study guide chap 1-5 dit 2013

8/11/2019 Study Guide Chap 1-5 DIT 2013

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USMLE STEP 1 REVIEWSTUDY GUIDE

2013 EDITION

BRIANJENKINS, MD


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Doctors In Training.com: USMLE Step 1 Review, 2013 edition

Author: Brian Jenkins, MD

Copyright 2013 Doctors In Training.com, LLCwww.doctorsintraining.com

Doctors In Training.com, LLC1701 River Run, Suite #750Fort Worth, TX 76107

All Rights Reserved. This text is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, orutilized by any storage and retrieval system, wi thout written permission from the copyright owner.

DISCLAIMER : THE AUTHOR DISCLAIMS ANY L IABILITY, LOSS, INJURY, OR DAMAGE INCURRED AS A CONSEQUENCE, DIRECTLY OR INDI-RECTLY, OF THE USE AND APPLICATION OF ANY OF THE CONTENT AND MATERIAL CONTAINED IN THIS TEXT. ALTHOUGH THE INFORMA-TION IN THIS TEXT HAS BEEN CAREFULLY REVIEWED FOR CORRECTNESS, THE AUTHOR CANNOT ACCEPT ANY RESPONSIBILITY FOR ANYERRORS OR OMISSIONS THAT MAY BE MADE. THE AUTHOR MAKES NO WARRANTY, EXPRESS OR IMPLIED, AS TO THE COMPLETENESS, CUR-RENCY OR ACCURACY OF THE CONTENTS OF THIS TEX T. THE INFORMATION CONTAINED IN THIS TEXT SHOULD NOT BE CONSTRUEDAS SPECIFIC INSTRUCTIONS FOR INDIV IDUAL PATIENTS. MANUFACTURERS PRODUCT INFORMATION AND PACKAGE INSERTS SHOULD BEREVIEWED FOR CURRENT INFORMATION, INCLUDING CONTRAINDICATIONS, DOSAGES, AND PRECAUTIONS.

For problems, questions, or concerns, you may contact the author at support@doctor sintraining.com .


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TABLEOFCONTENTS

TABLEOFCONTENTS

[ i ]

I FOUNDATIONS1. EMBRYOLOGYPART1 32. EMBRYOLOGYPART2 4

3. CELLULARORDER 64. CYTOSKELETONANDOTHERCELLULARCOMPONENTS 105. PLASMAMEMBRANE 126. CELLULARSUFFERINGANDDEATH 157. INFLAMMATION 178. CONTROLOFTHEEXTRACELLULARENVIRONMENT 199. CELLULARADAPTATIONS 21

II NEUROLOGY1. BRAINEMBRYOLOGY 252. ORGANIZATIONOFTHEBRAIN 263. HYPOTHALAMUS 284. SLEEP 295. CRANIALNERVES 31

6. BRANCHIALAPPARATUS 347. REGIONSOFTHEBRAIN 358. BRAINSTEMINCROSSSECTION 379. OCCLUSIONSYNDROMES 4110. VASCULAREVENTS 4411. MOVEMENT 4712. BASALGANGLIA 5313. SPINALCORDANDLESIONS 5514. BRACHIALPLEXUSANDUPPEREXTREMITYNERVES 5815. LOWEREXTREMITY& SKELETALMUSCLE 6416. SENSATION 6717. EYE 6918. EAR 7219. DELIRIUMANDDEMENTIA 7420. HEADACHE 76

21. BRAINTUMORS 7922. ANESTHETICS 8123. SEIZURES 83

III PHARM BASICS1. PARASYMPATHETICACTIVATION 892. PARASYMPATHETICINHIBITION 913. CELLULARCOMMUNICATION 934. SYMPATHETICACTIVATION 965. SYMPATHETICINHIBITION 986. PHARMACOKINETICS 997. DRUGMETABOLISM 1048. DRUGSIDEEFFECTS 1079. ANTIDOTES 110

IV ENDOCRINE1. ENDOCRINEOVERVIEW 1122. PITUITARY 1143. ADRENALSTEROIDSYNTHESIS 1164. GLUCOCORTICOIDSANDCUSHINGSYNDROME 1195. OTHERADRENALPATHOLOGY 1216. THYROIDBASICSANDHYPERTHYROIDISM 1237. HYPOTHYROIDISMANDTHYROIDCANCER 1258. DIABETES 1279. DKA ANDDIABETESTREATMENT 12810. OBESITY 13011. CALCIUMMETABOLISM 132


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TABLEOFCONTENTS

V GI1. OROPHARYNX 137

2. ESOPHAGUS 1393. STOMACH 142

4. UPPERGI PATH 1445. DUODENUM 146

6. PANCREAS 1487. ENTEROCYTESANDABSORPTION 150

8. DISEASESOFSMALLINTESTINE 1529. HEPATOCYTESANDCIRRHOSIS 154

10. LIVERPATHOLOGY 15611. HEPATITIS 158

12. B ILIARYTRACT 16013. LARGEINTESTINEPART1 162

14. LARGEINTESTINEPART2 164

VI IMMUNOLOGY1. IMMUNOLOGYBASICS 1692. ANTIGENPRESENTATION 1703. T CELLS 172

4. MONOCYTESANDMACROPHAGES 1735. B CELLSANDANTIBODIES 175

6. IMMUNIZATIONANDAUTOANTIBODIES 1777. GRANULOCYTES, CYTOKINES , ANDIMMUNOSUPPRESSANTS 178

8. COMPLEMENTANDHYPERSENSITIVITY 1809. IMMUNODEFICIENCIES 182

VII BIOCHEM1. RNA 189

2. PROTEIN 193

3. GLUCOSE 1944. GLYCOGEN 1975. ENERGY 199

6. HMP SHUNTANDOTHERSUGARS 2037. FUELUSE 204

8. LIPIDS 2079. AMINOACIDSANDNITROGEN 210

10. AMINOACIDDISORDERS 21211. DNA BASICS 213

12. DNA REPLICATION, MUTATION, ANDREPAIR 21513. MINERALS 217

14. FAT-SOLUBLEVITAMINSANDANTIOXIDANTS 21915. WATER-SOLUBLEVITAMINS 225

16. GENETICLABTECHNIQUES 23117. INHERITANCE 234


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VIII MICRO1. HIV 239

2. HIV DRUGS 2413. ENTEROBACTERIACEAE , D IARRHEA, ANDFOODPOISONING 243

4. PROTOZOA 2465. HELMINTHSANDECTOPARASITES 248

6. BACTERIALBASICS 2507. BACTERIALTOXINS 252

8. STAPHYLOCOCCUS 2549. STREPTOCOCCUS 256

10. OTHERGRAMPOSITIVES 25811. PENICILLINS 260

12. CEPHALOSPORINS 26313. OTHERCELLWALLINHIBITORS 265

14. TB ANDTB DRUGS 26715. SPIROCHETESANDZOONOTICS 270

16. NONSTAININGBACTERIA 27217. MYCOLOGY 274

18. ANTIFUNGALS 27619. UTI 278

20. OTHERGRAMNEGATIVEBACTERIA 28021. PROTEINSYNTHESISINHIBITORS 283

22. VIRALBASICS 28623. HERPESVIRUSES 288

24. OTHERDNA VIRUSES 29025. RNA VIRUSESPART1 292

26. RNA VIRUSESPART2 29427. MICROBYSYSTEMSPART1 297

28. MICROBYSYSTEMSPART2 300

IX HEME1. CLOTTINGFACTORS 305

2. RBCS 3073. NONHEMOLYTICANEMIAS 309

4. HEMOLYTICANEMIAS 3115. PLATELETS 314

6. CANCERSOFBLOOD 316

X ONCOLOGY1. GENETICSOFCANCER 321

2. CANCERRISKFACTORS 3233. NEOPLASTICPROGRESSION 325

4. CANCERPREVENTIONANDHOSTDEFENSE 327

5. CANCERDRUGS 330

XI MEDICINE IN SOCIETY1. STUDIESANDDIAGNOSTICTESTS 335

2. APPLICATIONOFTESTDATA 3373. B IASANDERROR 338

4. CONFIDENCEINTERVAL 3415. PUBLICHEALTH 343

6. GERIATRICS 3457. HEALTHCARESYSTEM 347

8. ETHICS 353


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XII PULMONARY1. ANATOMYANDPHYSIOLOGY 357

2. LUNGVOLUMESANDPULMONARYCIRCULATION 3593. OXYGENANDHEMOGLOBIN 362

4. OXYGENATIONANDVENTILATION 3645. EXTREMEENVIRONMENTS 367

6. PE ANDDVT 3707. COPD ANDASTHMA 372

8. RESTRICTIVELUNGDISEASE 3749. LUNGCANCERANDINFECTIONS 376

XIII CARDIOVASCULAR1. EMBRYOLOGY 381

2. DEVELOPMENTALPATHOLOGY 3843. CARDIACOUTPUT 386

4. HEARTFAILURE 388

5. EDEMAANDSHOCK 3906. CARDIACCYCLE 3927. HEARTMURMURS 394

8. ELECTROPHYSIOLOGY 3969. ANTIARRHYTHMICS 397

10. ELECTROCARDIOGRAPHY 39811. ARRHYTHMIAS 400

12. REGULATIONOFBP 40413. HYPERTENSION 406

14. ANTIHYPERTENSIVES 40815. ATHEROSCLEROSIS 411

16. ANTIANGINALTHERAPYANDLIPID-LOWERINGAGENTS 41417. MYOCARDIALINFARCTION 416

18. CARDIOMYOPATHIESANDENDOCARDITIS 41919. OTHERCARDIACPATHOLOGY 421

20. VASCULARDISEASES 432

XIV RHEUM & DERM1. BONEANDBONEDISORDERS 429

2. JOINTBASICS 4323. JOINTDISEASES 434

4. SYSTEMICDISORDERS 4365. DERMATOLOGY 439

XV PSYCH1. PSYCHOLOGY 445

2. CHILDPSYCH 4483. ALCOHOLABUSE 451

4. SUBSTANCEABUSE 4535. PSYCHOSIS 455

6. B IPOLARDISORDER 4577. DEPRESSION 458

8. ANTIDEPRESSANTS 4609. ANXIETYANDSOMATOFORMDISORDERS 462

10. EGODEFENSEMECHANISMSANDPERSONALITYDISORDERS 464


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XVI RENAL1. RENALBASICS 469

2. NEPHRONPHYSIOLOGY 4713. DIURETICS 475

4. METABOLICDISORDERS 4775. GLOMERULARPATHOLOGY 480

6. OTHERRENALPATHOLOGY 482

XVII REPRODUCTION1. ANATOMY& EMBRYOLOGY 487

2. ANDROGENS 4893. TESTICULARPATHOLOGY 490

4. PENISANDPROSTATEPATHOLOGY 4925. FEMALEREPRODUCTIVECYCLE 495

6. B IRTHCONTROLANDMENOPAUSE 4977. VAGINALANDCERVICALPATHOLOGY 499

8. UTERINEPATHOLOGY 5019. OVARIANPATHOLOGY 503

10. PREGNANCYPART1 50611. PREGNANCYPART2 509

12. CHROMOSOMALDISORDERS 51113. GENETICDISORDERS: AD ANDTRINUCLEOTIDEREPEATS 513

14. GENETICDISORDERS: AR ANDX-L INKED 51515. BREAST 518

XVIII PEDIATRICS1. PEDIATRICREVIEW 522


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NOTES

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NOTES

KEYTOABBREVIATIONSThis Study Guide contains page references to several medical educational resources.

Below is a key to the abbreviations that accompany the various page number referencesappearing in this text.

FA13Le, T, Bhushan, V, et al. First Aid for the USMLE Step 1 2013 . NewYork, NY: McGraw-Hill; 2013.

