexus
are absent in this disease.
·Postreptococcal Glomerulonephritis – is usually caused
by accumulations of Immune Globulin Deposits.
·Glucose Transport – into cells occurs by Facilitated
·TCA antidepressants – such as imipramine,
amytriptiline, must be used with caution in patients with BPH, because they
have strong anti-cholinergic side effects and may cause acute urinary retention
·Enterococci – produce aminoglycoside modifying
enzymes, that transfer chemical groups and will impair an antibiotic binding
and thus resistance
·IgA Protease – facilitates Mucosal Penetration.
·Nitrglycerin – works primarily as a Venodilator, where
cardiac workload is decreased, because the blood is collected in the venous
system and thus the preload is decreased as well
·Release of Lysozomal Enzymes – from ischemic tissue in
the brain, results in necrosis of the tissue in the affected region.
·Anencephaly – along with duodenal, esophageal or
intestinal atresia are the main cause for Polyhydramnios, where the swallowing
·TB Meningitis – will result in a Communicating
Hydrocephalus, where the impaired function is of Arachnoid Granulations.
·RhoGam Therapy – where the Rh- negative mother is
given an Anti D Globulin, and that globulin is IgG.
·Common Peroneal Nerve – is mostly commonly injured in
the trauma near the head of fibula and will cause Foot Drop.
·Calcium during Muscle Contraction – will cause an increased
degradation of Glycogen and have it converted into Glucose-1-phosphate.
·Risk of Fractures is lower in Blacks – some of the
risk factors of osteoporosis are smoking, menopause, corticosteroid therapy,
Caucasian race, physical inactivity, alcohol use.
·Collagen Molecule - has a triple helix formation,
where there is a Glycine Amino Acid in every third positon.
·Patients presenting with signs of Polydipsia –
polyuria but at the same time they have Hyponatremia, are usually caused by
Psychogenic Polydipsia, or Pathologic Water Drinkers.
·Aldosterone – increase sodium and water reabsorption
in the collecting ducts.
·ADH – increases water reabsorption in the collecting
·Retinoblastoma Protein (Rb) – is a regulator of G1 to
S phase transition.
·p27 protein – is a cell cycle inhibitor, so malignant
cells will have low number of p27 cells.
·Gluconeogenesis – is a major controller of glucose,
during an overnight fast, where it converts pyruvate to oxaloacetate and
oxaloacetate to phosphoenolpyruvate.
·ADH acts in Medullary Segment – of collecting duct,
where it acts to absorb water
·Aldosterone – mainly acts in Cortical Segment of
·Staph. Scalded Skin Syndrome – produce Exfoliating
Exotoxin, and there is a presence of Nikolsky Sign.
·Memory Loss and Confabulations – are hallmarks of
Korsakoff Syndrome and are permanent deficits, which don’t change with Vitamin
·Risperidone – is an anti-psychotic, that blocks D2
synthesis of Dopamine, and thus its side effects are Hyperprolactinemia, that
will cause Amenorrhea.
·Avascular Necrosis – of femoral head are the major
complications of Sickle Cell Anemia, Systemic Lupus and Steroid Therapy.
·Damage to Organ of Corti – occurs from prolonged
exposure to extremely loud noises.
·Ergot Compounds – such as Pergolide and Bromocriptine,
are associated with Side Effects that cause Raynaud Phenomenon.
·Enterococcal Endocarditis – is usually seen in elderly
patients who have undergone a procedure such as colonoscopy, where Enterococcus
has infected and caused Endocarditis
·Growth Factors and PDGF – rely on Tyrosine Kinase and
MAP pathways, and RAS protein is a part of MAP pathway.
·Villous Adenomas – can look like Cauliflower and
secrete a lot of mucus, that will cause diarrhea and thus Hypovolemia
·Jervell and Lange Nielsen Syndrome – is associated
with Neurosensory Deafness and QT prolongation.
·ARDS Patients – will have a normal Pulmonary Capillary
Wedge Pressure, where there is no edema involved.
·Red Ragged Muscle - is seen on the biopsy in
Mitochondrial Myopathy. This is a mitochondrial disease and thus only
transmitted through mother.
·Caudal Regression Syndrome – where Sacral Agenesis
causes lower extremity paralysis is usually seen in mothers with poorly
·Niacin – is the most effective in raising HDL levels.
Omega fatty acids will raise HDL but at very low levels.
·Patients with CF- their symptoms might be corrected
with administration of Pancreatic Enzymes, since they have its deficiencies.
·Infiltrative Ophthalmopathy – is usually seen in
Hyperthyroid Patients where their ocular muscles are infiltrated by
glycosaminoglycans and hence there is Exophthalmos.
·Best indicator of MS stenosis level – is a length of
interval between S2 and and OS (opening snap)
·Lipooligosaccharide (LOS) – of N. Meningitidis is
analogous to Lipopolysaccharide of Gram Negative Rods and this will determine
the severity of the disease. Usually seen in military recruits.
·Patients older than 65 – are prone to developing
pneumonia after Infection with Influenza, and the causative agents are Strep.
Pneumonia, Staph. Aureus and H. Influenza
·Patients with ANtiphospholipid Antibody Syndrome with
Lupus – present with positive VDRL test, have Anti-Phospholipid Antibodies
circulating. These antibodies are associated with increased risk of Thromboses,
·ACE – is expressed in the Lung Vascular Endothelium
and converts Angiotensin I to functional Angiotensin II
·Preload will increase End Diastolic Sarcomere Length –
in the ventricular myocardium, and will increase Stroke Volume and Cardiac
·Insulin – activated Protein Phosphatase in the cells,
and it works through Tyrosine Kinase receptor in the cells to stimulate
synthesis of fatty acids, protein, glycogen.
·Patients with Bilateral Cataracts and no Hepatic
Involvement – have a deficiency of Galactokinase and thus Galactose is shifted
and converted into Galactitol by Aldose Reductase and thus it accumulates in
the lens of the eye without Hepatic Involvement.
·Patients with Classic Galactosemia – have a deficiency
of Galactose 1-phosphate Uridyl Transferase deficiency and thus G1P accumulates
and will cause lethargy, vomiting and will present with Cataracts.
·Mycoplasma – lacks a cell wall, so antibiotics such as
PCN, Cephalosporins and Vancomycin will not be effective in these bacteria. So
it must be treated with Tetracylcines and Erythromycin that act on Ribosomal
·Reid Index – is a ratio of Mucus Gland Layer to the
total thickness of cell wall and cartilage, and this is an index of progression
·Agranulocytosis – might be caused by Anti-Thyroid
Drugs, so WBC counts must be checked prior to administration.
·Pituitary Apoplexy – is a complication of Hemorrhage
into Existing Pituitary Adenoma. It will present with Severe Headache and
Cranial Nerve Involvement.
·Crohn’s Disease will present with Oxalate Stones –
because impaired bile acid absorption, caused by fat malabsorption, will cause
the loss of Calcium in the bile, and since Calcium binds Oxalate, then there
will be a formation of Oxalate Stones.
·Capsule of Strep. Pneumonia – is the major Virulence
Factor, and it will swell up when Anti-Capsule agents are added.
·Endocarditis caused by Staph. Aureus – usually occurs
in IV drug abusers, or individuals with unaffected valves, and primarily
affects the Tricuspid Valve. While Strep. Viridans usually involved Mitral
Valve and is due to dental work etc.
