baroney poney

8/12/2019 Baroney Poney

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Baroney Poney - Day 1

Easy ways to remember things:

1. For Niacin deficiency (4D’s) think of the Macarena in terms of the order of

symptoms: First you touch your arms (dermatitis), then you touch your head(Dementia), then you touch your hips/butt (diarrhea), then you Kill em with

your hips (Death)

2.

Lou Gehrigs Disease (ALS)—5-10% are AD inheritance due to SOD2

mutation. Lou Gehrig was a baseball player and played on a field of SOD.

3.

Fas Ligand/Fas receptor codes for CD95. (The Disney movie Cars Lightning

McQueen liked to go FASt and his car had the number 95 on it)

4. Every virus that starts with an “R” is a RNA virus (Rhino Virus, Rota Virus,

etc.)

5.

Niemann Pick Kid: kid PICKS his nose with both fingers (making 11

sign=chromosome 11), he pulls out some Snot (S for Sphingomyelinase), then

eats it where it goes to his Liver for storage. He goes to the zoo and picks hisnose again and throws it on a zebra. (Layering of infected cells resembles a

zebras stripes)

6.

In the words of Barone: Bleomycin affects pulmonary functions via G2 cell

cycle involvement —think of two girls (G2) “BLOWING your mind”

Must Know Facts:

1. Ulcerative Colitis leading to toxic megacolon

a.

HLA-B27, arthritis, continuous lesions, rectal involvement,

P-ANCA (MPO)

2. Crohn’s NOD2 gene mutation, skip lesions, cobblestone, creeping fat,

granulomas, transmural inflammation, STRICTURES, FISTULA,

ASCA antibodies (Anti-saccharomyces cerevisiae antibodies)—they are

(yeast antibodies similar to what is in beer, and has “cervesa” inname—Crohn’s sounds like “Corona”)

3.

Different names for Acid Fast Stain—they interchange them and will not say

“acid fast” majority of the time Kinyoun, Auramine Rhodamine, Ziehl

Neelson

(remember that Nocardia is PARTIALLY acid fast)

4.

PAS stains crucial for: Diabetes (Kimmelstein Wilson nod.), glycogen storage

diseases, fungi, whipples disease, Glycoproteins, Paget’s disease of Nipple,

AML-M6:Erythroleukemia.



5.

Hypoxia most common cause of injury—ischemia is leading reason why you

get hypoxia, furthermore when you have no O2 it affects the ETC because O2

is final electron acceptor No O2= No ETC= No ATP

6.

Cyclophosphamide: needs to be converted to active form in liver via P450.

Active form is a Nitrogen mustard + Acrolein (what causes hemorrhagiccystitis). Administer MESNA to prevent hem. cystitis.

7. VIT C and VIT D deficiency can BOTH lead to bowing legs, key differential is

PETECHIAE Vit C has it, Vit D doesn’t.

8.

B6 deficiency due to recent Isoniazid therapy.

9.

Know the DNA damage pathway for apoptosis cold and everything involved

(P53-Rb, BAX, Cytochrome C, APAF-1, BCL-2, and caspases)

10.

Know the T-Cell cell death pathway involving the Fas Ligand/Fas receptorand know that it codes for CD95. (The Disney movie Cars Lightning

McQueen liked to go FASt and his car had the number 95 on it)

11.

Coagulative necrosis comes from the fact that during cell injury you have a

decrease in pH within cells enzymes denature and coagulate (protein

coagulation) giving rise to coagulative necrosis.

12.

Familial Melanoma Chr. 9, p16 mutation

13.

Psamomma bodies: Meningioma, Papillary Thyroid Carcinoma (called

orphan annie), Certain ovarian tumors.

14.

MELANOMA:

a. Nodular Melanoma

i.

vertical growth is biggest indicator of worse prognosis called

BRESLOW’S THICKNESS (should be less than 1mm).

ii.

Spreads via LNsentinel LN

b.

Acral Lentiginous*****

i.

Dark Skinned People

ii. Occuring under nails/toes mostly where only cure is resection

iii.

C-KIT mutation

iv.

What Bob Marley died from—refused amputation becauseRastafarian culture required them to remain “whole”.

c.

Superficial Spreading

d. Lentigo Maligna Melanoma

i.

Best prognosis, mostly on face in elderly patients

15.

Labile cells most affected by chemotherapy (labile cells are our stem cells)



16.

