Topic Educational Objective System Subject Repe

11
ats
Poststreptococc PSGN presents most commonly in childrenwith hematuria, HTN, and Renal, Pathology 8 RE
al periorbital oedema. RBC casts and mild proteinuria may be present on UA, Urinary & (Path)
1 glomerulonephr and serum creatinine may be ↑. Electrolyte
itis s (RE)

Anaphylaxis Anaphylaxis is the result of widespread mast cell and basophil Allergy & Immunology 3 AI
degranulation and the release of preformed inflammatory mediators, Immunolo (Immu)
2068 including histamine and tryptase. Tryptase is relatively specific to mast gy (AI)
cells and can be used as a marker for mast cell activation.

Anaphylaxis The high-affinity lgE receptor (FcERI) is found on the surface of mast Allergy & Immunology 3 AI
cells and basophils and normally binds the Fe portion of circulating Immunolo (Immu)
lgE antibodies. Cross-linking of multiple membrane-bound lgE antibodies gy (AI)
2069 by a multivalent antigen results in aggregation of the FcERI receptors,
causing degranulation and the release of preformed mediators (eg,
histamine, tryptase) that initiate an allergic respo nse.

Calcineurin Calcineurin is an essential protein in the activation of interleukin-2, Allergy & Immunology 1 AI
inhibitors which promotes the growth and differentiation of T cells. Immunolo (Immu)
1155
Immunosuppressants such as cyclosporine and tacrolimus work by gy (AI)
inhibiting calcineurin activation.
Cell mediated The process of negative selection in T cell maturation is essential for Allergy & Immunology 5 AI
immunity eliminating T cells that bind to self MHC or self antigens with overly high Immunolo (Immu)
affinity. This process occurs in the thymic medulla. If these cells were gy (AI)
558
permitted to survive, they would likely induce immune and inflammatory
reactions against self antigens leading to autoimmune disease .

Cell mediated NK cells recognize and kill cells with decreased MHC class I antigen Allergy & Immunology 5 AI
immunity cell surface expression, such as virus-infected cells and tumor cells. Immunolo (Immu)
745 They are large lymphocytes that contain perforins and granzymes in gy (AI)
cytoplasmic granules. NK cells kill target cells by inducing apoptosis.

Cell mediated Eosinophils play a role in host defense during multicellular parasitic Allergy & Immunology 5 AI
immunity infection. When stimulated by antibodies bound to a parasitic organism, Immunolo (Immu)
they destroy the parasite via antibody-dependent cell-mediated gy (AI)
750
cytotoxicity with enzymes from their cytoplasmic granules . Another
function of eosinophils is regulation of type I hypersensitivity reactions.

Cell mediated IL-12 stimulates the differentiation of naive Th0 cells into Th1 cells. Allergy & Immunology 5 AI
immunity Patients with IL-12 receptor deficiency are susceptible to severe Immunolo (Immu)
762 mycobacterial infections due to the inability to mount a strong cell- gy (AI)
mediated granulomatous immune response; therefore, they require
treatment with IFN-γ, (TNF-a, IL2).
Chediak- Chediak-Higashi syndrome is an autosomal recessive disorder affecting Allergy & Immunology 1 AI
Higashi vesicle fusion and lysosome transport that results in neurologic Immunolo (Immu)
1132 syndrome abnormalities, partial albinism, and immunodeficiency caused by gy (AI)
defective neutrophil and natural killer cell function.

Cytokines lnterteukin-2 (IL-2) is produced by helper T cells and stimulates the growth Allergy & Immunology 1 AI
of CD4+ and CD8+ T cells and B cells. IL-2 also activates natural killer Immunolo (Immu)
cells and monocytes. The increased activity of T cells and natural gy (AI)
8530
killer cells is thought to be responsible for IL-2's anti-cancer effect on
metastatic melanoma and renal cell carcinoma.

Humoral The primary immune response to a new antigen initially results in plasma Allergy & Immunology 1 AI
immunity cells that only produce IgM. Isotype switching later occurs in the germinal Immunolo (Immu)
centers of lymph nodes and requires interaction of the CD40 receptor on В- gy (AI)
1614
cells with the CD40 ligand (CD154) expressed by activated T-cells. IgG is
the main serum immunoglobulin of the secondary response.

Hyper-IgM Hyperimmunoglobulin M (hyper-IgM) syndrome results from defective Allergy & Immunology 1 AI
syndrome immunoglobulin class switching due to a defect in CD40 ligand-CD40 Immunolo (Immu)
interaction. Absence of the CD40 ligand is the most common cause and is gy (AI)
541
inherited in an X-linked recessive pattern. Clinical features include
recurrent sinopulmonary, gastrointestinal, and opportunistic
infections.
Hypersensitivit Wheal-and-flare lesions usually result from allergic (type I Allergy & Immunology 4 AI
y reactions hypersensitivity) reactions. On initial exposure, an allergen (eg, insect Immunolo (Immu)
venom) promotes antibody class switching to lgE. Subsequent exposure gy (AI)
556
promotes cross-linking of lgE on basophils and mast cells, resulting in
degranulation and release of multiple vasoactive mediators, including
histamine.
 Hypersensitivit The candidal antigen skin test assesses the activity of T cell-mediated Allergy & Immunology 4 AI
y reactions immunity through the recruitment of macrophages and CD4+ and CD8+ Immunolo (Immu)
2079 T lymphocytes in a type IV hypersensitivity reaction. Anergy, or failure to gy (AI)
respond to Candida antigen testing, is typical in patients with severe
combined immunodeficiency.
Immunizations The Haemophilus influenzae serotype b vaccine consists of a capsular Allergy & Immunology 4 AI
polysaccharide conjugated to a carrier protein (tetanus toxoid [TT] Immunolo (Immu)
protein or outer membrane protein [OMP] of Neisseria meningitidis). gy (AI)
965
Protein conjugation causes a T cell-mediated immune response leading
to long-term immunity through production of memory B-
lymphocytes.
Immunizations Pneumococcal conjugate vaccines are strongly immunogenic in Allergy & Immunology 4 AI
infancy due to both B and T cell recruitment. They provide higher, Immunolo (Immu)
longer-lasting antibody titers relative to pneumococcal polysaccharide gy (AI)
####
vaccines. The pneumococcal polysaccharide vaccine is poorly
immunogenic in infants due to their relatively immature humoral antibody
response.
Immunoglobuli The carboxy terminal of the Fc portion of the heavy immunoglobulin Allergy & Immunology 2 AI
ns chains represents the site that binds to the Fc receptors on neutrophils Immunolo (Immu)
and macrophages. Antibody bound to antigen is able to signal for the gy (AI)
phagocytosis of that antigen by a conformational change of the Fc region
539
allowing binding to the Fe receptor on phagocytes. This leads to
subsequent phagocytosis of the organism / antibody complex and
subsequent destruction of the organism.

Immunoglobuli The classical complement cascade begins with binding of the C1 Allergy & Immunology 2 AI
ns complement component to either two molecules of IgG or to two molecules Immunolo (Immu)
of IgM. Because IgM circulates in pentameric form, it is a much better gy (AI)
540
activator of the complement system. The C1 molecule binds to the Fc
region of the heavy immunoglobulin chain in the region near the hinge
point.
Inflammation Interleukin-8 is a chemokine produced by macrophages that induces Allergy & Immunology 3 AI
chemotaxis and phagocytosis in neutrophils (make pus). Other Immunolo (Immu)
8539 significant chemotactic agents include leukotriene B4, 5-HETE (the gy (AI)
leukotriene precursor), and complement component C5a.
 Influenza Interferons a and B are produced by most human cells in response to viral Allergy & Immunology 5 AI
infections. The production of a and B interferons helps suppress viral Immunolo (Immu)
1468 replication by halting protein synthesis and promoting apoptosis of gy (AI)
infected cells, limiting the ability of viruses to spread through the tissues.

Latex allergy
IL-4 is produced by the TH2 subset of T helper cells. It facilitates Allergy & Immunology 1 AI
proliferation of 8 cells and TH2 lymphocytes and stimulates antibody Immunolo (Immu)
759
isotype switching to lgE which mediates type I hypersensitivity (allergic) gy (AI)
reactions.
Pharyngitis Opsonization occurs when host proteins such as immunoglobulins or Allergy & Immunology 2 AI
complement bind to foreign cells such as bacteria and coat the surface, Immunolo (Immu)
####
enhancing phagocytosis. The most important opsonins (coating proteins) gy (AI)
are immunoglobulin G and complement C3b.
Primary Chronic granulomatous disease is an X-linked disorder resulting from Allergy & Immunology 7 AI
immunodeficie deficiency of NADPH oxidase, the enzyme responsible for formation of Immunolo (Immu)
ncy disorder reactive oxygen species in phagosomes. Neutrophils affected by this gy (AI)
557
disorder are unable to kill catalase-producing organisms, resulting in
recurrent bacterial and fungal infections that frequently involve the lungs,
skin, and lymph nodes.
Primary Chronic granulomatous disease (CGD) occurs most commonly due to an X- Allergy & Immunology 7 AI
immunodeficie linked mutation affecting NADPH oxidase. Deficiency of this enzyme Immunolo (Immu)
ncy disorder leads to an inability of neutrophils to form the oxidative burst necessary to gy (AI)
571 kill organisms in their phagolysosomes. CGD can be diagnosed by
absence of fluorescent green pigment on dihydrorhodamine flow
cytometry testing or an abnormal nitroblue tetrazolium test.

Primary Severe combined immunodeficiency is caused by a genetic defect in T Allergy & Immunology 7 AI
immunodeficie cell development, leading to loss of both cellular and humeral immunity. Immunolo (Immu)
2078 ncy disorder Patients present in infancy with recurrent bacterial, viral, fungal, and gy (AI)
opportunistic infections as well as failure to thrive and chronic
diarrhea.
Primary Inherited defects involving the interferon-y signaling pathway result in Allergy & Immunology 7 AI
immunodeficie disseminated mycobacterial disease in infancy or early childhood. Immunolo (Immu)
8384
ncy disorder Patients require lifelong treatment with antimycobacterial agents. gy (AI)

Reactive The classic triad of reactive arthritis is nongonococcal urethritis, Allergy & Immunology 2 AI
arthritis conjunctivitis, and arthritis. It is an HLA-B27-associated arthropathy that Immunolo (Immu)
occurs within several weeks following a genitourinary or enteric infection. gy (AI)
743
It belongs to the group of seronegative spondyloarthropathies (including
ankylosing spondylitis) and can cause sacroiliitis in about 20% of cases.

Severe The second most common cause of severe combined immunodeficiency is Allergy & Immunology 3 AI
combined autosomal recessive deficiency of adenosine deaminase, an enzyme Immunolo (Immu)
immunodeficie necessary for the elimination of excess adenosine within cells. Toxic levels gy (AI)
ncy disease of adenosine accumulate within lymphocytes in this condition, leading to
561
lymphocyte cell death and resultant cellular and humoral
immunodeficiency. Patients with this condition can be treated with
hematopoietic cell transplantation or gene therapy.

Severe Severe combined immune deficiency is characterized by combined T and Allergy & Immunology 3 AI
combined В cell dysfunction. It is a life-threatening condition that presents in infancy Immunolo (Immu)
immunodeficie with severe bacterial and viral infections; mucocutaneous candidiasis; gy (AI)
1995 ncy disease persistent diarrhea; and failure to thrive. Laboratory findings include
absent T cells and hypogammaglobulinemia. The thymic shadow is not
usually present due to severe T cell deficiency.

Severe Adenosine deaminase (ADA)( converts adenosine to inosine) Allergy & Immunology 3 AI
combined inhibition/absence is highly lymphocytotoxic. Medications that block Immunolo (Immu)
#### immunodeficie ADA are used to treat lymphocyte-derived cancers (like Hairy cell gy (AI)
ncy disease leukemia). Inherited gene mutations in ADA lead to the autosomal
recessive disease of severe combined immunodeficiency.
Transplant Hyperacute rejection is caused by preformed antibodies in the recipient Allergy & Immunology 4 AI
rejection that recognize and attack donor antigens (ie, type II hypersensitivity). Immunolo (Immu)
These are often anti-ABO blood group or anti-HLA antibodies. gy (AI)
569 Vascular injury and capillary thrombotic occlusion lead to rapid ischemic
necrosis of the renal graft, often evidenced by gross cyanosis and
mottling immediately following graft perfusion.

Thermal burn The earliest morphologic change that occurs after a superficial thermal Allergy & Immunology
burn is erythema due to the release of preformed mediators (eg, Immunolo (Immu)
#### histamine) from mast cells. Deeper (eg, partial-thickness) burn wounds gy (AI)
form blisters due to fluid extravasation through gaps between damaged
venule endothelial cells.
 Hereditary Hereditary angioedema is characterized by recurrent episodes of cutaneous Allergy & Immunology
angioedema and/or mucosal swelling due to C1 inhibitor deficiency. C4 levels are low Immunolo (Immu)
####
due to uninhibited cleavage of C4 by excess activated C1. gy (AI)

Asplenia The spleen acts as both a blood filter capable of removing circulating Allergy & Microbiolog 2 AI
pathogens and as a major site of opsonizing antibody synthesis (Systemic Immunolo y (Micr)
bacterial clearance). Asplenic patients are prone to infections caused by gy (AI)
732
encapsulated organisms such as Streptococcus pneumoniae, Haemophilus
influenzae, and Neisseria meningitidis.

Diphtheria The 1° Tx for diphtheria is diphtheria antitoxin (passive immunization), Allergy & Microbiolog 6 AI
which inactivates circulating toxin. Abx should also be administered to ↓ Immunolo y (Micr)
1388
continued production of toxin. gy (AI)

Syphilis The Jarisch-Herxheimer reaction is an acute inflammatory reaction that Allergy & Microbiolog 9 AI
occurs within hours of treatment for spirochetal (eg, syphilis) infections. Immunolo y (Micr)
7581 The rapid lysis of spirochetes releases inflammatory bacterial lipoproteins gy (AI)
into the circulation and causes acute fevers, rigors, and myalgias.

Tuberculosis Interferon-gamma (IFN-y) release assays test for latent tuberculosis Allergy & Microbiolog 18 AI
infection by measuring the amount of IFN-y released by T lymphocytes Immunolo y (Micr)
####
when exposed to antigens unique to Mycobacterium tuberculosis. gy (AI)

Angioedema C1INH defic causes ↑ cleavage of C2 and C4 and results in inappropriate Allergy & Pathology 2 AI
activation of the complement cascade. C1INH also blocks kallikrein- Immunolo (Path)
####
induced conversion of kininogen to bradykinin, a potent vasodilator a/w gy (AI)
angioedema.
Granulomatosis The histopath features of oesophageal SCC incl solid nests of neoplastic Allergy & Pathology 2 AI
with squamous cellswith abundant eosinophilic cytoplasm and distinct borders. Immunolo (Path)
459 polyangiitis Areas of keratinisation and the presence of intercellular bridges are also gy (AI)
char. patients typically presentwith progr solid and eventually liquid
dysphagia and weight loss.
Lymphadenopa Germinal centers are the sites where activated В cells proliferate and Allergy & Pathology AI
thy undergo affinity maturation during generation of a humoral immune Immunolo (Path)
response. The formation of multiple germinal centers is typically gy (AI)
####
marked by lymphadenopathy, pain, and inflammation in the affected
lymph node due to cellular recruitment and the release of inflammatory
cytokines.
Henoch- Henoch-Schonlein purpura, or IgA vasculitis, classically presents with Allergy & Pathology 3 AI
Schonlein palpable purpura, with or without abdominal pain, arthralgias, and renal Immunolo (Path)
purpura involvement. Histopathologic examination of the skin lesions reveals gy (AI)
damaged small vessels with fibrinoid necrosis, perivascular neutrophilic
458
inflammation, and nuclear debris (ie, leukocytoclastic vasculitis).
Immunofluorescence reveals deposition of IgA and C3. (Small vessels
damaged by perivascular neutrophil accumulation)

SLE Antinuclear antibodies are found in almost all patients with systemic lupus Allergy & Pathophysiol 7 AI
erythematosus but are also found in many other autoimmune disorders and Immunolo ogy (Patp)
761 have low specificity. Anti-double-stranded DNA antibodies and anti- gy (AI)
Smith antibodies have lower sensitivity but higher specificity.

Azathioprine Azathioprine is an immunosuppression drug that inhibits purine Allergy & Pharmacolog AI
nucleotide synthesis and incorporates false purine nucleotides into DNA Immunolo y (Phar)
####
and RNA. These effects reduce the proliferation and activity of both В gy (AI)
and T lymphocytes.
Anaphylaxis Anaphylactic shock is characterized by vasodilatation, increased vascular Allergy & Pharmacolog 3 AI
permeability, and bronchoconstriction. Epinephrine counteracts these Immunolo y (Phar)
1366
physiological mechanisms and is the drug of choice for the treatment of gy (AI)
anaphylaxis.
Angioedema Angioedema can be hereditary (autosomal dominant) or acquired Allergy & Pharmacolog 2 AI
(associated with angiotensin-converting enzyme [ACE] inhibitor Immunolo y (Phar)
1612 treatment). In hereditary angioedema, low C1 esterase inhibitor activity gy (AI)
leads to increases in bradykinin activity. ACE inhibitors (Captopril)
should not be used in these patients.
Antihistamines First-generation antihistamines (Loratadine) can cause significant side Allergy & Pharmacolog 3 AI
effects due to blockade of cholinergic, alpha-adrenergic, and serotonergic Immunolo y (Phar)
174
pathways. They should be avoided in older patients with cognitive or gy (AI)
functional impairments.
 Opioids Opioids (eg, morphine) can generate a pseudoallergic response by Allergy & Pharmacolog AI
directly activating mast cells to stimulate degranulation, releasing Immunolo y (Phar)
histamine and other vasoactive mediators. This nonimmunologic gy (AI)
#### reaction can cause itching, urticarial rash, wheezing, hypotension, and
tachycardia that closely mimic true IgE-mediated type 1 hypersensitivity.
However, true IgE-mediated allergic reaction is rare with opioids.