·Ethanol and Pancreatitis – ethanol induces secretion
of Pancreatic Juice with a high content of Protein and Low Fluid. Thus the
secretions are viscous and will form plugs and obstruct bile flow.
·Nasal Mucosal Ulcerations and Glomerulonephritis – is
seen in Wegener’s Granulomatosis and will have Anti-Neutrophil Antibodies
·Proton Pump Inhibitors – are the drug of choice for
Gastrinomas, which secrete Gastrin.
·Acetyl CoA – is an allosteric activator of
Gluconeogenesis and acts by increasing activity of Pyruvate Carboxylase.
·Cortisol – increases the transcription of enzymes
involved in Gluconeogenesis
·TCA overdose – may have a Quinidine like Side Effects
where they might cause QRS and QT interval prolongation and to reverse that,
Sodium Bicarbonate must be used.
·Digitalis Toxicity – might be treated with
supplementation with Potassium, since it blocks Na/K channel
·To calculate the Risk – divide the number of diseased
individuals by the total number of patients in the group.
·Subperiosteal Thinning – is a feature of Hyperparathyroidism,
where there is an increased resorption of the bone.
·Alkaline Phosphatase – is a group of enzymes involved
in many different organs, such as liver, bone, intestine, kidney. To clarify
whether it’s the liver infection, you must measure GGTP levels – which are
Gamma Glutamyl Transpeptidase.
·Axonal Reaction – is a repair of axons, where there is
a nucleus pushed to the side and the cell is compressed and finely granular
Nissl substance is seen.
·Cortisol – sensitizes vasoconstricitve effects of
Catecholamines and thus exerts Permissive Effects on the Vasculature.
·Endogenouse Administration of Thyroid Hormone – such
as Levothyroxine, will increase the Free Levels of T3 and thus in its turn
suppress TRH and then TSH levels.
·Pentazocine – is an opiod narcotic with partial
agonist activity and weak antagonist activity on Mu Receptors. Administration
of this drug in patients dependent on opioids, might trigger an Opiod
·GTP – is synthesized in the Succinyl CoA reaction in
TCA cycle, and used as an energy source for decarboxylation of Oxaloacetate to
Phosphoenolpyruvate by PEP Carboxykinase in Gluconeogenesis.
·Lysine and Leucine – are strictly Ketogenic Amino
Acids and would not increase blood Lactate Levels in patients with Pyruvate
·Patients with Friedrich’s Ataxia – present with
degeneration of Dorsal Columns, as well as 50% of them will develop
·HBsAg - is a component of the envelope of Hep. B virus
and will form spheres and tubules.
·Transposition of Great Arteries – results from failure
of Aorticopulmonary Septum to Spiral during Septation.
·Ataxia Telengectasia – is an autosomal recessive,
where there is a Cerebral Atrophy that will lead to ataxia, these patients are
also susceptible to DNA radiation, since they have a deficiency of Exonuclease
·Terbinafine - is a common drug used for
Dermatophytosis, where it inhibits synthesis of Ergosterol by inhibiting Enzyme
·Acute Pancreatitis – is usually caused by Gallstones
and Alcoholism, high levels of Triglycerides lead to increased production of
·Astrocytes – are found at the periphery of the
infarct, and are responsible for maintaining the same form, they are
responsible for Gliosis.
·Supraspinatus – is an Abductor of the arm, vulnerable
to injury due to impingement between acromion and the head of the Humerus.
·Subscapularis – is responsible for Medial Rotation of
·Latissimus Dorsi – is the major Adductor of the Arm.
·Neurons do not store Glycogen – and are highly
sensitive to Ischemia, profound hypotension during Cardiac Arrests will cause
Global Cerebral Ischemia.
·De Quervain Thyroiditis – or Granulomattous
Thyroiditis, presents after Viral Infections and will present areas of
infilitration by Lymphocytes and Multinuclear Giant Cells.
·Ceruloplasmin – and unabsorbed copper will be Secreted
into Bile and excreted Hepatically in the stool
·Dystrophic Calcification of Aortic Valves – is
preceded by the Cell Necrosis, where there is a destruction by Calcification
and that will cause Aortic Stenosis.
·Procollagen – is synthesized within Endoplasmic
Reticulum, then it’s released into Extracellular Space by transport through
Golgi, and then converted into Collagen by peptidases that will cleave off N
and C terminal portions. Only then they are crosslinked with other Collagen
Molecules after residues are oxidized by Lysyl Oxidase.
·Malassezia Furfur – are characteristics of Pityriasis
Versicolor and appear as Spaghetti and Meatballs.
·Abdominal Aorta – is mostly involved in the process of
Atherosclerosis, then followed by Coronary Arteries, Popliteal, internal
carotids and Vessels in the Circle of Willis.
·Extrahepatic Biliary Atresia – is a congenital
obstruction of Extrahepatic Bile Ducts seen by the 3rd week of Life.
·C peptide and Insulin – packaged together into
secretory granules and are released into an extracellular space.
·Fenfluramine and Phenteramine – extensive consumption
of Appetite Suppressors is associated with the risk of Pulmonary Hypertension.
Which can progress to Cor Pulmonale.
·Henoch Schonlein Purpura – consists of
Leukocytoclastic Angiitis and associated with deposits of IgA and C3, and is
common in children between 3-11 after recent infection.
·Lack of T tubules – would lead to uncoordinated
contraction of individual fibers in myofibrils.
·Ureteric Bud – gives rise to collecting ducts, minor
and major calyces, renal pelvis and ureters.
·Metanephric Mesoderm – gives rise to Glomerulus,
Bowman’s capsule, proximal, distal convoluted tubes and a connecting tubule
·Pulmonary Vascular Sclerosis – will occur in patients
with Eisenmenger Complex.
·Low Volume of Distribution of the Drug – such as 4-5
L, may be due to High Molecular Weight, High Plasma Protein, Hydrophillicity
and High Charge
·Staph Epidermidis – must be treated with Vancomycin
·Indirect Inguinal Hernias – are located Laterally to
Inferior Epigastric Vessels
·Direct Inguinal Hernia – is located Medially to
Inferior Epigastric Vessel.
·MAO Inhibitors – such as Phenelzine and
Tranycypromine, are particularly useful in treatment of Atypical Depressions,
such as in patients with Hyperphagia and Weight Gain.
·Osteoarthritis – will present with Short Morning
Stiffness, and will involve DIP and PIP joints.
·Rheumatoid Arthritis – will present with a Long
Morning Stiffness that will improve with Exercise, and will involve MCP and PIP
·Spironalactone – may be used in a female that
complains of increased Hair Growth on her face, since it will block androgen
receptors at hair follicles and decrease production of Testosterone.
·CFTR – is an ATP gated transmembrane ion transporter
that pumps Chloride ions out of the cell against a Concentration Gradient.
·Lead Time Bias – is an artificial increase in the survival
time among tested patients, who actually have an unchanged diagnosis
·Hepatitis B Prodromal Period – thay might last from
30-180 days, will present with the Serum Sickness Symptoms, where patients will
experience fever like condition, skin rash, and lymphadenopathy.
·V. Cholera – doesn’t invade the Intestinal Mucosa, so
it will present with watery mucus and some epithelial cells.
·Chronic Rejection of a Transplant – will present with
Obliterative Intimal Smooth Muscle Hypertrophy and Fibrosis.