TGFb, PDGF, TNF, IL-1 all involved in the scar formation process (all involved

in cirrhosis and scleroderma.

17.

Wound Contraction mediated by Myofibroblasts leading to a scar.

18. Keloid= persistant type 3 collagen (remember that normally in the scar

process type 3 collagen will be replaced by type 1).

19.

KNOW that goodpasture’s involves COL4alpha320. Collagen X= Epiphyseal Growth Plate

21.

In diabetes you have non-enzymatic glycosylation. Think of basement

membrane and the role of charges in determining diabetic nephropathy.

Sugar sticks to heparan sulfate making Hydrogen sulfate lose its charge

which leads to MICROALBUMINEMIA= first sign of Diabetes.

22.

Nutmeg liver is due to RHF but what they will ask is where is the first

location of Damage within the liver? Zone III (always pick zone III if they ask

anything)

23. Anytime you see the word “PALPABLE Purpura” it is only for one disease

HENOCH S. Purpura (remember involvement with IgA Nephritic)

24.

Abnormal Ristoceten levels are for only TWO possible diseases: GpIb andvWF deficiency

25.

Earliest clue for Hemophilia disorders (remember only affecting males) is

Circumcision bleed normally during after procedure but hours later start

bleeding. Why? Problem is with Fibrin NOT platelets.

Baroner’s all day long – Day 2

Easy Ways to remember things:

1. The sex before “pseudohermaphriditism” is what the individual actually is

but externally may be different. Ex. Male Pseudohermaphroditism = male

genetically and has testes present

2. Michael Jackson had Vitigilo= auto immune attack of Melanocytes. He

purposely bleached his skin to get rid of melanocytes (Albino). THAT’S why

he always wore gloves and covered up all the time—can’t explain the rest of

his behavior thou…suuuuusssppeccctttt

3. Tay Sachs story: Tay was a 15 yr old boy that took the evil witch’s Cherry.

She put a Hex on him that he would only buy GM(2) Cars. (Tay Sachs, Chrom

15, Cherry Red Spots, Hexoaminidase A, GM2 Ganglioside)

4.

Von Recklinghausen Disease aka Neurofibramatosis type 1 involves

Chromosome 17

17 letters in Von Recklinghausen= 17th

chromosome.

Must Know Facts:

1.

Why do Nephrotic patients present with Hypercoaguability? ATIII

(protein) leaks out into urine therefore you can’t stop clotting



2.

Factor V Leiden disease has been a different name on the step “Activated

Protein C Resistance” (Normally Factor Va is degraded by Protein C, in the

disease Factor Va can’t be turned off )

3. Estrogen enhances the synthetic activity of the liver including clotting

factors. THIS is the primary mechanism of why woman on

CONTRACEPTIVES get Hypercoagulability4. If asked which vessel DVT most likely occurred: Femoral Vein>

Popliteal>Illiac

5. Elevated D-Dimer is a marker of a thrombus ANYWHERE in the body—not

specific to the leg (aka not just for DVT)

6. The mechanism of death for a Saddle Embolus is due to RVHF any vignette

would involve sitting or laying down or being stationary…it could even be as

short as a bus driver working a 6 hour shift.

7.

The carotid sinus baroreceptor afferents are from CN IX and the aortic

baroreceptor afferents are from CN X.

8.

Downs Syndrome can have BRUSHFIELD SPOTS—speckled appearance of

the iris, Duodenal Atresia, Hirschprungs. Can progress to ALL andAlzheimers later in life. Why Atresia and Hirsch.? Failure of NEURAL CREST

CELL migration because of RET gene knockout.

9. Edwards Syndrome: buzz words in vignette horseshoe kidney,

overlapping flexed fingers, loss of arch of foot (they will not flat out say

rockerbottom feet)

10.

Patau: trisomy 13 kids only survive about 13days, cleft lip/palate,

holoprosencephaly, polydactyly

11.

CYSTIC HYGROMAbenign cystic tumor of Turner’s Syndrome that gives

typical web neck shape.

12.

Bicuspid aortic valve = most common cardiac defect in Turners

(Coarctation is the earliest presentation)13. Alkaptonuria presents with OCHRONOSIS (black cartilage)—a lot of times

people don’t realize the urine turns black because they never let it sit out

14. ALBINO’s have a lack of tyrosinase makes it very hard to diagnose

Melanoma because it will not be Black like everyone else but it will match

their skin color.

15.