Accuracy and A precise tool is one that consistently provides very similar or the same Biostatisti Biostatistics 1 BS
precision value when measuring a fixed quantity. An accurate tool is one that cs & (Bios)
provides a measurement identical or similar to the actual value (as reflected EpInfectio
1765 in a gold standard measurement). us
Diseases
(ID)emiol
ogy (BS)
Attack rate The attack rate is the ratio of the number of people who contract an illness Biostatisti Biostatistics 1 BS
divided by the number of people who are at risk of contracting that illness. cs & (Bios)
EpInfectio
#### us
Diseases
(ID)emiol
ogy (BS)
Bias Lead-time bias occurs when a new test Dx a condition earlier than Biostatisti Biostatistics 4 BS
conventional studies, causing an apparent ↑ in survival time despite no cs & (Bios)
improvement in overall mortality. Long-term mortality rates, not survival EpInfectio
1170 times, should be considered for measuring the effect of early screening and us
Tx. Diseases
(ID)emiol
ogy (BS)
Bias Recall bias results from study participants' inaccurate recall of past Biostatisti Biostatistics 4 BS
exposure and occurs most often in retrospective studies such as case- cs & (Bios)
control studies. People who have experienced an adverse event are more EpInfectio
1273 likely to recall RFx than those who have not experienced an adverse event. us
Diseases
(ID)emiol
ogy (BS)
Bias Observer bias occurs when the investigator's evaluation is affected by Biostatisti Biostatistics 4 BS
preconceived expectations or prior knowledge, typically leading to cs & (Bios)
overestimation of the disease association or Tx effects. This type of bias EpInfectio
1275 can be ↓ by conducting a blinded study in which observers are unaware of us
study details and pt Chx that could unduly influence them. Diseases
(ID)emiol
ogy (BS)
Central An outlier is defined as an extreme and unusual observed value in a Biostatisti Biostatistics 2 BS
tendency dataset. It can affect measures of central tendency (mean, median, mode) as cs & (Bios)
(mean, median, well as measures of dispersion (SD, variance). Modes tend to be resistant EpInfectio
1183 mode, outliers) to outliers. us
Diseases
(ID)emiol
ogy (BS)
Central The median is the value that is located in the precise center of an ordered Biostatisti Biostatistics 2 BS
tendency dataset. It separates the right half of the data from the left half. cs & (Bios)
(mean, median, EpInfectio
1281 mode, outliers) us
Diseases
(ID)emiol
ogy (BS)
Confounding, Confounding occurs when the exposure-disease relationship is muddled by Biostatisti Biostatistics 3 BS
effect the effect of an extraneous factor a/w both exposure and disease. cs & (Bios)
modification, Confounding bias can result in the false association of an exposurewith a EpInfectio
1173 bias, errors disease. us
Diseases
(ID)emiol
ogy (BS)
Confounding, In prospective studies, disproportionate loss to f/u b/w the exposed and Biostatisti Biostatistics 3 BS
effect unexposed groups creates the potential for attrition bias, which is a form of cs & (Bios)
modification, selection bias. As a result, investigators generally try to achieve high pt f/u EpInfectio
1188 bias, errors rates in prospective studies. us
Diseases
(ID)emiol
ogy (BS)
 Confounding, Effect modification is present when the effect of the main exposure on the Biostatisti Biostatistics 3 BS
effect outcome is modified by the presence of another variable. Effect cs & (Bios)
modification, modification is not a bias. EpInfectio
1279 bias, errors us
Diseases
(ID)emiol
ogy (BS)
Correlation The correlation coefficient (r) ranges from -1 to +1 and describes the Biostatisti Biostatistics 1 BS
coefficient strength and polarity of a linear association. cs & (Bios)
EpInfectio
1210 us
Diseases
(ID)emiol
ogy (BS)
Hawthorne The Hawthorne effect (observer effect) is the tendency of study subjects to Biostatisti Biostatistics 1 BS
effect change their behavior as a result of their awareness that they are being cs & (Bios)
studied. EpInfectio
1302 us
Diseases
(ID)emiol
ogy (BS)
Matching Matching is used in case-control studies in order to control confounding. Biostatisti Biostatistics 1 BS
Matching variables should always be the potential confounders of the study cs & (Bios)
(eg, age, race). Cases and controls are then selected based on the matching EpInfectio
1189 variables so that both groups have a similar distribution in accordancewith us
the variables. Diseases
(ID)emiol
ogy (BS)
Meta analysis A meta-analysis groups results of several trials to ↑ statistical power and Biostatisti Biostatistics 1 BS
provide an overall pooled effect estimate. cs & (Bios)
EpInfectio
#### us
Diseases
(ID)emiol
ogy (BS)
Morbidity and Case-fatality rate is calculated by dividing the number of fatal cases of a Biostatisti Biostatistics 1 BS
mortality rates disease or condition by the total number of peoplewith that disease or cs & (Bios)
condition. EpInfectio
1208 us
Diseases
(ID)emiol
ogy (BS)
Normal In a normal (bell-shaped) distribution curve, 68% of observations liewithi 1 Biostatisti Biostatistics 3 BS
distribution SD of the mean, 95% of observations liewithi 2 SDs of the mean, and cs & (Bios)
99.7% of observations liewithi 3 SDs of the mean. EpInfectio
1172 us
Diseases
(ID)emiol
ogy (BS)
Normal In a normal (bell-shaped) distribution: 68% of all values arewithi 1 SD Biostatisti Biostatistics 3 BS
distribution from the mean; 95% of all values arewithi 2 SDs from the mean; 99.7% of cs & (Bios)
all values arewithi 3 SDs from the mean. EpInfectio
1201 us
Diseases
(ID)emiol
ogy (BS)
Normal In general, in a (+)ly skewed distribution, the mean is the most shifted in Biostatisti Biostatistics 3 BS
distribution the (+) direction (to the right), followed by the median and then the mode. cs & (Bios)
In such a situation, the median often reflects a central tendency better than EpInfectio
1282 the mean does. us
Diseases
(ID)emiol
ogy (BS)
Number The NNT is the number of patients that need to be Txwith a Rx to avoid an Biostatisti Biostatistics 2 BS
needed to treat additional (-) outcome. NNT is calculated by dividing 1 by the ARR (the cs & (Bios)
difference b/w the control and experimental group event rates). Lower EpInfectio
1174 NNT values represent more beneficial Tx. us
Diseases
(ID)emiol
ogy (BS)
 Number The NNH represents the number of people who must be Tx before 1 Biostatisti Biostatistics 2 BS
needed to treat additional adverse event occurs. In order to calculate NNH, the absolute cs & (Bios)
risk ↑ b/w the Tx and control groups must be known: NNH = 1 / Absolute EpInfectio
1231 risk ↑. us
Diseases
(ID)emiol
ogy (BS)
Odds ratio The odds ratio (OR) is a measure of the strength of an association between Biostatisti Biostatistics 2 BS
an exposure and an outcome. Specifically, it represents the odds that an cs & (Bios)
outcome occurred in the presence of a particular exposure compared with EpInfectio
1205 the odds that the outcome occurred in the absence of that exposure. In a us
standard contingency table, OR = ad/bc. Diseases
(ID)emiol
ogy (BS)
Odds ratio A case-control study is used to compare the exposure status of peoplewith Biostatisti Biostatistics 2 BS
the disease (ie, cases) to the exposure status of peoplewitho the disease (ie, cs & (Bios)
controls). The main measure of association is the OR. EpInfectio
1277 us
Diseases
(ID)emiol
ogy (BS)
Power and The power of a study indicates the probability of seeing a difference when Biostatisti Biostatistics 3 BS
sample size there is one. The formula is Power = 1- β, where β is the type II error rate. cs & (Bios)
EpInfectio
1204 us
Diseases
(ID)emiol
ogy (BS)
Power and Power (1 - β) is the probability of rejecting a null hypothesis when it is Biostatisti Biostatistics 3 BS
sample size truly false. It is typically set at 80% and depends on sample size and cs & (Bios)
difference b/w outcomes. EpInfectio
1272 us
Diseases
(ID)emiol
ogy (BS)
Power and A study's power ↑ as its sample size ↑. Therefore, the larger the sample, the Biostatisti Biostatistics 3 BS
sample size greater the ability of a study to detect a difference when one truly exists. cs & (Bios)
EpInfectio
1303 us
Diseases
(ID)emiol
ogy (BS)
Predictive Negative predictive value (NPV) represents the probability of not having a Biostatisti Biostatistics 3 BS
values disease given a negative test result. NPV is inversely proportional to the cs & (Bios)
prevalence of a disease. When a patient has characteristics similar to the EpInfectio
1233 overall population (eg, age, sex, risk factor status), the disease prevalence us
is a valid estimate of the pretest probability of disease. Diseases
(ID)emiol
ogy (BS)
Predictive Various parameters are used to evaluate the accuracy and usefulness of Dx Biostatisti Biostatistics 3 BS
values tests. PPVs and NPVs are influenced by disease prevalence in the target cs & (Bios)
population; sensitivity, specificity, and likelihood ratios are not prevalence- EpInfectio
1271 dependent. us
Diseases
(ID)emiol
ogy (BS)
Prevalence and The cumulative incidence of a disease is the number of new cases of a Biostatisti Biostatistics 3 BS
incidence disease over a specific period divided by the total population at risk at the cs & (Bios)
beginning of the study (ie, the proportion of at-risk individuals who EpInfectio
1270 contract the disease over the specified period). us
Diseases
(ID)emiol
ogy (BS)
Prevalence and Unlike period prevalence, point prevalence considers only the number of Biostatisti Biostatistics 3 BS
incidence disease cases that are active at a specific point in time. cs & (Bios)
EpInfectio
#### us
Diseases
(ID)emiol
ogy (BS)
 Primary Health promotion, according to the WHO, is "the process of enabling Biostatisti Biostatistics 14 BS
hypertension people to ↑ control over their health and its determinants, and thereby cs & (Bios)
improve their health." EpInfectio
#### us
Diseases
(ID)emiol
ogy (BS)
Probability If events are independent, the probability that all events will turn out the Biostatisti Biostatistics 2 BS
theory same is the product of the separate probabilities for each event. The cs & (Bios)
probability of at least 1 event turning out differently is given as 1 - P(all EpInfectio
1284 events being the same). us
Diseases
(ID)emiol
ogy (BS)
Probability The multiplication law of probability states that the probability of 2 or more Biostatisti Biostatistics 2 BS
theory independent events occurring together can be calculated by multiplying the cs & (Bios)
individual probabilities of each event. The multiplication law of probability EpInfectio
#### can be extended to complementary events (1 - probability of event) in the us
same manner. Diseases
(ID)emiol
ogy (BS)
P-value and A result is considered statistically significant if the 95% CI does not cross Biostatisti Biostatistics 2 BS
confidence the null value, which corresponds to a p-value <0.05. cs & (Bios)
interval EpInfectio
1274 us
Diseases
(ID)emiol
ogy (BS)
P-value and The SD reflects the spread of individual values in a normal distribution (ie, Biostatisti Biostatistics 2 BS
confidence it measures the variability of the observationswithi a single sample). The cs & (Bios)
interval standard error of the mean reflects the variability of means (ie, variance EpInfectio
1299 b/w the means of different samples) and helps estimate the true mean of the us
underlying population. Diseases
(ID)emiol
ogy (BS)
Quantitative The cutoff value of a quantitative Dx test determines whether a given result Biostatisti Biostatistics 1 BS
diagnostic tests is interpreted as (+) or (-). Lowering the cutoff point typically causes more cs & (Bios)
ptswith the disease to test (+), ↓ the number of FNs and ↑ test sensitivity. EpInfectio
1191 Consequently, more ptswitho the disease will also test (+), resulting in an ↑ us
number of FPs and ↓ specificity. Diseases
(ID)emiol
ogy (BS)
Risk ARR = event rate in the control group - event rate in the Tx group. Biostatisti Biostatistics 6 BS
cs & (Bios)
EpInfectio
1175 us
Diseases
(ID)emiol
ogy (BS)
Risk RRR = (absolute risk [control] - absolute risk [Tx]) / absolute risk [control]. Biostatisti Biostatistics 6 BS
cs & (Bios)
EpInfectio
1176 us
Diseases
(ID)emiol
ogy (BS)
Risk Risk is the probability of developing a disease over a certain period of time. Biostatisti Biostatistics 6 BS
To calculate this probability, divide the number of affected subjects by the cs & (Bios)
total number of subjects in the corresponding exposure group. EpInfectio
1185 us
Diseases
(ID)emiol
ogy (BS)
Risk The attributable risk percent (ARP) in the exposed represents the excess Biostatisti Biostatistics 6 BS
risk in the exposed population that can be attributed to the risk factor. It cs & (Bios)
can be easily derived from the relative risk (RR) using the formula: ARP EpInfectio
1186 exposed = 100 [(RR - 1)/RR). us
Diseases
(ID)emiol
ogy (BS)
 Risk The RR represents the risk of an outcome in the exposed divided by the Biostatisti Biostatistics 6 BS
risk of that outcome in the unexposed. Applying the correct formula for RR cs & (Bios)
calculations depends on the proper formatting of a 2x2 (contingency) table. EpInfectio
1207 us
Diseases
(ID)emiol
ogy (BS)
Risk The concept of accumulation effect can be applied to disease pathogenesis Biostatisti Biostatistics 6 BS
and exposure to risk modifiers. Cumulative exposure to a RFx or risk cs & (Bios)
reducer must sometimes occur for prolonged periods before a clinically EpInfectio
1280 significant effect is detected. us
Diseases
(ID)emiol
ogy (BS)
Risk, rate, Incident cases represent new cases Dx in a given period of time. Prevalent Biostatisti Biostatistics 3 BS
prevalence, and cases are the total number of cases (both old and new) at a particular point cs & (Bios)
incidence in time. Any Tx that prolongs survival but does not cure the disease will ↑ EpInfectio
1171 prevalence due to an ↑ in the number of afflicted (but still living) us
individuals over time. Diseases
(ID)emiol
ogy (BS)
Risk, rate, Prevalence equals the incidence rate multiplied by the average disease Biostatisti Biostatistics 3 BS
prevalence, and duration. Changing disease prevalence in a steady-state populationwith a cs & (Bios)
incidence constant incidence rate means that there is an additional factor affecting EpInfectio
1187 the duration of the condition. A factor that prolongs disease duration (eg, us
improved quality of care) will ↑ disease prevalence, as affected patients Diseases
survive longer. (ID)emiol
ogy (BS)
Risk, rate, Incidence corresponds to the number of new cases of a disease in a certain Biostatisti Biostatistics 3 BS
prevalence, and population at risk over a given time period. Prevalence is the total number cs & (Bios)
incidence of cases in the population over a given period. EpInfectio
#### us
Diseases
(ID)emiol
ogy (BS)
Sensitivity and Specificity is the number of TNs divided by the total number of subjects Biostatisti Biostatistics 4 BS
specificity confirmed as not having the disease. TNs = (Specificity) * (Number of cs & (Bios)
patients confirmedwitho the disease). FPs = (1 - Specificity) * (Number of EpInfectio
1230 patients confirmedwitho the disease). us
Diseases
(ID)emiol
ogy (BS)
Sensitivity and The degree of overlap b/w the healthy and the diseased population curves Biostatisti Biostatistics 4 BS
specificity limits the maximum combined sensitivity and specificity of a quantitative cs & (Bios)
Dx test. The degree to which sensitivity or specificity is affected depends EpInfectio
1285 on the chosen cutoff value. us
Diseases
(ID)emiol
ogy (BS)
Sensitivity and The sensitivity of a test refers to its ability to correctly identify thosewith Biostatisti Biostatistics 4 BS
specificity the disease. A highly sensitive test should always be considered over a cs & (Bios)
highly specific test when screening for life threatening diseases, where EpInfectio
1300 identification of every personwith the disease is important. us
Diseases
(ID)emiol
ogy (BS)
Sensitivity, Sensitivity = true positives / (true positives + false negatives). Screening Biostatisti Biostatistics 4 BS
specificity, tests should have high sensitivity. cs & (Bios)
positive EpInfectio
predictive us
1177
value PPV, Diseases
negative (ID)emiol
predictive ogy (BS)
value NPV
Sensitivity, The specificity of a test is its ability to correctly identify individualswitho Biostatisti Biostatistics 4 BS
specificity, the disease. Specificity should be high in confirmatory tests to ↓ FPs. cs & (Bios)
positive EpInfectio
predictive us
1178
value PPV, Diseases
negative (ID)emiol
predictive ogy (BS)
value NPV
 Sensitivity, The PPV of a test answers the question: If the test result is (+), what is the Biostatisti Biostatistics 4 BS
specificity, probability that a pt has the disease? PPV = TPs / (TPs + FPs). cs & (Bios)
positive EpInfectio
predictive us
1192
value PPV, Diseases
negative (ID)emiol
predictive ogy (BS)
value NPV
Sensitivity, PPV represents the probability of truly having a disease given a (+) test Biostatisti Biostatistics 4 BS
specificity, result. It ↑with ↑ disease prevalence and ↓with ↓ disease prevalence. cs & (Bios)
positive EpInfectio
predictive us
1232
value PPV, Diseases
negative (ID)emiol
predictive ogy (BS)
value NPV
Statistical tests A 2x2 table is normally used to record the presence or absence of exposure Biostatisti Biostatistics 2 BS
and disease in research. Rows and columns represent the different levels cs & (Bios)
for each categorical (ie, exposure and disease) variable. The chi-square test EpInfectio
1184 for independence is used to evaluate the association b/w 2 categorical us
variables. Diseases
(ID)emiol
ogy (BS)
Statistical tests A t-test is used to compare the difference b/w the means of 2 groups. Biostatisti Biostatistics 2 BS
ANOVA compares the difference b/w the means of 2 or more groups. cs & (Bios)
Results from a t-test and ANOVA test will be equivalent when comparing EpInfectio
8519 the difference b/w the means of 2 groups. us
Diseases
(ID)emiol
ogy (BS)
Study designs Selection of control subjects in case-control studies is intended to provide Biostatisti Biostatistics 6 BS
an accurate estimation of exposure frequency among the non-diseased cs & (Bios)
general population. Cases and controls should be selected based on disease EpInfectio
1202 status, not exposure status. us
Diseases
(ID)emiol
ogy (BS)
Study designs In a cross-sectional study, exposure and outcome are measured Biostatisti Biostatistics 6 BS
simultaneously at a particular point in time ("snapshot study"). In other cs & (Bios)
study designs, a certain time period separates the exposure from the EpInfectio
1276 outcome. us
Diseases
(ID)emiol
ogy (BS)
Study designs In a crossover study, subjects are randomly allocated to a sequence of 2 or Biostatisti Biostatistics 6 BS
more Tx given consecutively. A washout (no Tx) period is often added b/w cs & (Bios)
Tx intervals to limit the confounding effects of prior Tx. EpInfectio
8422 us
Diseases
(ID)emiol
ogy (BS)
Study designs The unit of analysis in ecological studies is populations rather than Biostatisti Biostatistics 6 BS
individuals. cs & (Bios)
EpInfectio
#### us
Diseases
(ID)emiol
ogy (BS)
Study designs A RCT is an experiment in which participants are randomly allocated to >2 Biostatisti Biostatistics 6 BS
groups to Ax the effect of specific interventions (eg, Tx). cs & (Bios)
EpInfectio
#### us
Diseases
(ID)emiol
ogy (BS)
Study designs A case-control study is an observational study design; it beginswith Biostatisti Biostatistics 6 BS
selecting individuals who have the outcome ("cases") and individuals who cs & (Bios)
do not have the outcome ("controls") and then retrospectively comparing EpInfectio
#### their Hx of exposure to RFx. us
Diseases
(ID)emiol
ogy (BS)
 Urinary tract The average (or mean) of a dataset of values is the sum of the values Biostatisti Biostatistics 12 BS
infection divided by the total number of values. cs & (Bios)
EpInfectio
1209 us
Diseases
(ID)emiol
ogy (BS)
Validity and A precise/reliable test is reproducible in that it gives similar results on Biostatisti Biostatistics 1 BS
reliability repeat measurements. Reliability is maximal when random error is cs & (Bios)
minimal. EpInfectio
1278 us
Diseases
(ID)emiol
ogy (BS)
Autosomal The Hardy-Weinberg equation can be used to estimate carrier frequency, Biostatisti Genetics 5 BS
recessive disease frequency, and frequency of different genotypes if at least 1 of cs & (Gene)
inheritance these values is known. EpInfectio
#### us
Diseases
(ID)emiol
ogy (BS)
Aortic The intimal tear in Stanford type A aortic dissection (involving the Cardiovas Anatomy 6 CV
dissection ascending aorta) usually originates in the sinotubular junction whereas the cular (CV) (Anat)
#### intimal flap in Stanford type В aortic dissection usually starts near the
origin of the left subclavian artery. Dissections can propagate distally to
the thoracoabdominal aorta.
Atrial Atrial fibrillation is associated with increased risk of systemic Cardiovas Anatomy 5 CV
#### fibrillation thromboembolism. The left atrial appendage is the most common site of cular (CV) (Anat)
thrombus formation
AV node The atrioventricular node is located on the endocardial surface of the right Cardiovas Anatomy 1 CV
#### atrium, near the insertion of the interatrial septal leaflet of the tricuspid cular (CV) (Anat)
valve and the orifice of the coronary sinus.
Blunt aortic Traumatic aortic rupture is most often caused by the rapid deceleration that Cardiovas Anatomy 1 CV
injury occurs in motor vehicle collisions. The most common site of injury is the cular (CV) (Anat)
2130 aortic isthmus, which is tethered by the ligamentum arteriosum and is
relatively fixed and immobile compared to the adjacent descending aorta.

Brachiocephali The brachiocephalic vein drains the ipsilateral jugular and subclavian Cardiovas Anatomy 1 CV
c vein veins. The bilateral brachiocephalic veins combine to form the superior cular (CV) (Anat)
obstruction vena cava (SVC) . Brachiocephalic vein obstruction causes symptoms
similar to those seen in SVC syndrome, but only on one side of the body.
1943 UW
- Swollen arm + swollen face on one side>> unilateral brachiocephalic vein
obs.
- Swollen arm + swollen face on both sides>> SVC obstruction.
- Swollen arm alone >> axillary or subclavian vein obs.
CABG The great saphenous vein is a superficial vein of the leg that originates on Cardiovas Anatomy 1 CV
the medial side of the foot, courses anterior to the medial malleolus, and cular (CV) (Anat)
then travels up the medial aspect of the leg and thigh. It drains into the
1967
femoral vein within the region of the femoral triangle, a few centimeters
inferolateral to the pubic tubercle

Cardiac The optimal site for obtaining vascular access in the lower extremity during Cardiovas Anatomy 2 CV
catheterization cardiac catheterization is the common femoral artery below the inguinal cular (CV) (Anat)
####
ligament. Cannulation above the inguinal ligament can significantly
increase the risk of retroperitoneal hemorrhage.
Cardiac To access the left side of the heart, cardiac venous catheters must cross Cardiovas Anatomy 2 CV
catheterization the interatrial septum at the site of the foramen ovale. Entry into the cular (CV) (Anat)
#### left atrium allows for direct measurement of left atrial pressure and for
access to arrhythmogenic foci on the left atrial myocardium or pulmonary
veins.
Central venous central line is placed to access The common cardinal veins of the Cardiovas Anatomy 2 CV
catheter developing embryo drain directly into the sinus venosus. These cardinal cular (CV) (Anat)
2023
veins ultimately give rise to the superior vena cava and other constituents
of the systemic venous circulation.
Central venous The femoral triangle (lateral to medial) consists of the femoral nerve, Cardiovas Anatomy 2 CV
catheter femoral artery femoral vein, and deep inguinal nodes/lymphatic vessels. cular (CV) (Anat)
#### Cannulation of the femoral vein should occur approximately 1 cm below
the inguinal ligament and just medial to the femoral artery pulsation.

Community On posteroanterior chest x-ray, the right middle lobe is seen adjacent to the Cardiovas Anatomy 21 CV
acquired right border of the heart, which is primarily formed by the right atrium. cular (CV) (Anat)
1883
pneumonia Consolidation in the right middle lobe can obscure the x-ray silhouette of
the right heart border.
 Coronary artery The inferior epigastric artery branches off the external iliac artery Cardiovas Anatomy 4 CV
disease immediately proximal to the inguinal ligament. It provides blood supply to cular (CV) (Anat)
####
the lower anterior abdominal wall as it runs superiorly and medially up the
abdomen.
Coronary blood The inferior wall of the left ventricle forms most of the inferior Cardiovas Anatomy 9 CV
flow (diaphragmatic) surface of the heart and is supplied by the posterior cular (CV) (Anat)
1871 descending artery. In 85%-90% of individuals, the posterior descending
artery derives from the right coronary artery (right dominant coronary
circulation).
Coronary blood Coronary dominance is determined by the coronary artery supplying the Cardiovas Anatomy 9 CV
flow posterior descending artery. The posterior descending artery originates cular (CV) (Anat)
from the right coronary artery in approximately 70%-80% of patients (right
dominant), both the right coronary and left circumflex artery in 10%-20%
####
(codominant), and the left circumflex artery in 5%-10% (left dominant).
The dominant coronary artery supplies blood to the atrioventricular (AV)
node via the AV nodal artery

CT abdomen The inferior vena cava is formed by the union of the common iliac veins Cardiovas Anatomy 1 CV
at the level of L4-L5. The renal arteries and veins lie at the level of L1 The cular (CV) (Anat)
1884 inferior vena cava returns venous blood to the heart from the lower
extremities, portal system, and abdominal and pelvic viscera.

Echocardiograp The left atrium forms the majority of the posterior surface of the heart and Cardiovas Anatomy 2 CV
8332 hy resides adjacent to the esophagus. Enlargement of the left atrium can cular (CV) (Anat)
compress the esophagus and cause dysphagia.
Echocardiograp The descending thoracic aorta lies posterior to the esophagus and the left Cardiovas Anatomy 2 CV
hy atrium. This position permits clear visualization of the descending aorta by cular (CV) (Anat)
8333
transesophageal echocardiography, allowing for the detection of
abnormalities such as dissection or aneurysm
Implantable Left ventricular leads in biventricular pacemakers course through the Cardiovas Anatomy 1 CV
7646 cardioverter coronary sinus, which resides in the atrioventricular groove on the cular (CV) (Anat)
defibrillator posterior aspect of the heart.
Left atrial Cardiovascular dysphagia can result from external compression of the Cardiovas Anatomy 1 CV
enlargement esophagus by a dilated and posteriorly displaced left atrium in patients cular (CV) (Anat)
1623
with rheumatic heart disease and mitral stenosis/regurgitation.

Myocardial Leads I and aVL correspond to the lateral limb leads on ECG. Therefore. Cardiovas Anatomy 19 CV
infarction ST elevation or Q waves in these leads are indicative of infarction cular (CV) (Anat)
####
involving the lateral aspect of the left ventricle, which is supplied by the
left circumflex artery.
Myocardial Papillary muscle rupture is a life-threatening complication that typically Cardiovas Anatomy 19 CV
infarction occurs 3-5 days after myocardial infarction and presents with acute mitral cular (CV) (Anat)
#### regurgitation and pulmonary edema. The posteromedial papillary muscle is
supplied solely by the posterior descending artery, making it susceptible
to ischemic rupture.
Patent ductus The ductus arteriosus is derived from the sixth embryonic aortic arch. A Cardiovas Anatomy 4 CV
arteriosus patent ductus arteriosus (PDA) causes left-to-right shunting of blood that cular (CV) (Anat)
can be heard as a continuous murmur over the left infraclavicular region
1751 Indomethacin (a PGE2 synthesis inhibitor) can be used to close a PDA in
premature infants, but surgical ligation is often necessary in older patients.

PDA Differential cyanosis (ie, postductal < preductal oxygen saturation) in a Cardiovas Anatomy 1
neonate suggests right-to-left shunting across a patent ductus cular (CV) (Anat)
arteriosus, such as in persistent pulmonary hypertension of the newborn
####
(PPHN). Patients with PPHN typically have an underlying pulmonary
disorder with respiratory distress and strong femoral pulses.

Penetrating The left ventricle forms the apex of the heart and can reach as far as the Cardiovas Anatomy 2 CV
thoracic trauma fifth intercostal space at the left midclavicular line (MCL). All other cular (CV) (Anat)
654
chambers of the heart lie medial to the left MCL. The left lungs overlap
much of the anterior surface of the heart.
Penetrating The right ventricle composes most of the heart’s anterior surface. A deep, Cardiovas Anatomy 2 CV
1699 thoracic trauma penetrating injury at the left sternal border in the fourth intercostal space cular (CV) (Anat)
would puncture the right ventricle.
Pulmonary Pulmonary artery occlusion pressure is measured at the distal tip of the Cardiovas Anatomy 2 CV
blood flow pulmonary artery catheter after an inflated balloon occludes blood flow cular (CV) (Anat)
#### through a pulmonary artery branch. It closely corresponds to left atrial
and left ventricular end-diastolic pressure.
 Pulmonary The inferior vena cava (IVC) courses through the abdomen and inferior Cardiovas Anatomy 13 CV
embolism thorax in a location anterior to the right half of the vertebral bodies. The cular (CV) (Anat)
renal veins join the IVC at the level of L1/L2. and the common iliac veins
1538
merge to become the IVC at the level of L5. IVC filters are placed in
patients with deep venous thrombosis who have contraindications to
anticoagulation therapy.
Retinal artery Retinal artery occlusion is a cause of acute, painless, monocular vision Cardiovas Anatomy 1 CV
occlusion loss . It is usually caused by thromboembolic complications of cular (CV) (Anat)
#### atherosclerosis traveling from the internal carotid artery and through
the ophthalmic artery. path of the embolus--> Internal carotid artery,
ophthalmic artery, retinal artery
Sinoatrial node The sinoatrial node consists of specialized pacemaker cells located at the Cardiovas Anatomy 1 CV
junction of the right atrium near opining of superior vena cava. It is the cular (CV) (Anat)
####
site of earliest electrical activation in patients with sinus rhythm.

Subclavian Subclavian steal syndrome occurs due to severe stenosis of the proximal Cardiovas Anatomy 1 CV
steal syndrome (left) subclavian artery, which leads to reversal in blood flow from the cular (CV) (Anat)
contralateral vertebral artery to the ipsilateral vertebral artery. Patients may
#### have symptoms related to arm ischemia in the affected extremity (eg,
exercise-induced fatigue, pain, paresthesias) or vertebrobasilar
insufficiency (eg. dizziness, vertigo).

Tricuspid Infective endocarditis in intravenous drug users commonly affects the Cardiovas Anatomy 3 CV
regurgitation
tricuspid valve often leading to septic pulmonary emboli. Patients can have cular (CV) (Anat)
8294 an early- or holo-systolic murmur of tricuspid regurgitation, which is best
auscultated in the 4th or 5th intercostal space at the left lower sternal
border.
Varicocele Pressure in the left renal vein may become elevated due to compression Cardiovas Anatomy 1 CV
where the vein crosses the aorta beneath the superior mesenteric artery. cular (CV) (Anat)
1805 This "nutcracker effect" can cause hematuria and flank pain Pressure can
also be elevated in the left gonadal vein, leading to formation of a
varicocele.
Dilated Thiamine deficiency causes beriberi and Wernicke-Korsakoff syndrome. Cardiovas Biochemistr 8 CV
cardiomyopath Dry beriberi is characterized by symmetrical peripheral neuropathy; wet cular (CV) y (Bioc)
1047
y beriberi high-output cardiac failure
(dilated cardiomyopathy), edema.
Homocysteine Elevated levels of plasma homocysteine are an independent risk factor for Cardiovas Biochemistr 2 CV
thrombotic eve nts. Homocysteine can be metabolized to methionine via cular (CV) y (Bioc)
remethylation or to cystathionine via transsulfuration.
788
Hyperhomocysteinemia is most commonly due to genetic mutations in
critical enzymes or deficiencies of vitamin B 12, vitamin B6, and folate.

Southern Southern blotting is a technique used to identify DNA mutations. It Cardiovas Biochemistr 1 CV
2034 blotting involves restriction endonuclease digestion of sample DNA, gel cular (CV) y (Bioc)
electrophoresis, and gene identification with a labeled DNA probe.
Bias The main purpose of blinding is to prevent pt or researcher expectancy Cardiovas Biostatistics 4 CV
1301 from interferingwith an outcome. cular (CV) (Bios)

Comparing 2 The two-sample t test is a statistical method commonly employed to Cardiovas Biostatistics 1 CV
1283 means compare the means of 2 groups of subjects. cular (CV) (Bios)

Sensitivity and When undergoing Dx testing, ptswith the disease can test (+) (true (+), TP) Cardiovas Biostatistics 4 CV
specificity or (-) (false (-), FN). The sensitivity of a test determines the proportion of cular (CV) (Bios)
1229 patients that are correctly classified:
TP = (Sensitivity) x (Number of ptswith the disease)
FN = (1 - Sensitivity) x (Number of ptswith the disease)
Atrial septal The foramen ovale is patent in approximately 25% of normal adults. Cardiovas Embryology 2 CV
defect Although the foramen ovale usually remains functionally closed, cular (CV) (Embr)
(Incomplete fusion of atrial septum primum and secundum) transient
202 increases of right atrial pressure above left atrial pressure can produce a
right-to-left shunt, leading to paradoxical embolism of venous clots into the
arterial circulation. (bubbles are seen passing into the left side of the
heart.)
Embryologic The common carotid artery and the proximal portion of the internal carotid Cardiovas Embryology 2 CV
derivatives artery are derived from the third aortic arch. It is associated with the cular (CV) (Embr)
1750 third pharyngeal arch, which gives rise to the glossopharyngeal nerve (CN
IX), parts of the hyoid bone, and the stylopharyngeus muscle.
 Tetralogy of Tetralogy of Fallot results from anterior and cephalad deviation of the Cardiovas Embryology 3 CV
Fallot infundibular septum during embryologic development resulting in a cular (CV) (Embr)
malaligned ventricular septal defect (VSD) with an overriding aorta. As a
1705 result, the patient has right ventricular outflow obstruction (resulting in a
systolic murmur) and squats to increase the peripheral systemic vascular
resistance (afterload) and decrease right-to-left shunting across the VSD.

Transposition
An echocardiogram showing an aorta lying anterior to the pulmonary artery Cardiovas Embryology 1 CV
of the greatis diagnostic of transposition of the great arteries (TGA). This life- cular (CV) (Embr)
35 vessels threatening cyanotic condition results from failure of the fetal
aorticopulmonary septum to spiral normally during septation of the
truncus arteriosus.
Dilated Autosomal dominant mutations in the TTN gene, which encodes for the Cardiovas Genetics 8 CV
#### cardiomyopath sarcomere protein titin, are the most common cause of familial dilated cular (CV) (Gene)
y cardiomyopathy.
Down Down syndrome is most commonly caused by maternal meiotic Cardiovas Genetics 6 CV
syndrome nondisjunction, a process by which the fetus receives 3 full copies of cular (CV) (Gene)
chromosome 21. Dysmorphic features (eg, flat facial profile, protruding
882
tongue, small ears, upslanting palpebral fissures) and cardiac defects
(eg, endocardial cushion defects) are characteristic.

Turner Aortic coarctation in a child/young adult presents with lower-extremity Cardiovas Genetics 8 CV
syndrome claudication (eg, pain and cramping with exercise), blood pressure cular (CV) (Gene)
30 discrepancy between the upper and lower extremities, and delayed or
diminished femoral pulses. Turner syndrome (45,XO) is associated with
coarctation of the aorta in up to 10% of cases.
Turner Turner syndrome is associated with congenital anomalies of the aorta, and Cardiovas Genetics 8 CV
syndrome the most common defect is a bicuspid aortic valve. A nonstenotic bicuspid cular (CV) (Gene)
8292 aortic valve can manifest as an early systolic, high-frequency click over the
right second interspace. Bicuspid aortic valves are at risk for stenosis,
insufficiency, and infection.
Collagen types Type I collagen is the primary collagen in mature scars (eg, remote Cardiovas Histology 1 CV
myocardial infarction). It is the most prevalent type of collagen and cular (CV) (Hist)
8711
provides strength and support throughout the human body, particularly in
bones, tendons, ligaments, and skin.
Heart Acute cardiac transplant rejection occurs weeks following Cardiovas Immunology 1 CV
transplantation transplantation and is primarily a cell-mediated process. On cular (CV) (Immu)
histopathologic analysis of an endomyocardial biopsy, a dense
568
mononuclear lymphocytic infiltrate with cardiac myocyte damage will
be visualized. Treatment with immunosuppressive drugs is aimed primarily
at preventing this form of rejection.
Catheter The most important steps for prevention of CVC infections are as follows: Cardiovas Microbiolog 3 CV
related Proper hand hygiene cular (CV) y (Micr)
bloodstream Full barrier precautions during insertion
8282 infection Chlorhexidine skin disinfection
Avoidance of the femoral insertion site
Removal of the catheter when it is no longer needed

Endocarditis Staphylococcus epidermidis, a Gram (+) coccus that grows in clusters, is a Cardiovas Microbiolog 15 CV
skin commensal that is a common cause of infection in ptswith prosthetic cular (CV) y (Micr)
devices such as artificial joints or heart valves. Unlike S aureus, S
679
epidermidis is coagulase (-). Unlike S saprophyticus (another coagulase (-)
staphylococci species), S epidermidis is susceptible to novobiocin.

