Kaplan – Qbank – High Yield
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Anatomy –
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Drainage of ovaries/testes : left gonadal  left renal vein  IVC • right gonadal vein  IVC •
same situation occurs for left & right adrenal veins
Cervix drainage : cervical vein  uterine vein  internal iliac
Uterine tubes drainage : pampiniform plexus  ovarian vein  IVC
Radial nerve injury : inability to extend the wrist • digits (= wrist drop) • weakness of grip •
anesthesia of dorsal surface of the arm, forearm and hand
Axillary nerve injury : fracture at the surgical neck of humerus • supplies teres minor , deltoid and
skin of shoulder
Musculocutaneous nerve injury : innervates the flexors of the arm • weakness of arm flexion at
the shoulder (biceps, brachialis, coracobrachialis )• anesthesia of lateral forearm skin
CNS locations : pyriform cortex :primary olfactory cortex • postcentral gyrus : primary sensory
cortex •precentral gyrus : primary motor cortex • insula :primary gustatory cortex
Friedreich’s ataxia : ataxia,tremor, kyphoscoliosis,foot deformities • death by 40 yrs old • AR •
atrophy of spinal cord – spinocereblellar tracts, corticospinal tracts and posterior columns
Behavioral –
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Cooperative play : after 4 yrs •
Regression :automatic retreat to a less mature level of behavior in times of stress
Sublimation : turning socially unacceptable impulses into acceptable or more benign forms to allow
their expression
Minor with STD  no need to inform the parents • go ahead and treat !
Alprazolam is intermediate acting BSD • primarily used for panic attacks
Diazepam & lorazepam : status epilepticus
Toilet training : not possible befor the age of 18 months
Biostatistics –
Biochemistry –
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PDH deficiency : pyruvate will be used in other pathways • alanine & lactate will be elevated •
alanine aminotransferase converts pyruvate to alanine • LDH converts pyruvate to lactate
Leigh’s disease :(subacute necrotizing encephalomyopathy) : defective form of cytochrome C
oxidase • symmetric necrosis that affects central arease of the nervous sytem from the thalamus to
the spinal cord •
Glucagon inhibits fatty acid synthesis by a cAMP-dependent phosphorylation of acetyl-CoA
carboxylase
High carbohydrate & low fat diet would stimulate fatty acid synthesis
cDNA library is synthesized from the mRNA of a cell using the enzyme reverse transcriptase • it is
used to study the DNA and the RNA message from which proteins are transcribed
Fluorescence activated cell sorting (FACS) uses antibodies coupled to fluorescent markers to
determine cell surface molecules of whole cells
Genomic library is the chromosomal sequence of a gene including coding and non-coding regions
• it is synthesized directly from the DNA of a cell and it is used to study both the coding regions &
the areas such as promoters, enhancers, and introns of a gene
Deletions are detected by two methods : 1) Southern Blot 2) PCR ( 3. restriction enzymes)
Glutamate carboxylase : catalyzes the carboxylation of glutamic acid side chains in several
clotting factors ( II, VII, IX, X, protein C, S) • vitamin K acts as co-enzyme
Hemolytic anemia in newborn : as a result of vitamin E –tocopherol- deficiency
Vitamin B12 is required for two reactions in human body : methylation of homocysteine to
methionine • conversion of methylmalonyl CoA  succinyl CoA (methylomalonyl CoA mutase)
Vitamin C excess can lead to : decreased absorption of B12 • increased estrogen levels in women
on estrogen replacement therapy • kidney stones •
Vitamin A : necessary for retinal pigments  nyctalopia
Glucose transporters are integral membrane proteins with 12 spanning domains
Kaplan – Qbank – High Yield
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Beta-adrenergic receptors for Epinephrine have 7 transmembrane segments
Hexosaminidase A hydrolyzes a bond between N-acetylglucosamine and galactose in the polar
head of ganglioside GM2
Propionic aciduria : deficiency in biotin • propionyl CoA carboxylase