Family History of MI around age 25 = Homocystinuria or

Hypercholesterolemia

16.

2 Year old kid with MI ONLY cause is Kawasaki’s.

17. ****ASKED A LOT MARFANS is a DOMINANT NEGATIVE MUTATON.

18.

Cardiac issue most related to Marfans= Mitral Valve Prolapse

a.

Dissecting aneurysm is most lethal due to cystic medial degeneration19. Marfan’s and Homocystinuria has the EXACT same presentation biggest

differentiating factor is in regards to LENS SUBLAXTION

a. Marfans lens sublaxtion up and out bilaterally

b.

Normal Sublaxation down

20. Person with Ehlers Danlos Type 4 (Type 3 collagen defect) can have uterus

rupture during pregnancy (uterus and anything with stretching capability in

body is Type 3)



21. Menke’s Disease is Ehlers Danlos Type 9 Involves decreased lysyl oxidase

activity which is Cu2+ dependent for crosslinking of collagen. “Kinky hair”

because of excess copper.

22. NF1 inhibition leads to uninhibited p21 ras oncoprotein.

23.

NF2= bilateral acoustic neuromas that COMPRESS nerve

24.

Von Hippel-Lindau Diseasea. VHL gene normally inhibits HIF (Hypoxia Induced Factor). During

Hypoxia HIF causes growth of vessels into tissue to increase blood

flow. If born with one mutation in VHL, during Hypoxia vessels grow

into area but they can not be inhibited/removed once hypoxia is

resolved.

b.

This persistence leads to formation of HEMANGIOBLASTOMA’s

i. Hemangioblastoma’s stimulate EPO Reason why VHL

Disease presents with polycythemia and a mass

(hemangio.)

25.

Genomic Imprinting

a.

Prader Willi (2 ways)i. paternal deleted on 15, maternal imprinted on 15

ii.

maternal uniparental disomy

b. Angelman’s=

i.

maternal deleted on 15, paternal imprinted on 15

ii. paternal uniparental disomy

26. Hydralazine, Isoniazid, and Procainamide: can cause Lupus like syndrome

with Anti-Histone Antibodies

27. Libman-Sacks Endocarditis (SLE)—vegetations on BOTH sides of leaflets

(only one to do that)

28.

SLE renal presentation: Diffuse Proliferative Glomerulonephritis andMembranous Glomerulonephritis.

29.

Toxoplasmosis has affinity for the Basal Ganglia

30. CMV ENDOTHELIUM

31.

Herpes EPITHELIUM

32. TB vs. MAC (Mycobacterium Avium)

a.

Both are acid fast, both intracellular, both can be CD4<50

b.

KEY difference TB produces NIACIN

Baroned Hard – Day 3(Neoplasia, Environmental, vasculature, some cardio)



Easy Ways to Remember Things:

1. To remember chromosome for Rb gene right it: R13 (13 forms B)

a. Wilm’s Tumor = WT gene WT stands for World Trade Center = 11

i. (Barone is terrible for this, but think of the 11 as towers)

2.

Cancer Markers

a.

CA 15-3: turn 3 on side look like boobs = BreastCancer

b.

CA 19-9: turn 9 on side looks like pancreas =

Pancreatic Cancer

c.

CA 125: draw 25 on corners of 2 and 5 are ovaries

3. Shox gene involved with Turner’s Syndrome

a.

Flip Shox : XO45 = XO 45= turners

4. Edward’s Syndrome: Edward from Twilight was 18

5. Patau’s Syndrome: When your 13 you like to play Sonic

Hedgehog

6.

He popped her “Cherry” in college= Cherry Hemangioma in adults

7.

Congenital Bicuspid Valves (Turner’s)/Calcific Valve Stenosis a. Ever wonder why Arnold Schwarzenegger used to be really jacked but

suddenly got all gross and skinny? He had calcific aortic stenosis

basically before he got into politics he started having syncope and had

to get a valve replacement. He Got a metal valve replacement

problem is you need to be on Coumadin for life to prevent vegetation

formation. On Coumadin you can’t be physically exerting yourself, he

had syncopal episodes at the gym after 10 minutes and he stopped

and went into politics. He got rid of the metal valve and got a pig

Prosthetic valve which he has now—pig prosthetic valves need to be

replaced every 15 years. He will need a new one next year. Now you

know the treatment for Congenital Bicuspid valves.

Must Know Facts:

1. Leading cause of Death In US: 1) Heart Disease 2) Cancer 3) Stroke 4) COPD

2.