Endocarditis Severe tricuspid valve regurgitation (TR) can lead to right-sided heart Cardiovas Microbiolog 15 CV
failure, evidenced by jugular venous distension, hepatomegaly, lower cular (CV) y (Micr)
extremity edema, and the absence of pulmonary edema. Permanent
729
pacemaker placement can cause TR because the right ventricular lead
passes through the tricuspid valve orifice and can disrupt valve closure.

Endocarditis Enterococcus is a component of the normal colonic and urogenital flora Cardiovas Microbiolog 15 CV
and is capable of growing in hypertonic saline and bile. It is γ-hemolytic, cular (CV) y (Micr)
733 catalase (-), and pyrrolidonyl arylamidase (+). GU instrumentation or
catheterization has been a/w enterococcal endocarditis.

Endocarditis Streptococcus gallolyticus (formerly S bovis) endocarditis and bacteremia Cardiovas Microbiolog 15 CV
are a/w GI lesions (colon ca) in ~25% of cases. When S gallolyticus is cular (CV) y (Micr)
1001
cultured in the blood, workup for colonic malignancywith colonoscopy is
essential.
Endocarditis Viridans streptococci produce dextrans that aid them in colonizing host Cardiovas Microbiolog 15 CV
surfaces, such as dental enamel and heart valves. These organisms cause cular (CV) y (Micr)
1002
subacute BE, classically in ptswith pre-existing cardiac valvular defects
after dental manipulation.
 Endocarditis Viridans streptococci are normal inhabitants of the oral cavity and are a Cardiovas Microbiolog 15 CV
cause of transient bacteremia after dental procedures in healthy and cular (CV) y (Micr)
1003 diseased individuals. In ptswith pre-existing valvular lesions, viridans
streptococci can adhere to fibrin-platelet aggregates and establish infection
that leads to endocarditis.
Acute heart Acute cardiogenic pulmonary edema results from increased pulmonary Cardiovas Pathology 7 CV
failure venous pressure. The alveolar capillaries become engorged with blood and cular (CV) (Path)
7616 there is a transudation of fluid plasma across the alveolar-capillary
membrane, appearing as pink, acellular material within the alveoli.

Acute heart The chest x-ray in acute decompensated heart failure typically shows Cardiovas Pathology 7 CV
failure prominent pulmonary vessels: patchy, bilateral airspace opacification: cular (CV) (Path)
8610
and blunting of the costophrenic angles due to pleural effusions

Acute In contrast to angina, the chest pain of pericarditis is sharp and pleuritic Cardiovas Pathology 5 CV
pericarditis and may be exacerbated by swallowing or coughing. Peri-infarction cular (CV) (Path)
pericarditis (PIP) occurs between 2 and 4 days following a transmural
89
myocardial infarction (Ml). PIP is an inflammatory reaction to cardiac
muscle necrosis that occurs in the adjacent pericardium.

Acute Pericarditis is the most common cardiovascular manifestation associated Cardiovas Pathology 5 CV
pericarditis with systemic lupus erythematosus. It presents with sharp pleuritic cular (CV) (Path)
1040
chest pain that is relieved by sitting up and leaning forward.

Acute Fibrinous pericarditis is the most common type of pericarditis and is Cardiovas Pathology 5 CV
pericarditis characterized by pericardial inflammation with a serous fibrin-containing cular (CV) (Path)
exudate in the pericardial space. Pleuritic chest pain and a triphasic
#### friction rub are seen. Common causes include viral infection,
myocardial infarction, uremia, and rheumatologic disease (eg.
systemic lupus erythematosus, rheumatoid arthritis)

Acute Viral infection is thought to be the most common cause of acute Cardiovas Pathology 5 CV
pericarditis pericarditis. It causes a fibrinous or serofibrinous pericarditis that is often cular (CV) (Path)
#### characterized by pleuritic chest pain, a friction rub on cardiac auscultation
diffuse ST elevation on ECG and mild to moderate-sized pericardial
effusion.
Aging Normal morphological changes in the aging heart include a 1- decrease in Cardiovas Pathology 8 CV
left ventricular chamber apex-to-base dimension, 2- development of a cular (CV) (Path)
sigmoid-shaped ventricular septum, 3- myocardial atrophy with
180
increased collagen deposition and 4- accumulation of cytoplasmic
lipofuscin pigment within cardiomyocytes.

Aging Lipofuscin is the product of lipid peroxidation, accumulating in aging cells Cardiovas Pathology 8 CV
300 (especially in patients with malnutrition and cachexia). cular (CV) (Path)

Amyloidosis Restrictive cardiomyopathy can be caused by infiltrative diseases (eg, Cardiovas Pathology 3 CV
Senile amyloidosis, sarcoidosis, hemochromatosis) and often results in cular (CV) (Path)
diastolic heart failure due to ventricular hypertrophy with impaired
94
ventricular filling Cardiac amyloidosis is characterized histologically by
areas of myocardium infiltrated by an amorphous and acellular pink
material (amyloid).
Aortic Myxomatous changes, with pooling of mucopolysaccharides in the media Cardiovas Pathology 6 CV
aneurysm layer of large arteries, are found in cystic medial degeneration, which cular (CV) (Path)
462 predisposes affected patients to the development of aortic aneurysms.
Medial degeneration in younger individuals is frequently due to Marfan
syndrome.
Aortic Abdominal aortic aneurysm is associated with risk factors (eg age >60, Cardiovas Pathology 6 CV
aneurysm smoking, hypertension, male sex, family history) that lead to chronic cular (CV) (Path)
transmural inflammation and extracellular matrix degradation within
463
the wall of the aorta. This leads to weakening and progressive expansion of
the aortic wall resulting in aneurysm formation, typically below the renal
arteries.
Aortic Thoracic aortic aneurysms are usually asymptomatic until they grow Cardiovas Pathology 6 CV
aneurysm large enough to compress surrounding structures or cause rupture. The cular (CV) (Path)
#### most common symptomatic presentation is chest or back pain, but
compression of nearby structures can cause dysphagia, hoarseness,
cough, or dyspnea.
Aortic Ruptured abdominal aortic aneurysm is a surgical emergency that Cardiovas Pathology 6 CV
aneurysm usually presents with the acute onset of severe abdominal and back pain in cular (CV) (Path)
patients with appropriate risk factors (eg. advanced age, smoking,
####
atherosclerosis). Accompanying syncope, hypotension and shock may
occur quickly (intraperitoneal rupture) or may be delayed (retroperitoneal
rupture)
 Aortic Patients with adult-type coarctation of the aorta commonly die of Cardiovas Pathology 1 CV
coarctation hypertension-associated complications, including left ventricular failure, cular (CV) (Path)
ruptured dissecting aortic aneurysm, and intracranial hemorrhage These
31 patients are at increased risk for ruptured intracranial aneurysms because
of the increased incidence of congenital berry aneurysms of the Circle of
Willis as well as aortic arch hypertension

Aortic Aortic dissection classically presents with severe retrosternal pain that Cardiovas Pathology 6 CV
dissection radiates to the back. This condition develops when overwhelming cular (CV) (Path)
hemodynamic stress leads to tearing of the aortic intima with blood
464 subsequently dissecting through the aortic media The resulting intramural
hematoma can extend both proximally and distally and can compress major
arterial branches and impair blood flow

Aortic Hypertension is the single most important risk factor for the Cardiovas Pathology 6 CV
dissection development of intimal tears leading to aortic dissection. Hypertension, cular (CV) (Path)
473 smoking, diabetes mellitus, and hypercholesterolemia are all major risk
factors for atherosclerosis, which predisposes more to aortic aneurysm
formation than aortic dissection
 Aortic Acute aortic dissection typically presents with sudden-onset, severe chest Cardiovas Pathology 6 CV
dissection pain that is sharp or tearing in nature. Upper extremity blood pressure cular (CV) (Path)
asymmetry can result from extension of the dissection plane into the
subclavian artery, and additional complications (eg, stroke, myocardial
####
ischemia) can result from extension into other vessels. Extension into the
pericardium can cause acute tamponade (Blood in the pericardia! space)
with reduced cardiac output and shock.

Aortic Marfan syndrome involves a deleterious mutation in fibrillin that mainly Cardiovas Pathology 6 CV
dissection affects the structural integrity of the cardiovascular and musculoskeletal cular (CV) (Path)
systems. Aortic root disease predisposes to aortic dissection, which can
#### present with sudden-onset chest or back pain, acute aortic regurgitation,
and heart failure. Common histologic findings in aortic disease include
fragmentation and loss of the elastic lamellae with fibrosis and cystic
medial degeneration
Aortic Cystic medial degeneration (necrosis) is the classic histologic finding in Cardiovas Pathology 6 CV
dissection aortic dissection, as it weakens the aortic wall and allows a small intimal cular (CV) (Path)
tear to readily propagate. Collagen, elastin, and smooth muscle are replaced
####
by a basophilic mucoid extracellular matrix with elastic tissue
fragmentation and cystic collections of mucopolysaccharide.

Aortic Eccentric ventricular hypertrophy results in a dilated cavity with relatively Cardiovas Pathology 8 CV
regurgitation thin ventricular walls due to the addition of myocardial contractile fibers in cular (CV) (Path)
#### series in response to chronic volume overload. Chronic aortic
regurgitation can result from aortic root dilation and is a common cause
of eccentric hypertrophy.
Aortic stenosis Calcific degeneration of the trileaflet aortic valve is the most common Cardiovas Pathology 8 CV
cause of aortic stenosis (AS) in developed nations. AS is characterized by cular (CV) (Path)
progressive aortic valve leaflet thickening and calcification, leading to
242 restricted leaflet excursion and mobility. AS murmur is usually a harsh
ejection-type systolic murmur heard best at the base of the heart in the
"aortic area" (second right intercostal space) with radiation to the carotid
arteries.
Aortic stenosis The murmur of valvular aortic stenosis (calcification) is typically an Cardiovas Pathology 8 CV
ejection or midsystolic murmur of crescendo-decrescendo configuration cular (CV) (Path)
with maximum intensity over the right second interspace and radiation to
939
neck and carotid arteries. The most common cause of aortic stenosis in
elderly patients (age >70) is degenerative calcification of the aortic valve
leaflets.
Aortic stenosis AS most commonly results from age-related CAVD. The early Cardiovas Pathology 8 CV
pathogenesis of CAVD closely mimics that of arterial atherosclerosis. In cular (CV) (Path)
#### the later stages, fibroblasts differentiate into osteoblast-like cells and
deposit bone matrix, leading to progr valvular calcification and stenosis.

Aortic stenosis Concentric left ventricular hypertrophy involves thickening of the Cardiovas Pathology 8 CV
ventricular walls and reduction in the ventricular cavity size. It occurs via cular (CV) (Path)
the addition of myocardial contractile fibers in parallel in response to
####
chronic pressure overload. Aortic stenosis and prolonged systemic
hypertension are common causes of concentric left ventricular hypertrophy.

Atherosclerosis Stable angina pectoris results from myocardial oxygen demand-supply Cardiovas Pathology 8 CV
mismatch and manifests as chest pressure, tightness, or pain that is cular (CV) (Path)
reliably produced by exertion and relieved by rest. It most commonly
36
occurs due to a fixed atherosclerotic plaque obstructing >70% of the
coronary artery lumen that limits blood flow during exertion.

Atherosclerosis Gradually developing myocardial ischemia encourages the formation and Cardiovas Pathology 8 CV
maturation of collateral vessels and is most likely to occur in the setting of cular (CV) (Path)
a slow-growing, stable atherosclerotic plaque. An unstable
39 atherosclerotic plaque (eg, that with active inflammation, a lipid-rich core,
and/or a thin fibrous cap) is more likely to rupture, resulting in the abrupt
onset of ischemia/infarction that precludes the development of viable
collateral vessels.
Atherosclerosis Atherosclerosis is initiated by repetitive endothelial cell injury, which Cardiovas Pathology 8 CV
leads to a chronic inflammatory state in the underlying intima of large cular (CV) (Path)
442
elastic arteries as well as in large- and medium-sized muscular arteries

Atherosclerosis Fatty streaks are the earliest lesions of atherosclerosis and can be seen as Cardiovas Pathology 8 CV
early as the second decade of life. They appear as a collection of lipid- cular (CV) (Path)
444
laden macrophages (foam cells, yellow spots) in the intima that can
eventually progress to atherosclerotic plaques.
 Atherosclerosis During the development of atherosclerotic plaque (atheroma), activated Cardiovas Pathology 8 CV
macrophages, platelets and endothelial cells release growth factors (eg, cular (CV) (Path)
446 platelet-derived growth factor) that stimulate recruitment of smooth
muscle cells from the arterial wall media and their subsequent proliferation
in the intima.
Atherosclerosis The likelihood of plaque rupture is related to plaque stability rather than Cardiovas Pathology 8 CV
plaque size or the degree of luminal narrowing Plaque stability largely cular (CV) (Path)
depends on the mechanical strength of the fibrous cap Inflammatory
447
macrophages in the intima may reduce plaque stability by secreting
metalloproteinases, which degrade extracellular matrix proteins (eg,
collagen).
Atherosclerosis Atherosclerosis is a pathophysiologic process involving endothelial cell Cardiovas Pathology 8 CV
dysfunction, and it develops most rapidly in areas with bends and branch cular (CV) (Path)
points that encourage turbulent blood flow. The lower abdominal aorta
#### and coronary arteries are the vascular beds most susceptible to
atherosclerosis; they tend to develop atherosclerosis earliest in life and
have the highest overall atherosclerotic burden.

Atrial myxoma Myxomas are the most common primary cardiac neoplasm and usually Cardiovas Pathology 3 CV
arise within the left atrium. The tumors typically cause position-dependent cular (CV) (Path)
obstruction of the mitral valve, leading to a mid-diastolic murmur and
symptoms of decreased cardiac output (eg. dyspnea, syncope).
8296
Constitutional symptoms (eg, fever, weight loss) may also be present.
Histologically, the tumors demonstrate scattered cells within a
mucopolysaccharide stroma and abnormal blood vessels with
hemorrhaging
Atrial myxoma Myxomas are the most common primary cardiac neoplasm and Cardiovas Pathology 3 CV
approximately 80% originate in the left atrium. Patients may present with cular (CV) (Path)
symptomatic mitral valve obstruction that may worsen with certain
####
body positions, constitutional findings (eg, fever, weight loss), or
systemic embolization (eg, stroke mesenteric ischemia, acute limb
ischemia).
Atrial myxoma Myxomas are the most common primary cardiac neoplasm, and Cardiovas Pathology 3 CV
approximately 80% originate in the left atrium. Patients may have cular (CV) (Path)
systemic embolization (eg, stroke) or symptomatic mitral valve
#### obstruction that may be worse with certain body positions Histopathologic
examination reveals amorphous extracellular matrix with scattered
stellate or globular myxoma cells within abundant mucopolysaccharide
ground substance
Atrioventricula A complete atrioventricular (AV) canal defect is comprised of an atrial Cardiovas Pathology 1 CV
r canal defect septal defect, a ventricular septal defect, and a common AV valve. It is the cular (CV) (Path)
188
most common congenital cardiac anomaly associated with Down
syndrome. (Autosomal trisomy)
Carcinoid Carcinoid syndrome typically presents with episodic flushing, secretory Cardiovas Pathology 4 CV
tumors diarrhea, and wheezing. It can lead to pathognomonic plaque-like cular (CV) (Path)
deposits of fibrous tissue on the right-sided endocardium, causing
74
tricuspid regurgitation and right-sided heart failure. Elevated 24-hour
urinary 5- hydroxyindoleacetic acid 5-HIAA (serotonin)can confirm
the diagnosis.
Cardiac The combination of jugular venous distension, hypotension, and Cardiovas Pathology 2 CV
tamponade muffled heart sounds is highly suggestive of cardiac tamponade. cular (CV) (Path)
Tachycardia and pulsus paradoxus are also frequently seen with
1439
tamponade. Lung examination is normal, which can help distinguish
cardiac tamponade from tension pneumothorax.

Chronic heart Alveolar hemosiderin-laden macrophages indicate alveolar hemorrhage. Cardiovas Pathology 12 CV
failure They most commonly result from chronic elevation of pulmonary capillary cular (CV) (Path)
185
hydrostatic pressure in the setting of left-sided heart failure.

Chronic venous Varicose veins are dilated tortuous veins most commonly found in the Cardiovas Pathology 3 CV
insufficiency superficial veins of the leg. They are caused by chronically increased cular (CV) (Path)
intraluminal pressure and/or loss of tensile strength in the vessel wall,
474
leading to incompetence of the venous valves. Common complications
include edema, stasis dermatitis, skin ulcerations poor wound healing,
and infections.
Chronic venous Chronically elevated venous pressure in the lower extremities can lead to Cardiovas Pathology 3 CV
insufficiency incompetent venous valves and venous dilation (varicose veins). Venous cular (CV) (Path)
878
congestion and tissue ischemia can result in venous stasis dermatitis.
 Constrictive In constrictive pericarditis, normal pericardium is replaced by dense, rigid Cardiovas Pathology 2 CV
pericarditis pericardial tissue that restricts ventricular filling, leading to low cardiac cular (CV) (Path)
output and progressive right-sided heart failure. Physical examination
98 findings in such patients include elevated jugular venous pressure (JVP),
pericardial knock, pulsus paradoxus, and a paradoxical rise in JVP with
inspiration (Kussmaul sign).

Coronary artery Vascular smooth muscle cells (VSMCs) are the only cells within the Cardiovas Pathology 4 CV
disease atherosclerotic plaque capable of synthesizing structurally important cular (CV) (Path)
collagen isoforms and other matrix components. Progressive enlargement
443
of the plaque results in remodeling of the extracellular matrix and VSMC
death, promoting development of vulnerable plaques with an increased
propensity for rupture.
Coronary blood In 90% of individuals, occlusion of the RCA can result in transmural Cardiovas Pathology 9 CV
flow ischemia of the inferior wall of the LV, producing ST elevation in leads II, cular (CV) (Path)
III, and aVF as well as possible sinus node dysfxn. Occlusion of the
proximal LAD would be expected to result in anteroseptal transmural
179
ischemia,with ST elevations in leads V1-V4. Occlusion of the LCX would
produce transmural ischemia of the lateral wall of the LV,with ST
elevations mainly in V5 and V6, and possibly also in I and aVL.

Costochondritis Costosternal syndrome (costochondritis) usually occurs after repetitive Cardiovas Pathology 1 CV
#### activity and is charactenzed by pain that is reproducible with palpation and cular (CV) (Path)
worsened with movement or changes in position
Dilated Dilation of the left ventricular cavity commonly occurs in response to Cardiovas Pathology 8 CV
cardiomyopath systolic dysfunction (eg, ischemic heart disease dilated cardiomyopathy) or cular (CV) (Path)
y certain types of valvular disease (ie, aortic regurgitation, mitral
92 regurgitation). Chronic volume overload causes progressive eccentric
hypertrophy that eventually leads to reduced ventricular contractility
and decompensated heart failure.

Dilated Peripartum cardiomyopathy is a relatively uncommon cause of dilated Cardiovas Pathology 8 CV

cardiomyopath cardiomyopathy that may be related to impaired function of angiogenic cular (CV) (Path)
y growth factors. Dilated cardiomyopathy involves compensatory eccentric
hypertrophy, which increases ventricular compliance and also allows for
####
temporary maintenance of cardiac output. Over time, overwhelming wall
stress leads to left ventricular failure with reduced ejection fraction and
symptomatic heart failure

Dilated Dilated cardiomyopathy results from primary myocardial dysfunction Cardiovas Pathology 8 CV
cardiomyopath leading to eccentric remodeling of the left ventricle. Patients can develop cular (CV) (Path)
y left ventncular mural thrombus and are at risk for sudden cardiac death
due to ventricular arrhythmia. Familial dilated cardiomyopathy is typically
####
inhented in an autosomal dominant pattern, and most commonly results
from truncating mutations of the TTN gene that codes for the sarcomere
protein titin.

Electrical Although lightning injuries are rare, they are associated with a 25% Cardiovas Pathology 1 CV
injury fatality rate. Two-thirds of lightning-related deaths occur within the first cular (CV) (Path)
hour after injury, with fatal arrhythmias and respiratory failure as the
8458
most common causes. Patients with minor cutaneous involvement may still
have major internal injury after lightning strikes and high-voltage electrical
contact.
Endocarditis Janeway lesions are nontender, macular, and erythematous lesions typically Cardiovas Pathology 15 CV
located on the palms and soles of patients with acute infective endocarditis cular (CV) (Path)
72
and are the result of septic embolization from valvular vegetations.

Endocarditis Microemboli from the valvular vegetations of bacterial endocarditis are the Cardiovas Pathology 15 CV
most common cause of subungual splinter hemorrhages, nail beds. The cular (CV) (Path)
228
presence of these lesions necessitates careful cardiac auscultation to
detect a possible new-onset regurgitant murmur.
Endocarditis Mitral valve prolapse with regurgitation is the most common Cardiovas Pathology 15 CV
predisposing condition for native valve infective endocarditis (IE) in cular (CV) (Path)
230
developed nations. Rheumatic heart disease remains a frequent cause of IE
in developing nations.
Endocarditis Nonbacterial thrombotic endocarditis is a form of noninfectious Cardiovas Pathology 15 CV
endocarditis characterized by valvular deposition of sterile platelet-rich cular (CV) (Path)
thrombi. It likely results from valvular damage due to inflammatory
231 cytokines in the setting of an underlying hypercoagulable state, and it is
most commonly seen with advanced malignancy (especially mucinous
adenocarcinoma) or systemic lupus erythematosus
 Endocarditis Chronic valvular inflammation and scarring associated with rheumatic Cardiovas Pathology 15 CV
heart disease predispose to an increased risk of infective endocarditis, cular (CV) (Path)
2074
which is characterized by valvular vegetations with destruction of the
underlying cardiac tissue.
Endocarditis Vegetations are caused by bacterial colonization and growth on a sterile Cardiovas Pathology 15 CV
2075 fibrin-platelet deposition nidus that forms on the damaged/disrupted cular (CV) (Path)
endothelial surface of the valvular apparatus.
Heart block Third-degree (complete) atrioventricular block involves dysfunction of Cardiovas Pathology 2 CV
the atrioventricular node resulting in total lack of communication cular (CV) (Path)
between the atria and ventricles. On ECG, there is dissociation of P waves
#### and QRS complexes, with P waves marching out at the intrinsic rate of the
sinoatrial node and QRS complexes at the intrinsic rate of the His bundle
or ventricles (escape rhythm).

Hemangioma Cutaneous, strawberry-type capillary hemangiomas are common, benign, Cardiovas Pathology 6 CV
congenital tumors, which are composed of unencapsulated aggregates of cular (CV) (Path)
closely packed, thin-walled capillaries. Initially, strawberry hemangiomas
466
grow in proportion to the growth of the child, before eventually regressing.
In 75-95% of cases, the vascular tumor will regress completely by age 7.

Hereditary Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia) is Cardiovas Pathology 1 CV

hemorrhagic an autosomal dominant condition marked by the presence of telangiectasias cular (CV) (Path)
telangiectasia in the skin as well as the mucous membranes of the lips, oronasopharynx.
469 respiratory tract, gastrointestinal tract, and urinary tract. Rupture of these
telangiectasias may cause epistaxis, gastrointestinal bleeding, or hematuria.
 Hypertrophic In patients with hypertrophic cardiomyopathy, dynamic left ventricular Cardiovas Pathology 9 CV
cardiomyopath outflow tract obstruction is due to abnormal systolic anterior motion of cular (CV) (Path)
76
y the anterior leaflet of the mitral valve toward a hypertrophied
interventricular septum.
Hypertrophic Hypertrophic cardiomyopathy is a common cause of sudden cardiac death Cardiovas Pathology 9 CV
cardiomyopath (SCD) in young adults. Histologic features include cardiomyocyte cular (CV) (Path)
y hypertrophy and myofiber disarray with increased interstitial fibrosis
82
The structural disarray creates a substrate for ventncular arrhythmia (eg
ventricular tachycardia, ventricular fibrillation) that can lead to SCD.

83 Hypertrophic Hypertrophic cardiomyopathy is characterized by asymmetric (eg, septal) Cardiovas Pathology 9 CV

Hypertrophic Hypertrophic cardiomyopathy is caused by genetic mutations affecting Cardiovas Pathology 9 CV
cardiomyopath structural proteins of the cardiac sarcomere (eg beta-myosin heavy chain, cular (CV) (Path)
y myosin-binding protein C) and is one of the most common causes of
95 sudden cardiac death (SCD) in young adults. Histologically, it is
characterized by cardiomyocyte hypertrophy with haphazard cellular
arrangement and interstitial fibrosis.

Kawasaki Kawasaki disease is a vasculitis of medium-sized arteries that presents with Cardiovas Pathology 1 CV
disease persistent fever for >5 days, bilateral conjunctivitis, cervical cular (CV) (Path)
1852 lymphadenopathy. and mucocutaneous involvement. Coronary artery
aneurysms are a serious complication of Kawasaki disease

Long QT Unprovoked syncope in a previously asymptomatic young person may Cardiovas Pathology 4 CV
syndrome result from a congenital QT prolongation syndrome. The two most cular (CV) (Path)
important congenital syndromes with QT prolongation - Romano-Ward
84 syndrome and Jervell and Lange-Nielsen syndrome - are thought to result
from mutations in a K+ channel protein that contributes to the delayed
rectifier current (lK) of the cardiac action potential.

Long QT Congenital long QT syndrome is most often caused by genetic mutations Cardiovas Pathology 4 CV
syndrome in a K+ channel protein that contributes to the outward-rectifying cular (CV) (Path)
potassium current. A decrease in the outward K+ current leads to
86 prolongation of action potential duration and QT interval. This
prolongation predisposes to the development of life-threatening
ventricular arrhythmias (eg torsades de pointes) that can cause
palpitations, syncope, seizures, or sudden cardiac death
Long QT Jervell and Lange-Nielsen syndrome is an autosomal recessive disorder Cardiovas Pathology 4 CV
syndrome characterized by profound bilateral sensorineural hearing loss and cular (CV) (Path)
congenital long QT syndrome, which predisposes to ventricular
91
arrhythmias and sudden cardiac death. This condition occurs secondary to
mutations in genes that encode voltage-gated potassium channels.