Galactosemia : the only clinical significant complication is cataract
Fabry’s :a-galactosidase def • renal failure • telangiectasias • skin rash • ceramide trihexoside
accumulation
Farber disease : ceramidase def • hoarseness, dermatitis, skeletal deformations, mental
retardation, hepatomegaly
Niemann-Pick : def of sphingomyelinase • mental retardation, hepatosplenomegaly, foam cells in
bone marrow, cherry red spots in macula (40%) • death by 3 yrs of age
Von Gierke’s disease : glucose 6-phosphatase def • glucose 6P trapped in the liver cell is
degraded to lactate & pyruvate  released into serum • high serum lactate + high serum pyruvate
Ketone bodies : acetone, acetoacetate , b-hydroxybutyrate • produced by the liver by beta
oxidation of free fatty acids • occurs as follows :insulin deficiency  activated lipolysis  increased
plasma free fatty acids  increased hepatic fatty acids  accelerated ketogenesis
Malate shuttle : used to transport cytoplasmic NADH into mitochondria
Southwestern blotting :involves DNA-protein interactions. • a protein sample is subjected to
electrophoresis, transferred to a filter, and exposed to labeled DNA
UDP glucose phosphorylase :important in glycogen synthesis • glycogen synthase is the rate
limiting step in glycogen synthesis
Alkaptonuria :def of homogentisic acid oxidase (degradation of tyrosine) dark urine • dark
connective tissue  ear cartilage may appear bluish
Northern Blot : best test to determine whether a gene is expressed in a particular cell type
DNA sequencing & Southern Blot examine the DNA of the cell
Biochemical testing is usually used to detect a defective enzyme or a reduced amount of normal
enzyme • used in the detection of carriers of AR diseases such as Tay Sachs, sickle cell,
thalassemias
Vitamin C def : perifollicular hemorrhages, ecchymoses , splinter hemorrhages, hemorrhages into
muscle
Von Gierkes’s lab : increased lactate , cholesterol, TG, and uric acid
Wernicke’s : ataxia (= difficulty walking), dementia, paralysis of lateral gaze (= opthalmoplegia) •
thiamine deficiency
Transaminases require pyridoxal phosphate (vitamin B6)
Thiolase converts acetoacetyl-CoA into acetyl CoA
Abetalipoproteinemia : absence of apo-proteins • leads to fat malabsorption • complete absence
of chylomicrons • patient’s RBC’s are deformed (acanthocytosis)
Glycine is not hydroxylated • abundant in fibroblasts • constitutes every third aminoacid in collagen
structure
Proline is hydroxylated  hydroxyproline •
Serine, threonine, tyrosine can be phosphorylated post-translationally
Cystathionine synthetase :catalyzes the conversion of homocysteine  cystathionine 
cystein • if enzyme is deficient  homocysteine accumulates, is methylated  methionine •
patients with homocystinuria are vulnerable to thrombotic episodes
Genetics –
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Fragile X : enlarged testes + mental retardation • expansion of CGG trinucleotide repeat located
on X chromosome
Edwards syndrome : trisomy 18 • rocker bottom feet, micrognathia, mental retardation, 2 nd and 5th
finger over 3rd and 4th , congenital heart disease, death within a month
Patau syndrome : trisomy 13 • mental retardation, cleftlip/palate, polydactyly, rocker bottom feet
Kaplan – Qbank – High Yield
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-3-
Smith Lemli Opitz syndrome :ambiguous genitalia • failure to metabolize 7 dehydrocholesterol to
cholesterol • pyloric stenosis • syndactyly
Mosaic in trisomy 21 : 1% of children • some of their cells are normal • these individuals show only
a mild expression of the trisomy 21 phenotype
Locus heterogeneity : refers to the situation in which the same phenotype is caused by defects in
different genes • commonly seen in syndromes resulting from failures in a complex pathway, such
as hearing • - deaf parents produce nomrla hearing children,suggesting that the parents have
defects in different genes. The children are heterozygous at both loci and so have normal hearing
Pleiotropy : is observed in retinoblastoma • carriers may develop other cancers such as
osteosarcoma • inactivation of Rb suppressor gene in chromosome 13
SXD disorder with 60% penetrance • daughters have 60% chance to be affected
