MUDPILES

Methanol

Uremia

DKA

Paraldehyde or Phenformin

Iron Tablets or INH

Lactic Acidosis

Ethylene glycol (oxalic acid)

Salicylates

STOP Making New Thrombi

Sepsis (gram neg)

Trauma

Obstetric complications

Pancreatitis (acute)

Malignancy

Nephrotic syndrome

Transfusion

CAST

Clavulanic Acid, Sulbactam, Tazobactam

These are often added to penicillin antibiotics to protect the antibiotic from destruction by beta-lactamase

These Rascals May Microscopically Lack Color

Treponema (too thin to be visualized)

Rickettsia (intracellular parasite)

Mycobacteria (high lipid content cell wall)

Mycoplasma (no cell wall)

Legionella pneumophila (primarily intracellular)

Chlamydia (intracellular parasite; lacks muramic acid in cell wall) 

Chocolate agar with factors V (NAD+) and X (hematin)

 Nagging Pests Must Breathe

Nocardia, Pseudomonas aeruginosa, Mycobacterium tuberculosis, and Bacillus 

Anaerobes Can't breathe air

Clostridium, Bacteroides, and Actinomyces

They lack catalase and/or superoxide dismutase and are susceptible to oxidative damage

Stay inside (cells) when it is Really Cold

Rickettsia, Chlamydia 

These can't make their own ATP

Some Nasty Bugs May Live FacultativeLY

Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Legionella, Yersinia pestis

SHiN SKiS (group B)

Streptococcus pneumoniae, Haemophilus influenzae type B, Neisseria meningitidis, Salmonella, Klebsiella pneumoniae, group B Strep

You need SSPACE for your cats

S. aureus, Serratia, Pseudomonas, Actinomyces, Candida, E.coli 

PUNCH-K

Proteus, Ureaplasma, Nocardia, Cryptococcus, H.pylori, Klebsiella 

On the offices's staph retreat, there was NO StRES

NOvobiocin - Saprophyticus is Resistant ; Epidermidis is Sensitive 

OVRPS (overpass)

Optochin - Viridans is Resistant; Pneumoniae is Sensitive

B-BRAS

Bacitracin -- group B strep are Resistant; group A strep are Sensitive

ADP ribosylation

Beta-prophage

Corynebacterium

Diphtheria

Elongation Factor 2

Granules 

What are some of the spore-forming gram-positive bacteria?

1) found in soil

2) Others

1) Bacillus anthracis, Clostridium perfringens, C. tetani

2) B. cereus, C. botulinum, Coxiella burnetii 

1) What is the main purpose of autoclaving?

2) At what phase of bacterial growth are spores formed?

1) killing bacterial spores

2) formed at the end of the stationary phase (when nutrients are limited)

SNAP:

Sulfa for Nocardia

Actinomyces use penicillin 

Actinomyces and Nocardia are gram positive rods that form long branching filaments resembling fungi 

BLT. B is Big

Borrelia (Big size), Leptospira, Treponema

Leptospira interrogans (question mark-shaped bacteria) 

Weil's disease is also called icterohemorrhagic leptospirosis - severe form with jaundice and azotemia from liver and kidney dysfunction; fever, hemorrhage, and anemia

Caused by Borrelia burgdorferi

BAKE a Key LYME pie:  Bell's palsy (bilateral), Arthritis, Kardiac block, Erythema migrans

pupil constricts with accomodation but is not reactive to light.  "Prostitute's pupil" (accomodates but does not react)

Associated with tertiary syphillis

VDRL detects nonspecific antibody that reacts with beef cardiolipin.

VDRL: Viruses (mono, hepatitis), Drugs, Rheumatic fever, Lupus and leprosy

Given the following species, identify the disease, transmission and source.

1) Bartonella spp.

2) Borrelia burgdorferi

3) Borrelia recurrentis

4) Brucella spp. 

5) Campylobacter

6) Chlamydophila psittaci

1) Cat scratch disease; cat scratch

2) Lyme disease; Ixodes ticks (live on deer and mice)

3) Recurrent fever; Louse (recurrent b/c of variable surface antigens)

4) Brucellosis/undulant fever; unpasteurized dairy

5) Bloody Diarrhea ; puppies, livestock (also fecal-oral, ingestion, sexual transmission)

6) Psittacosis; parrots and other birds

Given the following species, identify the disease, transmission and source.

1) Coxiella burnetii

2) Ehrlichiosis chaffeensis

3) Francisella tularensis

4) Leptospira spp.