·Improperly Fitted Crutches – will impinge the Radial
Nerve and cause symptoms such as inability to Flex the Arm and Wrist
·Thyroid Hormones – alter Gene Transcription by Binding
to Receptors Inside the Nucles.
·Protein M – is a major Virulence Factor of Strep.
Pyogenes and Inhibits Phagocytosis and Complement Activation
·Lancet Shaped Gram Positive Diplococci – is indicative
of Strep. Pneumonia, which is Optochin Sensitive.
·Polyribosyl Ribitol Phosphate (PRP) – is a part of H.
Influenza Capsule and is part of HIb Vaccine and its conjugated with Diphtheria
and Tetanus Toxoid.
·Posterior Urethral Trauma – is associated with Pelvic
Fractures, and it will present with Inability to Void, despite Full Bladder and
Elevated Prostate on Rectal Exam.
·Retinal Damage in Infants – will usually be due to
Reperfusion Oxygen Damage, in infants born with Respiratory Distress Syndrome.
·Use of Terbutaline – will present in Infants with
Intracranial Hemorrhage, Hypoglycemia, Hypocalcemia and Ileus.
·Reye’s Syndrome – due to ASA in patients treated for
Influenza or Varicella Infection and will present with Microvesicular Steatosis
·Porcelain Gallbladder – Calcium Ladden Gallbladder and
will increase the risk of Gallbladder Carcinoma
·Hereditary Pancreatitis – may be due to mutation which
would activated Trypsinogen to convert into Trypsin and it would auto digest
Pancreas, before it would be released into duodenum as normally.
·Lithium – causes Nephrogenic Diabetes Insipidus,
Hypothyroidism and associated with Ebstein’s Anomaly.
·Osler Weber Rendu Syndrome – Hereditary Hemorrhagic
Telengectasia, may affect the Lips, Oropharynx, Respiratory Tract, Skin, GI
·Von Hippel Lindau – Capillary Hemangioblastomas in
Retina and Cerebellum, presents with Congenital Cysts in Liver, Kidney,
Pancreas and Increased Risk of Renal Carcinoma
·Tuberous Sclerosis – may cause cysts in the liver,
kidney, but in CNS it will be Subependymal Hamartomas, Renal Angiomyolipomas
and Cardiac Rhabdomyoma, clinically will present with Seizures!!!
·Sturge Weber – will present with Cutaneous Facial
Angiomas, as well as Leptomeningeal Angiomas, patients will have Mental
Retardation, Seizures and Skull will have Tram Track Calcifications.
·Aging – will present with Decreased Ventricular Size
at the Apex and will cause Sigmoid Septum.
·Fc Portion Closer to the Hinge Region – is where
·Heme – serves as a Negative Feedback on ALA Synthase.
Diagnosis of Accute Intermittent Porphyria is made by increase in
Aminolevulinic Acid and Porphobilinogen
·Duodenal Ulcers Location – is near Pylorus because of
the most Acid Present.
·Infants with Bilateral Renal Agenesis – will present
with Respiratory Problems, since Amniotic Fluid that needs to be swallowed and
urinated out, is essential in the process of Lung Maturation
·LH – stimulates Leydig Cells to Produce Testosterone,
FSH will stimulate Sertoli Cells to Produce Inhibin B, which will Negatively
Feedback on LH and FSH
·Until 4 hours – into Ischemia will not present with
any changes on Light Microscopy
·Bosental – is an Oral Endothelin Receptor Antagonist
and is used in Patient with Pulmonary Hypertension
·Reperfusion Arrhythmia – may be due to Fibrinolytics
that will cause Reperfusion on Arterial Re-Opening.
·Acute Fibrinous or Serous Pericarditis – acute onset
Pleuritic Chest that decreases on Sitting Up and Leaning Forward.
·Cardiac Defects in DiGeorge Syndrome – are associated
with Tetrallogy of Fallot and Interrupted Aortic Arch
·Addition of Spironolactone – will significantly Reduce
Mortality in Heart Failure Patients, since it will block Aldosterone.
·Chocolate Agar for Neisseria Gonorrhea – consists of
Vancomycin, Polymixin and Trimethoprim.
·Cryptococcus – that is Round Budding Yeast with Clear
halos will cause Meningitis in HIV + Patients.
·Down Syndrome – patients will have Ostium Primum
Endocardial Cushion Atrial Septal Defect.
·Nifedipine – is a selective Vascular Calcium Channel
Blocker and is different from Calcium Channel Blockers used in Arrhythmias
·Slow Onset of Anesthetic – is associated with High
Solubility of the Drug
·Thrombocytopenia in Hospital Patients – is mostly due
to Heparin Infusions, and is more present with Unfractionated Heparin rather
than Low Molecular Weight.
·On Off Phenomenon – seen in Parkinson Patients where they
will have days with Increased Mobility and other times with Decreased, that is
due to the effect of L-Dopa Therapy.
·Cauda Equina Syndrome – will present with Saddle
Anesthesia and Loss of Anocutaneous Reflex, and that will involved a Lesion
from S2 – S4 Areas.
·Differential Cyanosis – in Upper and Lower Extremities
is due to PDA.
·Alzheimer’s Disease – mostly affects Hippocampus and
·Alpha 1,4 Glucosidase – deficient in Pompe’s Glycogen
Storage Disease is also Called Acid Maltase
·C-Myc – is a nuclear Phosphoprotein and functions as
Transcription Activator that controls Cell Proliferation, Differentiation and
·Bcr –Abl – encodes a Protein that Inhibits Apoptosis
while Promoting Mitogenesis and Increased Tyrosine Kinase Activity.
·Postreptococcal Glomerulonephritis – will present with
Elevated Anti Streptolysin (ASO) titers, Decreased C 3 and Total Complement
Levels and presence of Cryoglobulins. C4 Levels are usually Normal.
·Attributable Risk Percent ARP – is calculated by
·Celial Disease – must be diagnosed with Colon Biopsy
where there is Flattening of Mucosa, Loss of Villi and Chronic Inflammatory
Infiltration of Lamina Propria.
·Apolipoprotein E -4 - may be involved in formation of
Senile Plaques in Alzheimer’s Disease
·Beta HCG – is detected in maternal serum on the 8th
day, but can take as long as 11. Blastocyst implants itself on the 6th day
·Hibernating Myocardium – can be caused by repetitive
ischemia of the myocardium or persisten hypoperfusion, and when the blood flow
is restored it will regain the circulation and strength
·Glucagonoma – are pancreatic tumors that are
characterized by necrolytic migratory erythema, erythematous rash affecting the
·Pancoast Tumors – are Superior Sulcus Tumors
characterized by Ipsilateral Horner’s Syndrome, rib destruction and other upper
extremities’ deficits in the distribution of C8, T1 and T2
·Alanine – can be Transaminated by Alanine
Aminotransferase to Pyruvate with Amino Group transferred to Alpha
Ketoglutarate to form Glutamate
·HbS – where charged Glutamic Acid Residue is replaced
by Nonpolar Hydrophobic Valine Residue at the 6th position and will cause
aggregation of Hemoglobin under Hypoxic Conditions
·Chemoreceptor Trigger Zone – is located at the base of
4th Ventricle, at the Dorsal Surface of Medulla.