FA12Le, T, Bhushan, V, et al. First Aid for the USMLE Step 1 2012 . NewYork, NY: McGraw-Hill; 2012.

SU13Jenkins, B, et al . Step-Up to USMLE Step 1 2013. Philadelphia, PA:Lippincott Williams & Wilkins; 2013

PhysHall, JE. Guyton and Hall Textbook of Medical Physiology. 12th ed.

Philadelphia, PA: Saunders Elsevier; 2011.

RKumar, V, Abbas, AK, et al. Robbins and Cotran Pathologic Basis ofDisease. 8th ed. Philadelphia, PA: Saunders Elsevier; 2010.

COAMoore, KL , Dalley, AF, & Agur, AMR. Clinically Oriented Anatomy.6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.

HLongo, DL, Fauci, AS, Kasper, DL, Hauser, SL, Jameson, JL, Loscalzo,

J, eds. Harrisons Principles of Internal Medicine. Vol. 2. 18th ed. NewYork, NY: McGraw-Hill; 2012.

GGBrunton, LL, Chabner, BA, & Knollman, BC, eds. Goodman & Gilmans ThePharmacological Basis of Therapeutics. 12th ed. New York, NY: McGraw-

Hill; 2011.

Neither the Doctors In Training USMLE Step 1 Review Course, nor this Study Guide, is endorsed by orafliated with any of the medical education resources referenced in the course. However, numerous imagescontained in the course have been licensed from Lippincott Williams and Wilkins.

COURSEVIEWINGOPTIONSPar t 2 consists of 205 videos . Examples of 12, 15, 19, 21, and 25 day plans are provid-ed below for maximum exibility to meet your personal study needs.

No. of Videos/Day Video Runtime/Day*

12-day p lan 17 Approx. 6.5 hrs

15-day plan 14 Approx. 5.5 hrs

19-day plan 11 Approx. 4.5 hrs

21-day plan 10 Approx. 4 hrs

25-day plan 8 Approx. 3 hrs

*Does not include study breaks or time spent annotating and answering questions.


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RECOMMENDED

COURSE

ORDER

RECOMMENDEDCOURSEORDER

[ vii ]

1. FOUNDATIONS1 - EMBRYOLOGYPART1

2. FOUNDATIONS2 - EMBRYOLOGYPART2

3. FOUNDATIONS3 - CELLULARORDER

4. FOUNDATIONS4 - CYTOSKELETONANDOTHERCELLULARCOMPONENTS

5. FOUNDATIONS5 - PLASMAMEMBRANE

6. FOUNDATIONS6 - CELLULARSUFFERINGANDDEATH

7. FOUNDATIONS7 - INFLAMMATION

8. FOUNDATIONS8 - CONTROLOFTHE

EXTRACELLULARENVIRONMENT

9. FOUNDATIONS9 - CELLULARADAPTATIONS

10. NEURO1 - BRAINEMBRYOLOGY

11. NEURO2 - ORGANIZATIONOFTHEBRAIN

12. NEURO3 - HYPOTHALAMUS

13. NEURO4 - SLEEP

14. NEURO5 - CRANIALNERVES

15. NEURO6 - BRAINSTEMANDBRANCHIALAPPARATUS

16. PHARMBASICS1 - PARASYMPATHETICACTIVATION

17. PHARMBASICS2 - PARASYMPATHETICINHIBITION

18. PHARMBASICS3 - CELLULARCOMMUNICATION

19. ENDOCRINE1 - ENDOCRINEOVERVIEW

20. ENDOCRINE2 - P ITUITARY

21. ENDOCRINE3 - ADRENALSTEROIDSYNTHESIS

22. ENDOCRINE4 - GLUCOCORTICOIDSANDCUSHINGSYNDROME

23. ENDOCRINE5 - OTHERADRENALPATHOLOGY

24. PHARMBASICS4 - SYMPATHETICACTIVATION25. PHARMBASICS5 - SYMPATHETICINHIBITION

26. GI 1 - OROPHARYNX

27. ENDOCRINE6 - THYROIDBASICSANDHYPERTHYROIDISM

28. ENDOCRINE7 - HYPOTHYROIDISMANDTHYROIDCANCER

29. IMMUNOLOGY1 - IMMUNOLOGYBASICS

30. IMMUNOLOGY2 - ANTIGENPRESENTATION

31. IMMUNOLOGY3 - T CELLS

ALTHOUGHYOUHAVETHEFLEXIBILITYTOVIEWTHEVIDEOSINANYORDER, WESTRONGLYRECOMMEND

THATYOUWATCHTHEVIDEOSINTHEORDERINWHICHYOURPERSONALIZEDDASHBOARDPRESENTSTHEM

REGARDLESSOFHOWMANYVIDEOSYOUVIEWINADAY.

32. IMMUNOLOGY4 - MONOCYTESANDMACROPHAGES

33. B IOCHEM1 - RNA

34. B IOCHEM2 - PROTEIN

35. IMMUNOLOGY5 - B CELLSANDANTIBODIES

36. IMMUNOLOGY6 - IMMUNIZATIONANDAUTOANTIBODIES

37. IMMUNOLOGY7 - GRANULOCYTES,CYTOKINES, ANDIMMUNOSUPPRESSANTS

38. IMMUNOLOGY8 - COMPLEMENTAND

HYPERSENSITIVITY

39. IMMUNOLOGY9 - IMMUNODEFICIENCIES

40. MICRO1 - HIV

41. MICRO2 - HIV DRUGS

42. GI 2- ESOPHAGUS

43. GI 3 - STOMACH

44. PHARMBASICS6 - PHARMACOKINETICS

45. GI 4 - UPPERGI PATH

46. GI 5 - DUODENUM

47. GI 6 - PANCREAS

48. ENDOCRINE8 - D IABETES

49. ENDOCRINE9 - DKA ANDDIABETESTREATMENT

50. GI 7 - ENTEROCYTESANDABSORPTION

51. GI 8 - DISEASESOFSMALLINTESTINE

52. B IOCHEM3 - GLUCOSE

53. B IOCHEM4 - GLYCOGEN

54. B IOCHEM5 - ENERGY

55. B IOCHEM6 - HMP SHUNTANDOTHERSUGARS

56. B IOCHEM7 - FUELUSE

57. ENDOCRINE10 - OBESITY

58. GI 9 - HEPATOCYTESANDCIRRHOSIS

59. GI 10 - LIVERPATHOLOGY

60. GI 11 - HEPATITIS

61. GI 12 - B ILIARYTRACT

62. B IOCHEM8 - L IPIDS

63. B IOCHEM9 - AMINOACIDSANDNITROGEN

64. B IOCHEM10 - AMINOACIDDISORDERS

65. PHARMBASICS7 - DRUGMETABOLISM


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RECO

MMENDED

COURSEORDER

66. HEME1 - CLOTTINGFACTORS

67. HEME2 - RBCS

68. BIOCHEM11 - DNA BASICS69. BIOCHEM12 - DNA REPLICATION,

MUTATION, ANDREPAIR

70. BIOCHEM13 - MINERALS

71. HEME3 - NONHEMOLYTICANEMIAS

72. HEME4 - HEMOLYTICANEMIAS

73. HEME5 - PLATELETS

74. HEME6 - CANCERSOFBLOOD

75. BIOCHEM14 - FAT-SOLUBLEVITAMINSANDANTIOXIDANTS

76. BIOCHEM15 - WATER-SOLUBLEVITAMINS

77. GI 13 - LARGEINTESTINE178. GI 14 - LARGEINTESTINE2

79. MICRO3 - ENTEROBACTERIACEAE , D IARRHEA,ANDFOODPOISONING

80. MICRO4 - PROTOZOA

81. MICRO5 - HELMINTHSANDECTOPARASITES

82. ONCOLOGY1 - GENETICSOFCANCER

83. ONCOLOGY2 - CANCERRISKFACTORS

84. ONCOLOGY3 - NEOPLASTICPROGRESSION

85. ONCOLOGY4 - CANCERPREVENTIONANDHOSTDEFENSE

86. ONCOLOGY5 - CANCERDRUGS

87. MEDICINEINSOCIETY1 - STUDIESANDDIAGNOSTICTESTS

88. MEDICINEINSOCIETY2 - APPLICATIONOFTESTDATA

89. MEDICINEINSOCIETY3 - B IASANDERROR

90. MEDICINEINSOCIETY4 - CONFIDENCEINTERVAL

91. MEDICINEINSOCIETY5 - PUBLICHEALTH

92. MEDICINEINSOCIETY6 - GERIATRICS

93. MEDICINEINSOCIETY7 - HEALTHCARESYSTEM

94. MEDICINEINSOCIETY8 - ETHICS

95. PULMONARY1 - ANATOMYANDPHYSIOLOGY

96. PULMONARY2 - LUNGVOLUMESANDPULMONARYCIRCULATION

97. PULMONARY3 - OXYGENANDHEMOGLOBIN

98. PULMONARY4 - OXYGENATIONANDVENTILATION

99. PULMONARY5 - EXTREMEENVIRONMENTS

100. PULMONARY6 - PE ANDDVT

101. PULMONARY7 - COPD ANDASTHMA

102. PULMONARY8 - RESTRICTIVELUNGDISEASE

103. PULMONARY9 - LUNGCANCERANDINFECTIONS

104. MICRO6 - BACTERIALBASICS

105. MICRO7 - BACTERIALTOXINS

106. MICRO8 - STAPHYLOCOCCUS

107. MICRO9 - STREPTOCOCCUS

108. MICRO10 - OTHERGRAMPOSITIVES

109. MICRO11 - PENICILLINS

110. MICRO12 - CEPHALOSPORINS

111. MICRO13 - OTHERCELLWALLINHIBITORS

112. MICRO14 - TB ANDTB DRUGS

113. MICRO15 - SPIROCHETESANDW

114. MICRO16 - NONSTAININGBACTERIA

115. CARDIOVASCULAR1 - EMBRYOLOGY

116. CARDIOVASCULAR2 - DEVELOPMENTALPATHOLOGY

117. CARDIOVASCULAR3 - CARDIACOUTPUT

118. CARDIOVASCULAR4 - HEARTFAILURE

119. CARDIOVASCULAR5 - EDEMAANDSHOCK

120. CARDIOVASCULAR6 - CARDIACCYCLE

121. CARDIOVASCULAR7 - HEARTMURMURS

122. CARDIOVASCULAR8 - ELECTROPHYSIOLOGY

123. CARDIOVASCULAR9 - ANTIARRHYTHMICS

124. CARDIOVASCULAR10 -ELECTROCARDIOGRAPHY

125. CARDIOVASCULAR11 - ARRHYTHMIAS

126. CARDIOVASCULAR12 - REGULATIONOFBP

127. CARDIOVASCULAR13 - HYPERTENSION

128. CARDIOVASCULAR14 - ANTIHYPERTENSIVES

129. CARDIOVASCULAR15 - ATHEROSCLEROSIS

130. CARDIOVASCULAR16 - ANTIANGINALTHERAPYANDLIPID-LOWERINGAGENTS

131. CARDIOVASCULAR17 - MYOCARDIALINFARCTION

132. CARDIOVASCULAR18 - CARDIOMYOPATHIESANDENDOCARDITIS

133. CARDIOVASCULAR19 - OTHERCARDIACPATHOLOGY

134. CARDIOVASCULAR20 - VASCULARDISEASES

135. NEURO7 - REGIONSOFTHEBRAIN

136. NEURO8 - BRAINSTEMINCROSSSECTION

137. NEURO9 - OCCLUSIONSYNDROMES


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RECOMMENDED

COURSE

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138. NEURO10 - VASCULAREVENTS