Lyme disease Early disseminated (spirochetal) Lyme disease can have cardiac Cardiovas Pathology 3 CV
involvement (Lyme carditis) that most commonly manifests with varying cular (CV) (Path)
#### degrees of atrioventricular (AV) conduction block Patients may be
asymptomatic, but those with complete AV conduction block are likely to
have dyspnea, lightheadedness or syncope
#### Lymphedema Chronic lymphedema is most commonly caused by an acquired disruption Cardiovas Pathology 1 CV
Mitral stenosis Rheumatic mitral stenosis is characterized by diffuse fibrous thickening Cardiovas Pathology 7 CV
and distortion of the mitral valve leaflets along with commissural fusion at cular (CV) (Path)
232 the leaflet edges. Patients often present with a diastolic murmur, dyspnea,
and fatigue and are at increased risk of atrial fibrillation and
thromboembolism (eg. stroke)
Mitral stenosis Left atrial enlargement can sometimes cause left recurrent laryngeal nerve Cardiovas Pathology 7 CV
236 impingement. Neurapraxia resulting in left vocal cord paresis and cular (CV) (Path)
hoarseness may result.
Mitral valve Mitral valve prolapse is most often caused by defects in connective tissue Cardiovas Pathology 1 CV
prolapse proteins that predispose to myxomatous degeneration of the mitral leaflets cular (CV) (Path)
and chordae tendineae. Cardiac auscultation typically reveals a midsystolic
947 click followed by a mitral regurgitation murmur; the click and murmur
occur later in systole or disappear completely with maneuvers (eg,
squatting) that increase left ventricular end-diastolic volume.

Myocardial ST-elevation myocardial infarction involves transmural (full-thickness) Cardiovas Pathology 19 CV

infarction infarction of the myocardial wall, and usually results from acute cular (CV) (Path)
atherosclerotic plaque rupture with the development of overlying
thrombus that fully occludes the coronary artery lumen. It classically
37
presents with sudden-onset substernal chest pain that is not relieved by rest
or short-acting nitrates. ECG demonstrates ST elevation in the affected
leads with subsequent development of Q waves.
 Myocardial After the onset of severe ischemia leading to myocardial infarction (Ml), Cardiovas Pathology 19 CV
infarction early signs of coagulative necrosis do not become apparent on light cular (CV) (Path)
40
microscopy (it will be normal) until 4 hours after the onset of Ml.

Myocardial Hibernating myocardium refers to the presence of left ventricular Cardiovas Pathology 19 CV
infarction systolic dysfunction due to reduced coronary blood flow at rest that is cular (CV) (Path)
43
partially or completely reversible by coronary revascularization.

Myocardial Mitochondrial vacuolization is typically a sign of irreversible cell injury, Cardiovas Pathology 19 CV
176 infarction signifying that the involved mitochondria are permanently unable to cular (CV) (Path)
generate ATP
Myocardial Ventricular fibrillation is the most common mechanism of sudden Cardiovas Pathology 19 CV
infarction cardiac death due to acute myocardial infarction. It results from cular (CV) (Path)
192
arrhythmogenic foci triggered by electrical instability in the ischemic
myocardium.
Myocardial Ion pump failure due to ATP deficiency during cardiac ischemia causes Cardiovas Pathology 19 CV
infarction intracellular accumulation of Na+ and Ca2+. The increased intracellular cular (CV) (Path)
1882 solute concentration draws free water into the cell, causing the cellular and
mitochondrial swelling that is observed histologically.

Myocardial Right ventricular infarction (right-sided heart failure) can lead to Cardiovas Pathology 19 CV
infarction shock via impaired forward blood flow to the left heart, which lowers left- cular (CV) (Path)
sided preload (decreased pulmonary capillary wedge pressure) and
7666
decreases cardiac output. The reduced right ventricular output also raises
right atrial and central venous pressure

7667 Myocardial Severe systemic hypotension (eg. shock) is most likely to cause ischemia Cardiovas Pathology 19 CV
#### Myocardial Myocardial infarction that causes ischemia of the papillary muscle or Cardiovas Pathology 19 CV
#### Myocarditis Acute myocarditis is most commonly caused by a viral infection (eg. Cardiovas Pathology 1 CV
Patent ductus coxsackievirus,
Differential adenovirus,
clubbing influenza).
and cyanosis It often
without bloodresolves without
pressure noticeable
or pulse cular (CV)
Cardiovas (Path)
Pathology 4 CV
arteriosus discrepancy are pathognomonic for a large patent ductus arteriosus cular (CV) (Path)
complicated by Eisenmenger syndrome (reversal of shunt flow from left-
32 to-right to right-to-left). Severe coarctation of the aorta can cause lower
extremity cyanosis. Right-to-left shunting in patients with large septal
defects and tetralogy of Fallot results in whole-body cyanosis.

#### Pericardial Acute viral pericarditis is commonly complicated by pericardial effusion. Cardiovas Pathology
Peripheral Intermittent claudication describes muscle pain that's reproducibly caused Cardiovas Pathology 4 CV
vascular by exercise and relieved by rest; it occurs due to atherosclerotic stenoses cular (CV) (Path)
disease (lipid-filled intimal plaques) in the large arteries that prevent sufficient
448 blood flow to exercising muscle. The lower extremities are most commonly
affected; however, proximal lesions (i.e. aortoiliac occlusion) can cause
gluteal claudication a/o impotence.

Peripheral Thromboangiitis obliterans (Buerger disease) is a segmental, Cardiovas Pathology 4 CV

vascular inflammatory vasculitis into contiguous veins and nerves that affects cular (CV) (Path)
disease the small- and medium-sized arteries and veins of the distal extremities
451 with inflammatory intraluminal thrombi and sparing of the vessel wall. It is
usually seen in young, heavy smokers, and can present with digital
ischemia and ulceration, extremity claudication, Raynaud phenomenon,
and superficial thrombophlebitis.
Polyarteritis Polyarteritis nodosa is characterized by segmental, transmural, Cardiovas Pathology 2 CV
nodosa necrotizing inflammation of medium-sized muscular arteries. cular (CV) (Path)
Manifestations arise due to tissue ischemia from arterial lumen
460
narrowing/thrombosis or bleeding from microaneurysms. The vessels of the
kidneys, skin, peripheral nerves, and gastrointestinal tract are affected most
commonly: the lung is typically spared.
Primary Concentric hypertrophy is characterized by uniform thickening of the Cardiovas Pathology 14 CV
hypertension ventncular wall and narrowing of the ventricular cavity due to increased cular (CV) (Path)
afterload (eg, chronic (Long-standing) hypertension, aortic stenosis).
181
Eccentric hypertrophy is characterized by reduced ventricular wall
thickness with an associated increase in chamber size due to volume
overload.
Primary Hypertensive emergency is severely elevated blood pressure (typically Cardiovas Pathology 14 CV
hypertension >180/120 mm Hg) with evidence of end-organ damage In the kidneys, this cular (CV) (Path)
can manifest as malignant nephrosclerosis, characterized by fibrinoid
449 necrosis and hyperplastic arteriolosclerosis ("onion-skin" appearance). A
microangiopjathic hemolytic anemia can occur due to erythrocyte
fragmentation and platelet consumption at the narrowed arteriolar lumen
 Primary Concentric left ventricular (LV) hypertrophy involves uniform Cardiovas Pathology 14 CV
hypertension thickening of the LV walls with reduction in LV cavity size and most cular (CV) (Path)
commonly results from prolonged systemic hypertension. It can progress
to hypertensive heart disease with impaired diastolic filling and heart
####
failure with preserved ejection fraction. Histopathology demonstrates
transverse thickening of cardiomyocytes with prominent hyperchromatic
nuclei and interstitial fibrosis.

Pulmonary Transcatheter aortic valve implantation (TAVI) allows for minimally Cardiovas Pathology 13 CV
embolism invasive management of severe aortic stenosis in elderly patients who are cular (CV) (Path)
unable to tolerate open surgical valve replacement. Paravalvular aortic
regurgitation is a common complication of TAVI, resulting from improper
#### sealing of the prosthetic valve to the native aortic valve annulus. A
large, acute pulmonary embolism causes a rapid increase in right
ventricular (RV) pressure that leads to RV cavity enlargement and RV
dysfunction. Thickening of the RV wall is not seen in acute pulmonary
embolism, as there is no time for compensatory hypertrophy to occur in
response to the increased pressure load.
Pulmonary Pulmonic valve stenosis causes a crescendo-decrescendo systolic murmur Cardiovas Pathology 1 CV
stenosis (best heard at the left upper sternal border) and delays closure of the cular (CV) (Path)
pulmonic valve, resulting in widened splitting of S2. Inspiration increases
####
blood flow to the right side of the heart, causing increased intensity of the
murmur and even later closure of the pulmonic valve.

Renal artery Renal artery stenosis is most often due to atherosclerosis. It can cause Cardiovas Pathology 9 CV
stenosis severe, refractory hypertension due to activation of the renin-angiotensin- cular (CV) (Path)
453 aldosterone fwstem Over time renal atrnnhv mav occur due to chronic
oxygen and nutrient deorivation Histnlonic examination may show

Renal artery In unilateral renal artery stenosis, the narrowed renal artery causes Cardiovas Pathology 9 CV
stenosis hypoperfusion of the affected kidney with subsequent ischemic damage cular (CV) (Path)
(eg. tubular atrophy, interstitial ischemia glomerular crowding). In contrast
7568 the contralateral kidney is exposed to high blood pressure and typically
shows changes of hypertensive nephrosclerosis (eg, arteriolar wall
thickening due to hyaline or hyperplastic arteriolosclerosis).

Renal Renal infarction presents with flank pain, hematuria, elevated lactate Cardiovas Pathology 2 CV
infarction dehydrogenase (LDH), and a wedge-shaped kidney lesion on CT scan. cular (CV) (Path)
The most common cause of renal infarction is systemic thromboembolism,
809 often due to thrombus formation during atrial fibrillation. The brain and
kidneys are more likely than other organs to suffer embolic infarctions
because they are perfused at a higher rate.

Rheumatic Interstitial myocardial granulomas (Aschoff bodies) are found in carditis Cardiovas Pathology 5 CV
fever due to acute rheumatic fever, which develops after an untreated (Bacterial cular (CV) (Path)
infection) group A streptococcal pharyngeal infection. Aschoff bodies
240
contain plump macrophages with abundant cytoplasm and central, slender
ribbons of chromatin (Anitschkow, or caterpillar, cells).

Rheumatic Sydenham chorea presents with involuntary, rapid, irregular jerking Cardiovas Pathology 5 CV
fever movements involving the face, arms, and legs It occurs months after group cular (CV) (Path)
241 A streptococcal infection and is one of the major clinical manifestations of
acute rheumatic fever. Patients with this condition carry a high risk of
chronic valvular disease.
73 SLE Cardiovascular manifestations of lupus (SLE) include accelerated Cardiovas Pathology 7 CV
atherosclerosis, small-vessel necrotizing vasculitis, pericarditis, and cular (CV) (Path)
Stress Stress-induced (takotsubo) cardiomyopathy is characterized by hypokinesis Cardiovas Pathology 1 CV
cardiomyopath of the mid and apical segments and hyperkinesis of the basal segments of cular (CV) (Path)
y the left ventricle, resulting in systolic dysfunction The condition is likely
#### caused by a surge of catecholamines in the setting of physical or
emotional stress. It usually affects postmenopausal women and resolves on
its own within several weeks

506 Subdural Subdural hematoma occurs due to the rupture of cortical bridging Cardiovas Pathology 1 CV
Takayasu Takayasu arteritis is a chronic, large-artery vasculitis that primarily Cardiovas Pathology 1 CV
arteritis involves the aorta and its branches. It presents with constitutional (eg, cular (CV) (Path)
fever, weight loss) and arterio-occlusive (eg, claudication, blood pressure
452
discrepancies, pulse deficits) findings in patients age <40. Histopathology
shows granulomatous inflammation of the vascular media.
 Thrombophlebi A paraneoplastic syndrome of hypercoagulability may be seen in some Cardiovas Pathology 1 CV
tis patients with cancer, especially adenocarcinomas of the pancreas, colon, or cular (CV) (Path)
lung Superficial venous thromboses may therefore appear in one site and
475
then resolve, only to recur in another site This is known as Trousseau
syndrome (migratory superficial thrombophlebitis), an indication of
visceral cancer.
Ventricular VSD typically presents in the neonatal period after pulm vascular Cardiovas Pathology 2 CV
septal defect resistance has declined. The clinical Px depends on the size of the defect, cular (CV) (Path)
203
which ranges from an aSSx holosystolic murmur (small VSD) to HF (large
VSD).
Acute heart Patients with decompensated heart failure have elevated left ventricular Cardiovas Pathophysiol 7 CV
failure end-diastolic pressure and decreased cardiac output that is most often cular (CV) ogy (Patp)
primanly due to left ventricular dysfunction. Right atrial pressure (ie,
#### central venous pressure) is also elevated in advanced heart failure due to
volume overload; right-sided heart failure (most often occuring secondary
to left-sided failure) can also contribute to elevated right atrial pressure.

Acute Acute-onset, sharp, and pleuntic chest pain that decreases with Cardiovas Pathophysiol 5 CV
pericarditis leaning forward is characteristic of acute pericarditis. cular (CV) ogy (Patp)
Fibnnous/serofibnnous pericarditis is the most common form of pencarditis
97
and a pericardial friction rub is the most specific physical finding. Viral
pericarditis is often preceded by an upper respiratory infection.

Aging Dystrophic calcification occurs in damaged or necrotic tissue in the setting Cardiovas Pathophysiol 8 CV
296 of normal calcium levels: metastatic calcification occurs in normal tissue in cular (CV) ogy (Patp)
the setting of hypercalcemia
Aortic Abdominal aortic aneurysm is focal dilation of the abdominal aorta >50% Cardiovas Pathophysiol 6 CV
aneurysm above normal (or >3 cm in diameter). It is generally asymptomatic until cular (CV) ogy (Patp)
####
aneurysm rupture, which is frequently fatal. Risk factors include age >65.
smoking and male sex.
Aortic Aortic regurgitation causes a decrescendo diastolic murmur with maximal Cardiovas Pathophysiol 8 CV
regurgitation intensity occurring just after closure of the aortic valve, when the pressure cular (CV) ogy (Patp)
gradient between the aorta and left ventricle is the highest. The pressure
227
tracing for aortic regurgitation is characterized by loss of the aortic dicrotic
notch, steep diastolic decline in aortic pressure, and high-peaking systolic
pressures.
Aortic In chronic aortic regurgitation, persistent left ventricular volume Cardiovas Pathophysiol 8 CV
regurgitation overload triggers eccentric hypertrophy, which causes a compensatory cular (CV) ogy (Patp)
increase in stroke volume to maintain cardiac output. This compensatory
237
mechanism allows for a relatively long asymptomatic period in most
patients: however, left ventricular dysfunction eventually occurs, leading to
heart failure
Aortic Chronic aortic regurgitation (AR) causes a reduction in diastolic blood Cardiovas Pathophysiol 8 CV
regurgitation pressure and a compensatory increase in left ventricular stroke volume. cular (CV) ogy (Patp)
These changes create a high-amplitude, rapid rise-rapid fall pulsation (ie,
238
widened pulse pressure) and the other characteristic findings of AR (eg,
head bobbing, "pistol-shot” femoral pulses)

Aortic Aortic regurgitation (AR) causes a high-pitched, blowing, diastolic Cardiovas Pathophysiol 8 CV
regurgitation murmur with a decrescendo intensity pattern. The murmur of AR due to cular (CV) ogy (Patp)
2105 aortic root dilation is best heard at the right upper sternal border, whereas
the murmur of AR due to valvular pathology is best heard at the left third
intercostal space
Aortic A large, acute pulmonary embolism causes a rapid increase in right Cardiovas Pathophysiol 8 CV
regurgitation ventricular (RV) pressure that leads to RV cavity enlargement and RV cular (CV) ogy (Patp)
#### dysfunction. Thickening of the RV wall is not seen in acute pulmonary
embolism, as there is no time for compensatory hypertrophy to occur in
response to the increased pressure load.
243 Aortic stenosis The murmur of aortic stenosis (AS) is a systolic ejection-type, crescendo- Cardiovas Pathophysiol 8 CV
Aortic stenosis In patients with chronic aortic stenosis and concentric left ventricular Cardiovas Pathophysiol 8 CV
hypertrophy, atrial contraction contributes significantly to left ventricular cular (CV) ogy (Patp)
filling. Loss of atrial contraction due to atrial fibrillation can reduce left
244 ventricular preload and cardiac output sufficiently to cause systemic
hypotension. Decreased forward filling of the left ventricle can also result
in backup of blood in the left atrium and pulmonary veins, leading to acute
pulmonary edema.
Aortic stenosis A bicuspid aortic valve is a common cause of aortic stenosis in the United Cardiovas Pathophysiol 8 CV
States. The classic auscultatory finding in patients with aortic stenosis is a cular (CV) ogy (Patp)
2106 harsh, crescendo-decrescendo systolic ejection murmur heard best in the
right second intercostal space with radiation to the carotids.
 Aortic stenosis Angina often occurs in aortic stenosis even in the absence of obstructive Cardiovas Pathophysiol 8 CV
coronary artery disease. It results from increased myocardial oxygen cular (CV) ogy (Patp)
####
demand due to an increase in left ventricular mass (le. concentnc
hypertrophy) and ventricular wall stress
Athlete's heart Athlete's heart refers to physiologic cardiac adaptations that improve Cardiovas Pathophysiol 1 CV
cardiac function in response to high-level endurance training. There is cular (CV) ogy (Patp)
predominant eccentric hypertrophy with a smaller component of concentnc
####
hypertrophy, leading to an overall increase in left ventricular (LV) mass,
enlarged LV cavity size, increased LV wall thickness, and decreased
resting heart rate
Atrial septal Wide, fixed splitting of the second heart sound is a characteristic Cardiovas Pathophysiol 2 CV
defect auscultatory finding in patients with ASD A hemodynamically significant cular (CV) ogy (Patp)
ASD can produce chronic pulmonary hypertension as a result of left-to-
right intracardiac shunting. Eisenmenger syndrome is the late-onset
201 reversal of a left-to-right shunt due to pulmonary vascular sclerosis
resulting from chronic pulmonary hypertension. Closure of the ASD may
be required to prevent irreversible pulmonary vascular sclerosis and a
permanent Eisenmenger syndrome

33 Bicuspid aortic Aortic stenosis is the most common complication of bicuspid aortic valves Cardiovas Pathophysiol 1 CV
Cardiac Cardiac tamponade typically presents with hypotension with pulsus Cardiovas Pathophysiol 2 CV
tamponade paradoxus, elevated jugular venous pressure, and muffled heart sounds cular (CV) ogy (Patp)
(Beck’s triad). Pulsus paradoxus refers to an abnormal exaggerated
96
decrease in systolic blood pressure >10 mm Hg on inspiration, and is a
common finding in patients with pericardial effusion with cardiac
tamponade.
Carotid sinus Carotid sinus hypersensitivity is most commonly seen in elderly men and Cardiovas Pathophysiol
hypersensitivity involves an exaggerated vasovagal response to tactile stimulation of carotid cular (CV) ogy (Patp)
sinus baroreceptors (eg, adjusting a shirt collar or necktie). The resulting
increase in parasympathetic output leads to a prolonged sinus pause that
####
contributes to the excessive drop in blood pressure, leading to transient
loss of cerebral perfusion that manifests as presyncope (eg,
lightheadedness) or syncope.

Chronic heart Decreased cardiac (Arteriolar resistance) output in heart failure triggers Cardiovas Pathophysiol 12 CV
failure neuroendocrine compensatory mechanisms to maintain organ perfusion; cular (CV) ogy (Patp)
however, the compensatory mechanisms are maladaptive over the long
term. Increased sympathetic output and activation of the renin-angiotensin-
843
aldosterone system stimulate vasoconstriction and volume retention,
compounding the hemodynamic stress on an already failing heart and
creating a vicious cycle of decompensation.

Chronic heart The reduced cardiac output in heart failure leads to decreased renal Cardiovas Pathophysiol 12 CV
failure perfusion and consequent stimulation of the renin-angiotensin-aldosterone cular (CV) ogy (Patp)
system in a maladaptive effort to maintain effective blood volume. Inactive
1532
angiotensin I is converted into active angiotensin II by endothelial- bound
angiotensin-converting enzyme in the lungs

Chronic heart The third heart sound (S3) is a low-frequency sound occurring immediately Cardiovas Pathophysiol 12 CV
failure after S2 that is commonly associated with increased ventricular end- cular (CV) ogy (Patp)
2108 systolic volume. S3 frequently occurs in the setting of mitral regurgitation
and systolic heart failure (eg. dilated cardiomyopathy).

Chronic heart The ventricular myocardium secretes brain natnuretic peptide (BNP) in Cardiovas Pathophysiol 12 CV
failure response to the ventricular stretch (Increase in ventricular wall stress) cular (CV) ogy (Patp)
and strain that typically occurs with volume overload BNP. along with
####
atrial natriuretic peptide secreted by the atrial myocardium, stimulates
vasodilation and salt and water excretion to help relieve volume overload.

Congenital Increased blood oxygen saturation between 2 right-sided vessels or Cardiovas Pathophysiol 2 CV
cardiac defects chambers indicates the presence of a left-to-right shunt. If the abnormal cular (CV) ogy (Patp)
oxygen increase occurs between the right atrium and the right ventricle, a
187
ventricular septal defect (VSD) is likely present. Small VSDs produce a
holosystolic murmur that is loudest over the lower left sternal border.

Constrictive Calcification and thickening of the pericardium are common features of Cardiovas Pathophysiol 2 CV
2071 pericarditis constrictive pericarditis on CT. Clinical findings include slowly cular (CV) ogy (Patp)
progressive dyspnea, peripheral edema, and ascites.
 Cor pulmonale Peripheral edema results from the accumulation of fluid in the interstitial Cardiovas Pathophysiol 1 CV
spaces Factors that promote edema include elevated capillary hydrostatic cular (CV) ogy (Patp)
pressure, decreased plasma oncotic pressure, sodium and water retention,
and impaired lymphatic drainage. In chronic heart failure increased
1578
lymphatic drainage initially offsets factors favoring edema, whereas acute
changes (eg, venous thrombosis, heart failure decompensation) are more
likely to produce edema

Coronary artery Stable angina results from fixed coronary artery stenosis that limits blood Cardiovas Pathophysiol 4 CV
disease flow to downstream myocardium, preventing the myocardial oxygen supply cular (CV) ogy (Patp)
from increasing during exertion. Dobutamine mimics the effects of
#### exercise and increases myocardial oxygen demand: it can be used during
stress testing to provoke areas of ischemic myocardium, which can be
recognized on imaging by a localized and transient decrease in contractility
(ie. wall motion defect).
Coronary blood Increases in resting blood flow to ischemic myocardium are primarily Cardiovas Pathophysiol 9 CV
flow mediated by locally-acting substances (eg. adenosine, nitric oxide) that cular (CV) ogy (Patp)
trigger coronary arteriolar vasodilation. Pharmacologic arteriolar
952 vasodilators (eg, adenosine, dipyridamole) mimic the vasodilation that
occurs with exercise and may cause redistribution of blood flow from
ischemic to nonischemic areas of myocardium, so-called coronary steal

Coronary blood The coronary sinus communicates freely with the right atrium and will Cardiovas Pathophysiol 9 CV
flow become dilated secondary to any factor that causes increased right atnal cular (CV) ogy (Patp)
2124
pressure. The most common cause is pulmonary hypertension, leading to
elevated right heart pressures.
Diastolic Heart failure with preserved ejection fraction is characterized by diastolic Cardiovas Pathophysiol 4 CV
dysfunction dysfunction, which frequently occurs in the setting of prolonged systemic cular (CV) ogy (Patp)
186 hypertension due to concentric left ventricular hypertrophy. Patients with
longstanding hypertension have increased systemic vascular resistance

Diastolic A low-frequency, late diastolic sound on cardiac auscultation that Cardiovas Pathophysiol 4 CV
dysfunctionimmediately precedes the first heart sound (S1) is most often a fourth heart cular (CV) ogy (Patp)
sound (S4). An abnormal S4 can be heard in patients with reduced
246 ventricular compliance (Increased stiffness of the left ventricular v,all)
(eg. hypertensive heart disease, aortic stenosis, hypertrophic
cardiomyopathy) due to a sudden rise in end-diastolic pressure with atrial
contraction.
Dilated Dilated cardiomyopathy results from direct damage to cardiomyocytes Cardiovas Pathophysiol 8 CV
cardiomyopath leading to myocardial contractile dysfunction (systolic dysfunction), cular (CV) ogy (Patp)
y volume overload, and ventricular dilation. Viral myocarditis is a common
75
cause of dilated cardiomyopathy and should be suspected in young patients
who develop heart failure following a symptomatic viral prodrome.

Embolic stroke Paradoxical embolism occurs when a thrombus from the venous system Cardiovas Pathophysiol 1 CV
crosses into the arterial circulation via an abnormal connection between the cular (CV) ogy (Patp)
right and left cardiac chambers (eg, patent foramen ovale, atrial septal
189 defect, or ventricular septal defect). Atrial left-to-right shunts cause wide
and fixed splitting of S2 and can facilitate paradoxical embolism due to
periods of transient shunt reversal (eg. during straining or coughing).

Hypertrophic Hypertrophic cardiomyopathy (HCM) is characterized by asymmetric Cardiovas Pathophysiol 9 CV

cardiomyopath ventricular septal hypertrophy and dynamic left ventricular outflow tract cular (CV) ogy (Patp)
y (LVOT) obstruction Decreases in LV blood volume, via maneuvers or
85 conditions that decrease preload (eg. abrupt standing: Valsalva strain
phase) or afterload, worsen LVOT obstruction and increase the intensity of
the HCM murmur.
#### Hypertrophic Patients with hypertrophic cardiomyopathy (HCM) may be Cardiovas Pathophysiol 9 CV
Jugular venous On jugular venous pressure tracings, the first peak is the a wave, which is Cardiovas Pathophysiol 1 CV
2070 pulse generated by atrial contraction This is notably absent in patients with cular (CV) ogy (Patp)
atrial fibrillation.
Long QT Congenital LQTS is commonly caused by a mutation that slows the delayed Cardiovas Pathophysiol 4 CV
syndrome rectifier K current that repolarizes the cardiomyocyte AP. Certain Rx (eg, cular (CV) ogy (Patp)
macrolide Abx, antipsychotics, antiemetics) (Erythromycin) also slow the
####
K repolarization current and prolong the QT interval. Excessive QT
prolongation can trigger serious cardiac arrhythmia (ie, TdP), resulting in
syncope or SCD.
Marfan Cardiovascular lesions (aortic disease) are the most life-threatening Cardiovas Pathophysiol 2 CV
syndrome complications associated with Marfan syndrome. Early-onset cystic medial cular (CV) ogy (Patp)
194
degeneration of the aorta predisposes to aortic dissection, the most
common cause of death in these patients.
 Mitral Decompensated heart failure is a common cause of secondary Cardiovas Pathophysiol 6 CV
regurgitation (functional) mitral valve regurgitation. Increased left ventricular end- cular (CV) ogy (Patp)
diastolic volume causes dilation of the mitral valve annulus and restncted
200
movement of the chordae tendineae with subsequent regurgitation.
Treatment with diuretics and vasodilators can improve heart failure-
induced MR
Mitral In patients with mitral regurgitation, left ventricular afterload is determined Cardiovas Pathophysiol 6 CV
regurgitation by the balance of resistance between forward flow (aortic pressure) and cular (CV) ogy (Patp)
943 regurgitant flow (left atrial pressure). A reduction in systemic vascular
resistance increases the ratio of forward to regurgitant blood flow and
improves cardiac output.
Mitral Patients with severe mitral regurgitation develop left-sided volume Cardiovas Pathophysiol 6 CV
regurgitation overload with an S3 gallop due to the large volume of regurgitant flow cular (CV) ogy (Patp)
944
reentering the ventricle during mid-diastole. The absence of an S3 gallop
excludes severe chronic MR.
Mitral Left ventricular systole corresponds to the time of passive filling of the left Cardiovas Pathophysiol 6 CV
regurgitation atrium (atrial diastole). Mitral valve regurgitation leads to markedly cular (CV) ogy (Patp)
945 elevated left atrial pressure during this period, creating the characteristic
early and large V wave on left atrial pressure tracing.