·Duration of Diastole – is a critical factor in
determining Coronary Blood Flow
·Ergot Compounds and Nonergot Compounds – Directly
Stimulate Dopamine Receptors. Ergot Compounds (Bromocriptine and Pergolide) and
Nonergot Compounds (Pramipexole and Ropinerole)
·Patients on Thiazides – have overall higher levels of
Calcium and thus it’s bone protective, so Hypocalciuria will decrease formation
of Renal Stones
·Nonnucleoside Reverse Transcriptase Inhibitors – do
not need to be phosphorylated to be activated and some of them are: Nevirapine,
Efavirenz and Delavirdine
·HIV Associated Esophagitis – is caused by Candida, CMV
and Herpes Virus
·After MAO Therapy – it will take 2 weeks to regenerate
enzyme, to have adequate neurotransmitter metabolism
·Primidone - is metabolized to Phenobarbital and PEMA,
all three are active compounds that are Anticonvulsants
·Superior Mesenteric Artery Syndrome – when Transverse
Portion of Duodenum is trapped between SMA and Aorta. That can happen due to
rapid weight loss.
·Bronchogenic Carcinoma – is the most common Lung
Cancer due to Asbestos Exposure, where Mesothelioma is 2nd Most Common.
·Majority of Anal Fissures – occur in the Posterior
Midline Distal to the Dentate Line.
·Pyrazinamide – is effective in Acidic Environment,
where other TB drugs are effective against extracellular mycobacteria.
·Liver Cirrhosis and Hepatocellular Carcinoma – are 2
outcomes associated with mutation of HFE protein which promotes attachment to
Transferrin Protein and Facilitates Iron Absorption, which are seen in
·Acute Rheumatic Fever – is the most common cause of
Mitral Stenosis. Where Infective Endocarditis is more associated with
Vegetaions and Destruction of the Valves.
·Valproic Acid – is the first line therapy for
Myoclonic Seizures. Where Phenyotin and Carbamazepine are 1st line in Tonic
·Nephrotic Syndrome – will present with loss of
Antithrombin III and that’s why will present with Thrombosis
·H. Influenza B Vaccine – is mixed with Diphtheria and
Tetanus Toxoid, and this in turn will Increase Immunogenicity of the Vaccine,
where Conjugate becomes T cell dependent Antigen
·Carcinoid Heart Disease – will present with Fibrous
Intimal Thickening with Endocardial Plaques and will be limited to Right Heart.
The symptoms are flushing, wheezing and diarrhea, due to production of
Serotonin, Kalikrein, Bradykinin, Histamine etc.
·Lispro and Aspart – are the best Short Acting Insulins
·Hydrocele and Indirect Hernia – are formed by a similar
mechanism. Both are caused by incomplete Obliteration of Processus Vaginalis.
·Gallstone Ileus – will cause an obstruction of the
bowel and will present with Air in the Billiary Tract.
·Increased Fecal Blood Loss – is the side effect of ASA
Therapy. Because there is a loss of Gastric Protection in addition to Impaired
·HSP 90 and HSP 56 – are Heat Shock Proteins that bind
Inactive Zinc Fingers that are involved in Steroid Hormone Synthesis.
·Complications of Ankylosing Spondylitis – may be
impaired Pulmonary Ventilation due to deformation of the spine, and in the
heart it will present with Ascending Aortitis leading to Dilatation of the
·Colon Cancer – most common location for this is
Ascending Colon, which will present with Bleeding, where the Left Side that
would involve ResctoSigmoid Region would present with Obstruction.
·Spread of Bronchogenic Carcinoma – may present with
Obstruction and Compression of Upper Vasculature such as Vena Cava, and
patients will present with Facial Swelling, Dilated Carotids.
·Hypermethylation of Histones – is the cause of Altered
Gene Expression of Huntington Disease.
·Gastroduodenal Artery – is mostly eroded by Posterior
Duodenal Ulcers and can be a source of Life Threatening Hemorrhage
·Femoral Hernias – will present with a Bulge in the
Upper Thigh, and will be accentuated on Valsalva Maneuver.
·Pol Gene Mutations – render the ability of HIV
Retroviral Therapy to take its effect
·Treatment for Gonoccocal Infection – must always
involve treatment for Chlamydia, since it often co infects at the same time.
Ceftriaxone is used for N. Gonnorhea and Azithromycin or Doxycycline are used
·NF-kB Protein – activity is reduced in Crohn’s Disease
and this protein is responsible for Cytokine Production
·Acarbose and Miglitol – are Alpha Glucosidase
Inhibitors that decrease Activity of Membraine Bound Disaccharides on the
Intestinal Brush Border.
·Increase in cAMP in Vascular Smooth Muscle – will
cause Vasodilation, which is a Side Effect of Phosphodiesterase Inhibitors in
·Fibrinous or Serofibrninous Pericarditis – develops in
20% of the Post MI patients between day 2 and 4, due to infiltration of
Inflammatory Cells of the Transmural Infarction. Dressler Syndrome occurs on
Day 7 and is an Autoimmune Process.
·Niacin and Fibrates (Ezetimibe) – are the most useful
Treatment in patients with Hypertriglyceridemia
·Airway Resistance – is Minimal in Bronchioles and
Maximal in Large Segments of Bronchi.
·Cold Agglutinins – are antibodies that will be
produced in Response to Mycoplasma Pneumonia Infection, also might be present
with Ebstein Barr Virus Infection
·Calcium Channel Blockers – might present with AV Nodal
Blocks and Bradycardia
·Local Defense against Candida – is produced by T
cells, that’s why we see Local Candidiasis in HIV+ Patients, since their T cell
Levels are Low
·Defense against Systemic Candidiasis – is produced by
Neutrophils, that’s why Neutropenic Patients will present with Systemic
·To prevent Neonatal Tetanus – is to ensure that
Mothers are Vaccinated with Toxoid to allow transfer of IgG Toxoid through
·Cervical Cancer Risk – Number 1 is History of Sexual
Partners, since HPV can be transmitted
·Endometrial Cancer Risk – is due to Nulliparity, early
Menarche and Obesity, where increased Estrogen Stimulation of the Endometrium
·Breast and Ovarian Cancers – Number 1 Risk is Family
·Minimal Change Disease – is usually due to the Loss of
Polyanion in the Basement Membrane, which will lose the Charge.
·Rifampin – is used as Prophylaxis against
Meningococcal Diseases, as it will Penetrate into Respiratory Tract and
Eliminate Nasopharyngeal Colonization
·Niacin – or Nicotinic acid has been used to treat
Hyperlipidemias, the side effects of Flushing are due to release of
·Left Ventricular Dysfunction – will cause Pulmonary
Vessel Vasoconstriction and will contribute to Pulmonary Hypertension
·Digitalis Toxicity – will present with Hyperkalemia
and at times with Bradycardia, Ventricular Tachycardia or Fibrillation
·Splitting of S2 in ASD – will be permanent and will
not change with Respiration
·Sixth Aortic Arch – gives rise to Pulmonary Arteries
and Ductus Arteriosus
·Neuropathic Incontinence – with Neurogenic Detrusor
Spasticity, will result from damage from T11 till L2, will cause relaxation,
since those nerves inhibit it. S2-S4 are responsible for excitation of the
·MCHC – Mean Corpuscular Hemoglobin Concentration is
the best Index in making Diagnosis of Hereditary Spherocytosis, Diagnosis is
best confirmed with Osmotic Fragility Test
·Musculocutaneous Nerve – provides innervation of
Flexor Muscles of upper arm Sensory to the Lateral Part of the Arm
·Haptoglobin – binds Free Hemoglobin, in Intravascular
Hemolysis, due to destruction of Erythrocytes, Free Hemoglobin Increases, an
Exceeds levels of Haptoglobin and thereby Decreasing the Levels of Haptoglobin
·In HIV – Nucleocapsid Proteins p24 and p7 are from GAG
Gene. Envelope Glycoprotein gp41 and gp120 are from ENV gene. Transcription and
Translation are from POL gene. TAT and REV are required for Replication
·Dietary Fructose – is Phosphorylated in the Liver to
Fructose 1 Phosphate and Rapidly Metabolized, because it Doesn’t Pass through
PFK 1, which is a Regulatory Enzyme of Glycolysis.