139. NEURO11 - MOVEMENT

140. NEURO12 - BASALGANGLIA141. NEURO13 - SPINALCORDANDLESIONS

142. NEURO14 - BRACHIALPLEXUSANDUPPEREXTREMITYNERVES

143. NEURO15 - LOWEREXTREMITY& SKELETALMUSCLE

144. RHEUM& DERM1 - BONEANDBONEDISORDERS

145. ENDOCRINE11 - CALCIUMMETABOLISM

146. RHEUM& DERM2 - JOINTBASICS

147. RHEUM& DERM3 - JOINTDISEASES

148. RHEUM& DERM4 - SYSTEMICDISORDERS149. NEURO16 - SENSATION

150. RHEUM& DERM5 - DERMATOLOGY

151. MICRO17 - MYCOLOGY

152. MICRO18 - ANTIFUNGALS

153. NEURO17 - EYE

154. NEURO18 - EAR

155. PSYCH1 - PSYCHOLOGY

156. PSYCH2 - CHILDPSYCH

157. PSYCH3 - ALCOHOLABUSE

158. PSYCH4 - SUBSTANCEABUSE

159. NEURO19 - DELIRIUMANDDEMENTIA

160. NEURO20 - HEADACHE

161. NEURO21 - BRAINTUMORS

162. NEURO22 - ANESTHETICS

163. NEURO23 - SEIZURES

164. PSYCH5 - PSYCHOSIS

165. PSYCH6 - B IPOLARDISORDER

166. PSYCH7 - DEPRESSION

167. PSYCH8 - ANTIDEPRESSANTS

168. PSYCH9 - ANXIETYANDSOMATOFORMDISORDERS

169. PSYCH10 - EGODEFENSEMECHANISMSANDPERSONALITYDISORDERS

170. RENAL1 - RENALBASICS

171. RENAL2 - NEPHRONPHYSIOLOGY

172. RENAL3 - D IURETICS

173. RENAL4 - METABOLICDISORDERS

174. RENAL5 - GLOMERULARPATHOLOGY

175. RENAL6 - OTHERRENALPATHOLOGY

176. MICRO19 - UTI

177. MICRO20 - OTHERGRAMNEGATIVEBACTERIA

178. MICRO

21 - PROTEIN

SYNTHESIS

INHIBITORS

179. MICRO22 - VIRALBASICS

180. MICRO23 - HERPESVIRUSES

181. MICRO24 - OTHERDNA VIRUSES

182. MICRO25 - RNA VIRUSESPART1

183. MICRO26 - RNA VIRUSESPART2

184. MICRO27 - MICROBYSYSTEMSPART1

185. MICRO28 - M ICROBYSYSTEMSPART2

186. PHARMBASICS8 - DRUGSIDEEFFECTS

187. PHARMBASICS9 - ANTIDOTES

188. REPRODUCTION1 - ANATOMY&

EMBRYOLOGY

189. REPRODUCTION2 - ANDROGENS

190. REPRODUCTION3 - TESTICULARPATHOLOGY

191. REPRODUCTION4 - PENISANDPROSTATEPATHOLOGY

192. REPRODUCTION5 - FEMALEREPRODUCTIVECYCLE

193. REPRODUCTION6 - B IRTHCONTROLANDMENOPAUSE

194. REPRODUCTION7 - VAGINALANDCERVICALPATHOLOGY

195. REPRODUCTION8 - UTERINEPATHOLOGY

196. REPRODUCTION9 - OVARIANPATHOLOGY

197. REPRODUCTION10 - PREGNANCYPART1

198. REPRODUCTION11 - PREGNANCYPART2

199. REPRODUCTION12 - CHROMOSOMALDISORDERS

200. REPRODUCTION13 - GENETICDISORDERS:AD ANDTRINUCLEOTIDEREPEATS

201. REPRODUCTION14 - GENETICDISORDERS:AR ANDX-L INKED

202. B IOCHEM16 - GENETICLABORATORY

TECHNIQUES203. B IOCHEM17 - INHERITANCE

204. REPRODUCTION15 - BREAST

205. PEDIATRICS- PEDIATRICREVIEW


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[ 1 ]

FOUNDATIONS

1 EMBRYOLOGY PART1

2 EMBRYOLOGY PART2

3 CELLULARORDER

4 CYTOSKELETONANDOTHERCELLULARCOMPONENTS

5 PLASMAMEMBRANE

6 CELLULARSUFFERINGANDDEATH

7 INFLAMMATION

8 CONTROLOFTHEEXTRACELLULARENVIRONMENT

9 CELLULARADAPTATIONS

FROMEMBRYOLOGYTOTHE

FUNDAMENTALSOFCELL

BIOLOGY, INFLAMMATION,

ANDAPOPTOSIS, THIS

SECTIONREVIEWSSOMEOF

THEBASICSCIENCETHATFORMSTHEFOUNDATIONAL

UNDERPINNINGSOF

MUCHOFOURMEDICAL

KNOWLEDGE.


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[ 3 ]

1

EMBRYOLOGY PART1 Fetal landmarks (FA12 p124) (FA13 p504)Early fetal development (FA13 p114) (FA13 p504)

1. What tissues are derived from ectoderm, mesoderm and ectoderm?

2. What is the formula for Gibbs free energy?

EMBRYOLOGYPART1

ENDOFSESSIONQUIZ

3. What developmental structure matches the following descr iption?(FA12 p129) (FA13 p508)

Fetal placental structure that secretes hCG

Maternal component of the placenta

4. Order the following molecules by how much energy they contain that can bemade available to fuel endergonic reactions:pyruvate, adenosine monophosphate, glucose, adenosine, adenosine triphosphate.

5. What are the stages of an embryo between conception and an inner cell mass?(FA12 p124) (FA13 p504)


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[ 4 ]

4. What neural crest derivatives are found in each of the following adult structures?

Peripheral nervous system

Ear

Eye

Adrenal gland

Mouth

Heart

Digestive system

Thyroid

Skin

5. Homeobox (HOX) Genes

Blueprint for skeletal morphology

Code for transcr iption regulators

Mutation in Homeobox HOXD-13synpolydactyly (extra fused digit between 3rd and4th ngers)

Retinoic acid alters HOX gene expression

EMBRYOLOGYPART2

3 QUESTIONWARM-UP1. What embryonic structure (derived from the hypoblast) serves as a secondary

energy source?

2. What embryonic structure serves as a reservoir of nonspecialized(undifferentiated) stem cells?

3. What are the 3 germ layers that derive from the epiblast? (FA12 p125) (FA13 p504)

EMBRYOLOGY PART2GG: Chapter 23, 66

Fetal landmarks (FA12 p124) (FA13 p504)Embryologic derivatives (FA12 p126) (FA13 p505)Neural development (FA12 p125) (FA13 p408) (SU13 p44-45)Teratogens (FA12 p127) (FA13 p506) (SU13 p34) (GG p1845)Important genes of embryogenesis (FA12 p124) (FA13 p504) (SU13 p222-225)

Fetal alcohol syndrome (FA12 p128) (FA13 p507) (GG p641)

2


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[ 5 ]

EMBRYOLOGYPART2

ENDOFSESSIONQUIZ6. A patient with an aganglionic colon and other neural crest derivative deciencies.

What other ndings would you expect to see?(SU13 p140)

7. List as many drugs as you can that are contraindicated in pregnancy.(FA12 p127) (FA13 p506)

8. What is the relationship between the notochord, the neural plate, the neuraltube, and the neural crest cells?(FA12 p125)

9. What is the embryologic origin of the following adult structures? (FA12 p126) (FA13 p505)

Anterior pituitary

Cornea

Lens

Retina

Olfactory epithelium

Mammary glands

Salivary glands

Sweat glands

RAPID-FIREFACTSMost common cause of neural tubedefects

Most common cause of congenitalmalformations in the US

Most common cause of congenital mentalretardation in the US

2


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CELLULARORDERPhys: Chapter 2R: Chapter 3

Nucleus (SU13 p15)Cell cycle phases (FA12 p79) (FA13 p74) (SU13 p12)Endoplasmic Reticulum and Golgi (FA12 p79, 80) (FA13 p74-75) (SU13 p15)Rough ER (FA12 p79) (FA13 p74) (SU13 p256)

Smooth ER (FA12 p79) (FA13 p74) (SU13 p256)Golgi apparatus (FA12 p80) (FA13 p75)Cell Trafcking (FA12 p80) (FA13 p75)Enzyme Terminology (FA12 p101) (FA13 p96) (SU13 p156)Protein Degradation

- Proteasome (FA12 p80) (FA13 p75) (SU13 p15)

- Lysosome

CELLULARORDER

3 QUESTIONWARM-UP1. What is the embryologic origin of the tissue just proximal to the pectinate line?

What is the origin of the tissue just distal to the anal canal?

(FA12 p126) (FA13 p505) (SU13 p138)

2. What effect might the following teratogens have on a developing fetus?(FA12 p127) (FA13 p506)

ACE inhibitors

Aminoglycosides

Diethylstilbestrol

Tetracyclines

Valproic acid

3. Which vitamin should not be supplemented in large amounts during pregnancy?(FA12 p127) (FA13 p506) (SU13 p364)

3


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CELLULARORDER

4. Nuclear Localization Signals

Amino acids sequences: 4-8 amino acids; rich in lysine, arginine, and protein

Essential component of proteins bound for or residing in the nucleus (e.g., histones)

Nuclear pores recognize these signals and transport proteins into the nucleus via ATPase

A mutation in a single amino acid may prevent nuclear transport

5. Cell Cycle Basics (FA12 p79) (FA13 p74) (SU13 p12) Cyclins + cyclin-dependent kinases (CDK) phosphorylate target proteins to drive the cell cycle

All cyclins are degraded by ubiquitin protein ligase when their cell-cycle specic job is

complete

p21, p27, and p57 bind to and inactivate cyclin-CDK complexes (p53 controls the activation of p21)

G1 S Cyclin D binds/activates CDK4 phosphorylation of Rb protein Rb protein is released

from transcription factor E2F with E2F unbound, the cell is free to transcribe/synthesizecomponents needed for progression through the S phase (cyclin E, DNA polymerase,

thymidine kinase, dihydrofolate reductase)

Cyclin E binds/activates CDK2 the cell is allowed to progress into S phase

G2 M Cyclin A CDK2 complex mitotic prophase

Cyclin B CDK1 complex activated by cdc25 breakdown of nuclear envelope (nuclearlamin breakdown) and initiation of mitosis

6. I-cell disease (FA12 p80) (FA13 p75) (SU13 p297)

Deciency in mannose phosphorylation

No mannose-6-phosphate to target lysosomal proteins secretion out of cell instead ofinto lysosomes

Death by age 8

(+) Corneal clouding, coarse facies, HSM, skeletal abnormalities, restricted joint movement,+/- MR

3


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7. Clathrin

A mutant LDLreceptor lacks thecoated-pit bindingsite but retains afunctioning LDL-binding site. As aresult, cells withmutant receptorsare able to bindLDL normally butare unable to ingest

it. Individuals withthis mutat ion have ahigher risk of dyingprematurely from amyocardial infarction.

CELLULARORDER


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3

CELLULARORDER

ENDOFSESSIONQUIZ8. What must be present on a protein in order for that protein to gain entry into

the nucleus?