Mitral Mitral regurgitation results in a blowing, holosystolic murmur heard best Cardiovas Pathophysiol 6 CV
regurgitation over the cardiac apex with radiation to the axilla Rheumatic heart disease cular (CV) ogy (Patp)
2096
is a very common cause of mitral regurgitation in underdeveloped
countries.
Mitral Regurgitant flow into the left atrium in acute mitral regurgitation leads to Cardiovas Pathophysiol 6 CV
regurgitation increased left atrial pressure and increased left ventncular end-diastolic cular (CV) ogy (Patp)
volume (preload). The low-resistance regurgitant pathway also decreases
left ventricular afterload with a resulting increase in ejection fraction but
#### overall decrease in forward stroke volume Increased left atrial pressure and
decreased cardiac output result in pulmonary edema and severe
hypotension, respectively (Afterload decrease, preload increase, ejection
fraction increase)

Mitral stenosis The best and most reliable auscultatory indicator of the degree of mitral Cardiovas Pathophysiol 7 CV
stenosis is the A2-opening snap time interval. A shorter interval indicates cular (CV) ogy (Patp)
233 more severe stenosis. Other auscultatory findings can include a diastolic
rumbling murmur with presystolic accentuation due to left-atrial
contraction.
Mitral stenosis Isolated mitral stenosis causes elevated upstream pressures in the left Cardiovas Pathophysiol 7 CV
atrium and pulmonary veins and arteries. Left ventricular end diastolic cular (CV) ogy (Patp)
pressure (LVEDP) is normal or decreased due to obstruction of blood flow
234
through the stenotic valve. An elevated LVEDP suggests additional
downstream pathology (eg aortic valve disease, left ventricular failure).

Mitral stenosis Cardiac auscultation in patients with mitral stenosis reveals a loud first Cardiovas Pathophysiol 7 CV
heart sound, an early diastolic opening snap after the second heart sound, cular (CV) ogy (Patp)
and a low-pitched diastolic rumble best heard at the cardiac apex. The
235
opening snap is caused by the sudden opening of the mitral valve leaflets
when the left ventricular pressure falls below the left atrial pressure at the
beginning of diastole
Myocardial Loss of cardiomyocyte contractility occurs within 60 seconds after the Cardiovas Pathophysiol 19 CV
infarction onset of total ischemia When ischemia lasts less than 30 minutes, cular (CV) ogy (Patp)
restoration of blood flow leads to reversible contractile dysfunction
42 (myocardial stunning), with contractility gradually returning to normal over
the next several hours to days. However, after about 30 minutes of total
ischemia, ischemic injury becomes irreversible.

Myocardial Left ventricular (LV) free-wall rupture is an uncommon but devastating Cardiovas Pathophysiol 19 CV
infarction mechanical complication of transmural myocardial infarction that occurs cular (CV) ogy (Patp)
within 5 days or up to 2 weeks following the event. Rupture leads to
193 cardiac tamponade that causes hypotension and shock with rapid
progression to cardiac arrest. Autopsy typically reveals a slitlike tear at the
site of infarction in the LV wall (Coronary atherosclerosis)

Myocardial Rupture of the LV free wall is a catastrophic mechanical complication of Cardiovas Pathophysiol 19 CV
infarction anterior wall MI that usually occurswithi the 1st 5-14 days after MI. cular (CV) ogy (Patp)
195 Rupture leads to hemopericardium and CT, causing profound hypotension
and shockwith rapid progression to PEA and death.
 Myocardial The dominant right coronary artery perfuses both the inferior wall of the Cardiovas Pathophysiol 19 CV
infarction left ventricle and the majority of the right ventricle. Proximal occlusion can cular (CV) ogy (Patp)
cause right ventricular myocardial infarction which presents with
#### hypotension (reduced cardiac output) and distended jugular veins (elevated
central venous pressures). The lungs will be clear on auscultation and x-ray
(lack of pulmonary edema) unless concomitant left-sided heart failure is
also present.
Patent ductus Patent ductus arteriosus (PDA) is characterized by a continuous murmur Cardiovas Pathophysiol 4 CV
arteriosus heard best in the left infraclavicular region with maximal intensity at S2. A cular (CV) ogy (Patp)
small PDA is often asymptomatic and is usually detected incidentally
2109
during routine cardiac auscultation. It occurs most commonly in patients
born prematurely and those with cyanotic congenital heart disease.

Peripheral Phenotypically mixing refers to coinfection of a host cell by 2 viral strains, Cardiovas Pathophysiol 4 CV
vascular resulting in progeny virions that contain nucleocapsid proteins from 1 cular (CV) ogy (Patp)
disease strain and the unchanged parental genome of the other strain. B/c there's no
293
change in underlying viral genomes (no genetic exchange), the next gen of
virions revert to their original, unmixed phenotypes.

Primary Plasma renin activity (PRA) is a measure of the amount of angiotensin I Cardiovas Pathophysiol 14 CV
hypertension generated per unit of time It provides a useful assessment of the renin- cular (CV) ogy (Patp)
angiotensin-aldosterone axis. Factors that increase PRA include low
#### sodium intake and antihypertensive medications such as diuretics (eg,
hydrochlorothiazide), ACE inhibitors, and angiotensin II receptor blockers
(eg valsartan). (Medication noncompliance)

Prostacyclins Prostacyclin (prostaglandin 12) is synthesized from prostaglandin H2 by Cardiovas Pathophysiol 1 CV

prostacyclin synthase in vascular endothelial cells. Once secreted, it cular (CV) ogy (Patp)
751 inhibits platelet aggregation and causes vasodilation to oppose the
functions of thromboxane A2 and help maintain vascular homeostasis.

Pulmonary Pulmonary arterial hypertension should be suspected in young and Cardiovas Pathophysiol 8 CV
arterial otherwise healthy patients with fatigue, progressive dyspnea, atypical chest cular (CV) ogy (Patp)
196 hypertension pain, or unexplained syncope. Long-standing pulmonary hypertension leads
to hypertrophy and/or dilation of the right ventricle (cor pulmonale).

Pulmonary Left-sided heart failure can cause secondary pulmonary hypertension Cardiovas Pathophysiol 8 CV
arterial (Increased pulmonary venous pressure) via elevated left-sided diastolic cular (CV) ogy (Patp)
hypertension filling pressures transmitting backward to the pulmonary veins, resulting in
198 pulmonary venous congestion. Overtime, pulmonary arterial remodeling
(medial hypertrophy and intimal thickening with fibrosis) can occur, but
not to the extent that occurs in (primary) pulmonary arterial hypertension.

Pulmonary Pulmonary arterial hypertension results from endothelial dysfunction that Cardiovas Pathophysiol 8 CV
arterial leads to an increase in vasoconstrictive, proproliferative mediators (eg, cular (CV) ogy (Patp)
hypertension endothelin. thromboxane A2) and a decrease in vasodilative,
#### antiproliferative mediators (eg nitric oxide, prostacyclin). The relative
imbalance in these mediators leads to vasoconstriction and intimal-wall
thickening with a consequent increase in pulmonary vascular resistance.

Pulmonary Pulmonary hypertension can be recognized on physical examination by a Cardiovas Pathophysiol 8 CV

arterial loud pulmonic component of S2 and an accentuated, palpable impulse at cular (CV) ogy (Patp)
####
hypertension the left sternal border (left parasternal lift due to right ventricular heave)

Pulsus Pulsus paradoxus is defined by a decrease in systolic blood pressure of >10 Cardiovas Pathophysiol 2 CV
paradoxus mm Hg with inspiration It is most commonly seen in patients with cardiac cular (CV) ogy (Patp)
2099
tamponade but can also occur in severe asthma, chronic obstructive
pulmonary disease, and constrictive pericarditis.
Pulsus Asthma and chronic obstructive pulmonary disease (COPD) exacerbation Cardiovas Pathophysiol 2 CV
paradoxus are the most frequent causes of pulsus paradoxus in the absence of cular (CV) ogy (Patp)
significant pericardial disease. Beta-adrenergic agonists control acute
2100
asthma and COPD exacerbations by causing bronchial smooth muscle
relaxation via increased intracellular cAMP.

Restrictive Diastolic heart failure (DHF) is caused by decreased ventricular Cardiovas Pathophysiol 1 CV
cardiomyopath compliance and is characterized by normal left ventricular (LV) ejection cular (CV) ogy (Patp)
y fraction, normal LV end-diastolic volume, and elevated LV filling
93
pressures Hypertension obesity, and infiltrative disorders (eg
transthyretin-related amyloidosis (deposition), sarcoidosis) are
important causes of DHF
 Rheumatic Acute rheumatic fever is a complication of untreated group A streptococcal Cardiovas Pathophysiol 5 CV
fever pharyngitis. Rheumatic heart disease is the most common cause of cular (CV) ogy (Patp)
acquired valvular heart disease and cardiovascular death in developing
726 countries The incidence of acute rheumatic fever and rheumatic heart
disease has been reduced in industrialized nations with prompt treatment of
streptococcal pharyngitis with penicillin.

S4 The fourth heart sound (S4) is a low frequency sound heard at the end of Cardiovas Pathophysiol 1 CV
diastole just before S1. It is due to decreased left ventricular compliance cular (CV) ogy (Patp)
2107
and is often associated with restrictive cardiomyopathy and left
ventricular hypertrophy.
Septic shock Septic shock causes widespread arteriolar vasodilation, which leads to a Cardiovas Pathophysiol 6 CV
decrease in systemic vascular resistance and a compensatory increase in cular (CV) ogy (Patp)
cardiac output. Central venous pressure and pulmonary capillary wedge
#### pressure are also decreased due to pooling of blood in the dilated veins.
Increased flow rates through the peripheral capillaries lead to incomplete
oxygen extraction by the tissues and high mixed venous oxygen
saturation.
Septic shock Septic shock (from bacterial infection) can present with either hyper- or Cardiovas Pathophysiol 6 CV
hypothermia. The initial disturbance is peripheral vasodilation leading to cular (CV) ogy (Patp)
decreased systemic vascular resistance, decreased central venous pressure,
and decreased pulmonary capillary wedge pressure. A compensatory
####
increase in sympathetic drive causes an increase in cardiac output: the
resulting high flow rates lead to incomplete oxygen extraction in the
tissues, resulting in high mixed venous oxygen saturation.

Sick sinus Asymptomatic left ventricular systolic dysfunction is a common stage in Cardiovas Pathophysiol 2 CV
syndrome the progression of heart failure. Neurohormonal mechanisms including the cular (CV) ogy (Patp)
sympathetic nervous system and renin-angiotensin-aldosterone system,
help maintain the asymptomatic period by increasing volume retention and
#### peripheral resistance to maintain organ perfusion. Although these
mechanisms (increase in Angiotensin II Norepinephrine Atrial
natriuretic peptide) are beneficial in the short term, they are ultimately
deleterious, increasing hemodynamic stress and cardiac remodeling that
eventually lead to decompensated heart failure.
Sick sinus Sick sinus syndrome results from degeneration (usually age-related) of the Cardiovas Pathophysiol 2 CV
syndrome sinoatrial node (RA wall), leading to impaired conduction and reduced cular (CV) ogy (Patp)
cardiac output with symptoms of dyspnea, fatigue. Iightheadedness.
####
presyncope, and syncope. ECG typically demonstrates bradycardia with
sinus pauses (delayed P waves), sinus arrest (dropped P waves), and
junctional escape beats
Tetralogy of In patients with Tetralogy of Fallot, the degree of right ventricular Cardiovas Pathophysiol 3 CV
204 Fallot outflow tract obstruction is the major determinant of the degree of right- cular (CV) ogy (Patp)
to-left intracardiac shunting and resulting cyanosis.
Tricuspid Severe tricuspid valve regurgitation (TR) can lead to right-sided heart Cardiovas Pathophysiol 3 CV
regurgitation failure, evidenced by jugular venous distension, hepatomegaly, lower cular (CV) ogy (Patp)
extremity edema, and the absence of pulmonary edema. Permanent
####
pacemaker placement can cause TR because the right ventricular lead
passes through the tricuspid valve orifice and can disrupt valve closure.

Vasospastic Vasospastic angina involves hyperreactivity of coronary artery smooth Cardiovas Pathophysiol 2 CV
angina muscle. Patients are usually young (age <50) and without significant risk cular (CV) ogy (Patp)
#### factors for coronary artery disease; they experience recurrent episodes of
chest discomfort that typically occur during rest or sleep and resolve within
15 minutes.
Ventricular A ventricular septal defect (VSD) is associated with a low-pitched, Cardiovas Pathophysiol 2 CV
septal defect holosystolic murmur at the mid to lower left sternal border. It accentuates cular (CV) ogy (Patp)
during maneuvers that increase afterload (eg, handgnp maneuver). A small
2117
VSD is usually asymptomatic and produces a louder murmur due to higher
interventricular pressure gradient.

Wolff- Wolff-Parkinson-White syndrome is characterized by symptomatic Cardiovas Pathophysiol 2 CV

Parkinson- paroxysmal supraventricular tachycardia (eg. atrioventricular reentrant cular (CV) ogy (Patp)
White tachycardia) due to the presence of an accessory conduction pathway
syndrome During normal sinus rhythm, the presence of this accessory pathway causes
90
ventricular preexcitation, which can be identified on ECG by the triad of a
shortened PR interval, early upslope of the QRS complex (delta wave),
and a widened QRS interval.
 Wolff- Wolff-Parkinson-White (WPW) pattern is characterized by a shortened PR Cardiovas Pathophysiol 2 CV
Parkinson- interval, widening of the QRS complex, and slurred initial upstroke of the cular (CV) ogy (Patp)
White QRS complex (delta wave). It is caused by an AV conduction pathway
syndrome that bypasses the atrioventricular node, causing preexcitation of the
#### ventricles Patients with WPW pattern can develop symptomatic arrhythmia
(eg: atrioventricular reentrant tachycardia) due to reentry of electrical
impulses through the accessory conduction pathway

Atrioventricular nodal reentrant tachycardia is the most common type of Cardiovas Pathophysiol
paroxysmal supraventricular tachycardia, resulting from abnormal cular (CV) ogy (Patp)
conduction through 2 distinct atrioventricular nodal pathways. ECG
####
typically demonstrates a narrow QRS complex tachycardia with a
regular rhythm and buried (not visible) P waves.

ACE inhibitors ACE inhibitors can cause significant first-dose hypotension in patients with Cardiovas Pharmacolog 7 CV
volume depletion (eg. from diuretic use) or heart failure. To reduce the cular (CV) y (Phar)
693
risk of first-dose hypotension, ACE inhibitor therapy should be initiated at
low dosages
ACE inhibitors Angioedema is a rare and serious adverse effect of ACE inhibitor therapy Cardiovas Pharmacolog 7 CV
ACE inhibition increases bradykinin levels (Bradykinin cular (CV) y (Phar)
accumulation), which increase vascular permeability and lead to
949
angioedema Symptoms include tongue, lips, or eyelid swelling and. less
frequently, laryngeal edema and difficulty breathing. ACE inhibitors
should be discontinued in affected patients.
ACE inhibitors Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor Cardiovas Pharmacolog 7 CV
blockers (ARBs(Valsartan)) reduce the risk of chronic kidney disease in cular (CV) y (Phar)
1166 patients with hypertension and diabetes. ACE inhibitors raise levels of
bradykinin and can cause a nonproductive cough, an effect not seen with
ARBs.
Aging Digoxin is a cardiac glycoside that is predominantly cleared by the Cardiovas Pharmacolog 8 CV
kidneys. Elderly patients typically exhibit age-related renal insufficiency, cular (CV) y (Phar)
1780 even in the presence of normal creatinine levels. The dose of digoxin must
be reduced in these patients to prevent toxicity.

Aldosterone Mineralocorticoid receptor antagonists (eg, spironolactone, eplerenone) Cardiovas Pharmacolog 3 CV

antagonists improve survival in patients with congestive heart failure and reduced left cular (CV) y (Phar)
686
ventncular ejection fraction. They should not be used in patients with
hyperkalemia or renal failure.
Aldosterone All diuretics except for the K-sparing class cause K loss by ↑ Na delivery to Cardiovas Pharmacolog 3 CV
antagonists the late distal tubule and cortical collecting duct, where aldosterone- cular (CV) y (Phar)
induced Na reabsorption occurs at the expense of K. K-sparing diuretics
2005
(eg, spironolactone, amiloride) act on the late distal tubule and cortical
collecting duct to antagonize the effects of aldosterone.

Alpha agonists a-adrenergic agonists increase systolic and diastolic blood pressure by Cardiovas Pharmacolog 1 CV
stimulating a,-adrenoreceptors the vascular walls, causing vasoconstriction. cular (CV) y (Phar)
1343 The elevated systemic blood pressure then causes a reflexive increase in
vagal tone, resulting in decreased heart rate and slowed atrioventricular
node conduction.
Amiodarone Amiodarone is 40% iodine by weight. It can cause hypothyroidism due to Cardiovas Pharmacolog 1 CV
decreased production of thyroid hormone. Amiodarone can also cause cular (CV) y (Phar)
625 hyperthyroidism due to increased thyroid hormone synthesis or destructive
thyroiditis with release of preformed thyroid hormone. must test Serum
TSH
Angina Pharmacologic nitrates (eg, nitroglycerin, isosorbide mononitrate, Cardiovas Pharmacolog 1 CV
isosorbide dinitrate) are metabolized to nitric oxide and S-nitrothiols in cular (CV) y (Phar)
vascular smooth muscle cells, leading to an increase in cyclic guanosine
monophosphate (cGMP) that stimulates vasodilation. Large veins are
137
predominantly affected, leading to increased venous capacitance and
reduced venous return (preload), which decreases left ventricular wall
stress and myocardial oxygen demand to relieve anginal symptoms.

Angiotensin Angiotensin II receptor blockers (ARBs) work by blocking angiotensin II Cardiovas Pharmacolog 1 CV
receptor type 1 receptors, inhibiting the effects of angiotensin II. This results in cular (CV) y (Phar)
blockers arterial vasodilation and decreased aldosterone secretion. The resulting
691 fall in blood pressure increases renin, angiotensin I, and angiotensin II
levels. ARBs do not affect the activity of angiotensin-converting enzyme,
and therefore they do not affect bradykinin degradation and do not cause
cough.
 Antiarrhythmic For class I antiarrhythmics (Lidocaine). sodium-channel-binding strength Cardiovas Pharmacolog 12 CV
drugs is 1C > IA > IB Use dependence describes the phenomenon in which cular (CV) y (Phar)
higher heart rates lead to increased sodium channel blockade due to
cumulative blocking effects over multiple cardiac cycles Class 1C
159
antiarrhythmics demonstrate the most use dependence due to their slow
dissociation from the receptor and class IB drugs have the least use
dependence as they rapidly dissociate.

Antiarrhythmic Adenosine causes hyperpolarization of the nodal pacemaker to briefly Cardiovas Pharmacolog 12 CV
drugs block conduction through the atrioventricular node and it is effective in the cular (CV) y (Phar)
initial treatment of paroxysmal supraventricular tachycardia Common
898
adverse effects include flushing, chest burning (due to bronchospasm),
hypotension, and high-grade atrioventricular block.

Antiarrhythmic Amiodarone (and other class III and class IA antiarrhythmic agents) Cardiovas Pharmacolog 12 CV
drugs causes lengthening of the cardiac action potential, which manifests as QT cular (CV) y (Phar)
899 interval prolongation on ECG. QT prolongation caused by amiodarone. in
contrast to other drugs, is associated with a very low risk of torsades de
pointes.
Antiarrhythmic Lidocaine is a class IB antiarrhythmic drug that tends to bind to Cardiovas Pharmacolog 12 CV
drugs inactivated sodium channels and rapidly dissociates As a result, it is cular (CV) y (Phar)
900
effective in suppressing ventricular tachyarrhythmias induced by rapidly
depolarizing and ischemic myocardium.
Antiarrhythmic Class III antiarrhythmic drugs (eg, amiodarone, sotalol, dofetilide) Cardiovas Pharmacolog 12 CV
drugs predominantly block potassium channels and inhibit the outward cular (CV) y (Phar)
901 potassium currents during phase 3 of the cardiac action potential, thereby
prolonging repolarization and total action potential duration.

Antiarrhythmic Sotalol has both beta adrenergic-blocking and class III antiarrhythmic (K+ Cardiovas Pharmacolog 12 CV
drugs channel-blocking) properties and is occasionally used in treatment of atrial cular (CV) y (Phar)
1506 fibrillation. Major side effects of sotalol include bradycardia,
proarrhythmia, and most commonly torsades de pointes due to QT interval
prolongation.
Antiarrhythmic Class III antiarrhythmic drugs (amiodarone, sotaloL dofetilide) Cardiovas Pharmacolog 12 CV
drugs predominantly block potassium channels and inhibit the outward potassium cular (CV) y (Phar)
1507 currents during phase 3 of the cardiac action potential thereby prolonging
repolarization and total action potential duration.

Antiarrhythmic Class 1C antiarrhythmic agents (flecainide) block the fast sodium channels Cardiovas Pharmacolog 12 CV
drugs responsible for ventricular depolarization (phase 0), prolonging QRS cular (CV) y (Phar)
1508
duration with little effect on the QT interval. Class 1A and class III agents
cause the most QT prolongation.
Antiarrhythmic The class IA antiarrhythmics (quinidine, procainamide, and Cardiovas Pharmacolog 12 CV
drugs disopyramide) are sodium channel-blocking agents that depress phase 0 cular (CV) y (Phar)
1509 depolarization. They also prolong repolarization due to moderate potassium
channel- blocking activity, increasing action potential duration cardiac
myocytes.
Antiarrhythmic Beta blockers decrease AV nodal conduction, leading to an increased AV Cardiovas Pharmacolog 12 CV
2006 drugs nodal refractory period. This correlates to PR interval prolongation on an cular (CV) y (Phar)
ECG.
Antiarrhythmic Class 1C antiarrhythmics such as flecainide are potent sodium channel Cardiovas Pharmacolog 12 CV
drugs blockers that have increased effect at faster heart rates (use-dependence). cular (CV) y (Phar)
8869 This makes them more effective at treating tachyarrhythmias, but can also
cause prolonged QRS duration (a proarrhythmic effect) at higher heart
rates
Anticoagulants Warfarin is an oral anticoagulant that inhibits the carboxylation of vitamin Cardiovas Pharmacolog 8 CV
К-dependent coagulation factors II, VII, IX. and X It is used in atrial cular (CV) y (Phar)
fibrillation, deep venous thrombosis, and pulmonary thromboembolism.
1200 Prothrombin time (PT)/lntemational Normalized Ratio (INR) should be
monitored regularly during treatment with warfarin. Activated partial
thromboplastin time (aPTT) is used for monitoring unfractionated heparin

Antiplatelet Gastrointestinal (Gl) mucosal injury and bleeding are the most common Cardiovas Pharmacolog 1 CV
therapy side effects of aspirin. These are due primarily to cyclooxygenase-1 cular (CV) y (Phar)
713 inhibition, which results in impaired prostaglandin-dependent Gl mucosal
defense and decreased platelet aggregation.

Beta 2 agonists Isoproterenol is a 3-1 and 3-2 adrenergic receptor agonist that causes Cardiovas Pharmacolog 1 CV
1836 increased myocardial contractility and decreased systemic vascular cular (CV) y (Phar)
resistance.
 Beta blocker Patients who have overdosed on beta blockers should be treated with Cardiovas Pharmacolog 1 CV
poisoning glucagon, which increases heart rate and contractility independent of cular (CV) y (Phar)
adrenergic receptors. Glucagon activates G-protein-coupled receptors on
1444 cardiac myocytes, causing activation of adenylate cyclase and raising
intracellular cAMP. The result is calcium release from intracellular stores
and increased sinoatrial node firing.

Beta blockers B1 adrenergic receptors are found in cardiac tissue and on renal Cardiovas Pharmacolog 3 CV
juxtaglomerular cells but not in vascular smooth muscle. Selective cular (CV) y (Phar)
8289 blockade of the B1 receptor (eg, with atenolol) leads to decreased cAMP
levels in cardiac and renal tissue without significantly affecting cAMP
levels in vascular smooth muscle.
Bradycardia Conduction impairment is common with acute inferior wall myocardial Cardiovas Pharmacolog 1 CV
infarction. Sinus bradycardia often occurs due to nodal ischemia and an cular (CV) y (Phar)
#### increase in vagal tone triggered by infarction of myocardial tissue; the
enhanced vagal tone can be counteracted by the anticholinergic effects of
atropine.
Calcium Calcium channel blockers inhibit the L-type calcium channel on vascular Cardiovas Pharmacolog 3 CV
channel blocker smooth muscle and cardiac cells. Dihydropyridines (eg, nifedipine, cular (CV) y (Phar)
amlodipine) primarily affect peripheral arteries and cause vasodilation.
145
Nondihydropyridines (eg, verapamil, diltiazem) affect the myocardium and
can cause bradycardia and slowed atrioventricular conduction.

Calcium Amlodipine is a dihydropyridine calcium channel blocker commonly used Cardiovas Pharmacolog 3 CV
channel blocker as monotherapy or in combination with other agents for treatment of cular (CV) y (Phar)
154
hypertension. Major side effects include headache, flushing, dizziness, and
peripheral edema.
Cardiogenic Dobutamine is a beta adrenergic agonist with predominant activity on beta- Cardiovas Pharmacolog 1 CV
shock 1 receptors. It causes an increase in heart rate and cardiac contractility, cular (CV) y (Phar)
1344
leading to an increase in myocardial oxygen consumption.

Chronic cough Cough is a very well recognized side effect of ACE inhibitor therapy. Cardiovas Pharmacolog 1 CV
Cough secondary to ACE inhibitor therapy is characterized as dry. cular (CV) y (Phar)
nonproductive, and persistent. The mechanism behind ACE inhibitor
948 induced cough is accumulation of bradykinin. substance P, or
prostaglandins. Because angiotensin receptor blockers (ARBs) do not
affect ACE activity they theoretically should not cause cough

Chronic heart Milrinone is a phosphodiesterase-3 inhibitor that reduces the degradation Cardiovas Pharmacolog 12 CV
failure of cyclic adenosine monophosphate to provide 2 beneficial effects for cular (CV) y (Phar)
treating systolic heart failure. Calcium influx into cardiomyocytes is
149 increased, which increases cardiac contractility. In addition, calcium-
myosin light chain kinase interaction is reduced, which causes
vasodilation and reduces cardiac preload and afterload.