Histology / Cellular Biology –
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Major basic protein : found in eosinophils •crystalline core of granules in eosinophils •destruction
of parasites • eosinophils contain also : histaminase, arylsulfatase
Histamine is produced by basophils & mast cells • eosinophil secretes histaminase
Circulating RBC’s : 60 days life span
Peroxisomes : single membrane bound organelles • important in alcohol detoxification & long
chain fatty acid metabolism • Degradation of ethanol to acetaldehyde occurs in humans in both
peroxisomes & smooth endoplasmic reticulum (P450) • aldehyde dehydrogenase –blocked by
disulfiram- occurs in mitochondria
Sialic acid : is a terminal glycosylation product added to proteins (usually those destined for
secretion) in the Golgi apparatus
P450 :located in SER •in chronic alcoholism  growth
Spleen : white pulp  contains collections of lymphocytes arranged around a central artery in a
configuration called the periarterial lymphatic sheath (PALS).germinal centers may occur within the
sheath in reaction to antigen exposure • red pulp  consists of splenic cords and splenic sinuses,
filters the blood
Ito cells: found in the perisinusoidal space (space of Disse) Ito cells are hepatic adipose cells and
provide primary storage site for vitamin A
Kupfeer cells :are found in liver sinusoids and belong to the mononuclear phagocytic system
•greatly increased function after splenectomy • final breakdown of senili RBC’s
Hemosiderin, a denatured form of ferritin, appears microscopically as yellow brown granules in
cytoplasm •
Masson’s trichrome is a connective tissue stain • blue :nuclei • green : connective tissue • red
:blood
Karyorrhexis : pattern of nuclear degradation • pyknotic nucleus undergoes degradation followed
by complete lysis • this pattern is common in neutrophils present in acute inflammation
Liquefactive necrosis :abcess • CNS infarct
Microbiology / Immunology –
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Neonate with widespread granulomas = Listeria monocytogenes (granulomatis infantiseptica)
Neisseria gonorrhea transmitted via birth canal • opthalmia neonatorum
Chediak –Higashi : small doses of vitamin C may effectively treat this disorder
Sporothrix schenkii : hyphae with rosettes of conidia : transmission form • unequal budding yeast
found in clinical speciment from a patient with sporotrichosis • Rx : KI or itraconazole
Tinea pedis /athlete’s foot :colorless, branching hyphae with cross walls and arthroconidia • rx :
topical azole
Malassezia furfur : pityriasis versicolor • short curved hyphae, and round yeasts = “ spapghetti and
meatball “ •
Common variable immunodeficiency : decreased number of plasma cells • NORMAL number of
B-cells • low levels of all antibody classes • lymph node architecture is unaltered in common
variable immunodeficiency
Kaplan – Qbank – High Yield
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Giardia lamblia : infects the small intestine • if biopsy : crescent shaped protozoa • if smear :
flagellated organism with face like appearance • prolonged diarrhea • may have low serum IgA •
river streams in mountains  giardia
Entamoeaba histolytica : affects the large intestine • may liver abcess
Scalded skin syndrome : Staphylococcus aureus • exfoliative toxin • splitting of the epidermis at
the level of the stratum granulosum, causing global denudation of the skin
Impetigo & post-streptococcal glomerulonephritis : group A b hemolytic streptococci •eroded
pustules covered by honey colored crusts
IgA deficiency :some patients with IgG2 deficiency also have IgA deficiency and may develop
anaphylaxis if given IgA-containing blood products
C4 deficiency : SLE like syndrome
DiGeorge : tetany (facial muscles first sign  Chvostek’s sign) •absent thymus •low set ears
recurrent candidal infections
Hyper IgM syndrome : high IgM, low all other classes • helper T cells defect in surface protein
CD40L that interacts with CD40 on B-cell surface •often form antibodies to neutrophils,platelets,
and tissue antigens
Ataxia telangiectasia :prominent telangiectasias around the eyes • AR • chromosomal breakage