9. Which types of proteins are responsible for fostering the progression throughthe cell cycle? (FA12 p79) (FA13 p74)

10. Which cyclin-CDK complexes assist in the progression from GI phase to Sphase?

11. Which cyclin-CDK complexes assist in the progression from G2 phase toM phase?

12. What molecule targets proteins in the endoplasmic reticulum for lysosomes?(FA12 p80) (FA13 p75)

13. What are the different methods that a cell uses to break down proteins(proteolysis)?

14. Which cell types are rich in smooth ER?(FA12 p79) (FA13 p74)


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CYTOSKELETONANDOTHERCELLULARCOMPONENTS

CYTOSKELETONANDOTHERCELLULARCOMPONENTSPhys : Chapter 2

Cytoskeleton

- Cytoskeletal elements (FA12 p81) (FA13 p76)

- Immunohistochemical stains (FA12 p82) (FA13 p76)

- Microtubule (FA12 p81) (FA13 p76)

-

Cilia structure (FA12 p81) (FA13 p76) (SU13 p83)- Kartagener syndrome (FA12 p81) (FA13 p76) (SU13 p83)Free soluble cytoplasmic elements

- Free ribosomes

- Enzymes

- Water, elements (potassium), organic molecules (amino acids, glucose)

- CytoskeletonInsoluble cytoplasmic inclusions

- Glycogen

- Lipid dropletsSarcoplasmic reticulum

Mitochondr ia (Phys p16)Peroxisome

3 QUESTIONWARM-UP1. Which amino acids are found in nuclear localization signals?

2. What is the most common cause of mental retardation in infants?(FA12 p128) (FA13 p506) (SU13 p45)

3. How do Rb protein and p53 regulate the cell cycle? (FA12 p79) (FA13 p74)

4. Intermediate Filament Structures

Intermediate Filaments Structural Component of:

Vimentin Support cellular membranes Keep certain organelles xed in

cytoplasm

Connective tissue(broblasts, leukocytes, endothelium)

Desmin Muscle cells (smooth, skeletal, heart)

Cytokeratin Epithelial cells (keratin in desmosomes and

hemidesmosomes)

Glial brillary acid proteins (GFAP) Astrocy tes, Schwann cells, other neuroglia

Peripherin Neurons

Neurolaments(L, M, H molecular weight)

Axons within neurons

Nuclear lamins (A, B,C) Nuclear envelope and DNA within

4


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CYTOSKELETONANDOTHERCELLULARCOMPONENTS

ENDOFSESSIONQUIZ5. What drugs act on microtubules? (FA12 p81) (FA13 p76) (SU13 p262, 319)

6. What two fundamental substances are required to make most things work insidethe cell?

7. Which organelle is responsible for the breakdown of very long-chain fatty acids?(FA12 p80) (FA13 p75)

8. What are the intermediate laments for the following tissue types and cellular

structures?(FA12 p82) (FA13 p79)

Connective tissue

Muscle tissue

Epithelial tissue

Axons

9. What are the defects seen in Kartagener syndrome?(FA12 p81) (FA13 p76) (SU13 p83, 124) 4


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PLASMAMEMBRANE

PLASMAMEMBRANEPhys: Chapters 2, 4R: Chapter 2

Plasma membrane

- Composition

- Sodium pump

- Sodium-mediated diffusion (Phys p54)Arachidonic acid (R p58)

3 QUESTIONWARM-UP

1. During what weeks of fetal development does organogenesis take place? (FA12 p124)(FA13 p504)

2. What molecules provide the structural framework for DNA and the nuclear envelope?

3. What is decient in I-cell disease? (FA12 p80) (FA13 p75) (SU13 p297)

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5. Tyrosine kinase receptor

Transmembrane receptors that bind an extracellular ligand then intracellularly transfer aphosphate group (phosphorylate) from ATP to selected tyrosine side chains on specic

cellular proteins including itself (autophosphorylation). The rst step in the signaling cascade

that is initiated by tyrosine kinase receptors is autophosphorylation.

PDGF and other growth factor receptors: single-pass transmembrane protein

Insulin and IGF-1 receptors:

- 2subunits (bound by disulde bonds) bind extracellular ligand- 2subunits tyrosine kinase activity

4. List the steps outlining the derivatives of arachidonic acid. (FA12 p429) (FA13 p404)PLASMAMEMBRANE

A.

B.

C.

D.

E.

F.

G.

H.

I.

J.

K.

L.

M.

N.

O.

P.

Q.

R.

5


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ENDOFSESSIONQUIZ6. Which arachidonic acid product causes each of the following effects?

(FA12 p429) (FA13 p404) (SU13 p272)

Increased bronchial tone

Decreased bronchial tone

Increased platelet aggregation Decreased platelet aggregation

Increased uterine tone

Decreased uterine tone

Increased vascular tone

Decreased vascular tone

7. What are the two most abundant substances in plasma membranes?(FA12 p81) (FA13 p76)

8. What drugs act on the arachidonic acid product pathway? What enzymes dothey affect? (FA12 p429) (FA13 p404)

PLASMAMEMBRANE

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4. Intrinsic Pathway of Apoptosis(FA12 p244) (FA13 p212)

Bcl-2 is the major anti-apoptotic regulator of mitochondrial permeabili ty

DNA damage or apoptotic signal activates Bax (pro-apoptotic)

Bax creates channels in mitochondrial membrane

Cytochrome C moves from the mitochondria into the cytosol and activates caspases

Caspases are primary initiator of apoptosis

5. Extrinsic Pathways of Apoptosis

Death receptor

- TNF receptor and Fas receptor are located on cell membrane

- TNF-and Fas ligand activate the receptors- Activated receptors will lead to activation of caspases

Cytotoxic T Lymphocyte

- Cytotoxic T cells recognize foreign or infected cell

- CTLs release perforin and granzyme B

- Perforin punches holes in membrane

- Granzyme B enters and activates caspases

CELLULARSUFFERINGANDDEATHR: Chapter 1

Apoptosis (FA12 p244) (FA13 p212)

- Intrinsic pathway

- Extrinsic pathwayNecrosis (FA12 p244) (FA13 p212)Reversible vs. irreversible injury (FA12 p245) (FA13 p213)

Mechanisms of cell injuryDefects in membrane permeabilityRed vs. pale infarcts (FA12 p245) (FA13 p213) (SU13 p103, 104)

3 QUESTIONWARM-UP

1. What drug inhibits the cellular sodium-potassium ATPase? (FA12 p82) (FA13 p77)

2. What drugs interfere with microtubule functioning? (FA12 p81) (FA13 p76) (SU13 p319)

3. Which cell types are constantly regenerating themselves due to an absence ofthe G0phase and a short G1phase?(FA12 p79) (FA13 p74)

CELLULARSUFFERINGANDDEATH

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ENDOFSESSIONQUIZ

8. What histologic features are seen in apoptotic liver cells? (FA12 p244) (FA13 p212)

9. What substances do cytotoxic T cells and NK cells use to induce apoptosis in thecells infected with virus? (FA12 p244) (FA13 p212) (SU13 p289)

10. What highly damaging events can cause irreversible cell injury?(FA12 p245) (FA13 p213)

11. What cellular enzymes are responsible for handling oxygen free radicals? (R p21)

CELLUL

ARSUFFERINGANDDEATH 6. Mechanisms of Cell Injury

ATP depletion: due to decreased oxygen/nutrients and toxins (cyanide)

Mitochondrial damage: impairs ATP production and can induce apoptosis

Inux of calcium: increases mitochondrial permeability and can activate phospholipases,

proteases, endonucleases and ATPases

Accumulation of oxygen-derived free radicals: cell dame through membrane lipidperoxidation, protein modication and DNA breakage. Multiple causes like radiation

exposure, metabolism of drugs, redox reaction, nitric oxide, transition metals, leukocyteoxidative burst, iron overdose and reperfusion injury.

7. What cellular byproducts might you detect in the serum when the following celltypes are injured?

Cardiac myocytes

Skeletal myocytes

Hepatocytes

Salivary gland cells

Pancreatic exocrine cells

RBCs

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INFLAMMATION

INFLAMMATIONR : Chapter 2

Inammation (FA12 p246) (FA13 p214)

- Acute inammation

- Leukocyte extravasation (FA12 p247) (FA13 p215) (SU13 p118)

Transudate vs. exudate (FA12 p248) (FA13 p216) (SU13 p113)Patterns of inammation (R p66)Chronic inammation

- Granulomatous diseases (FA12 p246) (FA13 p214)Markers of inammation

- Ery throcyte sedimentation rate (FA12 p248) (FA13 p217)

- C-reactive protein (R p74)

- Systemic effects (R p74)

3 QUESTIONWARM-UP

1. What are the characteristic features of a cell undergoing apoptosis?(FA12 p244) (FA13 p212)

2. What are some of the substances that can trigger apoptosis?

3. What neural crest derivatives are found in each of the following adult structures?(FA12 p126) (FA13 p505)

Peripheral Nervous System

Ear

Eye

Adrenal Gland

Mouth

Heart

Digestive System

Thyroid

Skin

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ENDOFSESSIONQUIZ6. Describe the process of leukocyte extravasation. (FA12 p247) (FA13 p215)

7. What cytokine is particularly important in the formation of granulomas? (FA12 p248)(FA13 p216)

8. What cell type plays a role in inammation by generating brinogen andC-reactive protein?

9. What cell is most responsible for the acute phase of inammation?

4. Elevated ESR(FA12 p248) (FA13 p217)

Polymyalgia rheumatica

Temporal arteritis

Disease activity in RA and SLE

Infection, Inammation (e.g., osteomyelitis)

Malignancy

5. C-Reactive Protein(R p498)

Acute-phase reactant synthesized by the liver

Part of the innate immune response: opsonizes bacteria and activates complement

Can be secreted from cells within atherosclerotic plaques to activate local endothelial cells

to induce a prothrombotic state and increase the adhesiveness of the endothelium toleukocytes

Elevations are a strong predictor of MI, stroke, PAD, and sudden cardiac death

CRP can be lowered by smoking cessation, exercise, weight loss, and statins

INFLAMMATION

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4. Epithelial Wound Healing

0-3 hours - Hemorrhage and clotting

12-24 hours - Acute inammation (PMN)

2-4 days - Macrophage inltration and epithelial cell migration

3-5 days - Granulation tissue (especially at wound edges)

Months - Collagen production (type III then type I)

CONTROLOFTHEEXTRACELLULARENVIRONMENTR: Chapter 3

Collagen (R p95)Collagen synthesis and structure (FA12 p83) (FA13 p78) (SU13 p256)FibroblastsOsteogenesis imperfecta (FA12 p83) (FA13 p78) (SU13 p258)Ehlers-Danlos syndrome (FA12 p83) (FA13 p78) (SU13 p265)

Alport syndrome (FA12 p84) (FA13 p79) (SU13 p178)Elastin (FA12 p84) (FA13 p79) (SU13 p256)

Mechanisms of angiogenesis (R p99)Cutaneous wound healing (FA12 p248) (FA13 p216) (R p102)

3 QUESTIONWARM-UP1. What protein is involved in transporting an endocytosed vesicle from the plasma

membrane to the endosome? (FA12 p80) (FA13 p75)

2. Which metals are known to facilitate the generation of oxygen free radicals?

3. Which tumor suppressor proteins prevent the progression of the cell into S phase?(FA12 p79) (FA13 p76) 8

CONTROLOFTHEEXTRA

CELLULARENVIRONMENT


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ENDOFSESSIONQUIZ5. What ndings are associated with Ehlers-Danlos syndrome? (FA12 p83) (FA13 p78)

6. What are the different types of collagen, and where can they be found?(FA12 p82) (FA13 p79)

7. Which amino acids are found in large concentrations in collagen? In elastin?(FA12 p83-84) (FA13 p78-79)

8. What is the role of vitamin C in collagen production? (FA12 p83) (FA13 p78)

8

CONTROLOFTHEEXTRACELLULARENVIRONMENT

RAPID-FIREFACTSHyperexible joints, arachnodactyly, aorticdissection, lens dislocation

Hereditary nephritis, cataracts,sensorineural hearing loss


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CELLULARADAPTATIONS

CELLULARADAPTATIONSR : Chapter 1, 3

Hypertrophy vs. hyperplasia (R p6)Replacement

- Stem cells (R p82)

- Liver regeneration (R p93)MetaplasiaAtrophy (FA12 p246) (FA13 p214) (R p9)Cellular aging (R p39-40)