Leading cause of Death in Children: 1)Accidents 2) Cancer 3) Congenital

3.

Most New Cancer Cases:

a.

BASAL CELL CARCINOMA is #1

b. SQUAMOUS CELL CARCINOMA is #2

c.

Prostate in males/Breast in Females is #3

4. Pheochromocytoma is not malignant —child form (Neuroblastoma) IS

MALIG.

5.

UVB sunlight most carcinogenic produces pyrimidine dimers in DNA

6.

In Von Hippau Lindau always check for: Hemangioblastomas, Renal Cell

Carcinoma, and Pheochromocytoma



7. Rb gene Retinoblastoma and Osteosarcoma

8.

NF-2: MERLIN gene via contact inhibition

9.

If a Medullary Thyroid Carcinoma is described and asked what to do next?

a.

Check for other diseases (MEN syndromes): ex. check urine for VMA

10.

Metastasis is biggest indicator for Staging of tumor EXCEPT with Brain

cancers because there is rarely metastasis use GRADE > metastasis

11. Patau’s Syndrome think Sonic Hedgehog gene (remember SH is

responsible for development so THAT’S why you get holoprosencephaly and

polydactyl

12. Carbon Monoxide Poisoning there is a problem with Saturation NOT

Pressure

a.

Low SaO2, Normal PaO2, left shiftb. Stops ETC via decrease in Cytochrome Oxidase

c.

Globus Palladius Necrosis from CO poisoning

13. Amanita Phalloides inhibits RNA Pol 2 (mRNA)

14. Arsenic Poisoning: garlic scented breath, MEES lines (transverse bands on

nails)

a. SCC and Angiosarcoma complications

15.

Lead Poisoning: wrist and foot drop (motor nerve demyelination) vignette

a. VERY similar to presentation of ADHD due to the fact lead messes up

myelination in the CNS cognitive impairment, behavioral, lethargy

16. Mercury Poisoning: intention tremor, dementia, delirium, acute tubular

necrosis

a. Avoid Fish in Pregnant: Mackeral, Shark, Swordfish, Tilefish

17. ****Cyanide Poisoning: cyanide blocks cellular respiration by binding to

mitochondrial cytochrome oxidase (Cytochrome A3).

a.

Bitter Almond Breath

18.

On the Step they use “Anti-myeloperoxidase anti-bodies” instead of P-ANCA

19. On the Step they use “Antibodies against Proteinase-3” instead of C-ANCA

20.

HBsAg+ for most cases of Polyarteritis Nodosa on the Step

21. Aortic Dissection & Takayasu Arteritis = both have decrease pulses in

upper limbs and head

22.

Coarctation of Aorta= increased pulses/BP in upper body.

23.

Only two diseases with “Strawberry Tongue” : Scarlet Fever and Kawasaki’s



24.

Atherosclerotic plaques: OXIDIZED LDL is depositing (Barone said they are

gay and put really similar options—its Oxidized which means it’s damaged).

25. Atherosclerosis worse at branches because of turbulence

26.

Strawberry Hemangioma Acquired in kids, will grow but regress on itsown

27. Cherry Hemangioma acquired in adults

28. Angiosarcomas associated with VINYL CHLORIDE, ARSENIC and

THOROTRAST.

29.

Why is Coronary Artery Disease most common in post-menopausal women?

a. Estrogen: normally estrogen increases HDL and decreases LDL

b.

No Estrogen: low HDL, increased LDLbad

30. Prinzmetal’s Angina can be caused by cocaine, stress, or nicotine

withdrawal.

a. Vignette say’s patient wakes up at 4am and has difficulty breathing,

gets coffee and has a cigarette and feels better

31. Myoglobin = most sensitive marker but not specific for heart

a.

CK-MB= reinfarction

b. Troponins= MOST specific

32.

***NON-STEMI = Subendocardial M.I. = ST depression33. ***STEMI= Transmural M. I. = ST elevation

34.

***Hypoxia or Hypokalemia causes tall and peaked T-Wave

a. Hypokalemia causes big T-wave because: no atp due to no O2= no

Na+/K+ ATPase= K+ out and washed away=hypokalemia)

35. ***Q Wave = only appears after 24 hours but remains forever on EKG.

a.

If a patient comes in with signs of M.I. that started today but after 4

hours a Q-wave shows up you know that he had another MI yesterday

because it takes 24 hours for the Q-Wave to appear.