syndrome • increased number of translocations • chromosome 11 related
Molluscum contagiosum :cytoplasmic inclusions in the epidermal cells are pathognomonic •
babies & AIDS • poxvirus
Mycobacterium & Treponema cause chronic meningitis • lymphocytic infiltrate
Enterococcus faecalis : cause UTI’s –often nosocomial & classically in ICU- • do NOT produce
nitrites from nitrates •
Nitrites + :usually a gram negative organism (enterobacteria) such as Klebsiella, pseudomonas,
E.Coli, Enterobacter sp. •
Omcogenesis in HPV : cervical intraepithelial neoplasia is associated with HP infection (types
16,18) • produce E6 & E7 proteins inhibiting p53
Progressive multifocal leukoencephalopathy : JC virus (papova virus) • infects
oligondendroglial cells in the brain • eosinophilic inclusions • AIDS-defining • only white matter
affected
Subacute sclerosing panencephalitis • may follow previous measles infection • gray matter &
white are affected • occurs usually before the age of 18
Yersinia pestis & plague : any previously healthy person in the Southwestern US who develops
septic shcok or sever pulmonary disease shold be evaluated for plague
Aspergilloma may be formed by tuberculosis, tumor, bronchiectasis • surgically resection
•antibiotics are ineffective
Syngeneic graft : transfer of tissue between genetically identical individuals (identical twins)
Allograft /homograft : graft between genetically different members of the same species
Xenograft : e.g pig heart valve
C5a & IL 8 most powerful chemotactic factors for neutrophils • LTB4 also
IgG subclass 2 is directed against polysaccharide antigens and is involved in the host defense
against encapsulated bacteria
C 3 nephritic factor = IgG autoantibody that binds to C 3 convertase making it resistant to
inactivation • persistently low serum complement levels • Type II MPGN
Scalded skin syndrome (Staphylococcus aureus phage II group ) : involves the very superficial
squamus cells just beneath the granular layer
Type II hypersensitivity : are mediated by IgG or IgM antibodies to fixed cell bound antigens •
this response may lead to cell destruction or cell dysfunction • important in the pathogenesis of
transfusion reactions, graft rejection, Graves disease, myasthenia gravis
Type III hypersensitivity :formation of circulating immune complexes • may precipitate in small
blood vessels  fix complement and incite an inflammatory reaction • glomerulonephritis,
vasculitides, collagen vascular diseases
Type IV hypersensitivity :sensitized T lymphocytes • either CD4+ (helper) T lympocytes or CD8+
(cytotoxic) T lymphocytes take part in this response • granulomas
Kaplan – Qbank – High Yield
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IFNγ produced by T1 helper cells instructs macrophages to become epithelioid cells
Aspirin-induced asthma : inhibition of cyclooxygenase/ but not lipooxygenase  decreased ratio
between PG’s (bronchodilators) and leukotrienes (bronchoconstrictors)
Germ tube test :diagnostic test for candida albicans
Cervical exudates  gram negative diplococci within neutrophils = Neisseria gonorrhea 1000%
Cervical exudates  gram negative cocci : 1) neisseria gonorrhea 2) acinetobacter (normal
flora) • use DNA probe to distinquish
Leptospirosis : abrupt onset of headache (98%) , fever, chills, conjunctivitis, muscle aches, GI
symptoms, rash, hypotension • this phase lasts 3-7 days • asymptomatic period  recurrence of
fever & generalized symptoms
Neisseria gonorrhea arthritis : patients are continuously susceptible to reinfection b/c of antigenic
variation of the pili
Molecular biology –
Pathology –
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Subcortical leukoencephalopathy (Binswanger’s disease) : diffuse loss of deep hemispheric
white matter • associated with hypertension • widespread gliosis
Yolk sac tumor a.k.a = infantile embryonal carcinoma/= endodermal sinus tumor : b/c of presence
of endodermal sinuses that resemble primitive glomeruli • cytoplasmic granules that contain alpha
fetoprotein. • can be used as a serum marker for recurrent disease
Still’s disease : a.ka juvenile rheumatoid arthritis • affects children younger than 16 yrs old , 1-3