5) Mycobacterium leprae

6) Pasteurella multocida

7) Rickettsia prowazekii

8) Rickettsia rickettsii

9) Rickettsia typhus

10) Yersinia pestis

1) Q Fever ; spores from tick feces and cattle placenta

2) Ehrlichiosis; Lone Star tick

3) Tularemia ; ticks, rabbits, deer fly

4) Leptospirosis ; animal urine

5) Leprosy; Armadillos

6) Cellulitis, osteomyelitis; animal bite, cats, dogs

7) epidemic typhus; louse

8) Rocky Mountain Spotted Fever ; Dermacenter tick bite

9) Endemic typhus, Fleas

10) Plague; flea bite, rodents, prairie dogs

you drive CARS using your palms and soles

Coxsackie A infection (hand, foot, and mouth disease)

Rocky Mountain Spotted Fever

Syphillis

Histoplasmosis, Blastomycosis, Coccidioidomycosis, Para-coccidioidomycosis (all of these are dimorphic fungi) 

They generally cause pneumonia and can disseminate 

Ingested - Enterobius, Ascaris, Trichinella --> you'll get sick if you EAT these!

Cutaneous - Strongyloides, Anclostoma, Necator --> These get into your feet from the SANd

Which parasite fits best with each finding?

1) Brain cysts, seizures

2)Liver cysts

3) B12 deficiency

4) Biliary tract disease, cholangiocarcinoma

5) Hemoptysis

1) Taenia solium (cysticercosis)

2) Echinococcus granulosus

3) Diphyllobothrium latum

4) Clonorchis sinensis

5) Paragonimus westermani

Which parasite fits best with each finding?

6) Portal hypertension

7) Hematuria, bladder cancer

8) microcytic anemia

9) perianal pruritis

6) Schistosoma mansoni

7) Schistosoma haematobium

8) Ancylostoma, Necator

9) Enterobius

Locus ceruleus (NE), raphe nucleus (serotonin), and reticular formation 

lesion of the Reticular Activating system causes coma

anterior hypothalamus 

Anterior region usually functions to cool off (cooling, parasympathetic) (A/C - anterior cooling)

paramedian pontine reticular formation/conjugate gaze center (PPRF)

PPRF is also responsible for rapid eye movements in nystagmus as well

What are the afferent and efferent branches of the following cranial nerve reflexes?

1) Corneal

2) Lacrimation

3) Jaw Jerk (normally is absent)

4) Pupillary

5) Gag

1) V1, VII (temporal branch: orbicularis oculi)

2) V1, VII

3) V3,  V3 (motor-masseter)

4) II , III

5) IX , IX and X

What are the main classes of drugs that are known to have anticholinergic side effects (besides the anticholinergics themselves)?

PSMM

Papillary carcinoma of thyroid, serous cystadenocarcinoma of ovary, meningioma, malignant mesothelioma

RIP Always

Rabies, Influenza, Salk Polio (SalK=Killed), and HAV

Smallpox, Yellow fever, chicken pox (VZV), Sabin's polio virus, MMR

Live! one night only! see small yellow chickens get vaccinated with Sabin's and MMR

Autoantibody w/ associated disorder

1) Antinuclear antibodies

2) Anti dsDNA, anti-Smith

3) Anti-histone

4) Anti-IgG (rheumatoid factor) (IgM antibody against IgG)

5) Anticentromere

1) SLE, nonspecific

2) SLE (anti-smith is more specific for SLE renal disease)

3) Drug induced lupus (like with Hydralazine)

4) Rheumatoid Arthritis

5) Scleroderma (CREST)

Autoantibody w/ associated disorder

1) Antimitochondrial 

2) Anti-Scl-70 (anti-DNA topoisomerase I)

3) anti-gliadin, antiendomysial

4) anti-basement membrane

5) Anti-desmoglein

1) primary biliary cirrhosis

2) Scleroderma (diffuse) 

3) celiac disease

4) Goodpasture's

5) Pemphigus vulgaris

Autoantibody w/ associated disorder

1) antimicrosomal, antithyroglobulin

2) Anti-Jo-1

3) Anti-SS-A (anti-Ro)

4) Anti-SS-B (anti-La)

5) Anti-U1 RNP (ribonucleoprotein) 

1) hashimoto thyroiditis

2) Polymyositis, dermatomyositis

3) Sjogren's Syndrome

4) Sjogren's syndrome

5) Mixed connective tissue disorder 

Autoantibodies w/ associated disorder

1) Anti-smooth muscle

2) Anti-glutamate decarboxylase (antiglutamic acid)