·Ecthyma Gangrenosum – is a Cutaneous Necrotic Disease
and it’s associated with Pseudomonas Aureginosa. P. Aeruginosa are common in
Neutropenic, Diabetic, Burn Patients.
·Glucocorticoids and HIV-1 Protease Inhibitors – are
associated with Cushingoid Appearance and Fat Distribution
·Gouty Arthritis – is a Side Effect of Niacin Therapy,
which increases Serum Uric Acid. Hepatotoxicity may occur at High Doses. In
Diabetics it might cause Hyperglycemia
·Amphotericin B – Polyene Antifungul and its Side
Effects are Renal Failure with Hypokalemia and Hypomagnesemia.
·Antiphagocytic Polysaccharide Capsule in H. Influenza
B – has Ribose in it, instead of Hexose and may be the reason for Increased
·Patients with Crohn’s Disease – are prone to
developing Gallstones. Decreased Bile Acid Reabsorption and Loss in the Feces
will increase Cholesterol Levels and formation of Gallstones
·Polymyositis – presents with Symmetrical Muscle
Weaknesses, on Biopsy there is necrosis, regeneration, large amounts of MHC I
molecules infiltrated with CD8 T cells.
·Primary Biliary Cirrhosis – Autoimmune Destruction of
Hepatic Bile Ducts and Cholestasis.
·All Sickle Cell Patients – at some point will present
with Asplenism and thus the increased risk of H. Influenza and Strep. Pneumonia
·AL Amyloidosis – is Associated with Multiple Myeloma.
·Generalized Lymphadenopathy – is another Side Effect
of Phenytoin, where it might present as a Lump in the Neck.
·Polycystic Ovarian Syndrome – is associated with
Endometrial Hyperplasia, due to Unopposed Effect of Estrogen and Increased Risk
of Endometrial Carcinoma. Patients also have a Higher Risk of Developing Type
·Hematogenous Osteomyelitis – will primarily affect
Metaphysis of the Bone, due to Rich Vascularization
·Very Long Chain Fatty Acids – which Cannot Undergo
Beta Oxidation, is due to Peroxisomal Absence or Defect, which will lead to
Defects from Improper CNS Myelination
·Half Life – Vd(.7)/CL. 1 Half Life is 50%, 2 Half
Lives is 75%, 3 Half Lives – 87.5%, 4 Half Lives – 93.75%
·Sarcoidosis – will usually present in African
Americans with Dry Cough, Pulmonary Infiltrates and Hilar Adenopathy. On Biopsy
it will be a Non Caseating Granuloma
·Major SE of Metformin – is Lactic Acidosis, which will
damage the Kidneys and GI Upset.
·Anemia in SLE – is due to Autoimmune Hemolysis and
will be due to formation of IgG Warm Antibodies to RBCs. Which is characterized
by Spherocytosis, + Coombs Test, and there will be Thrombocytopenia, due to
Antibodies against Platelets
·Benzodiazepines, Barbiturates and Alcohol – will Bind
to GABA Receptor and Stimulate Influx of Chloride Ions into Neurons
·Mycoplasma Pneumonia – can cause Hemolysis, due to
similarity between Antigens of Cell Membrane of M. Pneumonia and Cell Membrane
·Hydrocephalus Ex Vacuo – there is a Ventricular
Enlargement in the Brain, which is Due to Atrophy of Cerebrum (Picks,
Alzheimers). CSF Pressure is Not Increased
·Common Peroneal (Fibular) Nerve – is usually damaged
when patients wear a Cast and compress the head of the Fibula
·Takayasus and Giant Cell Arteritis – are very similar
in Mechanism. Takayasus involves Aorta and its Branches and it usually occurs
in Patients Younger than 40. If Patients are older than 40, we presume it’s
Giant Cell Temporal Arteritis
·Skeletal Muscles are Resistant to Calcium Channel
Blockers – because they largely Depend on Intracellular Calcium for Excitation
and Contraction Coupling. Where Smooth Muscle depends on Extracellular Calcium
·PDGF – is largely secreted by Smooth Muscle Cells and
it will promote migration to the Affected Site of Inflammation, with Production
of Intimal Thickening and Collagen Deposition
·Palmar Erythema – will be due to Cirrhotic
Hyperestrinism and it will also include Gynecomastia, Testicular Atrophy,
Spider Nevi and Decreased Body Hair
·TZDs (Thiazolidinediones) – New Group of Anti Diabetic
Drugs, Decrease Insulin Resistance by Binding to Peroxisome Proliferator
Activated Receptor Gamma, which is a Transcriptional Regulator of the Genes
involved in Glucose Metabolism
·Benzodiazepines – are First Line in Alcoholic
Seizures, because they will Substitute Alcohol Effect on GABA Receptors
·Adenomyosis – presence of Endometrial Glands in the
Uterine Myometrium, and it will cause an Enlargement of the Uterus with
Bleeding, and Painful Menses
·Endometriosis – presence of Endometrial Tissue Outside
of the Uterus, it will present with Painful Menses, Dyspareunia, but no Uterine
·Cause of Death in Acute Rhematic Fever – in Rare Cases
is Acute Myocarditis, where Mitral Stenosis takes years to form
·Adenosine – is DOC in treatment of Paroxysmal
Supraventricular Tachycardia, where there are palpitations. Side Effects
include Flushing, Burning in the Chest and Shortness of Breath
·Medullary Sponge Kidney – is characterized by Cystic
Dilatations of Medullary Collecting Ducts. Cortex is spared. Patients will
present with Kidney Stones and Hematuria.
·Lidocaine – is very Specific to Depolarized Tissue
such as Ischemic Tissue. That is why it’s a Treatment of Choice in Post
Myocardial Infarction Arrhythmias
·Dysplasia – is different from Cancer, because it’s
Reversible, where Cancer is not.
·Atheroembolic Disease of Renal Arteries – will present
with Renal Failure and Big Toe Discoloration in Elderly Patients
·CEA Levels – in patients with Colon Cancer are usually
used to Monitor Tumor Recurrence
·Cryptococcus Neoformans – is the only Fungus that has
a Polysaccharide Capsule, that appears Red on Mucicarmin Stain and Clear
Unstained Zone on India Ink
·3rd Aortic Arch – gives rise to Common and Proximal
Internal Carotid Arteries.