Ba(mioda)rone – Day 4(Cardio cont’, Resp)

Ways to Remember Things:1.

All congenital heart defects beginning with “T” will have early cyanosis.

ALWAYS think it’s Tetralogy of Fallot unless proven otherwise, he said 75%

of the time they always ask about Tetralogy.

2. Aspiration Locations:

3.

They LOVE granuloma pictures on the Step, follow this rule to identify it:

a. It will be Pink, nodular, and have giant cells = a granuloma

b.

Is the Center Dead (clear central demarcation) Caseating (left pic)

c. Center not dead? Non-Caseating (right pic)

d.

4. Emphysema Damage Locations

a.

Centriacinar Emphysema is related to smoking so remember that

“smoke rises” = holes form in APEX

b.

Panacinar Emphysema related to circulating protein def. (alpha1AT).

Worse at BASE

Must Know Facts:

1. For Rheumatic Heart Disease on the exam they will interchange ASO titers

with DNAse B



a.

Acute Rheumatic: aschkoff body (fibrinoid necrosis surrounded by

anitschkow cells)

b.

Chronic Rheumatic: valve thickening and FUSION of valve

commisures, damaged/FUSED and short chordae tendinae

2.

They like giving a picture of a bacterial vegatation on a valve and if it isLARGE it is most likely ACUTE endocarditis (Staph Aureus) and has a greater

risk for breaking apart into circulation

3.

Group D strep endocarditis—Strep Bovis. What do you look for? Underlying

COLON CANCER.

4. Congenital Heart Defects originate during 4-5th weeks of development

5. Both Coarctations of Aorta (Pre/Post Ductal) will have HIGH RENIN levels

(decreased blood bressure in lower ½ of body sensed by kidneysrenin)

6. Pre-ductal Coarctation of Aorta (Turner’s) nipple down you will see

decrease BP/pulses and will turn Blue. PRE-DUCTAL HAVE PDA: they will

have machine like murmur on exam (post-ductal will not have PDA)

7. Post-Ductal Coarctation of Aorta no PDA=no machine murmur but will

have SYSTOLIC EJECTION MURMUR in the back by the SCAPULA (think

about it, its loudest over the descending aorta post ductal)

8. All Right Left shunts (cyanotic) will have high EPO levels

9.

Transposition of Vessels Failure of Neural Crest Cells to Spiral

10.

Truncus Arteriosus and Tetralogy Failure of Neural Crest Cells to Migrate

11.

KNOW NORMAL PRESSURES

a. RA: 0-5 mmHg

b.

RV: 15-25 mmHg

c.

LA: 5-8 mmHg

d.

LV: 80-120 mmHg

e. Aorta: 80-120 mmHg

f.

****Question from recent exam: RV pressure is 120, LV pressure is 15-25, what drug is necessary to administer to the patient to ensure

survival?

i. Alprostadil (Prostaglandins): Patient has Transposition of

Great Vessels and they must have a Patent Ductus Arteriosus to

survive. Prostaglandins (Alprostadil) keep it open.



20. C-Section delivery of baby, what is mechanism of RDS?

a.

Normal vaginal birth puts stress on baby, which increases the babies

Cortisol levels. Increased cortisol levels rapidly mature the lungs in

preparation for exposure to oxygen. C-section bypasses this so you

must give mother DEXAMETHASONE (cortisol analogue) to maturefetal lungs prior to C-Section

21. Any one of the Pneumoconioses can develop CAPLAN SYNDROME

a.

Caplan Syndrome = pneumoconioses symptom + Rheumatoid

Arthritis

22. Amphibole Asbestos is WORSE and affects the Lower Lobe (test Q)

23.

BRONCHOGENIC CARCINOMA is most common tumor related to Asbestos

(everyone always associates Mesothelioma)

24.

L-MYC = small cell carcinoma25. K-RAS= adenocarcinoma

26.

Increased EGFR (tyrosine kinase) = tumor growth is rapid

27.

****Superior Vena Cava Syndrome from Lung Cancer Metastasis

Edema in face upper limbs and everything above nipples and

increased

JVP.

DIFFERENTIAL: They could very well describe similar situation without

saying

Superior Vena Cava syndrome—key feature is where the Edema is: RHF iseverywhere and SVCS is upper body above nipple line

(Barone said know Superior Vena Cava Syndrome for sure, they have been putting it

very frequently on the exam)

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