3) c-ANCA

4) p-ANCA

5) MPO-ANCA 

1) autoimmune hepatitis

2) Type I diabetes mellitis

3) Wegener's granulomatosis

4) microscopic polyangitis, Churg-Strauss

5) Pauci-immune crescentic glomerulonephritis 

NAACP D

Neoplastic

Asthma - includes Churg-Strauss

Allergic processes & acute interstitial nephritis

Collagen vascular diseases

Parasites (invasive)

Drugs

heparin (anticoagulant), histamine (vasodilator) and other vasoactive amines, and leukotrienes (LTD4) 

basophils are found in blood

WBC H

Wiscott-Aldrich

Bruton Agammaglobulinemia

Chronic Granulomatous disease

Hyper IgM syndrome (3 types: X-linked=no CD ligand, AR=noCD40, NEMO deficiency)

WAITER

Wiscott Aldrich

Immunodeficiency

Thrombocytopenia and purpura

Eczema

Recurrent pyogenic infections 

FATED

coarse Facies, cold (noninflamed) staphylocococcal Abscesses, retained primary Teeth (resulting in 2 rows of teeth), increased IgE, and Dermatologic problems (like eczema

1) Severe recurrent infections (chronic mucocutaneous Candidiasis, recurrent or fatal RSV, VZV, HSV, etc., PCP pneumonia)

2) chronic diarrhea

3) failure to thrive 

no thymic shadow as well 

defective IL-2 receptor (X-linked, most common)

adenosine deaminase deficiency

failure to synthesize MHC II antigens 

Defects in the ATM gene that codes for DNA repair enzymes

Triad: cerebellar defects (ataxia), spider angiomas (telangiectasia), IgA deficiency 

Leukocyte adhesion deficiency type 1 (phagocytes can't enter tissue b/c defect in LFA-1 integrin on phagocytes)

Chediak-Higashi syndrome (microtubule dysfunction in phagolysosome fusion, defect in lysosomal regulator trafficking gene) 

Chronic granulomatous disease (lack of NADPH oxidase, decreased ROS and absent respiratory burst--- see a negative tetrazolium dye reduction test)

BRICK L

Brain 

RBCs

Intestine

Cornea

Kidney

Liver

increase:  hyperglycemia, GH, cortisol, beta agonists

decrease: hypoglycemia, somatostatin, alpha agonists 

Where are GLUT 1 receptors located?

What about GLUT 2?

GLUT 4?

GLUT 1: RBCs and brain

GLUT2 (bidirectional): beta islet cells, liver, kidney, small intestine 

GLUT 4 (insulin responsive): adipose tissue, skeletal muscle

schwann cells, lens, retina and kidneys 

water comes in b/c sorbitol accumulation

1) Where is iron absorbed in GI tract?

2) Where is folate absorbed in GI tract?

1) duodenum

2) jejunum

These Will Cause Devastating Absorption Problems

Tropical sprue

Whipples disease

Celiac sprue 

Abeta-lipoproteinemia

Pancreatic insufficiency

Foamy Whipped cream in a CAN

Foamy (PAS-positive) macrophages

Cardiac symptoms

Arthralgias

Neurologic symptoms 

Most commonly occurs in older men

it is a dec. synthesis of apo B --> inability to generate chylomicrons --> dec. secretion of cholesterol, VLDL into bloodstream --> fat accumulation in enterocytes

presents in early childhood with malabsorption and neurologic manifestations 

dermatitis herpetiformis

moderately inc. risk of T cell lymphoma

2 inches long, 2 feet from the ileocecal valve, 2% of the population, presents within first 2 years of life, and may have 2 types of epithelia (gastric/pancreatic) 

most common congenital anomaly of the GI tract

5-HT, leads to carcinoid syndrome if the tumor or metastasis exists outside of the GI tract (usually liver), carcinoid syndrome is observed.  

B FDR : Bronchospasm (causing wheezing), Flushing, Diarrhea, Rt. sided heart murmur 

ABC:  adhesions, bulge (hernia), cancer/tumors

Other less common causes include volvulus, intussuscetion, Crohns, gallstone ileus, bezoar, bowel wall hematoma from trauma, inflammatory stricture, congenital malformation, radiation enteritis

What are the Rate limiting enzymes for the following?