yrs of age • female predominance •fever, splenomegaly, general lymphadenopathy, leukocytosis •
rheumatoid factor is usually negative • if +  poorer prognosis
Henoch Schonlein purpura : preceded by an URI • vasculitis, arthritis, purpura, GI pain & blood in
stool , kidney  nephritic syndrome
Kawasaki’s disease : fever, conjunctivitis, erosion of oral mucosa, lymphadenopathy, rash ,
coronary & aortic vasculitis  death
Fibrinous pericarditis : post MI • loud pericardial friction rub, chest pain,fever, symptoms of CHF
Caseous pericardtitis TB
Conn’s syndrome : hyperplasia of zona glomerulosa • hypertension secondary to sodium retention
• hypokalemia •decreased serum rennin (negative feedback of increased blood pressure on rennin
secretion)
Secondary aldosteronism :increased levels of rennin • due to renal ischemia
Dermatitis herpetiformis : associated with celiac sprue • type III hypersensitivity reaction •
immunocomplexes igA + complement
Discoid lupus erythematosous : localized cutaneous form of SLE • type III hypersensitivity
reaction
Urticaria : IgE mediated • type I hypersensitivity
ASD :prominent right ventricular cardiac impulse • systolic ejection murmur heard in the pulmonic
area & along the left sternal border • fixed splitting of the 2nd heart sound
Melasma :irregular patches of hyperpigmentation on the face •occurs in pregnancy • may not regress
Primary sclerosing cholangitis : beaded appearance on ERCP of biliary tree •
Osteosarcoma : XRay : bone destruction /soft tissue with “sunburst appearance “ / Codman’s
triangle (=periostal elevation) • Histo : anaplastic cells with osteoid
Exostoses (=osteochondromas), debaceous cysts, dermoid tumor’s, colonic polyps = Gardner’s
Lymph node structure & disease :
a. Viral infection – expansion of germinal centers without loss of normal architecture
b. AIDS – progressive transformation of germinal centers • not paracortical hyperplasia
c. Lymphomas – destroy the architecture of the lymph node
Complete hydatiform mole : elevated b-hCG •grape like cystic structures filling the uterus • no
embryo • the genotype of a complete hydatiform mole is purely paternal (XY), caused by
fertilization of an egg that has lost its chromosomes • danger : choriocarcinoma
Kaplan – Qbank – High Yield
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-6-
Partial moles : triploidy / tetraploidy • fertilization of an egg with two different sperm • one with X
& one with Y
AFP : hepatocellular carcinoma • yolk sac tumors • embryonal tumors in men
Irritable bowel syndrome : alternating constipation / diarrhea • more common in young females •
no organic changes are evident
Hypoaldosteronism :decrease in serum sodium increase in serum K+ • retain of H+ ions 
metabolic acidosis with low serum bicarbonate
Bernard Soulier disease : prolonged BT • normal PLT • dysfunction in glycoprotein Ib-IX complex •
only treatment in acute emergency : transfusion of PLT’s
Henoch-Schonlein : URI + purpura + abdominal pain + hematuria + child
Cryoprecipitate would help in a case of vWF disease
Hyaline droplets (dark staining droplets ) are found in the epithelium of PCT in cases of
proteinuria
Spongiosis : intercellular edema of the epidermis • fluid accumulates between the cells, pulling the
apart
Adult form of aortic coarctation :stenosis distal to the left subclavian artery • collateral circulation
by intercostal & internal mammary artery •notching of inferior margins of ribs •
Infantile form of aortic coarctation is associated with patent ductus arteriosus
Aortic stenosis : systolic hypotension throughout the body • recurrent syncope • hypertrophe /
dilatation of LV
Takayasu arteritis : a.k.a pulseless disease • vasculitis of the aortic arch and its branches 
stenosis of these arteries • signs & symptoms of ischemia to the upper part of the body • radial
pulses are weak/ absent = pulseless disease
Vascular proliferating skin lesions :hemangiomas • Kaposi • bacillary angiomatosis
Malignant mixed mullerian tumor : tumor with 2 components : stromal & epithelial (endometrial
glands) • both are malignant but only the epithelial metastizes • stromal component may contain