Chronic heart Neurohormones (eg, norepinephrine, angiotensin II, and aldosterone) play Cardiovas Pharmacolog 12 CV
failure a large role in the deleterious cardiac remodeling that occurs in heart cular (CV) y (Phar)
failure with reduced ejection fraction. ACE inhibitors (Lisinopril),
1565 angiotensin-receptor blockers (losartan)), mineralocorticoid receptor
antagonists (spironolactone)), and beta blockers (metoprolol) reduce
mortality in these patients by reducing neurohormonal-mediated cardiac
remodeling
Chronic heart Carvedilol is a drug that have been shown to improve long-term survival Cardiovas Pharmacolog 12 CV
failure in patients with heart failure due to left ventricular systolic dysfunction cular (CV) y (Phar)
1944
include beta blockers, ACE inhibitors, angiotensin II receptor blockers, and
aldosterone antagonists.
Contraception The absolute contraindications to the use of OCPs are: 1. Prior history of Cardiovas Pharmacolog 3 CV
thromboembolic event or stroke 2. History of an estrogen-dependent tumor cular (CV) y (Phar)
577 3. Women over age 35 years who smoke heavily 4. Hypertriglyceridemia
5. Decompensated or active liver disease (would impair steroid
metabolism) 6. Pregnancy
Coronary artery Clopidogrel irreversibly blocks the P2Y12 component of ADR receptors Cardiovas Pharmacolog 4 CV
disease on the platelet surface and prevents platelet aggregation. Clopidogrel is as cular (CV) y (Phar)
1828
effective as aspirin in the prevention of cardiovascular events in patients
with coronary heart disease.
Digoxin Digoxin toxicity typically presents with cardiac arrhythmias and Cardiovas Pharmacolog 4 CV
nonspecific gastrointestinal (nausea, vomiting), neurological (confusion, cular (CV) y (Phar)
147 weakness), and visual symptoms. Elevated potassium is another sign of
digoxin toxicity and is caused by inhibition of Na-K-ATPase pumps.
 Digoxin Digoxin directly inhibits the Na-K-ATPase pump in myocardial cells, Cardiovas Pharmacolog 4 CV
leading to a decrease in sodium efflux and an increase in intracellular cular (CV) y (Phar)
148 sodium levels. This reduces the forward activity of the sodium-calcium
exchanger, causing increased intracellular calcium concentration and
improved myocyte contractility.
Digoxin Digoxin is used for ventricular rate control in atrial fibrillation as it Cardiovas Pharmacolog 4 CV
decreases atrioventricular nodal conduction by increasing cular (CV) y (Phar)
155 parasympathetic vagal tone. Digoxin is also used in heart failure due to
its positive inotropic effect. These effects are accomplished via inhibition
of the sodium-potassium ATPase pump.
Digoxin Digoxin toxicity presents with nonspecific gastrointestinal (eg. anorexia Cardiovas Pharmacolog 4 CV
nausea, vomiting) and neurologic (eg, fatigue, confusion, weakness) cular (CV) y (Phar)
156 symptoms. Changes in color vision are a more specific, but rarer, finding.
Life-threatening ventricular arrhythmias are the most serious
complication.
Dilated Anthracycline chemotherapeutic agents (eg, doxorubicin, daunorubicin) Cardiovas Pharmacolog 8 CV
cardiomyopath cause cardiotoxicity mainly through the formation of anthracycline- cular (CV) y (Phar)
y topoisomerase II DNA cleavage complexes that affect healthy
1014
cardiomyocytes. The cardiotoxicity is dependent on the cumulative dose of
anthracycline received, and it manifests as dilated cardiomyopathy.

Dilated Trastuzumab is a monoclonal antibody that blocks human epidermal Cardiovas Pharmacolog 8 CV
cardiomyopath growth factor receptor-2 (HER2) to disrupt malignant cell signaling and cular (CV) y (Phar)
y encourage apoptosis. Because HER2 helps preserve cardiomyocyte
####
function, trastuzumab can cause cardiotoxicity that manifests as a decrease
in myocardial contractility without cardiomyocyte destruction or
myocardial fibrosis.
Dose response A permissive hormone has no effect on a physiologic process by itself but Cardiovas Pharmacolog 4 CV
curves allows another hormone to exert its maximal effect on that process Cortisol cular (CV) y (Phar)
exerts a permissive effect on catecholamines to potentiate vasoconstriction
551
and bronchodilation: it also has a permissive effect on glucagon to increase
glucose release from the liver.

Dose response Phenoxybenzamine is an irreversible a1 and a2 adrenergic antagonist that Cardiovas Pharmacolog 4 CV
curves effectively reduces the arterial vasoconstriction induced by norepinephrine cular (CV) y (Phar)
Because phenoxybenzamine is an irreversible antagonist, even very high
1947
concentrations of norepinephrine, such as those seen in
pheochromocytoma, cannot overcome its effects.

Drug induced Common side effects of HMG-CoA reductase inhibitors (statins) include Cardiovas Pharmacolog 2 CV
liver injury muscle and liver toxicity. Hepatic transaminases should be checked cular (CV) y (Phar)
780
prior to initiating therapy and repeated if symptoms of hepatic injury

Drug induced Statins primarily simvastatin lovastatin and atorvastatin, are metabolized by Cardiovas Pharmacolog 3 CV
myopathy CYP3A4 (Cyclosporine- CYP3A4 inhibitor). Drugs that inhibit this cular (CV) y (Phar)
enzyme (eg, macrolide antibiotics (erythromycin, clarithromycin),,
161
ketoconazole, non-dihydropyridine (verapamil, diltiazem), calcium channel
blockers, amiodarone) can cause increased statin drug levels and lead to
statin myopathy
Drug induced The 1° side effects of statins include myopathy and hepatitis. Fibrates such Cardiovas Pharmacolog 3 CV
778 myopathy as gemfibrozil can impair hepatic clearance of statins, ↑ the risk of severe cular (CV) y (Phar)
myopathy.
Dyslipidemia Niacin is used in the treatment of hyperlipidemia It increases HDL levels Cardiovas Pharmacolog 11 CV
and decreases LDL levels and triglycerides Niacin causes cutaneous cular (CV) y (Phar)
160
flushing, which is mediated by prostaglandins and can be diminished by
pretreatment wrth aspirin
Dyslipidemia Treatment with statins causes hepatocytes to increase their LDL receptor Cardiovas Pharmacolog 11 CV
711 density, leading to increased uptake of circulating LDL. cular (CV) y (Phar)

Dyslipidemia Although low HDL concentration is associated with increased Cardiovas Pharmacolog 11 CV
cardiovascular risk, the use of medications to raise HDL levels does not cular (CV) y (Phar)
improve cardiovascular outcomes. (Enzyme inhibitor) HMG-CoA
781 reductase inhibitors (statins) lower total cholesterol and LDL levels. Statins
are the most effective lipidlowering drugs for primary and secondary
prevention of cardiovascular events, regardless of baseline lipid levels

Dyslipidemia Fibrates lower triglyceride levels by activating peroxisome proliferator- Cardiovas Pharmacolog 11 CV
activated receptor alpha, which leads to decreased hepatic VLDL cular (CV) y (Phar)
production and increased lipoprotein lipase activity Fish oil supplements
####
containing high concentrations of omega-3 fatty acids lower triglycerides
by decreasing production of VLDL and apolipoprotein B.
 Endocarditis
Initial empiric treatment of coagulase-negative staphylococcal infection Cardiovas Pharmacolog 15 CV
should include vancomycin due to widespread methicillin resistance, cular (CV) y (Phar)
645 especially in nosocomial infections. If susceptibility results indicate a
methicillin-susceptible isolate, vancomycin can be switched to nafcillin or
oxacillin.
Heart block Common side effects of nondihydropyridine calcium channel blockers (eg: Cardiovas Pharmacolog 2 CV
diltiazem, verapamil) include constipation, bradycardia, atrioventricular cular (CV) y (Phar)
153 conduction block (negative chronotropic effect) and worsening of heart
failure in patients with reduced left ventricular function (negative inotropic
effect).
Hyperkalemia ACE inhibitors block the conversion of angiotensin I to angiotensin II. Cardiovas Pharmacolog 1 CV
thereby reducing vasoconstriction and aldosterone secretion. Decreased cular (CV) y (Phar)
aldosterone leads to potassium retention, which can cause hyperkalemia,
697 especially in patients with renal insufficiency and those taking other
medications that raise potassium levels (eg, angiotensin II receptor
blockers, mineralocorticoid receptor blockers (spironolactone,
eplerenone)).
Hypertrophic The dynamic left ventricular (LV) outflow tract obstruction that occurs in Cardiovas Pharmacolog 9 CV
cardiomyopath hypertrophic cardiomyopathy worsens with decreased LV volume, which cular (CV) y (Phar)
y can be caused by reduction in cardiac preload and/or afterload. Therefore,
141 medications that decrease venous return or systemic vascular resistance
(dihydropyridine calcium channel blockers, nitroglycerin (Isosorbide
dinitrate)) should generally be avoided.

Hypertrophic Many patients with hypertrophic cardiomyopathy have poor cardiac Cardiovas Pharmacolog 9 CV
cardiomyopath reserve (eg, exercise intolerance) due to left ventricular (LV) outflow tract cular (CV) y (Phar)
y obstruction. This outflow obstruction is worsened by decreased LV blood
####
volume. Beta blockers decrease heart rate and LV contractility to
increase LV blood volume, reduce LV outflow tract obstruction, and
improve symptoms.
Myocardial Fibrinolytic therapy for acute ST segment elevation myocardial infarction Cardiovas Pharmacolog 19 CV
infarction is a reasonable reperfusion technique for patients with no contraindications cular (CV) y (Phar)
to thrombolysis. Fibrinolytic agents such as alteplase bind to fibrin in the
823
thrombus (clot) and activate plasmin: which leads to thrombolysis. The
most common adverse effect of thrombolysis is hemorrhage (eg,
gastrointestinal, intracerebral).
Myocardial In the fibrinolytic pathway, tPA converts plasminogen to plasmin, which Cardiovas Pharmacolog 19 CV
infarction then breaks down fibrin clot. The administration of a tPA analogue (eg, cular (CV) y (Phar)
1082 alteplase, tenecteplase, streptokinase) triggers fibrinolysis and can restore
myocardial perfusion in ptswith STEMI who cannot undergo timely PCI.

1196 Myocardial Beta blockers are used in acute myocardial infarction to reduce morbidity Cardiovas Pharmacolog 19 CV
Myocardial Following myocardial infarction, collagen deposition and fibrosis within Cardiovas Pharmacolog 19
infarction the infarct region and eccentric hypertophy of surviving myocytes can lead cular (CV) y (Phar)
to progressive left ventricular (LV) dilation and worsening contractile
dysfunction. Because much of this remodeling is driven by neurohormonal
####
signaling via angiotensin II, ACE inhibitors (eg, lisinopril) reduce
deleterious cardiac remodeling following myocardial infarction,
minimizing LV dilation and helping preserve contractile function.

Nitrates Nitrates (via conversion to nitric oxide) activate guanylate cyclase and Cardiovas Pharmacolog 7 CV
increase intracellular levels of cyclic guanosine monophosphate (cGMP). cular (CV) y (Phar)
136 Increased levels of cGMP lead to myosin light-chain dephosphorylation,
resulting in vascular smooth muscle relaxation.

Nitrates Sublingual nitroglycerin is used for rapid symptom relief in patients with Cardiovas Pharmacolog 7 CV
stable angina. The primary anti- ischemic effect of nitrates is mediated by cular (CV) y (Phar)
138 venodilation with a decrease in left ventricular end-diastolic volume
and wall stress, resulting in decreased myocardial oxygen demand and
relief of angina symptoms.
Nitrates Isosorbide dinitrate has a low bioavailability due to extensive first-pass Cardiovas Pharmacolog 7 CV
hepatic metabolism prior to release in systemic circulation. Sublingual cular (CV) y (Phar)
139
nitroglycerin is absorbed directly from oral mucosa into the venous
circulation and has a higher bioavailability
Nitrates The main adverse effects seen with nitrate therapy include throbbing Cardiovas Pharmacolog 7 CV
140 headaches and cutaneous flushing along with lightheadedness and cular (CV) y (Phar)
hypotension due to systemic vasodilation.
Nitrates Patients taking daily maintenance nitrates need to have a nitrate-free period Cardiovas Pharmacolog 7 CV
142 every day to avoid tolerance to the drug cular (CV) y (Phar)
 Nitrates Using nitrates together with phosphodiesterase (PDE) inhibitors used for Cardiovas Pharmacolog 7 CV
erectile dysfunction and pulmonary hypertension causes a profound cular (CV) y (Phar)
systemic hypotension because they both increase intracellular cGMP
143
(accumulation) which causes vascular smooth muscle relaxation. Their
use together is absolutely contraindicated.

Nitrates Nitrates are primarily venodilators and increase peripheral venous Cardiovas Pharmacolog 7 CV
capacitance, thereby reducing cardiac preload and left ventricular end- cular (CV) y (Phar)
#### diastolic volume and pressure. Nitrates also have a modest effect on
arteriolar dilation and cause a decrease in systemic vascular resistance
and cardiac afterload
Orthostatic Orthostatic hypotension is a frequent cause of lightheadedness and syncope Cardiovas Pharmacolog 1 CV
hypotension and is defined as a decrease in systolic (>20 mm Hg) or diastolic (>10 mm cular (CV) y (Phar)
Hg) blood pressure on standing from the supine position. Medications (a 1-
1342
adrenergic antagonists, diuretics), volume depletion, and autonomic
dysfunction are common causes of orthostatic hypotension

Patent ductus Patency of the ductus arteriosus is maintained in utero due to placental Cardiovas Pharmacolog 4 CV
arteriosus production of prostaglandin E2 (PGE2) and low oxygen levels in the fetal cular (CV) y (Phar)
circulation. Persistence after birth (ie, patent ductus artenosus) is
315
associated with elevated postnatal PGE2 and typically presents with a
continuous murmur, widened pulse pressure, and bounding pulses in a
preterm infant.
Peripheral SSx Mx PVD includes a graded exercise program and cilostazol. Cilostazol Cardiovas Pharmacolog 4 CV
vascular is a PDEI that inhibs platelet aggregation and acts as a direct arterial cular (CV) y (Phar)
1080 disease vasodilator. Ptswith PVD should also receive an antiplatelet agent (aspirin
or clopidogrel) for 2° prevention of CAD and stroke.

Pharmacokineti Clearance (CL) determines the dose rate required to maintain a steady- Cardiovas Pharmacolog 1 CV
cs state plasma concentration (Cpss): cular (CV) y (Phar)
8291
Maintenance dose = Cpss x CL / [Bioavailability fraction]
The bioavailability fraction = 1 if administered IV.
Phosphodiester Atrial natriuretic peptide, brain natriuretic peptide, and nitric oxide Cardiovas Pharmacolog 1 CV
ase inhibitors activate guanylyl cyclase and increase conversion of guanosine 5'- cular (CV) y (Phar)
triphosphate to |cyclic guanosine 3':5'-monophosphate (cGMP).
1118
Phosphodiesterase inhibitors (eg. sildenafil) decrease the degradation of
cGMP Elevated intracellular cGMP levels lead to relaxation of vascular
smooth muscle and vasodilation
Potassium- Potassium-sparing diuretics are often added to loop or thiazide diuretics to Cardiovas Pharmacolog
sparing prevent hypokalemia. Amiloride and triamterene directly inhibit the cular (CV) y (Phar)
diuretics epithelial sodium channel, preventing sodium from entering the principal
####
cell, which reduces the electrochemical gradient (ie, negative luminal
charge) that helps drive potassium secretion.

Primary 1. Alphal-blockers such as Doxazosin, Prazosin and Terazosin are useful Cardiovas Pharmacolog 14 CV
hypertension for the treatment of both benign prostatic hyperplasia and hypertension. cular (CV) y (Phar)
2. Patients with coronary artery disease and heart failure along with
150 hypertension will benefit from cardioselective beta-blockers.
3. Hydrochlorothiazide is presently the first-line medication for the
treatment of essential hypertension in the general population.

Primary Fenoldopam is a selective peripheral dopamine-1 receptor agonist. It Cardiovas Pharmacolog 14 CV

hypertension causes vasodilation of systemic and renal arterioles to lower blood pressure cular (CV) y (Phar)
689 while also increasing renal perfusion, urine output, and natriuresis, making
it useful in the treatment of hypertensive emergency in patients with renal
insufficiency.
Primary Direct arteriolar vasodilators lower blood pressure but trigger reflex Cardiovas Pharmacolog 14 CV
hypertension sympathetic activation and stimulate the renin-angiotensin-aldosterone cular (CV) y (Phar)
axis. This results in tachycardia and edema. To counteract such
1252
compensatory effects, these agents (Sodium and fluid retention) are often
given in combination with sympatholytics and diuretics.

Primary Beta blockers inhibit release of renin from renal juxtaglomerular cells Cardiovas Pharmacolog 14 CV
hypertension through antagonism of beta-1 receptors on these cells. Inhibition of renin cular (CV) y (Phar)
1948 release prevents activation of the renin-angiotensin-aldosterone pathway
which results in decreased vasoconstriction and decreased renal sodium
and water retention.
Primary TZDs ↑ serum Ca, uric acid, Glc, cholesterol, and triglyceride lvls. They ↓ Cardiovas Pharmacolog 14 CV
2002 hypertension serum Na, K, and Mg lvls. cular (CV) y (Phar)
 Septic shock Phenylephrine is a selective alpha-1 agonist with no effect on alpha-2 or Cardiovas Pharmacolog 6 CV
beta receptors. It causes peripheral vasoconstriction that increases systemic cular (CV) y (Phar)
6811 vascular resistance and blood pressure. It has no direct effect on the heart
but stimulates a reflex-mediated decrease in heart rate and myocardial
contractility.
SLE Procainamide and hydralazine have the highest risk of causing drug- Cardiovas Pharmacolog 7 CV
induced lupus erythematosus (DILE), which is characterized by the cular (CV) y (Phar)
development of lupus-like symptoms in addition to positive ANA and anti-
1505
histone antibodies Unlike with SLE. anti-dsDNA antibodies are rarely
seen

Sympathomime Blanching of a vein into which norepinephrine is being infused together Cardiovas Pharmacolog 5 CV
tic agents with induration and pallor of the tissues surrounding the IV site are signs cular (CV) y (Phar)
1164 of norepinephrine extravasation and resulting vasoconstriction. Tissue
necrosis is best prevented by local injection of an a receptor blocking drug,
such as phentolamine.
Sympathomime Epinephrine increases systolic blood pressure (a1 + B1) and heart rate Cardiovas Pharmacolog 5 CV
tic agents (B1), and either increases or decreases diastolic blood pressure depending cular (CV) y (Phar)
on the dose (either a1 or B2 predominates). Pretreatment with propranolol
1364
eliminates the B effects of epinephrine (vasodilatation and tachycardia),
leaving only the a effect (vasoconstriction).

Sympathomime Norepinephrine stimulates cardiac (31 adrenoreceptors, which increases Cardiovas Pharmacolog 5 CV
tic agents cAMP concentration within cardiac myocytes and leads to increased cular (CV) y (Phar)
contractility, conduction, and heart rate Peripheral vasoconstriction occurs
1367
via stimulation of ci1 adrenoreceptors in vascular smooth muscle cells and
activation of an IP3 signaling pathway

#### Sympathomime Dobutamine is a (β-adrenergic agonist with predominant activity on β, Cardiovas Pharmacolog 5 CV
Torsades de Torsades de pointes (TdP) refers to polymorphic ventricular tachycardia Cardiovas Pharmacolog 1 CV
pointes that occurs in the setting of a congenital or acquired prolonged QT interval. cular (CV) y (Phar)
TdP is most commonly precipitated by medications that prolong the QT
7640
interval such as certain antiarrhythmics (sotalol, quinidine), antipsychotics
(haloperidol), and antibiotics (macrolides, fluoroquinolones).

Vasospastic Vasospastic angina is the result of intermittent coronary vasospasm caused Cardiovas Pharmacolog 2 CV
angina by endothelial dysfunction and autonomic imbalance. Although cular (CV) y (Phar)
38 acetylcholine normally stimulates vasodilation: it triggers coronary
vasospasm in affected patients due to a deficiency of vasodilatory
endothelial nitric oxide
Acute heart Stroke volume is the absolute volume of blood ejected from the left Cardiovas Physiology 7 CV
failure ventricle with each contraction and is calculated by subtracting left cular (CV) (Phys)
ventricular end-systolic volume from left ventricular end-diastolic volume
(LVEDV) Ejection fraction is the relative volume of blood ejected from the
####
left ventricle with each contraction; it is calculated by dividing stroke
volume by LVEDV. Cardiac output, the volume of blood ejected into the
aorta per unit time, is estimated by multiplying stroke volume by heart rate.

Antiarrhythmic Class IV antiarrhythmics (eg, verapamil, diltiazem) are commonly used to Cardiovas Physiology 12 CV
drugs prevent recurrent nodal arrhythmias (eg. paroxysmal supraventricular cular (CV) (Phys)
tachycardia) They work by blocking calcium channels in slow-response
1973 cardiac tissues, slowing phase 4 (spontaneous depolarization) and phase
0 (upstroke). This reduces impulse conduction velocity in the sinoatrial and
atnoventricular nodes.

Aortic Aortic regurgitation causes an increase in total stroke volume with abrupt Cardiovas Physiology 8 CV
regurgitation distension and rapid falloff of peripheral arterial pulses, resulting in a wide cular (CV) (Phys)
1661
pulse pressure. This leads to bounding peripheral pulses and head bobbing
with each heartbeat.
Aortic Aortic regurgitation causes a rapid fall in aortic pressure during diastole Cardiovas Physiology 8 CV
regurgitation with an increase in left ventricular end-diastolic volume and a cular (CV) (Phys)
compensatory increase in stroke volume. These hemodynamic changes
####
create characteristic pressure changes, including reduced aortic diastolic
pressure and increased left ventricular diastolic and systolic pressures.

Arginine in NO Nitric oxide is synthesized from arginine by nitric oxide synthase As a Cardiovas Physiology 1 CV
production precursor of nitric oxide, arginine supplementation may play an adjunct cular (CV) (Phys)
8563
role in the treatment of conditions that improve with vasodilation, such
as stable angina.
 Atrial Atrial fibrillation occurs due to irregular, chaotic electrical activity within Cardiovas Physiology 5 CV
fibrillation the atria and presents with absent P waves, irregularly irregular R-R cular (CV) (Phys)
intervals, and narrow QRS complexes The atrioventricular node
1977 refractory period regulates the number of atrial impulses that reach the
ventricle and determines the ventricular contraction rate in conditions
where the atria undergo rapid depolarization

Atrial Palpitations refer to a subjective sensation/awareness of the heartbeat due Cardiovas Physiology 5 CV
fibrillation to rapid arrhythmias or forceful ventricular contractions. Atnal fibrillation cular (CV) (Phys)
2055 is the most common cause of an irregularly irregular rhythm and is detected
on ECG by an absence of organized P waves and varying R-R intervals.

Atrial Atrial fibrillation is recognized by an irregularly irregular rhythm with Cardiovas Physiology 5 CV
fibrillation vanable R-R intervals and absence of P waves on ECG. The development cular (CV) (Phys)
#### of AF most commonly involves ectopic electrical foci in the pulmonary
veins that trigger fibrillatory conduction in abnormal (remodeled) atrial
tissue.
#### Atrial flutter Atrial flutter demonstrates rapid and regular atrial activity in a saw-toothed Cardiovas Physiology 1 CV
AV fistula and An arteriovenous fistula allows blood to shunt from the arterial circulation Cardiovas Physiology 1 CV
P/V curves to the venous circulation, bypassing the high resistance of the systemic cular (CV) (Phys)
arterioles. This leads to reduced systemic vascular resistance (ie reduced
1518
afterload), increased venous return (ie, increased preload), and
increased stroke volume. Left ventricular contractility is unchanged.

Calcium Contraction initiation in cardiac and smooth muscle cells is dependent on Cardiovas Physiology 3 CV
channel blocker extracellular calcium influx through L-type calcium channels, which can cular (CV) (Phys)
be prevented by calcium channel blockers (eg, verapamil) Skeletal
144 muscle is resistant to calcium channel blockers, as calcium release by
the sarcoplasmic reticulum is triggered by a mechanical interaction
between L-type and RyR calcium channels.

Cardiac AP The cardiac myocyte action potential consists of rapid depolarization Cardiovas Physiology 1 CV
(phase 0), initial rapid repolarization (phase 1), plateau (phase 2): late rapid cular (CV) (Phys)
repolarization (phase 3), and resting potential (phase 4). The action
1974
potential is associated with increased membrane permeability to Na+
and Ca+* and decreased permeability to K+

Cardiac output Myocardial infarction causes a sharp decrease in cardiac output due to Cardiovas Physiology 2 CV
and venous loss of function of a zone of myocardium. On a cardiac function curve, cular (CV) (Phys)
1624
return myocardial infarction would decrease both the slope and the maximal
height of the line
Cardiac output Cardiovas Physiology 2 CV
1625 and venous High-output heart failure results from markedly decreased systemic vascular cular (CV) (Phys)
resistance
return
Cardiac Cardiovas Physiology 6 CV
1510 physiology An increase in effective stroke volume or ejection fraction is depicted on thecular (CV) (Phys)
left ventricular pressure-volume relationship by widening of the loop

Cardiac Pressure-volume loops represent the relationship between pressure and Cardiovas Physiology 6 CV
physiology volume in the left ventricle during systole and diastole. An increase in the cular (CV) (Phys)
1511 circulating volume increases preload (left ventricular end-diastolic volume)
and causes a rightward widening of the pressure-volume loop. (normal
saline diffusion)
Cardiac Cardiovas Physiology 6 CV
1513 physiology cular
The cardiac action potential conduction speed is slowest in the atrioventricular (CV)
node and(Phys)
fastest in the Purkinje system. Conduction speed of the atri

Cardiac Cardiovas Physiology 6 CV

1529 physiology The Fick principle can be applied to calculate cardiac output using the rate of oxygen
cular (CV)consumption
(Phys)

Cardiac Cardiovas Physiology 6 CV

1531 physiology In cardiac pacemaker cells, phase 0 depolarization is mediated by an inward cular
flux of(CV) (Phys)

Cardiac Cardiovas Physiology 6 CV

1975 physiology The phase 4 slow depolarization in cardiac pacemaker cells occurs due to thecular (CV)
closure (Phys)
of repolarizing K* channels, the slow influx of Na

Cardiac Cardiovas Physiology 1 CV

1653 pressure range Right-sided pressures in the heart are lower than left-sided pressures due to lower
cular (CV) (Phys)
resistance in the pulmonary vasculature.