1) glycolysis

2) gluconeogenesis

3) TCA cycle

4) Glycogen synthesis

5) Glycogenolysis

6) HMP shunt (Pentose Phosphate)

1) phosphofructokinase 1

2) Fructose-1,6-bisphosphatase

3) isocitrate dehydrogenase

4) glycogen synthase

5) glycogen phosphorylase

6) Glucose-6-phosphate dehydrogenase

What are the rate limiting enzymes for the following?

1) De novo pyrimidine synthesis

2) De novo purine synthesis

3) Urea cycle

4) Fatty acid synthesis

5) Fatty acid oxidation

6) Ketogenesis

7) Cholesterol synthesis

1) Carbamoyl phosphate synthetase II

2) Glutamine-PRPP amidotransferase

3) Carbamoyl phosphate syntetase I

4) Acetyl CoA carboxylase (ACC)

5) Carnitine acyltransferase I (carnitine shuttle)

6) HMG-CoA synthase

7) HMG-CoA reductase 

They are carriers of nitrogen from tissues into the urea cycle. 

A transamination is the transfer of the amino group of an amino acid (like alanine) to alpha-ketoglutarate to form glutamate (glutamate can then transfer NH4+ into the urea cycle),  The remaining deaminated amino acid is a keto-acid (such as pyruvate) that is used in energy metabolism.

Pyridoxal phosphate (Vitamin B6 derivative).

Alanine aminotransferase (ALT) and Aspartate Aminotransferase (AST) 

ALT converts alanine to pyruvate and in doing so converts alpha ketoglutarate to glutamate

AST converts oxaloacetate to aspartate and in doing so converts glutamate to alphaketoglutarate.

This is why you can have a urea cycle problem either by liver disease or by a deficieny in a urea cycle enzyme. 

get backup of substrate (pyruvate and alanine) resulting in lactic acidosis.  

Findings: neurologic defects 

Tx: inc. intake of ketogenic nutrients (e.g. high fat content or inc. in lysine and leucine which are the only purely ketogenic amino acids) ... this helps to make acetyl CoA in a different way 

2,4-dinitrophenol (a wood preserving agent), aspirin, thermogenin in brown fat (used in hibernating animals)

inc. permeability of membrane causing a decrease in proton gradient and inc. oxygen consumption.  ATP synthesis stops, but electron transport continues. Produces heat (wasted energy). 

The Vowels hit your Bowels

HAV and HEV (naked viruses do not rely on an envelope so they are not destroyed by the gut

What dare the characteristics of the disease caused by Leishmania donovani?

How is it transmitted?  What is the diagnosis and treatment?

Viceral leishmaniasis (kala-azar): spiking fevers, hepatosplenomegaly, pancytopenia

transmission by the sandfly (it is in the middle east-think lots of deserts);  diagnosis by macrophages containing "amastigotes" ; treatment is sodium stibogluconate

postive serum ANA, + anti-smotth muscle, + anti/liver/kidney microsomal antibody

negative antimitochondrial and negative viral serology

micronodular cirrhosis, Diabetes mellitus and skin pigmentation --> "bronze diabetes"

results in CHF, testicular atrophy in males and inc. risk of HCC

Hemochromotosis Can Cause Deposits

1) digestion and absorption of lipids and fat-soluble vitamins

2) cholesterol excretion (body's only means of eliminating cholesterol)

3) Antimicrobial activity (via membrane disruption)

PVT TIM HALL

Phenylalanine, valine, threonine, tryptophan isoleucine, methionin, histidine, arginine, leucine, lysine

PICK EGS

Protease inhibitors

Isoniazid

Cimetidine

Ketoconazole

Erythromycin

Grapefruit juice

Sulfonamides

BCG PQRS

Barbiturates

Carbamazepine

Griseofulvin

Phenytoin

Quinidine (can both induce and inhibit P450)

Rifampin

St. John's Wort

rash around the eyes, mouth, nose, anus (Acrodermatitis enteropathica)

delayed wound healing, hypogonadism, decreased adult hair, dysgeusia, anosmia 

decreased mental function, impaired night vision, infertility,

Night blindness

Xerophthalmia (pahologi dryness of the conjunctiva and cornea) --> corneal ulceration and blindness

Keratomalacia (wrinkling, clouding of cornea)

Bitot's spots (dry, silver-gray plaques on the bulbar conjunctiva)

Headache, nausea/vomiting, stupor, skin (dry and pruritic) liver enlarged and possibly cirrhotic, bone and joint pain, increase in intracranial pressure (psuedotumor cerebri)

Spinocerebellar degeneration --> ataxia

Peripheral neuropathy and proximal muscle weakness 

increased fragility of erythrocytes (hemolytic anemia)

Pellagra 

Diarrhea, Dermatitis, Dementia

It is a cofactor in oxidation/reduction reactions (e.g. FADH2) 

Deficiency causes Cheilosis and Corneal vascularization

Duodenal atresia, hirschsprungs disease, celiac disease, annular pancreas

Aspiration pneumonia

Abscess in lungs and liver

Alcoholics

di-A-betics

Red currant jelly sputum. 