metaplastic components such as cartilage & bone
Endometrial carcinoma is derived form epithelial glandular component of endometrium • abnormal
bleeding is the usual presentation •
Small parietal lobe abcesses : septic emboli from infective endocarditis
Albinism & associated skin cancer : squamus cell carcinoma (multiple)
Rheumatoid nodules are composed histologically of areas of fibrinoid necrosis surrounded by
palisading epithelioid cells
Thalassemia & sickle cell anemia do not usually present until about the 6 months of age ,when
fetal hemoglobin production ceases
Celiac disease : limited to proximal small bowel • anti-gliadin antibodies • granular deposits of
IgA and C3 in dermal papillary tips • gluten free diet as Rx • tropical sprue affects the entire
small bowel ( ETEC infection) •
Basal cell carcinoma : “pearly papules” on sun exposed skin • almoste never metastize •
palisading of the cell nuclei •
Resistance to thyroid hormone (Refetoff’s syndrome ): mutation in thyroid hormone receptor
gene • affects also the cells in pituitary  “no” negative feedback  increased plasma TSH 
increase in serum T4
Low T3 syndrome (euthyroid sick syndrome) occurs with certain systemic illnesses such
pneumonia or septicemia,afterm major surgery and with malnutrition or starvation • decrease of 5’
monodeiodinase activity • decreased levels of T3
Addison’s disease : decreased secretion of cortisol, aldosterone and adrenal androgens •
hypotension may be present b/c arterioles are less responsive to the constrictor effects of
catecholamines in the absence of cortisol • hyperkalemia & hyponatremia due to lak of cortisol
Nelson’s syndrome : usually post-adrenalectomy for Cushing • extreme hyperpigmentation due to
hypersecretion of ACTH from pituitary adenoma that is no longer being restrained by the
supressibve effect of cortisol
Head & neck (particularly nose,nasopharynx and orbit is the most frequent site for embryonal
rhabdomyosarcoma • other sites are the genitourinary tract
Kaplan – Qbank – High Yield
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Hereditary factor XIII deficiency :presentation at birth when the umbilical stump bleeds
excessively • factor XIII is necessary to stabilize clot formation ; in its absence clots will rapidly lyse
• spontaneous abortion in women is common
Complications of MVP :atrial thrombosis, caclcification, infective endocarditis, emboli to the brain,
rupture of chordae, mitral regurgitation,,arrythmias, and premature ventricular contractions
Conn’s syndrome : hypertension, hypernatremia, hypokalemia, low rennin levels, metabolic
alkalosis
Vitamin K dependent factors : II (prothrombin), VII, IX, X, C, S • deficiency in protein C would
cause thrombosis NOT bleeding • check hemorrhagic skin necrosis by warfarin
Prostatic hyperplasia : periurethral zone
Reye’s syndrome : fatty liver with encephalopathy • Hx : viral illness, severe vomiting, irritability,
hepatomegaly, elevation of serum ammonia • aquired mitochondrial abnormality •may occur also
without exposure to salicylates • esp after influenza and cickenpox • mortality rate 50%
Pharmacology –
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DMARDS for RA : MTX • azathiprine • penicillamine •hydroxycholroquine • chloroquine • organic
gold compounds • sulfasalazine
Glucocorticoids SE : hypocalcemia, fluid retention, hypokalemia, hyperglycemia, hypernatremia ,
adrenal suppression, muscle weakness & atrophy, gastrtits, Cushingoid state, immunosuppression,
hypertension, psychosis , osteoporosis, glaucoma, cataract
N acetylcyteine : mucolytic used in CF to thin mucous •splits disulfide linkages between these
mucoproteins  ↓ mucous viscosity
Dextromethorphan is a cough depressant
Pentamidine : used in HIV patients with PCP
Metoclopramide :stimulates motility of intestinal tract • contraindicated in patients with bowel
obstruction  danger for perforation
Anticholinergic drugs : may precipitate attacks of narrow angle glaucoma b/c muscarinic
receptors on the papillary constrictor muscle of the iris are blocked • TCA’s – imipramine,
amitryptiline, nortriptyline, desipramine, clomipramine,doxepine- can do that !