3 QUESTIONWARM-UP1. What is the underlying dysfunction in Chdiak-Higashi syndrome?

(FA12 p81) (FA13 p16)

2. How does having a high cholesterol content in the plasma membrane affect thefunction of the plasma membrane?(FA12 p81) (FA13 p76)

3. What area of the colon is most susceptible to ischemic damage?(FA12 p245) (FA13 p213)

9


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ENDOFSESSIONQUIZ4. Does the compensatory growth of muscle bers occur primarily as a result of

hyperplasia or hypertrophy? (R p6)

5. Does myometrial growth in pregnancy occur primarily as a result of hyperplasiaor hypertrophy?(R p7)

6. What can happen to the cells of the lower esophagus in response to chronic acidreux?(FA12 p352) (FA13 p325) (SU13 p142) (R p10)

7. What is actually occurring at the cellular level during atrophy? (R p10)

8. What is a lipofuscin granule? (R p10)

CELLULARADAPTATIONS

9


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NEUROLOGY

1 BRAINEMBRYOLOGY

2 ORGANIZATIONOFTHEBRAIN

3 HYPOTHALAMUS

4 SLEEP

5 CRANIALNERVES

6 BRANCHIALAPPARATUS

7 REGIONSOFTHEBRAIN

8 BRAINSTEMINCROSSSECTION

9 OCCLUSIONSYNDROMES

10 VASCULAREVENTS

11 MOVEMENT

12 BASALGANGLIA

13 SPINALCORDANDLESIONS

14 BRACHIALPLEXUSANDUPPEREXTREMITYNERVES

15 LOWEREXTREMITYANDSKELETALMUSCLE

16 SENSATION

17 EYE

18 EAR

19 DELIRIUMANDDEMENTIA

20 HEADACHE

21 BRAINTUMORS

22 ANESTHETICS

23 SEIZURES

NEUROANATOMYAND

NEUROSCIENCEARESO

IMPORTANT ANDATTHE

SAMETIMESOIMPOSING

THATWEPREFERTO

DOLEITOUTINDISCREETBUNDLESTHATARESPACED

THROUGHOUTTHEPART

2 VIDEOS. WESTRONGLY

RECOMMENDTHATYOU

FOLLOWTHECOURSEIN

THEPRESCRIBEDORDER,

WHICHOURPHYSICIAN

EDUCATORSWILLEXPLAIN

ASTHECOURSEUNFOLDS.


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BRAINEMBRYOLOGY

BRAINEMBRYOLOGYR: Chapter 28

Developing brain (FA12 p133) (FA13 p408) (SU13 p44)

Neural tube defects (FA12 p133) (FA13 p409) (SU13 p45) (R p1284)Forebrain anomalies (FA12 p134) (FA13 p409) (SU13 p45)Posterior fossa malformations (FA12 p134) (FA13 p409) (SU13 p45)Syringomyelia (FA12 p134) (FA13 p410) (R p1286) (H p3373)

3 QUESTIONWARM-UP1. What adult cell types arise from neural crest cells? (FA12 p126) (FA13 p505) (SU13 p44)

2. Which amino acids are modied in the Golgi apparatus? (FA12 p80) (FA13 p75) (SU13 p15)

3. Failure of what process results in I-cell disease?(FA12 p80) (FA13 p75)

ENDOFSESSIONQUIZ

4. What abnormalities are often found with an Arnold-Chiari malformation?(FA12 p134) (FA13 p409) (SU13 p45)

5. What are the classic presenting symptoms of a syringomyelia? (FA12 p134) (FA13 p410)

6. What amniotic uid lab abnormality might point you to a diagnosis of

anencephaly? (FA12 p134) (FA13 p409) (SU13 p45)

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4. What are the 4 major dopaminergic pathways, and what is the result of blockingthese pathways?

Major pathway Result of blocking

Mesocortical pathway

Mesolimbic pathway

Nigrostriatal pathway

Tuberoinfundibularpathway

ORGANIZATIONOFTHEBRAIN

ORGANIZATIONOFTHEBRAINR: Chapter 28GG: Chapter 14Phys: Chapter 45

Cells of the nervous system (FA12 p434) (FA13 p411)Blood-brain barrier (FA12 p436) (FA13 p413) (SU13 p48)Neurotransmitters (FA12 p435) (FA13 p413) (GG p376) (Phys p550)

3 QUESTIONWARM-UP1. What organelle becomes hypertrophied in hepatocytes with chronic

phenobarbital use? (R p7)

2. What enzyme mitigates the aging effects of cellular division by maintaining

chromosomal length? (R p40)

3. What is currently the known as the most effective way of prolonging life span? (R p41)

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5. What disorder is thought to arise from reduced norepinephrine activity? Increasednorepinephrine activity?

6. What disease is associated with the degeneration of the basal nucleus of Meynert

and less CNS acetylcholine?

ORGANIZATIONOFTHE

BRAIN

ENDOFSESSIONQUIZ

7. Which nervous system cell matches each of the following descriptions?(FA12 p434, 436) (FA13 p411-413)

Look like fried eggs under histologic staining

Form multinucleated giant cells in the CNS when infected with HIV

Myelinates multiple CNS axons Myelinates one PNS axon

Damaged in Guillain-Barr syndrome

Damaged in multiple sclerosis

Macrophages of the CNS

Cells of the blood brain barrier

8. In which neurological diseases is acetylcholine altered? (FA12 p435) (FA13 p413)

9. What is the main inhibitory neurotransmitter of the CNS? In which diseases arelevels altered?(FA12 p435) (FA13 p413)

10. What are the components of the blood-brain barrier?(FA12 p436) (FA13 p413) (SU13 p48)

2


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HYPOTHALAMUS

HYPOTHALAMUSPhys: Chapter 58

Organization of the cerebrum

- Limbic system (FA12 p437) (FA13 p415) (SU13 p59)Nuclei of the hypothalamus (FA12 p436) (FA13 p414) (SU13 p60)Posterior pituitary (FA12 p436) (FA13 p414)Oxytocin (Phys p905)

Melatonin

3 QUESTIONWARM-UP1. Which neurotransmitters have altered levels in anxiety disorder?

(FA12 p435) (FA13 p413)

2. What arachidonic acid product has actions that oppose that of prostacyclin?(FA12 p429) (FA13 p404)

3. What organelle and cytochrome are particularly important in intrinsic apoptosis?(FA12 p244) (FA13 p212)

ENDOFSESSIONQUIZ4. Which nucleus of the hypothalamus ts each of the following descriptions?

(FA12 p436) (FA13 p414)

Considered the master clock for most of our circadian rhythms

Regulates the parasympathetic NS

Destruction results in hyperthermia

Regulates the sympathetic NS

Produces antidiuretic hormone (ADH) to regulate water balance

Receives input from the retina

Savage behavior and obesity result from stimulation

Savage behavior and obesity result from destruction

Stimulation leads to eating and destruction leads to starvation Regulates the release of gonadotropic hormones (i.e., LH and FSH)

Responsible for sweating and cutaneous vasodilation in hot temperatures

Responsible for shivering and decreased cutaneous blood ow in the cold

Destruction results in neurogenic diabetes insipidus

Destruction results in inability to stay warm

Releases hormones affecting the anterior pituitary

3


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SLEEPSLEEP

Phys: Chapter 59H: Chapter 27

Sleep stages (FA12 p64) (FA13 p61) (SU13 p63-64)Common Sleep Disorders

- Insomnia (SU13 p64)

- Restless leg syndrome (SU13 p64)

- Night Terrors (FA12 p65) (FA13 p62) (SU13 p64)

- Obstructive sleep apnea

- Narcolepsy (FA12 p65) (FA13 p62) (SU13 p64)

- Nocturnal enuresis (SU13 p64)Sleep patterns of depressed patients (FA12 p64) (FA13 p62)

Medications for insomnia

3 QUESTIONWARM-UP1. What effect might aminoglycosides have on a developing fetus? (FA12 p127) (FA13 p506)

2. What molecule targets proteins in the endoplasmic reticulum for lysosomes?

3. Which amino acids are found in nuclear localization signals?

4. What medications are common in the treatment of insomnia? What makes eachone unique?

Melatonin Non-addictive, OTC, vivid dreams, safe for < 3months

Valerian OTC herbal remedy, studies show no benet

Antihistamines (Benadryl,Tylenol PM, doxylamine)

Commonly used by patients rst-line, a ssociatedwith poor sleep quality, not for long-term use,anticholinergic side effects (avoid in the elderly)

Trazodone Antidepressant, increases REM sleep, small risk ofpriapism

TCAs such as amitriptyline,doxepin

Antidepressant, small risk of arrhy thmias (obtainEKG prior to use), anticholinergic side-effects(avoid in the elderly)

Long acting benzodiazepines

such as temazepam,lorazepam, clonazepam,diazepam, chlordiazepoxide

Addictive, short-term only (< 35 days)

Zolpidem (Ambien), zaleplon(Sonata)

Act at the benzo receptor, short-term only (< 35days), rebound insomnia when discontinued

Eszopiclone (Lunesta) May be used long-term (FDA 2004)

Ramel teon (Rozerem) Non-addic ti ve because i t works at melatoninreceptors instead of GABA/benzo receptors;avoid if hepatic insufciency; long-term s tudiesare lacking

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ENDOFSESSIONQUIZ

6. What EEG waveforms correspond to the different stages of sleep? (SU13 p64)

7. What drugs are used to shorten Stage N3 sleep?

8. What is the key to initiating sleep? What is the principle neurotransmitter involvedin REM? (SU13 p63)

9. What is the pathway by which retinal information induces the release ofmelatonin? (FA12 p65) (FA13 p65)

SLEEP 5. What is the treatment for narcolepsy?(H p220)

Avoidance of drugs that cause sleepiness

Scheduled naps (once or twice a day for 10-20 min)

Stimulants modanil is rst-line

Support group attendance

If cataplexy then use venlafaxine, uoxetine, or atomoxetine

Sodium oxybate (GHB) can assist in sleep and reduce cataplexy

4


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CRANIALNERVES

CRANIALNERVESCOA: Chapter 7

Cranial nerves (FA12 p465) (FA13 p434) (SU13 p61-62)Cranial nerve reexes (FA12 p465) (FA13 p434)Cranial nerve nuclei (FA12 p456) (FA13 p434)Extraocular muscles and nerves (FA12 p462) (FA13 p439) (SU13 p58)Cavernous sinus (FA12 p458) (FA13 p436) (SU13 p63)

Reticular activating systemVagal nuclei (FA12 p457) (FA13 p435)Horner syndrome (FA12 p453) (FA13 p431) (SU13 p137)

3 QUESTIONWARM-UP1. What brain structure is responsible for extraocular movements during REM sleep?

(FA12 p64) (FA13 p617)

2. Name 7 teratogens. (FA12 p127) (FA13 p507)

3. Which areas of the hypothalamus regulate the autonomic nervous system?(FA12 p436) (FA13 p414)

5


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ENDOFSESSIONQUIZ5. Which cranial nerves have their nuclei located in the medulla?

(FA12 p456) (FA13 p434)

6. Which cranial nerves have their nuclei in the pons?(FA12 p456) (FA13 p434)

7. Which cranial nerves have their nuclei in the midbrain? (FA12 p456) (FA13 p434)

8 A 19-year-old patient presents with a furuncle on his philtrum, and the cavernoussinus becomes infected. What neurological decits might you see in this patient?