PUNCH-K

Proteus, Ureaplasma, Nocardia, Cryptococcus, H.pylori, Klebsiella

SAT for photos

Sulfonamides, amiodarone, tetracycline 

Popular FACTSSS

Probenecid, Furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfonamide antibiotics, Sulfasalazine, Sulfonylureas

Penicillin

Seizure drugs: Ethosuximide, Carbamazepine,Lamitrigine, Phenytoin, Phenobarbital

Sulfa drugs

Allopurinol

Yersinia enterocolitica, Campylobacter jejuni, non-typhoidal Salmonella

mimic appendicitis by causing mesenteric adenitis 

Myeloid leukemia - ALL and CML

Thyroid

Which neoplasm is associated with each of these conditions?

1) Down syndrome

2) Xeroderma pigmentosum, albinism

3) Chronic atrophic gastritis, pernicious anemia, postsurgical gastric remnants

4) Tuberous sclerosis (facial angiofibroma, seizures, mental retardation)

5) Actinic keratosis

1) ALL (we ALL fall down), AML

2) Melanoma, basal cell carcinoma, and especially squamous cell carcinomas of skin

3) gastric adenocarcinoma

4) cardiac rhabdomyoma, astrocytoma, angiomyolipoma

5) SCC of skin

Which neoplasm is associated with each of these conditions?

1) Barrett's esophagus 

2) Plummer-Vinson syndrome

3) cirrhosis (alcoholi, hepatitis B or C)

4) ulcerative colitis

5) Paget's disease of bone

1) esophageal adenocarcinoma

2) SCC of esophagus

3) Hepatocellular carcinoma

4) colonic adenocarcinoma

5) secondary osteosarcoma and fibrosarcoma

Which neoplasm is associated with the following condition?

1) Immunodeficiency states

2) AIDS

3) Autoimmune diseases

4) Acanthosis nigricans

5) dysplastic nevus

6) radiation exposure

7) Achalasia

8) Sjogren's

1) Malignant lymphomas

2) aggressive malignant lymphomas (non hodgkin's) and Kaposi sarcoma

3) lymphoma

4) visceral malignancy (stomach, lung, breast, uterus)

5) malignant melanoma

6) papillary thyroid cancer

7) SCC of esophagus

8) B cell lymphoma

PSaMMoma

Papillary (thyroid), Serous (ovary), meningioma, mesothelioma

Which structures perforate the diaphragm at the following levels?

1) T8

2) T10

3) T12

1) vena cava (8 letters)

2) o-esophagus (10 letters)

3) aortic hiatus (12 letters), azygos vein, thoracic duct

inspiration: diaphragm

expiration: passive

inspiration: external intercostals, Scalene muscles, Sternocleidomastoids

expiration: internal intercostals, rectus abdominis, internal and external obliques, transversus abdominis 

pulmonary artery and bronchial artery are located in the center 

veins and lymphatics drain along the edges 

while upright - lower portion of right inferior lobe

while supine - superior portion of right inferior lobe

secrete pulmonary surfactant (dipalmitoyl phosphatidylcholine) and serve as precursors to type I cells and other type II cells.   

type II cells proliferate during lung damage 

Nitrites

antimalarial drugs

Dapsone

Sulfonamides

Metoclopramide (Reglan)

Nitrates

local anesthetics 

What is the V/Q at the apex of the lung?  

What is the V/Q at the base of the lung?

At the apex, V/Q is 3 

At the base, V/Q is 0.6

What is V/Q during airway obstruction?

What is V/Q during blood flow obstruction?

V/Q appraches 0 during airway obstruction (shunt).  100% Oxygen will not improve PO2

V/Q approaches infinity in a blood flow obstruction (physiologic dead space).  100% Oxygen will improve PO2 assuming less than 100% dead space

Virchow's triad:

Stasis, hypercoagulability, and endothelial damage

DNAACP

Drugs

Neoplasm

Atopic Diseases (allergy, asthma, Churg Strauss)

Addison's Disease

Acute Interstitial nephritis

collagen vascular diseases

parasites (strongyloides, etc.) 