Decrease of blood levels of a drug : 1 half life  50 % • 2 half lifes  25 % left in blood • 3 half
lifes  12,5 % left • 4 half lifes  6,25% left in blood • levels decrease by half every half life
Retarded ejaculation : can be improved by admin a SSRI • fluexitine, sertraline,citalopram,
paroxetine.
β-blockers are used in treatment of hypertrophic cardiomyopathy • β1-blockers : atenolol,
betaxolol, esmolol, acebutolol, metoprolol
Bretylium : class III anti-arrythmic • indicated for treatment of ventricular fibrillation and ventricular
tachycardia
Digoxin :used in atrial fibrillation • atrial flutter • CHF
Lidocaine : class Ib antiarrythmic • used in Rx of ventricular tachycardia
Ventricular tachycardia : amiodarone • bretylium • lidocaine
Succinylcholine : depolarizing skeletal muscle relaxant • can cause hyperkalemia • PR
prolongation , widening of QRS , peaked T waves
Acute interstitial nephritis : caused by ibuprofen, indomethacin, methicillin, cephalothin,
sulfonamides,thiazides, furosemide, cimeridine,methyldopa •Clinical : ARF ( ↑ BUN, creatinine 0,61,2 ) fever, maculopapular rash, EOSINOPHILIA !, periorbital edema, wheezing
Acarbose : delays glucose absoption from GI
Metformin : causes lactic acidosis • increases the binding of insulin to its receptor
Oxybutynin : inhibits muscarinic action on smooth muscle (antimuscarinic action) • Rx for bladder
instability – incontinence, persistent urinary urgencyBetanechol : used in urinary retention to contraction of detrusor muscle •
Gabapentin : used to treat neuropathic pain in diabetic patients • antiepileptic
Primidone : anticonvulsant • has two active metabolites 1) ohenobarbital 2) phenethylmalonamide •
associated with cross- hypersensitivity to Phenobarbital
Kaplan – Qbank – High Yield
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-8-
T3 therapy : increases serum T3 levels • but NOT serum T4 b/c T3 is not converted peripherally to
T4 • TSH will be low due to feedback inhibition by T3 • decrease of TSH causes also decrease in T4
Salicylate intoxication : dizziness, tinnitus, hearing impairment , nausea, vomiting,
hyperventilation , flushing, sweating, metabolic acidosis • agents that acidify urine , such as NH4Cl
are known dramatically decrease salicylate excretion and subsequently increase salicylic acid
blood levels • Rx : sodium bicarbonate, sodium lactate
Jimson weed contains anti-muscarinic agents • in overdose : agitation,mydriasis, hot dry skin,
tachycardia , decreased bowel sounds
Stimulants : best way to differentiate stimulatnt overdose from anticholinergic overdose is the skin
• sweaty  stimulants • dry  anticholinergics
Opioid intoxication : sleepiness, lethargy, miosis, cool skin , hypoventilation, hypotension,
bradycardia, decreased bowel sounds •
Cefoperazone : 3rd generation cephalosporin •can cause vitamin K deficiency • disulfiram like
reaction with alcohol • DOC in people with impaired renal function b/c 60% is eliminated by the
biliary route
Ticarcillin : β—lactamase sensitive • causes a large salt load  salt retention and hypokalemia
Carbidopa blocks a pyridoxal dependent decarboxylase located in the mucosa of the GI tract and
in systemic circulation
Heparin is the most common cause of drug induced thrombocytopenia •risk for development
thrombocytopenia increases as the duration of therapy increases (more than 10days e.g) • no skin
necrosis
Warfarin & hemorrhagic skin necrosis : associated protein C deficiency in the patient • presents
on 3rd- 10th day of therapy • may lead to necrosis of skin (typically on breast, thighs, and buttocks) •
heterozygote carriers for protein C become homozygote when given warfarin in 6~8 hrs when the
half life of previously γ-carboxylated protein C disappears.Now the patient is hypercoagulable •
warfarin is used for prophylaxis and treatment of thromboembolic complications associated with
cardiac valve replacement and atrial fibrillation, as well as the prophylaxis and treatment of venous