(FA12 p458) (FA13 p436)

9. What are the muscles of mastication?(FA12 p459) (FA13 p437)

RAPID-FIREFACTSUnilateral facial drooping involving theforehead

Ptosis, miosis and anhidrosis

5

CRANIALNERVES


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BRANCHIALAPPARATUSBranchial apparatus (FA12 p135) (FA13 p509) (SU13 p254)Branchial cleft derivatives (FA12 p136) (FA13 p509)Branchial pouch derivatives (FA12 p137) (FA13 p511)Branchial arch derivatives (FA12 p136) (FA13 p510) (SU13 p254)

3 QUESTIONWARM-UP1. Which cranial nerve is responsible for each of the following actions? (FA12 p456) (FA13 p434)

Eyelid opening

Taste from anterior 2/3 of tongue

Head turning

Tongue movement

Muscles of mastication

Balance

Monitor ing carotid body and sinus chemo- and baroreceptors

2. A woman involved in an accident cannot turn head to the left and has a rightshoulder droop. What structure is damaged?

3 During what sleep stage would a man have variable BP, penile tumescence, andvariable EEG? (SU13 p64)

ENDOFSESSIONQUIZ

4. What nerves innervate the branchial arches? Later, what structures are derivedfrom these arches? (FA12 p136) (FA13 p510)

5. From which branchial pouch are each of the following structures derived?(FA12 p137) (FA13 p511)

Middle ear and eustachian tubes

Superior parathyroids

Inferior parathyroids

Epithelial lining of the palatine tonsil

Thymus

6

BRANCHIALAPPARATUS


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PHARMBASICS

1 PARASYMPATHETICACTIVATION

2 PARASYMPATHETICINHIBITION

3 CELLULARCOMMUNICATION

4 SYMPATHETICACTIVATION

5 SYMPATHETICINHIBITION

6 PHARMACOKINETICS

7 DRUGMETABOLISM

8 DRUGSIDEEFFECTS

9 ANTIDOTES

MOSTPHARMACO-

THERAPEUTICSARE

DISCUSSEDTHROUGHOUT

THEPART2 VIDEOS,

ALONGSIDETHEDISEASES

THEYTREAT. THEPHARMBASICSSECTIONCOVERS

THEAUTONOMICNERVOUS

SYSTEMANDDRUGSTHAT

MODULATEIT, CELLULAR

MESSENGERSYSTEMS, DRUG

METABOLISMANDTHE

FOURPHARMACOKINETIC

EQUATIONSTHAT

ABSOLUTELYMUSTBE

UNDERSTOODINORDERTO

SURVIVEYOUREXAM. THIS

SECTIONALSOINCLUDES

MATERIALONTOXICOLOGY

ANDIMPORTANTDRUGSIDE

EFFECTS.


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PARASYMPATHETICACTIVATION

3 QUESTIONWARM-UP1. Which collagen is typically decient in Ehlers-Danlos syndrome? In osteogenesis

imperfecta? (FA12 p83) (FA13 p78) (SU13 p265)

2. What regulates the progression of G1 phase of the cell cycle to S phase?(FA12 p79) (FA13 p74)

3. What cranial nerves innervate the tongue in the following ways?(FA12 p137) (FA13 p410)

Taste in the anterior 2/3

Taste in posterior 1/3 (main innervation)

Motor

Sensation in the anterior 2/3

Sensation in the posterior 1/3

PARASYMPATHETICACTIVATIONGG: Chapters 8-10Phys: Chapter 60

Autonomic nervous system (FA12 p262) (FA13 p230)Nicotinic vs. muscarinic receptors (FA12 p262) (FA13 p230)Parasympathetic activation (SU13 p46)Cholinergic agonists (FA12 p265) (FA13 p233)

Alzheimer diseaseMyasthenia gravis (FA12 p422) (FA13 p394)

4. What are the symptoms of excess parasympathetic activity?(FA12 p265) (FA13 p233) (SU13 p46)

5. Alzheimer disease anticholinesterases

Donepezil

Galantamine

Rivastigmine

1


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4. What are the symptoms of inhibiting parasympathetic activity?

(FA12 p266) (FA13 p234)

5. What drugs inhibit parasympathetic activity? What are their uses?(FA12 p266) (FA13 p233)

6. What anticholinergics are used in the treatment of urge type urinary incontinence?

Oxybutynin

Tolterodine

Darifenacin and solifenacin

Trospium

PARASYMPATHETICINHIBIT

ION

3 QUESTIONWARM-UP

1. What are the symptoms of excess parasympathetic activity? (FA12 p265) (FA13 p233)

2. Atropine is not effective in reversal of organophosphate poisoning. What drugwould best help this patient?

3. What are the components of the blood-brain barrier?(FA12 p436) (FA13 p413)

PARASYMPATHETICINHIBITIONGG: Chapters 9, 11

Parasympathetic activation reviewParasympathetic inhibition

Muscarinic antagonists (FA12 p266) (FA13 p234)Other drugs with anticholinergic side effects

2


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ENDOFSESSIONQUIZ

9. Identify the following drugs as a direct cholinergic agonist, anticholinesterase, anti-muscarinic, or cholinesterase regenerator:

Physostigmine

Pilocarpine Oxybutynin

Atropine

Donepezil

Pralidoxime

Bethanechol

Neostigmine

Darifenacin

Ipratropium

10. Which of the muscarinic antagonists discussed could be used to improve FEV1 in

a patient with COPD?

PARASYMPATHETICINHIBITION 7. In what patient populations is atropine contraindicated?

(FA12 p266) (FA13 p234) (SU13 p340)

8. What other medications have anticholinergic side effects?

First generation H1 blockers: diphenhydramine (Benadryl), doxylamine (Unisom),chlorpheniramine

Neuroleptics

Tricyclic antidepressants

Amantadine

Tropicamide

Benztropine

Scopolamine

Edrophonium

Tolterodine

Trospium

Rivastigmine

Homatropine

Pyridostigmine

Carbachol2


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4. Fill in the diagram of acetylcholine synthesis and neurotransmission:

CELLULARCOMMUNICATION

3 QUESTIONWARM-UP

1. Which agents are often used in the treatment of urge incontinence?

2. What group of genes is responsible for skeletal development?(FA12 p124) (FA13 p504)

3. Which cell types are derived from the neural crest?(FA12 p126) (FA13 p505) (SU13 p44-45)

CELLULARCOMMUNICATIONGG: Chapter 3, 8Phys: Chapter 45, 60R: Chapter 3

Cholinergic neurotransmission (FA12 p264) (FA13 p232) (SU13 p47) (GG p182) (Phys p731)Catecholamine synthesis (FA12 p112) (FA13 p108)Noradrenergic neurotransmission (FA12 p264) (FA13 p232) (SU13 p47)

G protein second messengers (FA12 p263) (FA13 p231) (SU13 p46, 197) (Phys p548) (R p90-91) (GG p52)

3


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6. Fill the signal transmission pathways:

5. Fill in the diagram of norepinephrine synthesis and neurotransmission:

C

ELLULARCOMMUNICATION

3


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CELLULARCOMMUNICATION

ENDOFSESSIONQUIZ7. What substances inhibit the reuptake of norepinephrine?

(FA12 p264) (FA13 p232) (SU13 p47)

8. What substances stimulate the release of norepinephrine from neurons?(FA12 p264) (FA13 p232) (SU13 p47)

9. What G protein class does each of the following receptors stimulate?(FA12 p263) (FA13 p231) (SU13 p197)

M M M

D

10. Outline the pathway by which stimulation of a Gs receptor activates proteinkinase A. (FA12 p263) (FA13 p231) (SU13 p197) 3


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SYMPATHETICACTIVATION

3 QUESTIONWARM-UP1. What are the symptoms of organophosphate poisoning? What are the

symptoms of atropine overdose? (FA12 p265-266) (FA13 p234) (SU13 p340)

2. What are the 3 different G proteins and what are their downstream effects?Which receptors use these G proteins? (FA12 p263) (FA13 p231) (SU13 p197)

3. What regulates prolactin secretion from the pituitary?(FA12 p317) (FA13 p290) (SU13 p195)

Autonomic nervous system reviewAdrenerg ic receptors (FA12 p263) (FA13 p231) (SU13 p46)Sympathomimetics (FA12 p266) (FA13 p235)


4


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ENDOFSESSIONQUIZ4. Which receptors are stimulated by each of the following sympathomimetics?

(FA12 p266-267) (FA13 p235-236)

Clonidine

Dopamine

Phenylephrine Albuterol

Norepinephrine

Isoproterenol

Epinephrine

Dobutamine

Terbutaline

5. Which sympathomimetic matches each of the following statements?(FA12 p266-267) (FA13 p235-236)

Given as a nebulizer for asthma

Drug of choice for anaphylaxis

Most common rst line agent for patients in cardiogenic shock

Most common rst line agent for patients in septic shock

Given subQ for asthma

Used by ENT to vasoconstrict nasal vessels

4


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GG: Chapter 12

Alpha-blockers (FA12 p268) (FA13 p237) (SU13 p97-98)Beta-blockers (FA12 p269) (FA13 p238) (SU13 p99-100)

A2 adrenerg ic agonists (FA12 p267) (FA13 p235)

SYMPATHETICINHIBITION

SYMPATHETICINHIBITION

3 QUESTIONWARM-UP1. What is the main inhibitory neurotransmitter of the CNS? In which diseases are

levels altered? (FA12 p435) (FA13 p413) (SU13 p47, 74-76)

2. What are the classic presenting symptoms of syringomyelia?(FA12 p134) (FA13 p410) (SU13 p60)

3. What drug inhibits the cellular sodium-potassium ATPase?(FA12 p82) (FA13 p77) (SU13 p106)

ENDOFSESSIONQUIZ

4. How does blood pressure response to phenylephrine administration change ifan -blocker is administered beforehand? Why is this different than the change

seen when epinephrine is used rather than phenylephrine?(FA12 p268) (FA13 p238)

5. What are the common side effects of -blockers? Which patient populationsshould use caution when taking -blockers? (FA12 p269) (FA13 p238) (SU13 p99-100)

6. What are the various clinical applications of beta-blockers?(FA12 p269) (FA13 p238) (SU13 p99-100)

5


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1 ENDOCRINEOVERVIEW

2 PITUITARY

3 ADRENALSTEROIDSYNTHESIS

4 GLUCOCORTICOIDSANDCUSHINGSYNDROME

5 OTHERADRENALPATHOLOGY

6 THYROIDBASICSANDHYPERTHYROIDISM

7 HYPOTHYROIDISMANDTHYROIDCANCER

8 DIABETES

9 DKA ANDD IABETESTREATMENT

10 OBESITY

11 CALCIUMMETABOLISM

ENDOCRINE THEENDOCRINOLOGYQUESTIONSONBOARD

EXAMSTENDTOBEFAIRLY

STRAIGHTFORWARD, BUT

THEREISAWIDEAND

COMPLEXVARIETYOFSYSTEMSTOUNDERSTAND:

PITUITARY, ADRENALS,

THYROID, PARATHYROIDS,

ANDTHEENDOCRINE

PANCREAS . PAYSPECIAL

ATTENTIONTODIABETES

MELLITUS, ADISEASEWITHA

HIGHPREVALENCEINBOTH

THECLINICANDONTHE

EXAM.