·4th Aortic Arch – gives rise to True Aortic Arch and
portion of Subclavian Arteries
·6th Aortic Arch – gives rise to Pulmonary Arteries and
·MCA – supplies Broca’s and Wernicke’s Areas, Frontal
Eye Fields, Face and Arm Areas of Motor and Sensory Cortex
·Shiga and Shiga Like Toxin of E.Coli – inactivated 60S
Subunit of the Ribosome and thus inhibit Protein Synthesis and Eventual Death
·Formation of Billiary Sludge – will be formed due to
Incomplete Emptying of Gallbladder in Response to CCK, thus Bile will
·Chloramphenicol – will cause Aplastic Anemia, it will
bind to 50S Subunit and Inhibit Peptidyl Transferase Enzyme
·Kallman’s Syndrome – will present with Delayed Puberty
Plus Anosmia, where there is a Failure of GnRH Neurons to Migrate to Olfactory
Placode and Hypothalamus. Boys will be feminine with Poorly Developed Secondary
·Intimal Tear – is the Initiating Process of Dissecting
·Weakened Vesicoureteral Junction – will be due to
Frequent Bladder Infections and will Facilitate Reflux
·Suppression of 7 α Hydroxylase Activity – due to the
drugs such as Clofibrate, will reduce Solubilization of Cholesterol into Bile
and there will be Excess Cholesterol
·Defficiency of Lipoprotein Lipase – will cause
impaired Tryglyceride Clearance from Blood Stream. Lipoprotein Lipase is
secreted from Uniloculated Adipocytes, which are Adipose Tissue, also by Skeletal
and Cardiac Muscle
·Effect of Hypothalamus on Prolactin – is Inhibitory
via Dopamine Production
·Senile Cardiac Amylidosis – is due to Depositon of
Abnormally Folded (β Pleated Sheet) ANP Derived Proteins and is confined to
·Women in Hemochromatosis – tend to not present until
Menopause, since Menstruations will be like Phlebotomy. So After Menopause, the
symptoms will kick in.
·Neonates born to Hep B mothers – are at High Risk of
Chronic Disease, Fast HBV replication and Moderate Hepatic Injury
·Mesothelioma – associated with Asbestos Exposure, it
will present with Long Microvilli and Abundant Tonofilaments, which will differ
it from Bronchoalveolar type of Adenocarcinoma, which will present with Short
·To prevent Recurrent Seizures – in patients with
Status Epilepticus. First Line of Treatment is Addition of Phenytoin to Regular
·Corticosteroids – are the Strongest and Most
Predictable Effects in patients with Asthma
·Nitrates – mimic Action of Endothelial Derived
Relaxing Factor, which will lead to Increased cGMP and Myosin
Dephosphorylation, and Reduced Intracellular Calcium
·Isosorbide Mononitrate – is the most Bioavailable Oral
·Loss of GABA Neurons in Striatum – is characteristic
of Huntington due to Increased CAG Repeats on Chromosome 4
·Acute Acalculous Cholecystitis – is an Acute
Inflammation of Gallbladder without formation of Stones and it’s mostly present
in Hospitalized or Severely ill
·Ethylene Glycol Ingestion – will lead to Acute Renal
Failure with Precipitation of Oxalate Stones, such as Calcium Oxalate Crystals
·Partial Mole – has a Triploid Karyotype, patient will
present with Vaginal Bleeding and Lower Abdominal Pain
·Tertiary Syphilis – will present with Neuro Involvement
and Gummas. That are Necrotizing Granulomas that appear on Skin, Mucosa,
Subcutaneous Tissue, Bones and Within Organs. Similar to Chancre in Primary
·Watershed Areas – are Splenic Flexure and Distal
Sigmoid Colon, are Most Susceptible to Ischemia During Hypotension and Low
·Splenic Hypertrophy in Pyruvate Kinase Defficiency –
is due to Increased Work to Remove Deformed Erythrocytes from Circulation
·MacConkey Agar – is used for Many Enteric Bacteria
·Thayer Martin VCN – is for Neisseria Species
(Vancomycin, Polymyxin and Nystatin to remove all other bacteria)
·Blood Agar – are used to distinguish between
Enterococcal and NonEnterococcal Infections. Enterococcal such as E. Faecalis
and E. Faecium will grow in both Bile Salts and 6.5% Hypertonic Saline. Where
NonEnterococcal (Strep. Bovis) will grow in presence of Bile Salts, but Not 6.5
·Cysteine Tellurite Agar – is for Clostridium
·Bordet Gengou – is for Bordetella Pertussis
·Primary Billiary Cirrhosis – is due to Autoimmune
Granulomatous Destruction of Hepatic Bile Ducts and Cholestasis. Side Effects
will include Pruritis, worse at Night.
·Gonococcal Arhtritis – is a complication of Neisseria
Gonorrhea, and must be suspected in Sexually Active Young Adults
·Slow Acetylators – are at increased risk of Toxicity
to certain drugs, such as Isoniazid, Dapsone, Hydralazine and Procainamide
·Imperforate Anus in an infant – may also be associated
with abnormal development of Urorectal, Urovesical and Urovaginal Fistulas
·Chronic Rejection – might produce Chronic Obstructive
Lung Disease and cause Bronchiolitis Obliterans. Pathology includes Lymphocytic
Inflammation and Necrosis of Bronchiolar Walls.
·Acute Rejection – will present with Mononuclear
Infiltration on Histological Examination
·Beck’s Triad – of Hypotension, JVD and Distal or
Muffled Heart Sounds is indicative of Tamponade
·Serine and Threonine Residue Phosphorylation – by
Tyrosine Kinase can lead to Insulin Resistance, and can be caused by TNF-α,
Catecholamines, Glucocorticoids and Glucagon
·Chronic Systemic Use of Steroids – will Promote
Osteoporosis and cause Vertebral Fractures, by Inhibiting Vitamin D and
Promoting PTH activity
·Anaplastic Tumors – bear no resemblance to the Tissue
·Lacunar Infarcts – occur due to Hypertensive
Arteriolosclerosis in Basal Ganglia, Pons and Internal Capsule
·Hypertrophic Cardiomyopathy – may involve a mutation
in Beta Myosin Heavy Chain and Cardiac Cell Sarcomere Protein (Troponin,
·External Branch of Superior Laryngeal Nerve – is
susceptible to injury in patients undergoing Thyroidectomy, this nerve
innervates Cricothyroid Muscle, all other Muscles are innervated by Recurrent
·Intracranial Schwannomas – are usually located in
Cerebropontine Angle, which is between Pons and Cerebellum
·Octreotide – Synthetic Analog of Somatostatin with a
Long Half Life is used in Carcinoid Syndrome.
·Intrapartum Antibiotics – may be used to decrease
Incidence of Group Beta Strep Meningitis in Newborns
·Disruption of Macrophage Phagolysosomes – in Patients
with Silicosis, will make them susceptible to Infection with TB
·Neural Tube Defects – are associated with Increased
Levels of Alpha Fetoprotein and Acetylcholinesterase
·Seizures Side Effects – are usually seen in therapy
with Bupropion, Isoniazid and Imipenem
·Tremor in patients – may be treated with
Anticholinergics, such as Benztropine, but must be avoided in patients with BPH
and Closed Angle Glaucoma
·Suspensory Ligament – must be occluded during Surgery
to Remove ovaries, to reduce the risk of accidental ligation of Ureters
·Clonal T Cell Receptor Gene Rearrangement – is seen in
·Adrenals – are the Most Common Site of Metastases of
Lung Cancers, other sites include Bone, Brain and contralateral Lung
·Carotid Massage – will Increase Firing of Baroreceptor
Rate thus Increasing Parasympathetic Stimulation and thus Prolong AV Node
·Crescent Formation – in Light Microscopy is Diagnostic
of RPGN, and there will be Accumulations of Fibrin, Monocytes and Macrophages
·TNF –α Therapy – is associated with Reactivation of
Latent Tuberculosis. Thus PPD Screens are required before Initiating Therapy.