GRUELING

Granulomas, RA, Uveitis (eye), Erythema nodosum (tibial), lymphadenopathy (hilar, bilateral), idiopathic, not TB, gamma globulinemia, (ACE increase)

PSaMM

papillary thyroid, serous cystadenoma, meningioma, mesothelioma

SPHERE of complications

Superior vena cava syndrome

Pancoast tumor

Horner's Syndrome

Endocrine (paraneoplastic)

Recurrent laryngeal symptoms (hoarseness)

Effusions (pleural or pericardial)

Lambert-Eaton syndrome (autoantibodies against calcium channels) - weakness improves with use (prime the muscles) 

These Rascals May Microscopically Lack Color

Treponema (too thin to be visualized)

Rickettsia (intracellular parasite)

Mycobacteria (high lipid content cell wall, acid fast stain)

Mycoplasma (no cell wall)

Legionella pneumophila (primarily intracellular) 

Chlamydia (intracellular parasite; lacks muramic acid in cell wall) 

PASs the sugar 

stains glycogen, mucopolysaccharides; used to diagnose Whipple's disease 

Cryptococcus neoformans (mucicarmine can also be used to stain thick polysaccharide capsule red)

Some Killers Have Nice Shiny Bodies

Streptococcus pneumoniae, Haemophilus influenzae type B, Neisseria meningitidis, Salmonella, Klebsiella pneumoniae, group B Strep. 

you need SSPACE for your cat

S. aureus, Serratia, Pseudomonas, Actinomyces, Candida, E.Coli

Actinomyces israelii -- yellow "sulfur" granules

S. aureus - yellow pigment

Pseudomonas aeruginosa - blue/green pigment

Serratia marcescens - red pigments

SHiN

S. pneumoniae, H. influenzae type B, and Neisseria.... in order to colonize respiratory mucosa

Strep. viridans (most common), also Enterococci, and Staph epidermidis

Strep. Bovis in colon cancer patients

found in soil: Bacillus antracis, Clostridium perfringens, C. tetani

Other spore formers:  B. cereus, C. botulinum, Coxiella burnetii 

Nagging Pests Must Breathe

Nocardia, Pseudomonas aeruginosa, Mycobacterium tuberculosis, and Bacillus

Which bacteria are obligate anaerobes?  

Which 2 main antibiotics cover for anerobes?

Anaerobes Can't Breath Air 

Clostridium, Bacteroides, and Actinomyces (these all lack catalase and/or SOD and are susceptible to oxidative damage) 

Metronidazole or Clindamycin

Which 2 gram positive rods form long branching filaments that resemble fungi?

What drugs treat these 2?

Actinomyces israelii (an anaerobe) and Nocardia asteroides (an aerobe)

SNAP:  Sulfa for Nocardia... Actinomyces use Penicillin 

Extended coverage:  HEELPSS

treats the gram + as well as Haemophilus influenzae, E. coli, enterococci Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella

gram postive cocci as well as PEcK.

Proteus, E.coli, Klebsiella pneumonia

treats UTIs, URT infection, viridans strep endocarditis prophylaxis 

these organisms are LAME

Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA, and Enterococci 

cefoxitin, cefaclor, cefuroxime 

gram + cocci plus HEN PEcKS

H. influenzae, Enterobacter, Neisseria spp., Proteus, E.coli, Klebsiella pneumonia, Serratia marcescens 

Ceftriaxone, Cefotaxime, ceftazidime,

treat serious gram negative infections resistant to other gram positive organisms

Ceftazidime - Pseudomonas 

Ceftriazone - meningitis and gonorrhea

Cefepime

Pseudomonas and gram positive organisms 

Mechanism is inhibition of cell wall synthesis (by binding PBP3).  Is synergistic w/ aminoglycosides and has no cross-allergenicity w/ penicillins

Clinical use is gram-negative rods only 

Cilastatin, which enhances imipenem by inhibiting renal dehydropeptidase I) to dec. inactivation of drug in renal tubules 

This is used as a big gun in ICU setting when most other drugs have failed.

RNA pol. inhibitor

Revs up microsomal P450

Red/orange body fluids

Rapid resistance if used alone 

M. TB

Leprosy

minococcal prophylaxis

prophylaxis for H. influenzae type B 

BLT. B is Big 

Borrelia (big size), Leptospira, and Treonema

BAKE a Key LYME pie:  

Bell's palsy (bilateral), Arthritis, Kardiac block, erythema migrans

VDRL:

Viruses (mono and hepatitis), Drugs, Rheumatic fever, lupus and leprosy 

What is the disease associated with th following zoonotic bacteria and what is the transmission and source?