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3 QUESTIONWARM-UP

1. Which cytokine is particularly important in maintaining granulomas?(FA12 p248) (FA13 p216)

2. What is the function of the lysosome? (FA12 p80) (FA13 p75)

3. Outline the pathway by which stimulation of a Gq receptor activates protein

kinase C.(FA12 p263) (FA13 p231)

4. What hormone has each of the following action(s)?

Stimulates bone and muscle growth

Stimulates milk production and secretion

Stimulates milk secretion during lactation

Responsible for female secondary sex characteristics

Stimulates metabolic activity

Increases blood glucose level and decreases protein synthesis

Responsible for male secondary sex characteristics Prepares endometrium for implantation / maintenance of pregnancy

Stimulates adrenal cortex to synthesize and secrete cortisol

Stimulates follicle maturation in females and spermatogenesis in males

Increases plasma calcium, increases bone resorption

Decreases plasma calcium, increases bone formation

Stimulates ovulation in females and testosterone synthesis in males

Stimulates thyroid to produce TH and uptake iodine

ENDOCRINEOVERVIEW

ENDOCRINEOVERVIEW

Phys: Chapter 74H: Chapter 338

Signaling pathways of endocrine hormones (FA12 p321) (FA13 p294) (Phys p886) (H p2869)Signaling pathways of steroid hormones (FA12 p322) (FA13 p295) (Phys p891)Review of hormone actions and origins (Phys p883)

1


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Thyroid-stimulating hormone (TSH)

Epinephrine and norepinephrine

Insulin

Estradiol

Estriol

Estrone

Estrogen in males

Parathyroid hormone (PTH)

Somatostatin

Luteinizing hormone (LH)

Mineralocorticoids (aldosterone)

Adrenocorticotropic hormone (ACTH)

5. From where is each of the following hormones secreted?

Growth hormone (GH)

Thyroid hormone

Glucocorticoids (cortisol)

Progesterone

Prolactin

Oxytocin

Atrial natriuretic hormone (ANH)

Glucagon

Testosterone

Follicle-stimulating hormone (FSH)

Vasopressin (ADH)

Calcitonin

ENDOCRINEOVERVIEW

ENDOFSESSIONQUIZ

6. In what part of the cell would you nd steroid hormone receptors?

7. What clinical nding would you expect to nd in a man with high sex hormone

binding globulin?

8. What clinical nding would you expect to nd in a woman with low sex hormone

binding globulin? 1


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PITUITARY

PITUITARY

3 QUESTIONWARM-UP1. A gardener presents with shortness of breath, salivation, miosis, and diarrhea. What

caused this? What is the mechanism of action? (FA12 p265) (FA13 p233)

2. What enzyme catalyses the conversion of tyrosine to dopa? (FA12 p112) (FA13 p108)

3. A 30-year-old schizophrenic man now has urinary retention due to his neuroleptic.What do you treat it with? (FA12 p265) (FA13 p233) (SU13 p341)

R: Chapter 24Phys: Chapter 75H: Chapter 339

Posterior pituitary (FA12 p314) (FA13 p287) (SU13 p89)

- Antidiuretic hormone

- Oxytocin

Anterior pitui tary (FA12 p314) (FA13 p287) (SU13 p193)- Luteinizing hormone

- Follicle stimulating hormone

- Adrenocor ticotropic hormone

- Melanocy te-st imulating hormone

- Thyroid stimulating hormone

- Growth hormone

- ProlactinHyperprolactinemia (FA12 p317, 538) (FA13 p290, 523) (SU13 p208, 220) (H p2887)Pituitary adenoma (FA12 p328) (FA13 p301) (SU13 p208)

Acromegaly (FA12 p328) (FA13 p301) (SU13 p208)Somatostatin (FA12 p334, 346) (FA13 p306, 319) (SU13 p139, 194, 198)Sheehan syndrome (FA12 p328) (FA13 p301) (SU13 p208)

4. ACTH and MSH (SU13 p210) (H p2896)

ACTH is synthesized as part of a large precursor called proopiomelanocortin (POMC),which also contains the sequences for other hormonal peptides, including the lipotropins,

melanocyte-stimulating hormones (MSH) and beta-endorphin.

5. Hyperprolactinemia (FA12 p317, 538) (FA13 p290, 523) (SU13 p208, 220) (H p2887)

Causes

- Pregnancy/nipple stimulation

- Stress (physical or psychological)- Prolactinoma (associated with bitemporal hemianopia)

- Dopamine antagonists: antipsychotics (haloperidol, risperidone), domperidone,metoclopramide, methyldopa

Premenopausal female symptoms hypogonadisminfertility, oligo/amenorrhea; rarely

galactorrhea

Postmenopausal female symptoms none since already hypogonadal

Male symptoms hypogonadism (low testosterone)decreased libido, impotence,infertility (low sperm counts), gynecomastia, rarely galactorrhea

2


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6. Somatostatin (FA12 p334, 346) (FA13 p306, 319) (SU13 p139, 194, 198)

Produced throughout the GI tract but notably by D cells in gut mucosa and pancreatic islet

cells

Also produced throughout the nervous system

In the CNS, PNS, and peripheral organs somatostatin decreases endocrine and exocrinesecretion, reduces splanchnic blood ow, reduces gastrointestinal motility and gallbladder

contraction, and inhibits secretion of most gastrointestinal hormones

Clinical Uses for somatostatin analogs (octreotide, somatostatin LAR, and lanreotide-P):- Pituitary excesses: acromegaly, thyrotropinoma, ACTH-secreting tumors

- GI endocrine excess: Zollinger-Ellison Syndrome, carcinoid syndrome, VIPoma (AKApancreatic cholera), glucagonoma, insulinoma

- Certain diarrheal diseases

- Need to reduce splanchnic circulation: portal hypertension (bleeding varices), bleedingpeptic ulcers

PITUITARY

ENDOFSESSIONQUIZ

7. A patients MRI reveals replacement of tissue in the sella turcica with CSF. What is

the most likely clinical presentation?

8. Which hormones share a common alpha subunit?

9. What is the most common presentation of hyperprolactinemia in a female patient?

10. What are some of the possible clinical features of acromegaly?(FA12 p328) (FA13 p301) (SU13 p208)

RAPID-FIREFACTSInability to breastfeed, amenorrhea, coldintolerance

Infertility, galactorrhea and bitemporalhemianopsia

2


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3 QUESTIONWARM-UP

1. What is the precursor molecule of ACTH synthesis?

2. What is required for a molecule to enter into the nucleus through a nuclear pore?

3. What are the various clinical applications of atropine? (FA12 p266) (FA13 p234) (SU13 p340)


Adrenal anatomy (FA12 p314) (FA13 p286) (R p1148) (Phys p921)Fetal adrenal gland (FA12 p314) (FA13 p286)Steroid synthesis (FA12 p318) (FA13 p291) (SU13 p210) (Phys p923) (H p2940)Congenita l adrenal hyperplasia (FA12 p318) (FA13 p291) (SU13 p209-210) (R p1152) (H p2959)

ADRENALSTEROIDSYNTHESIS


3


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5. What features characterize a deciency in 3-hydroxysteroid dehydrogenase?

Inability to produce

6. What features characterize a deciency in 17-hydroxylase? Inability to produce sex hormones and cortisol

Increased production of mineralocor ticoids (i.e. aldosterone)sodium and uid retention

7. What features characterize a deciency in 21-hydroxylase?

Inability to produce cortisol

Inability to produce mineralocorticoids

Increased production of sex hormones

ADRENALSTEROIDSYNTH

ESIS

4. Complete the steroid synthesis pathway:

A.

B.

C.

D.

E.

F.

G.

H.

I.

J.

K.

L.

M.

N.

O.

P.

Q.

R.

S.

T.

U.

V.

W.

X.

Y.

Z.

3


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8. What features characterize a deciency in 11-hydroxylase?

Inability to produce

Increased production of deoxycorticosterone (a weak mineralocorticoid)

Increased production of sex hormones

ENDOFSESSIONQUIZ9. What are the symptoms of 21-hydroxylase deciency? (FA12 p318) (FA13 p291)

(SU13 p210)

10. What are the symptoms of 11-hydroxylase deciency?(FA12 p318) (FA13 p291)(SU13 p210)

11. What food substance is an essential starting point in the synthesis of adrenal steroids?(FA12 p318) (FA13 p291) (SU13 p210)


3


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Cortisol (FA12 p323) (FA13 p292)Glucocorticoids (FA12 p334) (FA13 p306) (SU13 p213)Cushing syndrome (FA12 p323) (FA13 p296) (SU13 p209-212) (R p1148) (H p2945)

GLUCOCORTICOIDSANDCUSHINGSYNDROME

3 QUESTIONWARM-UP

1. What are the symptoms of inhibiting parasympathetic activity?(FA12 p266) (FA13 p234) (SU13 p340)

2. Outline the pathway for the generation of norepinephrine from tyrosine.(FA12 p112) (FA13 p108) (SU13 p47)

3. What hormones arise from the anterior pituitary? (FA12 p314) (FA13 p287) (SU13 p193-195)

GLUCOCORTICOIDSAND

CUSHINGSYNDROME

4


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ENDOFSESSIONQUIZ4. An adult male with elevated serum cortisol levels and signs of Cushing syndrome

undergoes a dexamethasone suppression test. 1 mg of dexamethasone does notdecrease cortisol levels, but 8 mg does. What is the diagnosis?(FA12 p323) (FA13 p296) (SU13 p212)

5. What effect does cortisol have on bone formation and immune system functioning?(FA12 p319) (FA13 p292) (SU13 p193, 349)

6. What are the potential side effects of glucocorticoid use?(FA12 p334) (FA13 p306) (SU13 p259)

GLUCOCORTICOIDS

ANDCUSHINGSYNDROME

RAPID-FIREFACTS

Most common causes of Cushing syndrome

4


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3 QUESTIONWARM-UP

1. What primary hormone is increased or decreased in the following diseases?(FA12 p323-324)

Disease Hormone that is increased or decreased

Cushing syndrome

Conn syndrome

Addison disease

2. What is the drug of choice for anaphylactic shock? Cardiogenic shock? Septicshock? (FA12 p266) (FA13 p235)

3. What cancers are associated with RET gene mutation? (FA12 p232) (FA13 p304)

THYROIDBASICSANDHYPERTHYROIDISM


Thyroid development (FA12 p138) (FA13 p286)Formation of thyroid hormone (FA12 p322) (FA13 p295)Hyperthyro idism (FA12 p325-326) (FA13 p286) (SU13 p215-217)Graves disease (FA12 p326) (FA13 p299) (SU13 p215)Other causes of hyperthyroidism (FA12 p326) (FA13 p299)

Approach to thyrotoxicosis (SU13 p217)

THYROIDBASICSANDHY

PERTHYROIDISM

6


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ENDOFSESSIONQUIZ4. A 35-year-old woman presents with diffuse goiter and hyperthyroidism. What are

the most likely relative values of TSH and thyroid hormones?(FA12 p326) (FA13 p299) (SU13 p215-216)

5. What would you suspect to be the cause of hyperthyroidism in a patient presentingwith the symptoms of hyperthyroidism in addition to each of the following ndings?

(FA12 p325-326) (FA13 p298-299) (SU13 p214-217)

Extremely tender thyroid gland

Pretibial myxedema

Pride in recent weight loss, medical professional

Palpation of single thyroid nodule

Palpation of multiple thyroid nodules

Recent study using IV contrast (iodine)

Eye changes: proptosis, edema, injection

History of thyroidectomy or radioablation of thyroid

6. What is the most common location for ectopic thyroid tissue?(FA12 p138) (FA13 p286)

7. How would pregnancy affect serum thyroid hormone levels?(FA12 p322) (FA13 p295)

THYROIDBASICSANDHYPERTHYROIDISM

6


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Hypothyroidism (FA12 p325) (FA13 p298) (SU13 p214)Causes of hypothyroidism (FA12 p325) (FA13 p298)Thyroid cancer (FA12 p326) (FA13 p299) (SU13 p218)Recurrent laryngeal nerve injury

HYPOTHYROIDISMANDTHYROIDCANCER

3 QUESTIONWARM-UP1. In the dark, both pupils are dilated. (see image) In the light, the control pupil is miotic

while the pupil given drug X remains mydriatic. What is drug X?(FA12 p266) (FA13 p234-235) (SU13 p46, 340)

2. What are some of the clinical uses for somatostatin?(FA12 p334, 367) (FA13 p306, 340) (SU13 p287)

3. What is the name given to a thyroid hormone-secreting teratoma?(FA12 p546) (FA13 p331) (SU13 p238)


7


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ENDOFSESSIONQUIZ4. What type of thyroid cancer matches each of the following statements?