Drugs include (Infliximab, Etanercept)
·Envelope proteins gp41 – are Fusion Inhibitors that
allow Virus to Fuse with Membrane. Drugs Enfuvirtide are useful to prevent this
·Gp120 – is used for Viral Attachment to CD4 membrane
on T cells
·Apical Subpleural Blebs – will be seen in patients
with Spontaneous Pneumothorax
·Mifepristone – is Progesterone Antagonist and is
Abortificent, Misoprostol is Prostaglandin Analog, that will cause Uterine
Contractions and is used in combination with Mifepristone
·Disseminated Histoplasmosis – is associated with
Hepatosplenomegaly in Immunosuppressed Patients
·Pruritis – is usually a First Symptom of Primary
Billiary Cirrhosis, where there are antibodies against Hepatic Bile Ducts and
will cause Cholestasis
·Neisseria Meningitis – will proceed from Pharynx into
Blood, then Choroid Plexus and then Meninges. Where H. Influenza will go from
Pharynx to Lymphatics and then to Meninges
·Hyper IgM Syndrome – will present with inability of B
Lymphocytes to Undergo Isotype Switching, and will present with Lymphoid
Hyperplasia and Recurrent Sinus Infections. Most commonly it’s due to absence
of CD 40 Ligand on B Lymphocytes
·Fibromyalgia – usually affects women of 20-50 and
presents with Diffuse Musculoskeletal Pain with pain in the Spine of Scapula,
Lateral Epicondyle, Medial Fat Pad in the Knees and pain associated with
·Tamoxifen – in Breast Tissue is Anti Estrogenic Effect
and Hyperestrogenic Effect in Endometrial Tissue, thus increasing the Risk of
Endometrial Cancers, Polyps and Hyperplasia
·Patients on Levodopa – should not be taking Vitamin B6
Supplements due to Increase Metabolism of Levodopa caused by Vitamin B 6
·Hepatic Angiosarcoma - is associated with Exposure to
Arsenic, Polyvinyl Chloride and will express CD 31 Tumor Markers
·Tuberoinfundibular Dopaminergic Pathway – is
associated with connecting Hypothalamus to Pituitary and responsible for
Dopamine Inhibition of Prolactin
·Sucrose – is a combination of Glucose and Fructose.
·Lactose – is Galactose and Glucose
·Maltose – is Glucose and Glucose
·Corneal Reflex – is associated with Nasocilliary
Branch of V 1 Nerve. Motor Component is due to Facial Nerve Temporal Branch
·Conversion of Tyrosine to DOPA – requires enzyme
·DOPA to Dopamine – Dopamine Decarboxylase
·Dopamine to Norepinephrine – Dopamine Beta Hydroxylase
·Norepinephrine to Epinephrine – require PNMT
(Phenylethanolamine –N- MethylTransferase) and Cortisol Increases Transcription
of this Enzyme
·Presence of Jejunal Ulcers – is Highly Indicative of
Gastrinoma, there will also be Diarrhea and Abdominal Pain
·Respiratory Acidosis – will be seen in patients with
Heroin Overdose. Bicarcbonate Levels will be Low, because it will take 24 hours
for Bicarb Levels to Compensate
·Sudden Standing or Valsalva Maneuvers – will increase
Intensity of Murmurs in patients with Hypertrophic Cardiomyopathy
·IGF-1 of the Liver – is responsible for Growth Hormone
Effect in Human Growth
·IGF -1 from Hypothalamus – is not Responsible for the
Growth, but more for CNS Activity
·Akathisia – usually present as feeling on the Edge,
Restlessness, Restless Leg Syndrome
·Side Effects of Protease Inhibitors – are usually
associated with Hyperglycemia, Lipodystrophy (Buffalo Hump etc) and Inhibition
·Main Side Effect of Cholestyramine – are GI Upset,
Increased Triglyceridemia and Impaired Absorption of Nutrients and Drugs
·End Stage Renal Disease – will be associated with
Osteitis Fibrosa Cystica, with Retention of Phosphorus, Loss of Calcium and
Activation of 2ndary Hyperparathyroidism
·Dense Pigment containing Epinephrine Metabolites – is
seen in the Lysosomes of the Liver in patients with Dubin Johnson Syndrome
·Silicosis – will present with Egg Shell Calcification
of Lung Hilar Nodes and Birefringent Particles Surrounded by Collagen Fibers
·Berilliosis – may present with Non Caseating
·Hamartomas – are the most common Benign Lung tumors
composed of Collagen, Fibrous and Adipose Tissue
·Small Cell Lung Carcinoma – is usually associated with
Neuroendocrine Markers and will present in the Center of the Lung usually in
·ACE Inhibitors – can cause an Increase in Creatinine
and Decrease in Hydrostatic Pressure and Decreased Renal Perfusion
·Acute Appendicitis – is usually due to Obstruction of
Lymph Flow of Fecalith. Bacterial Infection will be a pathogenesis of
·Positive Kussmaul Sign – will be seen in Patients with
Chronic Constrictive Pericarditis.
·Midsystolic Click – is usually seen in Patients with
Mitral Valve Prolapse
·Immunocompromised Patients with >200 CD4 Count –
will have Strep. Pneumonia as a cause of their Lung Infections
·Incidence of Squamous Cell Carcinoma – and Esophageal
Adenocarcinoma are now Equal
·Smoking – is the most Important Risk Factor for
Pancreatic Cancer. Diabetes, Chronic Pancreatitis and Age >50 are Strong
Risk Factors as well
·Dating Error – where the expectance Date was
miscalculated, might be the most Important Reason for Increase in Alpha
·Digoxin – will decrease AV Nodal Conduction, by
Increasing Parasympathetic Tone of the Cardiac Muscle
·Pancreatic Pseudocyst – is a most common complication
of Acute Pancreatitis, and is composed of Granulation Tissue and Fibrosis
·Langerhan Cells – present in Histiocytosis have a
Tennis Racquet Shape Intracytoplasmic Granules and are called Birbect Granules
·JAK/STAT Signaling Pathway – is used by Colony
Stimulating Factors, Growth Hormones and Cytokines associated with Tyrosine
·Cysteine – becomes an Essential Amino Acid in patients
with Homocystinuria, where there is a defect of Cystathione Synthetase and
accumulationg of Methionine
·Atherosclerotic Plaques with more 75% Occlusion – are
a cause of Stable Angina. Where plaques that occlude less than 75% of the
Coronary Vessel will be Asymptomatic.
·Ulcerated Plaque – with partially obstructive
thrombosis is associated with Unstable Angina or Subendocardial Infarction.