1515 Carotid Carotid sinus massage leads to an increase in parasympathetic tone causing Cardiovas Physiology 1 CV
Carotid sinus Cardiovas Physiology 2 CV
1609 hypersensitivity The carotid sinus is a dilation of the internal carotid artery located just abovecular (CV) (Phys)
the bifurcation of the common carotid artery. The carotid sinus reflex

Chronic heart Cardiovas Physiology 12 CV

1978 failure cularby
Atrial natriuretic peptide (ANP) and brain natnuretic peptide (BNP) are secreted (CV) (Phys)
 Chronic heart Cardiovas Physiology 12 CV
8546 failure The reduced cardiac output in heart failure triggers compensatory activationcular (CV)
of the (Phys) nervous system
sympathetic

Chronic heart Cardiovas Physiology 12 CV

#### failure cular (CV)
Neprilysin (Increased urinary sodium excretion) is responsible for the breakdown (Phys)
of the natnuretic peptides and angiotensin II; therefore, inhibiti

Chronic heart Cardiovas Physiology 12 CV

#### failure cular (CV)
Left-sided heart failure leads to chronically elevated pulmonary venous and capillary (Phys) with resulting pulmonary edema and extravasation o
pressures,

Coronary blood Cardiovas Physiology 9 CV

183 flow cular
During ventricular systole, the coronary vessels supplying the left ventricle are (CV) (Phys)
compressed by the surrounding muscle. As a result, the majority of

Coronary blood Cardiovas Physiology 9 CV

951 flow The high systolic intraventricular pressure and wall stress of the left ventriclecular (CV)
prevent (Phys) perfusion during systole: therefore, the majority of
myocardial

Coronary blood Cardiovas Physiology 9 CV

1516 flow Coronary autoregulation allows coronary blood flow to be primanly driven bycular (CV) (Phys)
myocardial oxygen demand over a wide range of perfusion pressures

Coronary blood Myocardial oxygen extraction exceeds that of any other tissue or organ; Cardiovas Physiology 9 CV
flow therefore, the cardiac venous blood in the coronary sinus is the most cular (CV) (Phys)
2009 deoxygenated blood in the body. Due to the high degree of oxygen
extraction, increases in myocardial oxygen demand can only be met by an
increase in coronary blood flow.
Diastolic Sodium nitroprusside is a short-acting agent that causes balanced Cardiovas Physiology 4 CV
dysfunction vasodilation of the veins and arteries to decrease both left ventricular cular (CV) (Phys)
1652 (LV) preload and afterload. The balanced vasodilation allows for
maintenance of stroke volume and cardiac output at a lower LV
pressure (lower cardiac work).
Diastolic Cardiovas Physiology 4 CV
#### dysfunction cular (CV)via
Prolonged systemic hypertension leads to concentric left ventricular (LV) hypertrophy (Phys)
the addition of myocardial contractile fibers in parallel. T

#### Endocarditis During the normal cardiac cycle, central aortic pressure is higher than right Cardiovas Physiology 15 CV
Heart sounds ventricular pressure
The third heart soundduring
(S3) issystole and diastole.
a low-frequency Consequently,
sound an
occurring during early cular (CV)
Cardiovas (Phys)
Physiology 1 CV
diastole after S2. Left ventricular gallops (S3 and/or S4) are best heard cular (CV) (Phys)
1557 with the bell of the stethoscope over the cardiac apex while the patient is in
the left lateral decubitus position at end expiration.

Hypertrophic Hypertrophic cardiomyopathy (HCM) typically involves interventricular Cardiovas Physiology 9 CV

cardiomyopath septal hypertrophy that obstructs left ventricular (LV) outflow and creates a cular (CV) (Phys)
y systolic murmur that decreases in intensity with maneuvers that increase
LV blood volume (eg, hand grip, passive leg elevation). HCM is
####
characterized by increased LV muscle mass with a small LV cavity,
preserved ejection fraction and impaired LV relaxation leading to
diastolic dysfunction.

Hypovolemic Intravenous fluids increase the intravascular and left ventricular end- Cardiovas Physiology 1 CV
shock diastolic volumes. The increase in preload stretches the myocardium and cular (CV) (Phys)
1512 increases the end-diastolic sarcomere length, leading to an increase in
stroke volume and cardiac output by the Frank-Starling mechanism.

LV volume and Cardiovas Physiology 1 CV

1530 pressure cular
Ventricular pressure and volume curves allow one to identify the phases of the (CV)cycle
cardiac (Phys)
and to determine the exact time of opening and closure

Mitral stenosis The classic cardiac auscultation findings in mitral valve stenosis include an Cardiovas Physiology 7 CV
opening snap followed by a diastolic rumbling murmur that is heard best cular (CV) (Phys)
1517 over the apex of the heart. On the ventricular pressure-volume loop,
mitral valve opening occurs at the point between isovolumetric relaxation
and diastolic filling.
Mitral stenosis Cardiovas Physiology 7 CV
1591 Under normal circumstances, pulmonary capillary wedge pressure (PCWP) closely cular (CV) (Phys)
reflects left atrial (LA) and left ventricular end-diastolic pressure

Muscle Calcium efflux from cardiac cells prior to relaxation is primarily Cardiovas Physiology 1 CV
1931 structure and mediated via an Na+/Ca2+ exchange pump and sarcoplasmic reticulum cular (CV) (Phys)
physiology Ca2+- ATPase pump
Natriuretic Atrial natriuretic peptide and brain natriuretic peptide are released from the Cardiovas Physiology 1 CV
peptides atria and ventricles, respectively, in response to myocardial wall stretch cular (CV) (Phys)
157 due to intravascular volume expansion. These endogenous hormones
promote increased glomerular filtration rate, natriuresis, and diuresis

Pacemaker Cardiac pacemaker impulse generation normally occurs in the SA node, Cardiovas Physiology 1 CV
potential which has the fastest firing rate of all conductive cells The cells in other cular (CV) (Phys)
1976 areas of the conduction system (eg, AV node, bundle of His. and Purkinje
fibers) may serve as pacemakers if normal impulse conduction is impaired.
 Pericardial Pulsus paradoxus refers to an exaggerated drop (>10 mm Hg) in systolic Cardiovas Physiology 2 CV
effusion blood pressure during inspiration. It is most commonly seen in patients cular (CV) (Phys)
1782 with cardiac tamponade but can also occur in severe asthma, chronic
obstructive pulmonary disease, hypovolemic shock, and constrictive
pericarditis
1589 Physical The cardiorespiratory response to exercise includes increased heart rate, Cardiovas Physiology 2 CV
Physical Exercising muscles can receive up to 85% of the total cardiac output dunng Cardiovas Physiology 2 CV
exercise periods of strenuous activity. Although sympathetic discharge during cular (CV) (Phys)
exercise causes increased cardiac output and splanchnic
1622 vasoconstriction, there is only a modest increase in mean blood pressure
as vasodilation within active skeletal muscles significantly decreases the
total systemic vascular resistance

Primary Cardiovas Physiology 14 CV

456 hypertension cular (CV)
Isolated systolic hypertension (systolic blood pressure >140 mm Hg with diastolic blood (Phys)
pressure <90 mm Hg) is due to age-related

Pulmonary Cardiovas Physiology 2 CV

1528 blood flow cular
The circulatory system is a continuous circuit, and therefore the volume output (CV)
of the left(Phys)
ventricle must closely match the output of the right ventric

Renal artery Blood flow is directly proportional to the vessel radius raised to the fourth Cardiovas Physiology 9 CV
1621 stenosis power Resistance to blood flow is inversely proportional to the vessel cular (CV) (Phys)
radius raised to the fourth power.
Supine Cardiovas Physiology 1 CV
8293 hypotension cular (CV)
Pregnant women > 20 weeks gestation can experience compression of the inferior (Phys)
cava by the gravid uterus while in the supine position. This

Tetralogy of In patients with Tetralogy of Fallot, squatting during a Tet spell increases Cardiovas Physiology 3 CV
Fallot systemic vascular resistance and decreases right-to-left shunting, thereby cular (CV) (Phys)
205
increasing pulmonary blood flow and improving oxygenation status.

Tricuspid Cardiovas Physiology 3 CV

1983 regurgitation A holosystolic murmur that increases in intensity on inspiration most likelycular (CV) (Phys)
represents

With endurance training, the physiologic changes of athlete's heart allow Cardiovas
for increased maximum cardiac output via an increase in stroke volume. cular (CV)
The left ventricle undergoes eccentric hypertrophy to increase left
ventricular cavity size and improve diastolic filling capacity. The
#### resulting increase in end-diastolic volume capacity allows for increased
stroke volume and cardiac output. Because end-diastolic volume and stroke
volume are both proportionally increased, left ventricular ejection
fraction is mostly unchanged.

Collagen Ehlers-Danlos syndrome is a group of rare hereditary disorders Dermatolo Biochemistr 1 DE

synthesis characterized by defective collagen synthesis. It can be caused by gy (DE) y (Bioc)
procollagen peptidase deficiency (N-terminal propeptide removal),
1245 which results in impaired cleavage of terminal propeptides in the
extracellular space. Patients often have joint laxity, hyperextensible skin,
and tissue fragility due to the formation of soluble collagen that does not
properly crosslink.
Ehlers-Danlos Ehlers-Danlos syndrome (EDS) is a heritable connective tissue disease Dermatolo Biochemistr 1 DE
syndrome associated with abnormal collagen formation. EDS usually manifests gy (DE) y (Bioc)
1244 clinically as overflexible (hypermobile) joints, overelastic (hyperelastic)
skin, and fragile tissue susceptible to bruising, wounding, and
hemarthrosis.
Niacin Niacin (vitamin B3) can be synthesized endogenously from tryptophan Dermatolo Biochemistr 3 DE
deficiency and is an essential com ponent of nicotinamide adenine dinucleotide gy (DE) y (Bioc)
(NAD) and nicotinamide adenine dinucleotide phosphate (NADP). A
1064
deficiency of this vitamin results in pellagra, which is characterized by
photosensitive dermatitis, diarrhea, and dementia.

#### Niacin Niacin is a precursor for nicotinamide adenine dinucleotide (NAD) and Dermatolo Biochemistr 3 DE
Splice site Splicing is performed by spliceosomes, which remove introns containing Dermatolo Biochemistr 1 DE
mutation GU at the 5' splice site and AG at the 3' splice site. Splice site mutations gy (DE) y (Bioc)
2038 of pre-mRNA may result in inappropriate removal of exons and retention
of introns, leading to the formation of dysfunctional proteins.

Vitamin C Ascorbic acid (vitamin C) is a cofactor in the hydroxylation of proline Dermatolo Biochemistr 3 DE
deficiency and lysine residues and is important in the synthesis of collagen. gy (DE) y (Bioc)
1061
Deficiency (scurvy) is characterized by microvascular bleeding,
gingivitis, and impaired wound healing.
Vitamin C The hydroxylation of praline and lysine residues in collagen helps it Dermatolo Biochemistr 3 DE
deficiency attainits maximum tensile strength. This process occurs in the rough gy (DE) y (Bioc)
endoplasmic reticulum and requires vitamin C as a cofactor. Impaired
1247
collagen synthesis resulting from vitamin C deficiency (scurvy) can lead to
fragile vessels, predisposing to gingival bleeding, ecchymosis, and
petechia.
 Melanoma The most common metastatic tumors to the brain are lung cancer, renal Dermatolo Embryology 6 DE
cancer, and melanoma. Melanoma is a malignancy of melanocytes, which gy (DE) (Embr)
1960
are embryologically derived from neural crest cells.

Hair loss Androgenetic alopecia is the most common cause of hair loss in both males Dermatolo Genetics 2 DE
and females. The pattern and severity of the baldness depend on both gy (DE) (Gene)
1725 hormonal (circulating androgens) and genetic factors and vary between
males and females. The condition is polygenic with variable expressivity.

Xeroderma Xeroderma pigmentosum develops due to a defect in nucleotide excision Dermatolo Genetics 2 DE
pigmentosum repair. This disease is characterized by increased sensitivity to ultraviolet gy (DE) (Gene)
883
radiation and a high incidence of cutaneous malignancy.

Xeroderma Xeroderma pigmentosum is an autosomal recessive disorder characterized Dermatolo Genetics 2 DE

pigmentosum by defective nucleotide excision repair often caused by a deficiency in UV- gy (DE) (Gene)
1476 specific endonuclease. Affected children usually have severe
photosensitivity, hyperpigmentation in sun-exposed areas, and a greatly
increased risk for skin cancer.
Histiocytosis Langerhans cells are dendritic cells found in the skin that act as Dermatolo Histology 1 DE
professional antigen presenting cells. These cells are derived from the gy (DE) (Hist)
588
myeloid cell line and they possess characteristic racquet shaped
intracytoplasmic granules known as Birbeck granules.
Contact Poison ivy dermatitis is a form of allergic contact dermatitis, which is a Dermatolo Immunology 2 DE
dermatitis type IV hypersensitivity reaction mediated primarily by T gy (DE) (Immu)
1133
lymphocytes. It manifests as intensely pruritic erythematous papules,
vesicles, or bullae that often form linear patterns.
Graft versus Graft-versus-host disease can occur following transplantation of organs Dermatolo Immunology 1 DE
host disease rich in lymphocytes (eg. liver). T lymphocytes found in the donor organ gy (DE) (Immu)
1613 become sensitized against the MHC antigens of the recipient and
subsequently attack the host's tissues. The skin, liver, and gastrointestinal
tract are most frequently affected.
Melanoma Melanoma lesions often have multiple color variations. The different colors Dermatolo Immunology 6 DE
represent different activities within the tumor. Whitish/gray areas occur gy (DE) (Immu)
when cytotoxic T cells recognize tumor antigens and destroy malignant
#### cells, leading to melanocyte regression. Red areas arise due to vessel
ectasia and local inflammation, whereas brown or black areas are generally
due to advancing malignant melanocytes.

Melanoma PD-1 is a checkpoint inhibitor that downregulates the Tc cell response. Dermatolo Immunology 6 DE
Neoplastic cells often exploit this receptor via the overexpression of PD- gy (DE) (Immu)
#### L1. PD-1 receptor inhibitors (eg, Pembrolizumab) restore the T cell
response, allowing Tc cells to invade the tumor and induce apoptosis of
neoplastic cells.
Bartonella Bartonella henselae causes cat-scratch disease, bacillary angiomatosis, Dermatolo Microbiolog 2 DE
and culture-negative endocarditis. Cat-scratch disease is characterized by gy (DE) y (Micr)
1898
low fever, lymphadenopathy, and a self-limited course.

Cutaneous Hookworm infections are transmitted via direct contact between human Dermatolo Microbiolog 1 DE
larva migrans skin and contaminated soil/sand (eg, walking barefoot). Dermal penetration gy (DE) y (Micr)
#### is often characterized by an intensely pruritic papule that may form
serpiginous tracks due to the subcutaneous migration of hookworm larvae.

Febrile Ecthyma gangrenosum is a cutaneous necrotic disease with a strong Dermatolo Microbiolog 4 DE
neutropenia association with Pseudomonas aeruginosa bacteremia. It occurs from gy (DE) y (Micr)
perivascular invasion and release of tissue-destructive exotoxins, causing
vascular destruction and insufficient blood flow to patches of skin that
973
become edematous and subsequently necrose. Pseudomonas infections are
common in patients who are neutropenic, are hospitalized, have burns, or
have indwelling catheters.

Herpes zoster A unilateral vesicular rash localized on a single dermatome in an older Dermatolo Microbiolog 4 DE
patient is most likely herpes zoster. Postherpetic neuralgia is the most gy (DE) y (Micr)
1553
common neurologic complication of varicella zoster virus infection.

Leishmaniasis Leishmania species are obligate intracellular protozoa that mature in Dermatolo Microbiolog 1 DE
macrophages and can be identified on biopsy by the presence of rod-shaped gy (DE) y (Micr)
kinetoplasts. They are transmitted to humans by infected sand flies and
####
cause the clinical syndrome of cutaneous leishmaniasis, characterized by a
chronic, pinkish papule that evolves into a nodule or plaque.
 Leprosy The severity of leprosy, a systemic illness caused by Mycobacterium leprae, Dermatolo Microbiolog 2 DE
depends on the strength of the cell-mediated immune (CMI) response, with gy (DE) y (Micr)
1313 tuberculoid leprosy representing the milder form intact Th1 CMI response)
and lepromatous leprosy, the more severe form (weak CMI response).

Lice infestation Pediculus humanus capitis (ie, head lice) infestation is common in school Dermatolo Microbiolog 2 DE
children and adults who come into close contactwith infested individuals. gy (DE) y (Micr)
Transmission is usually by direct contact. The eggs (nits) are attached to
#### the hair shaft and can be identified on inspection. Head lice do not carry
infection, but the bite can induce a pruritic allergic rxn. 1st-line Tx
includes topical pediculicides (eg, permethrin, ivermectin).

Rubella In a susceptible child, a febrile maculopapular rash that begins on the face Dermatolo Microbiolog 3 DE
and spreads to the trunk and extremities is suggestive of rubeola (measles) gy (DE) y (Micr)
1669 or rubella (German measles). The additional finding of postauricular
lymphadenopathy indicates that rubella is the most likely etiology.

Scabies Scabies is a highly contagious disease that presents with an intensely Dermatolo Microbiolog 2 DE
pruritic rash (usually worse at night) in the flexor surfaces of the wrist, gy (DE) y (Micr)
lateral surfaces of the fingers, and the finger webs. Patients usually have
#### excoriations with small, crusted, red papules scattered around the affected
areas. Diagnosis is confirmed by skin scrapings from excoriated lesions
that show mites, ova, and feces under light microscopy.

Scabies Scabies is a human mite infection associated with a pruritic papular rash Dermatolo Microbiolog 2 DE
with excoriations and burrows. Patients with impaired cell-mediated gy (DE) y (Micr)
#### immunity (eg, HIV) often develop a very high mite burden. Treatment with
topical permethrin and/or ivermectin is generally curative.

Skin and soft Hot tub folliculitis is a superficial and self-limited Pseudomonas aeruginosa Dermatolo Microbiolog 8 DE
tissue infection of the hair follicles that tends to occur in minor outbreaks gy (DE) y (Micr)
infections following exposure to a pool or spa in which the chemicals have not been
974
maintained at appropriate concentrations. Pseudomonas are gram negative,
oxidase-positive, nonlactose-fermenting, motile rods that produce green
pigment.
Skin and soft Pseudomonas aeruginosa is a major pathogen in burn patients. Only a few Dermatolo Microbiolog 8 DE
tissue specific penicillins (eg. ticarcillin, piperacillin) and cephalosporins (eg, gy (DE) y (Micr)
infections ceftazidime, cefepime) have activity against it. Certain aminoglycosides,
8858
fluoroquinolones (eg, ciprofloxacin, levofloxacin), and carbapenems (eg,
imipenem, meropenem) are also effective.

Skin and soft The most common cause of nonpurulent cellulitis is beta-hemolytic Dermatolo Microbiolog 8 DE
#### tissue streptococci, particularly group A streptococcus. The most common cause gy (DE) y (Micr)
infections of purulent cellulitis is Staphylococcus aureus.
Sporotrichosis Sporothrix schenckii is a dimorphic fungus that causes a subcutaneous Dermatolo Microbiolog 1 DE
270 mycosis. It is often transmitted by a thorn prick. The disease manifests with gy (DE) y (Micr)
nodules that spread along lymphatics.
Staphylococcal The staphylococcal scalded skin syndrome occurs in infants and children Dermatolo Microbiolog 1 DE
scalded skin due to the production of the exotoxin exfoliatin by Staphylococcus species. gy (DE) y (Micr)
680
syndrome It causes widespread epidermal sloughing. especially with gentle pressure
(Nikolsky's sign).
Tinea Pityriasis versicolor (tinea versicolor) is a superficial skin infection caused Dermatolo Microbiolog 4 DE
by Malassezia species. It causes erythematous, hyper- or hypopigmented gy (DE) y (Micr)
104 macules and patches. Malassezia forms spores and hyphae, producing the
characteristic "spaghetti and meatballs" appearance on KOH preparation
light microscopy.
Tinea Tinea corporis presents with round or ovoid lesions with a raised, scaly Dermatolo Microbiolog 4 DE
border and central clearing. Trichophyton rubrum is the most common gy (DE) y (Micr)
#### cause and infects keratinized matter in the stratum corneum of the
superficial epidermis but does not invade the dermis and subcutaneous
tissues.
Acanthosis Acanthosis nigricans presents with thickening and hyperpigmentation of Dermatolo Pathology 1 DE
nigricans skin in the flexural areas The lesions have a classic "velvety" texture gy (DE) (Path)
936 Acanthosis nigricans is commonly associated with insulin-resistant states
(eg. diabetes mellitus. acromegaly, obesity) and gastrointestinal
malignancies.
Acne vulgaris Risk factors for acne include increased androgen levels; obstruction of Dermatolo Pathology 3 DE
pilosebaceous glands by oil-based hair products: and mechanical irritation gy (DE) (Path)
####
of skin follicles. Sports participation frequently triggers acne due to the use
of tight-fitting clothing and protective gear
 Acne vulgaris Acne vulgaris is an inflammatory disorder of pilosebaceous follicles. Dermatolo Pathology 3 DE
Contributing factors include hyperkeratinization and obstruction of gy (DE) (Path)
follicles; sebaceous gland enlargement with increased secretion of sebum;
####
colonization and proliferation in the gland by Propionibacterium
(Cutibacterium) acnes; and follicular and perifollicular inflammation.

Actinic Actinic keratosis (AK) develops on chronically sun-exposed areas of the Dermatolo Pathology 2 DE
keratoses skin in predisposed individuals. The lesions consist of erythematous gy (DE) (Path)
935 papules with a central scale and a rough "sandpaper-like" texture AKs are
considered premalignant lesions and have the potential to progress to
squamous cell carcinoma.
Actinic Actinic keratoses (AKs) are small (usually <1 cm), erythematous epidermal Dermatolo Pathology 2 DE
keratoses lesions with adherent scale that are the result of chronic sun exposure. gy (DE) (Path)
Histologic findings include keratinocyte atypia: hyperkeratosis, and
1993
parakeratosis A small percentage of AKs progress to invasive squamous
cell carcinoma; therefore, frequent monitoring is necessary.

Atopic Atopic dermatitis (eczema) is a common, chronic inflammatory disorder Dermatolo Pathology 2 DE
dermatitis caused by impairment of the skin's barrier function. Eczema presents with gy (DE) (Path)
876 pruritus and erythematous papules and plaques and is associated with other
atopic diseases, such as allergic rhinitis and asthma.

Bullous BP is characterised by auto-Abs against hemidesmosomes along the BM of Dermatolo Pathology 1 DE

1105 pemphigoid the DEJ. This causes the entire epidermis to separate from the dermis, gy (DE) (Path)
forming tense, subepidermal blisters.
Cherry Cherry hemangiomas are small, red. cutaneous papules common in aging Dermatolo Pathology 1 DE
angioma adults. They do not regress spontaneously and typically increase in number gy (DE) (Path)
826 with age. Light microscopy of these lesions shows proliferation of
capillaries and post-capillary venules in the papillary dermis.

Chronic venous Stasis dermatitis is characterized by chronic erythema, fibrosis, and reddish- Dermatolo Pathology 3 DE
insufficiency brown discoloration due to deposition of hemosiderin (from breakdown gy (DE) (Path)
#### of extravasated red cells). Symptoms are typically bilateral, and usually
worse at or above the |ankles Complications include poor wound healing,
weeping, and ulceration.
Contact Acute allergic contact dermatitis is caused by a type IV (delayed) Dermatolo Pathology 2 DE
dermatitis hypersensitivity reaction to an antigen on the skin surface. Gross findings gy (DE) (Path)
include erythematous, papulovesicular, weeping lesions. Histology is
1115 characterized by spongiosis, an accumulation of edema fluid in the
intercellular spaces of the epidermis. With chronic exposure, lesions
become less edematous, with thickening of the stratum spinosum and
stratum comeum.
Dermatitis Dermatitis herpetiformis is characterized by erythematous pruritic papules, Dermatolo Pathology 1 DE
herpetiformis vesicles, and bullae that appear bilaterally and symmetncally on the gy (DE) (Path)
1111 extensor surfaces. Dermatitis herpetiformis is strongly associated with
celiac disease (Increased intestinal intraepithelial lymphocytes).

Diabetic foot Neuropathic foot ulcers can occur in diabetic patients when loss of pain Dermatolo Pathology 2 DE
sensation and proprioception delays recognition of injury due to trauma, gy (DE) (Path)
#### friction, or sustained pressure (on plantar surface of foot bones). The risk is
greatest in ptswith longstanding DM who have poor glycaemic control.

Dyslipidemia Xanthomas are suggestive of hyperlipidaemia, esp. when present in Dermatolo Pathology 11 DE
1108
conjunctionwith a FHx of early cardiac death. gy (DE) (Path)
Ecchymosis Ecchymoses frequently indicate a deep hemorrhage (hematoma) due to Dermatolo Pathology 1 DE
bony fracture, ligamentous rupture, or muscular injury. They do not blanch gy (DE) (Path)
under pressure as the red blood cells are not contained within the
1878
vasculature Ecchymoses often pass through an evolution of color change
(blue or red to brown, green, and yellow), which can be used to estimate
the age of the injury.
Erythema Erythema multiforme is a cell-mediated inflammatory disorder of the Dermatolo Pathology 2 DE
multiforme skin characterized by erythematous papules that evolve into target lesions. gy (DE) (Path)
####
It is most commonly associated with herpes simplex virus.

Erythema Erythema multiforme is a target-shaped, inflammatory skin lesion that Dermatolo Pathology 2 DE
multiforme typically arises in the setting of infection, particularly with herpes simplex gy (DE) (Path)
#### virus or Mycoplasma pneumoniae. It is caused by the deposition of
infectious antigens in keratinocytes, leading to a strong cell-mediated (eg,
cytotoxic T-cell) immune response.
Glomus tumor A benign glomus tumor (glomangioma) can produce a very tender, small (a Dermatolo Pathology 1 DE
few millimeters in diameter), red-blue lesion under the nail bed This type gy (DE) (Path)
467 of tumor originates from the modified smooth muscle cells that control the
thermoregulatory functions of dermal glomus bodies.
 Hand, foot, Hand-foot-and-mouth disease is a common childhood illness characterized Dermatolo Pathology 2 DE
mouth disease by painful, vesicular mouth lesions; ulcers on the extremities; and low- gy (DE) (Path)
####
grade fever. It is caused by the ingestion and subsequent dissemination of
an enterovirus (eg, Coxsackievirus).
Hemangioma Superficial infantile hemangiomas (ie: strawberry/capillary Dermatolo Pathology 6 DE
hemangiomas) are benign vascular tumors of childhood. They appear gy (DE) (Path)
during the first weeks of life initially grow rapidly, and typically regress by
827
the time the child is 5-9 years old. These tumors are composed of blood-
filled capillaries separated by connective tissue.

Herpes zoster HZ (shingles) develops due to reactivation of VZV in the DRG (sensory Dermatolo Pathology 4 DE
neurons). It presentswith a painful vesicular rash in a dermatomal gy (DE) (Path)
1042
distribution. Intranuclear inclusions in keratinocytes and multinucleated
giant cells are seen on LM.
Ichthyoses Ichthyosis vulgaris is characterized by dermal xerosis (dryness) and scaling Dermatolo Pathology 1 DE
that primarily affect the trunk and extensor surfaces of the extremities It is gy (DE) (Path)
#### caused by mutations of the filaggrin gene, resulting in epidermal
hyperplasia, defective desquamation, and loss of the normal barrier
function.
Keloid Transforming growth factor-(B (TGF-(5) is critical for fibroblast migration, Dermatolo Pathology 2 DE
proliferation, and connective tissue synthesis Increased TGF-B activity is gy (DE) (Path)
#### responsible for the hypertrophic/keloid scarring and fibrosis of the lung,
liver, and kidney that occur with chronic inflammation

Leprosy The lepromin skin test will be positive in patients with tuberculoid leprosy Dermatolo Pathology 2 DE
as they exhibit a strong CD4+ TH1 cell-mediated immune response to gy (DE) (Path)
Mycobacterium leprae Patients with lepromatous leprosy will test negative
1314
due to their weak TH1 cell-mediated immune response. Increased
interleukin-2 and interferon-y in skin lesions

Lichen planus Lichen planus presents with pruritic, purple/pink: polygonal papules and Dermatolo Pathology 1 DE
plaques that can affect the flexural surfaces of the wrists and ankles, along gy (DE) (Path)
with the nails, oral mucous membranes, and genitalia. Histologic findings
#### include hyperkeratosis, lymphocytic infiltrates at the dermoepidermal
junction, thickened stratum granulosum with sawtooth rete ridges, and
eosinophilic colloid bodies in the papillary dermis.