1) Bartonella spp.

2) Borrelia bugdorferi

3) Borrelia recurrentis 

4) Brucella spp.

5) Campylobacter

6) Chlamydophila psittaci

1) Cat scratch disease, cat scratch

2) Lyme disease, Ixodes ticks (live on deer and mice)

3) Recurrent fever, Louse (recurrent b/c of variable surface antigens)

4) Bucellosis/undulant fever, unpasteurized dairy

5) Bloody diarrhea, puppies and livestock (also fecal-oral, ingestion, sexual transmission)

6) Psittacosis, parrots and other birds

What is the disease associated with th following zoonotic bacteria and what is the transmission and source?

1) Coxiella burnetii

2) Ehrlichiosis chaffeensis, 

3) Francisella tularensis

4) Leptospira spp.

5) Mycobacterium leprae

6) Pastuerella multocida 

1) Q fever, spores from tick feces and cattle placenta

2) Ehrlichiosis, lone star tick

3) Turaremia, ticks and rabbits and deer fly 

4) Leptospirosis, animal urine

5) Leprosy, armadillos

6) Cellulitis, osteomyelitis ; animal bite, cats, dogs 

What is the disease associated with th following zoonotic bacteria and what is the transmission and source?

1) Rickettsia prowazekii 

2) Rickettsia rickettsii

3) Rickettsia typhus

4) Yersina pestis

1) Epidemic typhus, louse

2) Rocky Mountain spotted ever, dermacentor tick bite

3) Endemic typhus, fleas

4) Plague; flea bite and rodents and prairie dogs 

you drive CARS using your palms and soles. 

Coxsackievirus A infection (hand, foot, and mouth disease), Rocky Mountain spotted fever, syphillis

Some Nasty Bugs May Live FacultativeLY

Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Legionella, Yersinia pestis 

Which antibiotic should be used to treat the following?

1) Mycoplasma pneumoniae

2) RMSF

3) Early Lyme disease

4) Late Lyme disease 

5) Syphillis

6) Leprosy

7) Bacterial vaginosis

1) tetracycline or macrolides

2) doxycycline

3) doxycylcine

4) ceftriaxone

5) penicillin G

6) Dapsone, Rifampin , and Clofuzimine for 6-24 months

7) metronidazole 

3rd: common carotid and proximal part of internal carotid

4th: left-->aortic arch   ; right--> prox. part of subclavian

6th: left--> ductus arteriosus   ;  right--> prox. part of pulmonary arteries 

Tetralogy, Transposition, Truncus (persistent), Tricuspid atresia, TAPVR (total anomalous pulmonary venous return)

Associated with maternal lithium use.

Tricuspid leaflets are displaced into right ventricle, hypoplastic right ventricle, tricuspid regurg or stenosis... results in dilated right atrium (which causes an inc. risk of supraventricular tachycardia and WPW)

80% of these patients have a patent foramen ovale

SV CAP

Contractility, Afterload, and preload

What is preload?

What is afterload?

Preload = ventricular EDV, atrial pressure, or central venous pressure

Afterload= Mean arterial pressure (proportional to total peripheral resistance 

130/10 in left ventricle

25/5 in the right ventricle 

LMNOP

Loop diuretics, morphine, nitrates (dilates peripheral vasculature), oxygen, pressors (like dobutamine) and positioning (sit on edge of bed w/ legs down)

increase survival: ACE inhibitors, beta blockers, digoxin, spironolactone

Diuretics (no improved survival)

pitting edema is mostly water (due to inc capillary pressure like in heart failure)

non-pitting edema is a lot of colloid in interstitial fluid (jello-like) - exudate (due to inc. capillary permeability or inc. colloid oncotic pressure in the interstitium) 

normal splitting occurs durign inspiration (aortic valve closes before the pulmonic) 

a split S2 during expiration is NEVER normal 

phase 4 in the SA node.  beta blockers dec. the heart rate

Sodium funny channels work here  

Class IC is contraindicated for post-MI

Class IB is Best for post-MI

It will have a narrow QRS, meaning it has originated from the atria

if you have a long QRS, it has probably originated from the ventricle itself 

Which drugs from the following classes are known to prolong the QT interval (thus predisposing to torsade de pointes)?