(FA12 p326) (FA13 p299) (SU13 p218)

Most common type of thyroid cancer (70-75%)

Second most common type of thyroid cancer (10%)

Activation of receptor tyrosine kinases Hashimoto thyroiditis is a risk factor

Cancer arising from parafollicular C cells

Commonly associated with either a RAS mutation or a PAX8-PPAR gamma 1rearrangement

Commonly associated with rearrangements in RET oncogene or NTRK1

Most common mutation in the BRAF gene (serine/threonine kinase)

5. What is the mechanism of action of propylthiouracil? What other drug works likePTU? What are their side effects? (FA12 p334) (FA13 p306) (SU13 p216)


RAPID-FIREFACTSMost common thyroid cancer

Cold intolerance

Enlarged thyroid cells with ground-glassnuclei7


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GI

1 OROPHARYNX

2 ESOPHAGUS

3 STOMACH

4 UPPERGI PATH

5 DUODENUM

6 PANCREAS

7 ENTEROCYTESANDABSORPTION

8 DISEASESOFTHESMALLINTESTINE

9 HEPATOCYTESANDCIRRHOSIS

10 LIVERPATHOLOGY

11 HEPATITIS

12 BILIARYTRACT

13 LARGEINTESTINE1

14 LARGEINTESTINE2

JOINUSONAJOURNEY

THROUGHTHE

GASTROINTESTINALTRACT,

FROMTHEMOUTHTOTHE

ANUS, ANDALLPOINTSIN

BETWEEN! ENJOYSCENICEXCURSIONSINTOTHE

HEPATOBILIARYSYSTEMAND

PANCREAS! FOLLOWING

THERECOMMENDEDCOURSE

ORDER, THISCHAPTERALSO

SERVESASTHESTEPPING-

OFFPOINTFORTHE

BIOCHEMISTRYOFENERGY

METABOLISMANDNUTRIENT

UTILIZATION.


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3 QUESTIONWARM-UP1. Place the following agents in the appropriate categories:

(FA12 p265-269) (FA13 p233-238)

norepinephrine, metoprolol, timolol, scopolamine, phenoxybenzamine, bethanechol,

isoproterenol, donepezil, prazosin, atropine, propranolol, labetalol, hexamethonium,

atenolol, terbutaline, dopamine, pilocarpine, carbachol, edrophonium, phenylephrine,

glycopyr rolate, phentolamine, neost igmine, benz tropine, terazosin, pral idoxime,

echothiophate, ipratropium, epinephrine, esmolol, oxybutynin

Direct cholinergic agonists:

Cholinergic antagonists:

Sympathomimetics:

1 2 1 2 agonist

1 2 1 agonist

D1 = D2 > 1 > 1 agonist

1 = 2 agonist

2 > 1 agonist

a1 > a2 agonist

Indirect cholinergic agonists(anti-acetylcholinesterases)

OROPHARYNXR: Chapter 16Phys: Chapter 64H: Chapter 317

Tongue development (FA12 p137) (FA13 p410) (SU13 p59)Tongue pathologySalivary glands (FA12 p347) (FA13 p320)

Salivary gland pathologyTumors of the salivary glands (FA12 p350) (FA13 p324)Cleft lip and cleft palate (FA12 p138) (FA13 p511)NoseParanasal sinusesTonsils and adenoids

OROPHARYNX

Nicotinic antagonist

Cholinesterase regenerator

-adrenergic antagonists (-blockers)

-adrenergic antagonists (-blockers)

Nonselective

(2 = 1)

1 selective

1

(continued)


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ENDOFSESSIONQUIZ4. What is the most common location of salivary gland tumors?

5. What is the most common salivary gland tumor? What is the histological appearanceof this tumor? (SU13 p141)

6. What is the second most common benign salivary gland tumor? (SU13 p141)

7. What is the most common malignant salivary gland tumor (the second mostcommon tumor overall of the salivary gland)?

8. What medication is often used in the treatment of allergic rhinitis, nasal polyps, andEustachian tube dysfunction?

3 QUESTIONWARM-UP- CONT2. Which portions of the hypothalamus are inhibited by Leptin? Which are

stimulated? (FA12 p436) (FA13 p414) (SU13 p194)

3. Which cranial nerve relays the following types of information?(FA12 p456) (FA13 p434) (SU13 p61-62)

Hypoxia measured by the carotid body

Motor information for swallowing

Blood pressure from the aortic arch

Salivation from the sublingual glands

Salivation from the parotid gland

Blood pressure from the carotid

OROPHARYNX

1


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IMMUNOLOGY

1 IMMUNOLOGYBASICS

2 ANTIGENPRESENTATION

3 T CELLS

4 MONOCYTESANDMACROPHAGES

5 B CELLSANDANTIBODIES

6 IMMUNIZATIONANDAUTOANTIBODIES

7 GRANULOCYTES, CYTOKINES, ANDIMMUNOSUPPRESSANTS

8 COMPLEMENTANDHYPERSENSITIVITY

9 IMMUNODEFICIENCIES

MANYMEDICALSTUDENTS

SEEMTOVIEWTHEIMMUNE

SYSTEMASACOMPLETELY

UNFATHOMABLEAND

UNKNOWABLEMYSTERY,

ADEEPOCEANOFINFORMATIONWHOSE

DEPTHSARENEVERTOBE

PLUMBED. BUTFEARNOT!

OURPHYSICIANEDUCATORS

WILLBREAKITDOWN

SYSTEMATICALLY, ADDING

LAYERSOFKNOWLEDGE

THATFOCUSONTHE

PRECISEFACTSYOUNEEDTO

MASTERFORYOUREXAM.


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3 QUESTIONWARM-UP

1. What would you suspect to be the cause of hyperthyroidism in a patientpresenting with the symptoms of hyperthyroidism in addition to each of thefollowing ndings? (FA12 p326) (FA13 p299) (SU13 p215-218)

Extremely tender thyroid gland

Palpation of single thyroid nodule

Palpation of multiple thyroid nodules

Recent study using IV contrast dye (iodine)

Eye changes: proptosis, edema, injection

2. What are the differences between oligodendroglia and Schwann cells?(FA12 p434-435) (FA13 p412) (SU13 p44)

3. Describe the sensory innervation of the tongue. (FA12 p137) (FA13 p410) (SU13 p59)

IMMUNOLOGYBASICS

R: Chapter 6H: Chapter 314

MALT (SU13 p287) (H p2675)Lymph nodes (FA12 p222) (FA13 p192) (SU13 p286) (R p189)Lymph drainage (FA12 p222) (FA13 p192) (SU13 p286) (COA p44)Innate vs. adaptive immunity (FA12 p223 ) (FA13 p193) (R p184)

T lymphocytes (FA12 p375) (FA13 p347) (SU13 p288-289) (R p186)

IMMUNOLOGYBASICS

ENDOFSESSIONQUIZ4. To which lymph nodes do the sigmoid colon and the rectum drain?

(FA12 p222) (FA13 p192)

5. Where can B cells and T cells be found in the lymph nodes? (FA12 p222) (FA13 p192)

6. Which MHC are found in T helper cells? Which MHC are found on cytotoxic Tcells? (FA12 p226) (FA13 p196) (SU13 p288)

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R: Chapter 6

MHC 1 and 11 (FA12 p224) (FA13 p194) (SU13 p288) (R p190)HLA subtypes (FA12 p224) (FA13 p194) (R p193)Dendritic cells (FA12 p374) (FA13 p346) (R p187)Langerhans cell histiocytosis (FA12 p394) (FA13 p266) (R p631)

ANTIGENPRESENTATION

ANTIGENPRESENTATION

3 QUESTIONWARM-UP1. A 48-year-old woman has been suffering with progressive lethargy and extreme

sensitivity to cold temperatures. What is the most likely diagnosis?

2. What is the most common salivary gland tumor?

3. What are the different sinuses that can become infected and cause sinusitis?

4. Dendritic Cells (FA12 p374) (FA13 p346)

Covered with long membranous extensions that resemble the dendrites of nerve cells

All display both class I and II MHC, B7 family of co-stimulatory molecules, CD80 and CD86

All also have CD40 which can inuence T cells by way of interaction with a complementaryligand

Purpose: antigen capture at one location and presentation at another location. This isaccomplished by migration to lymph nodes for presentation at T cells

When acting as peripheral sentinels (immature or antigen-capturing state), antigens are

captured by 3 different mechanisms:

- Phagocytosis

- Receptor mediated endocytosis

- Pinocytosis

Immature sentinels make a transition into a new type of cell (antigen-presenting state) that

can travel into circulation and into a cell that has maximal capacity to present to Th cells(increased expression of class II MHC and co-stimulatory molecules)

Different types:

- Langerhans (from immature epithelial tissue): in epidermal layers of skin (= Cutaneous-

associated lymphoid tissue, CALT)- Interstitial (from immature nonepithelial, interstitial tissue): in interstitial spaces ofvirtually all organs (except brain)

- Monocyte-derived (from monocytes (which also give rise to macrophages)): migratedfrom bloodstream into tissuesmigrate from tissues to blood and lymph and lymphnodes

- Plasmacytoid derived (from plasmacytoid): APCs in the innate immune response

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5. Follicular Dendritic Cells

Do not arise from bone marrow like the dendritic cells

Do not express class II MHCdo not present antigen to Th cells

Exclusively reside in lymph follicles

Important in the maturation and diversication of B cells

ANTIGENPRESENTATION

ENDOFSESSIONQUIZ

6. What characteristic nding would you see on electron microscopy of a dendritic

cell with Langerhans cell histiocytosis? (FA12 p394) (FA13 p366)

7. What molecules are expressed on the surface of antigen presenting dendriticcells? (FA12 p374) (FA13 p366)

8. What are 3 cell types that are known for presenting antigens to T cells?(FA12 p226) (FA13 p196)

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R: Chapter 6H: Chapter 314

T cell differentiation (FA12 p225) (FA13 p195) (SU13 p289) (R p195)Helper T cells (FA12 p226 ) (FA13 p196) (R p186)Thymus (FA12 p223) (FA13 p193) (SU13 p286) (R p635)T cel l activation (FA12 p226) (FA13 p196) (R p195)

Cytotoxic T cells (FA12 p227) (FA13 p197) (SU13 p288-289) (R p207)Regulatory T cells (FA12 p227) (FA13 p197)NK cells (FA12 p224) (FA13 p194) (R p188)

T CELLSTCELLS

3 QUESTIONWARM-UP

1. What are the various clinical uses for the following sympathomimetics?(FA12 p266-267) (FA13 p235)

Dopamine

Clonidine

Amphetamine

Terbutaline

Epinephrine

2. Where can you nd nicotinic acetylcholine receptors in the body?

(FA12 p262) (FA13 p230) (Phys p733) (GG p255-258)

3. What structures are derived from the branchial pouches? (FA12 p137) (FA13 p511)

ENDOFSESSIONQUIZ4. Which cytokines are produced by Th1cells? Which cytokines are produced by

Th2cells? (FA12 p226) (FA13 p196)

5. Which cytokines inhibit Th1cells? Which inhibit Th2cells? (FA12 p226) (FA13 p196)

6. How do cytotoxic T cells kill virus-infected cells and neoplastic cells?(FA12 p227) (FA13 p197)

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ENDOFSESSIONQUIZ5. Which cytokine more than any other should be known as the macrophage-

activating cytokine?(FA12 p373) (FA13 p345) (SU13 p285)

6. What are the acute phase cytokines that are produced by macrophages?(FA12 p231) (FA13 p200) (SU13 p292)

7. What is the function of macrophages in the spleen?(FA12 p223) (FA13 p193)

8. What name is given to RBCs partially digested by splenic macrophages?(FA12 p378-379) (FA13 p350-351)

MONOCYTESANDMACROPHAGES

4

study guide chap 1-5 dit 2013

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