thrombosis and pulmonary embolism •
Aminoglycosides & nonoliguric RF : some patients develop a non-oliguric form of renal failure
when treated with aminoglycosides such as gentamycin • elevation of creatinine •
Cephalothin/Methicillin interstitial nephritis : fever + rash + acute renal failure + eosinophilia
Central pontine myelinolysis : demyelination affecting the central region of basis pontis • in
severe malnourished & dehydrated alcoholics • from rapid correction of hyponatermia
Hydrocarbon exposure  scrotal carcinoma
Zolpidem : non-benzodiazepine • hypnotic agent
Buspirone : non-benzodiazepine •anxiolytic • devoid of sedative ,hypnotic,anticonvulsant and
muscle relaxant properties
Obsessive compulsive disorder : clomipramine (TCA) or SSRI (e.g fluexitine)
Nortriptyline  hyperplrolactinemia (methyl dopa, phenothiazines also)
Diabetic with sulfa allergy : contraindicated sulfonylureas (chlorpropamide,
tolbutamide,glyburide,glipizide)
Methamphetamine : indirect- acting agonist • acts inducing dopamine, NE, and 5HT release •
dopamine is believed to play an important role in the reward system of the brain and is thought to
be a significant factor in the reinforcing effects of stimulants ( area involved in reward system :
ventral tegmental area of midbrain to the nucleus accumbens of the forebrain)
Hydrocortisone suppositories : indicated for treatment of distal ulcerative colitis • sulfasalazine is
also used in treatment of UC
Metronidazole gold standard for pseudomembranous colitis • vancomycin is another option
Hyoscyamine : anticholinergic • Rx : irritable bowel syndrome • administered before the meal
Prednisone for treatment of acute flare ups of Crohn’s
Megestrol acetate & leuprolide : for prostate cancer • GnRH analogs
Cyclobenzaprine : centrally acting skeletal muscle relaxant • structurally related to tricyclic
antidepressants • is has anticholinergic side effects ( blurred vision, urinary retention,
constipation,tachycardia etc)
Kaplan – Qbank – High Yield
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Baclofen :centrally acting skeletal muscle relaxant • inhibition of both monosynaptic and
polysynaptic reflexes • indicated for treatment of spasticity resulting from multiple sclerosis or
secondary to spinal cord injuries • also Rx for trigeminal neuralgia • fatigue & hypotension
Traveler;s diarrhea Rx : most cases of traveler’s diarrhea are caused by ETEC, Shigella species
and Campylobacter jejuni • treat with fluoroquinolones ( ciprofloxacin,ofloxacin, norfloxacin) •
TMP/SFX is used for children !
Mebendazole : used for elminths such as Enterobius, Trichuris trichiura, Ascaris lumbricoides
Diabetic with hypertension : ACE inhibitors • ca2+ blockers
Cefazolin & Cefadroxil : 1st generation cephalosporins • used surgical prophylaxis
SIADH & drugs : carbamazapine • vincristine,vinblastine • cyclophosphamide • chlorpropamide •
TCA
Physiology –
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Glycoprotein hormones : EPO, LH, FSH, hCG, TSH • bind at cell surface receptors ↑ cAMP levels
Catecholamine hormones : epinephrine, norepinephrine, dopamine
Oligopeptide hormones : endorphins, ADH, oxytocin, TRH, GnRH, SS, CCK, secretin, VIP, GIP
Polypeptide hormones : PTH, calcitonin, insulin, glucagons, pancreatic polypeptide, gastrin,
ACTH, IGF’s, EGF, FGF, NGF
Baroreceptor reflex (patient stands up from supine condition) :patient stands up  less blood
to brain  less firing to baroreceptors  sympathetic stimulation  increase in HR, conduction
velocity and myocardial contractility  constriction of all arterioles  ↑ TPR  sympathetic
stimulation of renal vasculature  decrease in renal blood flow  constriction of large veins 
increases venus return to the heart  ↑ preload
Transcutaneous electrical nerve stimulation is a method used to lessen severe,chronic pain by
overly stimulating the involved neurons • gate theory of pain