1) Anti-infection: 

2) Anti-psychotics

3) Anti-HIV

4) Anti-Arrhythmic

1) macrolides, chloroquine

2) haloperidol, risperidone

3) HIV protease inhibitors (-navirs)

4) class IA (quinidine), class III (K+ channel blockers such as sotalol, amiodarone, bretylium) 

MONA

morphine, oxygen, nitrates (dec. preload), aspirin

ABCCCD

Alcohol abuse, Beriberi (wet), Coxsackie B vrus myocarditis, chronc Cocaine use, Chagas disease, Doxorubicin toxicity.  Also hemochromatosis, and peripartum cardiomyopathy, CHF

systolic disfunction is seen

concentric hypertrophy (sarcomeres added in parallel) -- tangled, disarray of myocytes 

see diastolic dysfunction

FROM JANE

Fever

Roth Spots (on retina)

Osler's nodes (tender raised lesions on finger or toe pads)

Murmur (new)

Janeway lesions (small erythematous lesions on palm or sole)

anemia

nailbed hemorrhage

emboli 

FEVERSS

Fever

Erythema marginatum

Valvular damage (vegetation and fibrosis)

ESR elevated

Red-hot joints (migratory polyarthritis)

Subcutaneous nodules

St. Vitus dance (chorea) 

Major criteria: JONES

Joints (migratory polyarthritis), Heart (O is a heart) pancarditis, Nodules (subcutanous aschoff nodules), Erythema marginatum (creeping skin rash), Syndenham chorea

Kussmaul's sign is JVD with inspiration (rt. sided heart failure) 

Pulsus paradoxus is decreased SBP by more than 20 mmHG w/ inspiration

adult: left atrial myxoma

child:  rhabdomyomas (assoc. w/ tuberous sclerosis)

My Lovely Belle Had An STD

Lyme Disease, Herpes zoster, AIDS, sarcoidosis, Tumors, Diabetes

How do symptoms of a lesion to the cortical motor region of the face differ from a lesion of the facial nerve or nucleus?

Lesion in cortical motor face region --> paralysis of contralateral side of lower face

Lesion of facial nerve or nucleus --> paralysis or ipsilateral side of entire face

Midbrain infarction resulting from occlusion of the paramedian branches of the PCA. 

Cerebral peduncle lesion--> contralateral spastic paralysis

Oculomotor nerve palsy --> ipsilateral ptosis, pupillary dilation, and lateral strabismus (eye looks down and out) 

Caused by occlusion of one of the PICAs causing unilateral infarct of lateral portion of rostral medulla.

Loss of PT over contralateral body (Spinothalamic tract damage)

Loss of PT over ipsilateral face (trigeminothalamic tract damage)

Hoarseness, difficulty swallowing, loss of gag reflex ( nucleus ambiguus: CN IX and X damage)

Ipsilateral Horner syndrome (descending sympathetic tract) 

Vertigo, nystagmus, nausea/vomiting (vestibular nuclei damage)

Ipsilateral cerebellar deficits (i.e. ataxia, past pointing) due to inferior cereellar peduncle damage

Anterior communicating arteries

PCKD, Marfans, HTN, Ehlers Danlos 

protamine sulfate for heparin overdose 

Fresh frozen plasma for fast treatment of warfarin overdose, vitamin K for slow treatment of warfarin overdose

Vermis, intermediate (paravermal) zones (right and left), and lateral hemispheres (right and left) 

Based on the primary source of information brought into the cerebellar cx, which cerebellar regions are referred to as the vestibulocerebellum, spinocerebellum, and cerebrocerebellum? (To which deep nuclei do these regions project?)

Vestibulocerebellum -- Flocculonodular lobe and vermis (--->fastigial)

Spinocerebellum -- Vermis and paravermal regions (-->fastigial and interposed) 

Cerebrocerebellum -- lateral hemispheres (--> dentate) 

The most anterior portion of the vermis belongs to the legs.

Ataxia/dystaxia of legs (even when the trunk is supported) causing broad based staggering gait.

Chronic alcohol abuse --> thiamine deficiency-0> degeneration of cerebellar cx (starting at the anterior lobe)

lack of coordination of volunatary mvmt with respect to both the timing and rate of the movement.

delays in initiating mvmts and trouble stopping movmvnets

dysmetria (imparied ability to control the distance, speed, and power of movement)

Intention tremor 

Disequilibrium: difficulty in maintaining balance

Abnormal eye movements