·Ruptured Plaque – is associated with Transmural
Infarction with a Full Obstructive Thrombus
·Friedrich’s Ataxia – is associated with Degeneration
of Spinocerebellar Tracts, Kyphoscoliosis, Foot Abnormalities (High Arch),
Hypertrophic Cardiomyopathy and Increased Risk of Diabetes Mellitus
·Cleft Lip – is associated with Impaired Fusion of
Maxillary Prominence and Medial Nasal Processes
·Cleft Palate – is due to incomplete Fusion of Palatine
Shelves of Maxillary Prominences
·Spinal Scoliosis – is usually seen in Marfan’s
·Coccioidis Immitis – presents as Flu Like Symptoms,
Cough and Erythema Nodosum. Will Have Thick Walled Spherules with Endospores
·Histoplasma Capsulatum – will present with Pulmonary
Symptoms similar to TB, and has Oval Yeast Within the Macrophages (found in
caves, infested with bats)
·Blastomycis – Large Round Yeast with Broad Based Bud,
presents with Pulmonary Pneumonia
·Caspofungin – which are Echinocandins, Inhibit
Synthesis of Polysaccharide Glucan and used as Anti Fungal.
·Wilson’s Disease – will affect degeneration of Putamen
as well as Damage to Basal Ganglia.
·MAP Kinase – signal pathway includes RAS Protein which
is a G Protein
·Colon Adenocarcinoma in UC Patients – will present in
30s and will be Uniformly Spread out. Unlike Sporadic, that arise in patients
in 60s and more localized to the Left Side.
·Carcinoid Syndrome – when Localized to Intestine, it’s
products will be Metabolized by the Liver and Patients will not have Symptoms.
When it’s Metastasized to the Liver, then Secretory Products are Not Degraded
and Patients Will Experience Symptoms.
·Carcinoid Tumors – arise from Chromaffin Cells of the
Intestine, have Eosinophilic Cytoplasm and Oval Shaped Nuclei
·4 Stages of Lobar Pneumonia : 1) Congestion (first 24
hours) – Vascular Dilatation, Alveolar Exudate Contains Mostly Bacteria 2) Red
Hepatization (2-3 Days) Alveolar Exudate – Erythrocytes, Neutrophils and Fibrin
3) Grey Hepatization (4-6 Days) No RBCs, mostly Neutrophils and Fibrin
·Polyarteritis Nodosa – will present with Fibrinoid
Necrosis with Transmural Inflammation of Arterioles, fever, malaise, melena.
Associated with Hep. B Infection
·Alpha 1 Antitrypsin Defficiency – presents with
red-pink PAS Granules of Unsecreted A1AT in Periportal Hepatocytes
·Hepatic Abscess – will present with Fluid Filled
Cavity in the Liver, usually due to Staph Aureus, due to Hematogenous Spread.
Where Entamoeba Hystolytica will have Aerobic and Non Aerobic Bacteria containing
·Hemosiderin Laden Macrophages – are usually due to
Elevated Pulmonary Pressure, secondary to Left Sided Heart Failure
·Paraneoplastic Cerebellar Degeneration – is an
Autoimmune Process and presents with Limb and Truncal Ataxia, Dysarthria. Occurs
in patients with Ovarian, Small Cell Carcinoma of the Lung, Breast and Uterine
·Space Constant – how far along an axon signal will
travel is Decreased in patients with Multiple Sclerosis
·Class Switching for IgE – is due to IL-4 and IL-13
produced by TH2 cells.
·IL-5 – is responsible for Eosinophilia and Class
Switching and Synthesis of IgA
·Central Retinal Artery Occlusion – presents with
Painless, Permanent Monocular Blindness and will have Cherry Macula
·Patients with Essential Fructosuria – Metabolism of
Fructose by Hexokinase to Fructose 6 Phosphate is primary methode of
Metabolizing Dietary Fructose
·Carbamoyl Phosphate Synthase and N-Acetylglutamate
Synthetase – have increased levels of Ammonia and Neurological Defects.
·Mycoplasma Pneumonia – will require Cholesterol to
grow on Artificial Media, due to Single Layer of Cholesterol Phospholipid
Bilayer. They Completely Lack Peptidoglycan Cell Wall, Envelope or Capsule.
Usually seen among Military Recruits
·Optic Nerve Damage – will cause neither pupil to react
to Light, but when Light is shined into an opposite eye, both eyes will
Constrict due to Intact Motor Function
·Occlusion of Right Coronary Artery – will result in
Transmural Ischemia of Left Ventricle, producing ST Elevation in Leads II, III
·Occlusion of LAD – will result in Anteroseptal
Transmural Ischemia with ST Elevation in V1-V4
·Occlusion of Left Circumflex – will result in
Transmural Ischemia of Lateral Wall of Left Ventricle and ST Elevation in V5
·Combination of Statins and Fibrates – increases the
Risk of Myopathy and Hepatotoxicity
·Combination of Fibrates and Bile Acid Resins – will
result in Increased Risk of Cholesterol Stones, due to Increased Cholesterol in
·Neuron Specific Enolase, Chromogranin – along with
Synapthophysin are Neuroendocrine Markers in Patients with Small Cell
Carcinoma, which is located Centrally in Smokers.
·Meniere’s Disease – characterized by Triad of
Tinnitus, Vertigo and Sensorineural Hearing Loss. Due to Increased Pressure and
Volume of Endolymph in Vestibular Apparatus
·α 3 chain of Type IV Collagen – is targeted by
anti-glomerular basement membrane antibodies in Goodpasture’s Syndrome
·Drug Induced Nephritis – due to NSAIDS will
predominantly affect Interstitium, leaving Glomeruli Intact.
·Beta Endorphin and ACTH – are derived from the same
Origin. Beta Endorphin has Increased Affinity to Delta and Mu Receptors.
·Pulsion Diverticulitis – is usually seen in Older
Patients due to Increased Pressure, and will affect primarily Sigmoid Colon.
·Li Fraumeni Syndrome – Autosomal Dominant Syndrome,
due to Mutation of p53 Gene and will cause Breast, Brain and Adrenal Cortex
Sarcomas and Tumors mainly.
·Niacin – potentiates the effects of Anti Hypertensive
Medications and Decrease the Effect of Diabetic Medications.
·Eplerenone and Spironolactone – are Aldosterone
Antagonists are a usual Therapy for Conn’s Syndrome
·Portal Vein Thrombosis – will present with Normal
Liver, because the Defect is Distal to the Liver, will cause Portal Hypertension
without affecting the Liver.
·Pick’s Disease – is pronounced with Frontal Lobe
Atrophy, and patients present with Dementia, Mood Disturbance and Speech
·Estrogen and Progesterone in Pregnancy – Estrogen will
cause Increased Cholesterol Synthesis by Upregulating HMG CoA Reductase and
Progesterone will reduce Bile Acid Secretion and Slow Gallbladder Emptying
·Muddy Brown Granular Casts – are seen in Ischemic
Tubular Necrosis in hospitalized patients.
·Papillary Necrosis – occurs in patients with Sickle
Cell, Diabetes Mellitus, Analgesic Nephropathy and Obstructive Pyelonphritis.
·Hypersensitivity to Intradermal Injections of Tobacco
– are seen in Buerger’s Disease, which is Thromboangitis Obliterans among Heavy
·Opening Snap – is an abrupt Opening of Stenosed Mitral
·Villous Adenomas – are more likely to undergo
Malignant Transformation, unlike Tubular Adenomas
·Amifostine – thiol based cytoprotective free radical
scavenger used in patient on Cisplatin, to prevent nephrotoxicity.