Lymphoedema Axillary lymph node dissection is a risk factor for the development of Dermatolo Pathology 1 DE
chronic lymphedema involving the ipsilateral arm. Chronic lymphedema gy (DE) (Path)
1937
predisposes to the development of angiosarcoma (Stewart-Treves
syndrome).
Melanocytic Compound melanocytic nevus are benign proliferations of melanocytes Dermatolo Pathology 1 DE
nevus that involve both the dermis and epidermis. The lesions appear as slightly gy (DE) (Path)
####
raised papuleswith uniform pigmentation and symmetrical sharp borders.

Melanoma Melanoma often has an early horizontal growth phase with low metastatic Dermatolo Pathology 6 DE
potential followed by a nodular, vertical growth phase with a significantly gy (DE) (Path)
1113 increased risk of metastasis. Depth of invasion (Breslow thickness) is the
most important prognostic indicator in malignant melanoma.

Melanoma BRAF is a PK involved in activation of signalling pathways for melanocyte Dermatolo Pathology 6 DE
7707 proliferation; the BRAF V600E mut is seen in 40-60% of ptswith gy (DE) (Path)
melanoma.
Melanoma Melanoma is often diagnosed when immunostaining of biopsy samples Dermatolo Pathology 6 DE
#### reveals multiple melanocyte markers (eg, S-100, HMB-45, MART-1). gy (DE) (Path)

Pemphigus Pemphigus vulgaris is an autoimmune bullous disease characterized by Dermatolo Pathology 1 DE

vulgaris autoantibodies directed against desmosomal proteins (eg, desmoglein). It gy (DE) (Path)
presents with painful flaccid bullae and erosions affecting the skin and
2065
mucosal membranes. The bullae spread laterally with pressure and new
blisters may form with gentle rubbing.

Primary biliary A yellowish eyelid papule or plaque containing lipid-laden macrophages is Dermatolo Pathology 4 DE
cholangitis most likely xanthelasma. Xanthelasma may occur in association with gy (DE) (Path)
primary or secondary hyperlipidemia. Cholestatic conditions such as
1867
primary biliary cirrhosis are a potential cause of hypercholesterolemia
leading to xanthelasma. Primary biliary cholangitis

Psoriasis Common complications of psoriasis incl psoriatic arthritis, nail changes, Dermatolo Pathology 5 DE
1116
and uveitis. gy (DE) (Path)
 Psoriasis Psoriasis is characterised by hyperkeratosis and confluent parakeratosis of Dermatolo Pathology 5 DE
the stratum corneum, and epidermal hyperplasia (acanthosis)with gy (DE) (Path)
1117 elongated rete ridges. Neutrophilic foci in the stratum corneum and
epidermis may coalesce to form microabscesses (Munro microabscesses).

Psoriasis Psoriasis is characterised on histo by hyperkeratosis and confluent Dermatolo Pathology 5 DE

parakeratosis of the stratum corneum (producing the char silvery scales gy (DE) (Path)
#### seen on gross Ex), diffuse epidermal hyperplasiawith elongated and
clubbed rete ridges (corresponding to the typical erythematous plaques),
and dilated caps in the dermal papillae.
Psoriasis Psoriasis is a common inflammatory skin disorder characterised by Dermatolo Pathology 5 DE
hyperkeratosis (overgrowth of the stratum corneum) and epidermal gy (DE) (Path)
#### hyperplasia. Plaque psoriasis is the most common form and presentswith
chronic, well-demarcated, erythematous plaqueswith a thick, silver scale.

Seborrheic SK is a common epidermal tumour that presents as a tan or brown, round Dermatolo Pathology 2 DE
keratosis lesionwith a well-demarcated border and 'stuck-on' appearance. Micro Ex gy (DE) (Path)
shows small cells resembling basal cells,with pigmentation, hyperkeratosis,
1112
and keratin-containing cysts. Rapid onset of numerous lesions is often a/w
internal malignancy (Leser-Trelat sign).

Seborrheic SKs are pigmented macules or plaqueswith a greasy surface and well- Dermatolo Pathology 2 DE
7649 keratosis demarcated borders. Rapid onset of numerous lesions is an indicator of gy (DE) (Path)
internal malignancy (Leser-Trelat sign), esp. GAC.
Skin and soft Granulomatous inflammation is a form of chronic inflammation Dermatolo Pathology 8 DE
tissue characterised by aggregates of activated macrophages that assume an gy (DE) (Path)
8334 infections epithelioid appearance. Persistent granulomatous inflammationwith subseq
fibrosis can cause organ dysfxn, which is seen in a # of granulomatous
diseases.
Skin and soft Bullous impetigo is a superficial infection by Staphylococcus aureus that is Dermatolo Pathology 8 DE
tissue most common in young children. It is characterized by a blistering skin gy (DE) (Path)
infections rash with tan- to honey-colored crusts. The blistering in bullous impetigo is
####
caused by exfoliative toxin A, which targets desmoglein 1 in epidermal
cellular junctions and causes a loss of cell adhesion.

Urticaria Urticaria is a transient hypersensitivity disorder characterized by pruritic Dermatolo Pathology 2 DE

erythematous plaques that arise suddenly and resolve over hours. They are gy (DE) (Path)
1114 most often caused by IgE-mediated degranulation of mast cells, leading to
increased permeability of the microvasculature with dermal edema of the
superficial dermis
Urticaria A number of medications, including opioids, radiocontrast agents, and Dermatolo Pathology 2 DE
some antibiotics (eg. vancomycin), can trigger IgE-independent mast cell gy (DE) (Path)
#### degranulation. Common symptoms include diffuse itching and pain,
bronchospasm, and localized swelling (urticaria).

Vitiligo Vitiligo is a common condition characterised by the loss of epidermal Dermatolo Pathology 1 DE
melanocytes. It occurs more commonly in ptswith autoimmune disorders gy (DE) (Path)
1110
(e.g. autoimmune thyroiditis, DM-1) and results in well-defined, variably
sized patches of hypopigmentation.
Accessory Accessory nipples are the most common congenital breast anomaly Dermatolo Pathophysiol 1 DE
nipple resulting from failed (involution) regression of the mammary ridge in gy (DE) ogy (Patp)
8904 utero. They are usually asymptomatic but can become tender along with
breast tissue during times of hormonal fluctuation.

Acne vulgaris Acne typically arises in adolescents and young adults due to adrenarche- Dermatolo Pathophysiol 3 DE
associated enlargement in sebaceous glands with subsequent increases in gy (DE) ogy (Patp)
sebum production. Follicles clogged with sebum provide the anaerobic,
#### lipid-rich environment necessary for the proliferation of Propionibacterium
acnes, the skin commensal responsible for acne lesions. (Proliferation of
lipid-utilizing bacteria within pilosebaceous follicles)

Aging Photoaging is a product of excess exposure to ultraviolet A wavelengths Dermatolo Pathophysiol 8 DE

and is characterized by epidermal atrophy with flattening of rete ridges. In gy (DE) ogy (Patp)
1860 addition, there is decreased collagen fibril production and increased
degradation of collagen and elastin in the dermis

Keloid Keloids result from excessive collagen formation during the remodeling Dermatolo Pathophysiol 2 DE
874 phase of wound healing. They present as raised, painful, and pruritic gy (DE) ogy (Patp)
nodules that grow beyond the wound borders.
 Sunburn Pyrimidine dimers are formed in DNA as a result of ultraviolet light Dermatolo Pathophysiol 1 DE
exposure. They are recognized by a specific endonuclease complex that gy (DE) ogy (Patp)
initiates the process of repair by nicking the damaged strand on both
1477
sides of the pyrimidine dimer The damaged segment is then excised, and
replacement DNA is synthesized by DNA polymerase. (Endonuclease
nicking of the damaged DNA strand)
Androgenic Androgens stimulate follicular epidermal hyperproliferation and excessive Dermatolo Pharmacolog 2 DE
steroids sebum production, thereby promoting acne development. Anabolic steroid gy (DE) y (Phar)
7585
(Methyltestosterone) misuse is a known cause of acne, especially in
competitive athletes.
Atopic Local cutaneous adverse effects of chronic topical corticosteroid Dermatolo Pharmacolog 2 DE
dermatitis administration include atrophy/thinning of the dermis that is associated gy (DE) y (Phar)
1214
with loss of dermal collagen, drying, cracking, and/or tightening of the
skin, telangiectasias, and ecchymoses.
Hair loss Androgenetic alopecia causes hair loss primarily at the anterior scalp and Dermatolo Pharmacolog 2 DE
vertex. It shows polygenic inheritance, with dihydrotestosterone (DHT) gy (DE) y (Phar)
being the primary pathogenic factor. 5-a-reductase inhibitors decrease the
1726
conversion of testosterone to DHT and are effective for treating the
condition. Increased Testosterone and Estradiol

Herpes zoster Acyclovir, the acyclovir prodrug valacyclovir, famciclovir, and ganciclovir Dermatolo Pharmacolog 4 DE
are all nucleoside analogues that require both herpes viral and cellular gy (DE) y (Phar)
1641 kinases for conversion to their active nucleoside triphosphate form.
Cidofovir is a nucleoside monophosphate (ie, a nucleotide) that requires
only cellular kinases for activation.
Psoriasis First-line treatment options for localized psoriasis include high-potency Dermatolo Pharmacolog 5 DE
topical corticosteroids and vitamin D analogs. Vitamin D analogs inhibit T- gy (DE) y (Phar)
cell and keratinocyte proliferation and stimulate keratinocyte
8569
differentiation. Corticosteroids also have anti-inflammatory and
antiproliferative properties; their mechanism of action is complementary to
the vitamin D analogs.
Tinea Terbinafine is used for treatment of dermatophytosis. It inhibits synthesis Dermatolo Pharmacolog 4 DE
836 of fungal membrane ergosterol by suppressing the enzyme squalene gy (DE) y (Phar)
epoxidase.
Airway Cricothyrotomy is indicated when an emergency airway is required and Ear, Nose Anatomy 1 EN
emergency orotracheal or nasotracheal intubation is either unsuccessful or & Throat (Anat)
8631 contraindicated. The cricothyrotomy incision passes through the superficial (EN)
cervical fascia, pretracheal fascia, and the cricothyroid membrane.

Epistaxis Epistaxis is commonly caused by irritation of the highly vascular mucosa at Ear, Nose Anatomy 1 EN
the anterior nasal septum. The anterior nasal septum contains the & Throat (Anat)
Kiesselbach plexus. The anterior ethmoidal, sphenopalatine, and superior (EN)
####
labial arteries anastomose in this region. Cautery (silver nitrate)

Foreign body The internal laryngeal nerve mediates the afferent limb of the cough reflex Ear, Nose Anatomy 1 EN
aspiration above the vocal cords. Foreign bodies (eg, fish bones) can become lodged & Throat (Anat)
8703
in the piriform recess and may cause damage to the nerve, impairing the (EN)
cough reflex.
Hearing loss Prolonged exposure to loud noises causes hearing loss due to damage to Ear, Nose Anatomy 2 EN
1633 the stereociliated hair cells of the organ of Corti. & Throat (Anat)
(EN)
Orbital fracture Blunt trauma to the globe can cause orbital blowout fractures. These Ear, Nose Anatomy 2 EN
fractures most commonly involve the medial or inferior orbital walls due to & Throat (Anat)
1698
the thin bone bordering the ethmoid and maxillary sinuses. (EN)

Otitis externa The vagus nerve provides cutaneous sensation to the posterior external Ear, Nose Anatomy 2 EN
auditory canal via its small auricular branch. Sensation to the rest of the & Throat (Anat)
1814
canal is from the mandibular division of the trigeminal nerve. (EN)

Thyroid cancer The recurrent laryngeal nerve travels in close proximity to the inferior Ear, Nose Anatomy 6 EN
1686 thyroid artery and can be injured during thyroid surgery, resulting in vocal & Throat (Anat)
cord paralysis (eg, hoarseness). (EN)
Cleft lip and Cleft lip results when the maxillary prominence fails to fuse with the Ear, Nose Embryology 1 EN
cleft palate intermaxillary segment during the fifth-sixth week of embryonic & Throat (Embr)
1740 development. Cleft palate occurs when the palatine shelves fail to fuse with (EN)
one another or with the primary palate. Cleft lip and palate can occur
together or in isolation.
Thyroglossal Thyroglossal duct cysts form from epithelial remnants of the thyroglossal Ear, Nose Embryology 1 EN
#### duct cyst duct along the path of thyroid descent. They present as midline masses that & Throat (Embr)
rise with swallowing or tongue protrusion. (EN)
 Otitis externa Pseudomonas aeruginosa is a non lactose-fermenting, oxidase (+), motile, Ear, Nose Microbiolog 2 EN
Gram (-) rod. It is the most common cause of MOE, a serious infection of & Throat y (Micr)
8342 the ear seen in elderly diabetic pts. MOE Pxwith exquisite ear pain and (EN)
drainage, and granulation tissue is often seenwithi the ear canal.

Otitis media Nontypeable strains of Haemophilus influenzae are part of the normal Ear, Nose Microbiolog 1 EN
upper respiratory tract flora and are a common cause of acute otitis media, & Throat y (Micr)
1102 sinusitis, and bronchitis. Because nontypeable strains do not form a (EN)
polysaccharide capsule, immunity is not conferred by vaccination with the
H influenzae type b vaccine.
Upper For a purified RNA molecule to induce viral protein synthesis in a host Ear, Nose Microbiolog 2 EN
respiratory tract cell, it must be able to act directly as mRNA using the host's intracellular & Throat y (Micr)
1373 infections machinery for translation. Therefore, in general, purified (+) sense ssRNA (EN)
can be infectious; (-) sense ssRNA or dsRNA is not.

Cholesteatoma Cholesteatomas are collections of squamous cell debris that form a mass Ear, Nose Pathophysiol 1 EN
behind the TM. Cholesteatomas can be congenital or may occur as an & Throat ogy (Patp)
#### acquired 1° lesion or following infection, trauma, or Sx of the middle ear. (EN)
They can cause hearing loss due to erosion into auditory ossicles.

Meniere Ménière disease is Chx by tinnitus, vertigo, and sensorineural hearing loss. Ear, Nose Pathophysiol 1 EN
308 disease Its pathogenesis is related to an ↑ volume and pressure of endolymph in the & Throat ogy (Patp)
vestibular apparatus. (EN)
Mucocutaneou Nystatin is a polyene antifungal and the Rx of choice for oropharyngeal Ear, Nose Pharmacolog 3 EN
s candidiasis candidiasis in ptswitho advanced immunodeficiency. It acts by binding to & Throat y (Phar)
ergosterol in the fungal cell membrane, causing the formation of pores and (EN)
1195
leakage of fungal cell contents. Nystatin is not absorbed from the GIT and
is administered as an oral "swish and swallow" agent.

Nonallergic Topical preparations of α-adrenergic agonists cause vasoconstriction of the Ear, Nose Pharmacolog 1 EN
rhinitis nasal mucosa vessels and are used as decongestants. Overuse of these Rx & Throat y (Phar)
1345 causes (-) feedback, resulting in ↓ NE synthesis and release from nerve (EN)
endings, which ↓ their effect (ie, tachyphylaxis).

Hearing loss In conductive hearing loss, bone conduction will be greater than air Ear, Nose Physiology 2 EN
conduction (abnormal Rinne test), and the Weber test will lateralize to the & Throat (Phys)
8589 affected ear. In sensorineural hearing loss, air conduction will be greater (EN)
than bone conduction (normal Rinne test), and the Weber test will
lateralize to the unaffected ear.
206 Diabetes Injury to the hypothalamus or posterior pituitary (eg, head trauma, Endocrine Anatomy 5 ES
Thyroid cancer The ext branch of the sup laryngeal nerve is at risk of injury during Endocrine Anatomy 6 ES
thyroidectomy due to its proximity to the sup thyroid art and vein. This , Diabetes (Anat)
nerve innervates the cricothyroid muscle. &
1747
Metabolis
m (ES)

Treatment Physicians should use a nonjudgmental, patient-centered approach in Endocrine Behavioral 5 ES

adherence discussing treatment nonadherence. Acknowledging the difficulty of , Diabetes Science
taking medication regularly can strengthen the therapeutic alliance, & (Beha)
1144
potentially improving patient receptiveness to educational efforts. (Taking Metabolis
medications daily can be difficult, especially on days you feel well.") m (ES)

Beta oxidation Carnitine deficiency impairs fatty acid transport from the cytoplasm into Endocrine Biochemistr 3 ES
mitochondria, preventing (3-oxidation of fatty acids into acetyl CoA , Diabetes y (Bioc)
(Acetoacetate). This leads to cardiac and skeletal myocyte injury (lack of &
1886
ATP from citric acid cycle) and impaired ketone body production by the Metabolis
liver during fasting periods. m (ES)

Beta oxidation Impaired beta-oxidation of fatty acids causes hypoglycemia after prolonged Endocrine Biochemistr 3 ES
fasting and insufficient levels of ketone bodies. Acyl-CoA dehydrogenase , Diabetes y (Bioc)
catalyzes the first step in the beta-oxidation pathway and is the most &
1888
commonly deficient enzyme. Metabolis
m (ES)

Beta oxidation Cytosolic acetyl-CoA carboxylase converts acetyl-CoA to malonyl-CoA Endocrine Biochemistr 3 ES
during the rate-limiting step of de novo fatty acid synthesis. Malonyl-CoA , Diabetes y (Bioc)
also inhibits the action of mitochondrial carnitine acyltransferase, thereby &
####
inhibiting beta-oxidation of newly formed fatty acids. Metabolis
m (ES)
 Biotin Biotin acts as a C02 carrier on the surface of carboxylase enzymes and is Endocrine Biochemistr 1 ES
deficiency an essential cofactor for numerous reactions, including the conversion of , Diabetes y (Bioc)
pyruvate to oxaloacetate and fatty acid metabolism. Excess ingestion of &
1063
avidin, found in egg whites, has been associated with biotin deficiency. Metabolis
This condition presents with mental status changes, myalgias, anorexia, m (ES)
macular dermatitis, and lactic acidosis.
Body fluid Volume contraction and expansion can be divided into isosmotic, Endocrine Biochemistr 1 ES
distribution hyposmotic, and hyperosmotic states. Hyperosmotic volume contraction is , Diabetes y (Bioc)
caused by a loss of free water (with retention of electrolytes). It can occur &
1379
in patients with diabetes insipidus or as a result of decreased fluid Metabolis
intake/excessive sweating. m (ES)

Citric acid GTP is synthesized by succinyl-CoA synthetase during the conversion of Endocrine Biochemistr 1 ES
cycle succinyl-CoA to succinate in the citric acid cycle. During , Diabetes y (Bioc)
gluconeogenesis, phosphoenolpyruvate carboxykinase uses GTP to &
1022
synthesize phosphoenolpyruvate from oxaloacetate. Metabolis
m (ES)

Diabetes In hyperglycemic states, aldose reductase converts glucose to sorbitol at a Endocrine Biochemistr 31 ES
mellitus rate faster than sorbitol can be metabolized. Sorbitol accumulates in certain , Diabetes y (Bioc)
cells such as lens cells, causing an influx of water and resulting in osmotic &
846 cellular injury. Depletion of NADPH by aldose reductase also increases Metabolis
oxidative stress, which accelerates development of cataracts and diabetic m (ES)
microvascular complications (eg, neuropathy, retinopathy).

Diabetes Glucose transport protein (GLUT)-4 is an insulin-sensitive glucose Endocrine Biochemistr 31 ES

mellitus transporter expressed in skeletal muscle cells and adipocytes that , Diabetes y (Bioc)
translocates to the plasma membrane in response to increasing insulin &
847
levels. In contrast, GLUT-1,2, 3, and 5 are always present on the plasma Metabolis
membrane and constitutively transport glucose in an insulin-independent m (ES)
manner.
Diabetes In the polyol pathway, aldose reductase converts glucose into sorbitol, Endocrine Biochemistr 31 ES
mellitus which is slowly metabolized into fructose by sorbitol dehydrogenase. , Diabetes y (Bioc)
Chronic hyperglycemia overwhelms this pathway, causing intracellular &
934 sorbitol accumulation and increased osmotic/oxidative stress. This Metabolis
accelerates cataract development in patients with diabetes, and contributes m (ES)
to the pathogenesis of diabetic retinopathy, neuropathy, and nephropathy.

Diabetes Insulin release by pancreatic beta cells is stimulated by increased glucose Endocrine Biochemistr 31 ES
mellitus metabolism and ATP production. Glucokinase functions as a glucose , Diabetes y (Bioc)
sensor in pancreatic beta cells by controlling the rate of glucose entry into &
1010 the glycolytic pathway. Mutations in the glucokinase gene lead to a state in Metabolis
which higher glucose levels are required to stimulate insulin secretion and m (ES)
are a cause of maturity-onset diabetes of the young.

1121 Diabetes Insulin is an anabolic hormone that acts via receptor tyrosine kinase Endocrine Biochemistr 31 ES
Dyslipidemia Familial dysbetalipoproteinemia (type III hyperlipoproteinemia) is an Endocrine Biochemistr 11 ES
autosomal recessive disorder characterized by elevated cholesterol and , Diabetes y (Bioc)
triglyceride levels. It is caused by defects in АроЕЗ and ApoE4, leading to &
2064
decreased clearance of chylomicrons and VLDL remnants uptake by Metabolis
liver cells. Patients can develop eruptive and palmar xanthomas and m (ES)
premature atherosclerosis.
Fabry disease In Fabry disease, a-galactosidase A deficiency causes accumulation of the Endocrine Biochemistr 1 ES
sphingolipid globotriaosylceramide. The earliest manifestations of Fabry , Diabetes y (Bioc)
disease are neuropathic pain and angiokeratomas. Glomerular (eg; &
1989 proteinuria, renal failure), cardiac (eg, left ventricular hypertrophy), and Metabolis
cerebrovascular (eg, transient ischemic attack, stroke) complications m (ES)
develop in adulthood.

Fructose 2,6 F-2,6-BP activates PFK-1 (↑ glycolysis) and inhibs F-1,6-BPase (↓ GNG). Endocrine Biochemistr 1 ES
bisphosphate F-2,6-BP conc is regulated by a bifxnal enzyme complex: PFK-2 ↑ F-2,6- , Diabetes y (Bioc)
BP lvls in response to insulin, and F-2,6-BPase ↓ F-2,6-BP lvls in response &
1031
to glucagon. Metabolis
m (ES)

Fructose Unlike hereditary fructose intolerance (aldolase В deficiency) and classic Endocrine Biochemistr 4 ES
metabolism galactosemia (galactose-1-phosphate uridyl transferase deficiency), , Diabetes y (Bioc)
essential fructosuria (fructokinase deficiency) is a benign disorder &
1067
Although affected patients are asymptomatic, their urine will test positive Metabolis
for a reducing sugar due to the presence of unmetabolized fructose m (ES)
 Fructose Essential fructosuria is a benign disorder of fructose metabolism caused by Endocrine Biochemistr 4 ES
metabolism fructokinase deficiency. In ptswith essential fructosuria, some of the , Diabetes y (Bioc)
dietary fructose load is converted by hexokinase to F6P, which can then &
1070
enter glycolysis; this pathway is not significant in normal individuals. Metabolis
m (ES)

Fructose Aldolase B defic, or HFI, leads to accumulation of the tox metabolite F1P. Endocrine Biochemistr 4 ES
metabolism patients have hypoglycaemia and vomiting when fructose or sucrose is , Diabetes y (Bioc)
consumed. Tx involves strict removal of both carbs from the diet. &
1073
Metabolis
m (ES)

Gluconeogenes In a fasting state, glucagon and epinephrine bind to transmembrane Endocrine Biochemistr 4 ES
is receptors and prevent hypoglycemia by increasing hepatic glycogenolysis , Diabetes y (Bioc)
and gluconeogenesis. Prolonged fasting increases the secretion of &
989
cortisol, a steroid hormone that binds to an intracellular receptor and Metabolis
acts to increase transcription of enzymes involved in gluconeogenesis. m (ES)
lipolysis, and proteolysis.
Gluconeogenes After 12-18 hours of fasting, gluconeogenesis becomes the principal source Endocrine Biochemistr 4 ES
is of blood glucose. Gluconeogenesis uses many glycolytic enzymes, but , Diabetes y (Bioc)
hexokinase, phosphofructokinase, and pyruvate kinase need to be bypassed &
as they are unidirectional. The initial steps of gluconeogenesis involve the Metabolis
997
conversion of pyruvate to oxaloacetate and oxaloacetate to m (ES)
phosphoenolpyruvate by pyruvate carboxylase and phosphoenolpyruvate
carboxykinase, respectively.

Gluconeogenes Acetyl-CoA stims GNG by ↑ the activity of PC when acetyl-CoA is Endocrine Biochemistr 4 ES
is abundant. This regulatory step allows pyruvate to be shunted toward acetyl- , Diabetes y (Bioc)
CoA production when acetyl-CoA lvls are low, preventing the cell from &
1034
becoming depleted of energy. Metabolis
m (ES)

Glycogen Acid maltase (a-glucosidase) deficiency presents in early infancy with Endocrine Biochemistr 3 ES
storage disease cardiomegaly, macroglossia, and profound muscular hypotonia. Abnormal , Diabetes y (Bioc)
glycogen accumulation within lysosomal vesicles is seen on muscle biopsy. &
1023
Metabolis
m (ES)

Glycogen Debranching enzyme defic (Cori disease) leads to accumulation of Endocrine Biochemistr 3 ES
storage disease glycogenwith abnly short outer chains (limit dextrins) due to the inability , Diabetes y (Bioc)
to degrade α-1,6-glycosidic branch points. patients presentwith &
1030
hypoglycaemia, ketoacidosis, hepatomegaly, and muscle weakness and Metabolis
hypotonia. m (ES)

Glycogen Glycogen serves as a source of Glc during fasting and as an energy store Endocrine Biochemistr 3 ES
storage disease that can be mobilised quickly during strenuous muscle contraction. , Diabetes y (Bioc)
Myophosphorylase defic (McArdle disease or GSD-V) causes failure of &
1032
muscle glycogenolysis, resulting in ↓ exercise tolerance, muscle pain and Metabolis
cramping, and myoglobinuriawith physical activity). m (ES)

Hereditary Aldolase В deficiency causes hereditary fructose intolerance. This disease Endocrine Biochemistr 1 ES
fructose manifests after introduction of fructose into the diet with vomiting and , Diabetes y (Bioc)
intolerance hypoglycemia about 20-30 minutes after fructose ingestion. These infants &
1069
can present with failure to thrive, jaundice, and hepatomegaly. Metabolis
m (ES)

Hyperphosphat Glucose-6-phosphate dehydrogenase is the rate-limiting enzyme in the Endocrine Biochemistr 1 ES

emia pentose phosphate pathway, the major source of cellular NADPH. This , Diabetes y (Bioc)
molecule is necessary for (Fatty acid synthesis) reducing glutathione &
1066
(protects red blood cells from oxidative damage) and for the biosynthesis of Metabolis
cholesterol, fatty acids, and steroids. m (ES)

Ketone When glycogen stores are depleted during fasting: ketone bodies are Endocrine Biochemistr 1 ES
utilization produced in the liver and can be used as an energy source in the , Diabetes y (Bioc)
mitochondria of peripheral tissues. The brain preferentially uses glucose, &
1887
but will utilize ketones for most of its energy needs during prolonged Metabolis
starvation. Erythrocytes lack mitochondria and are unable to use ketones. m (ES)

LDH and Under anaerobic conditions, NADH transfers electrons to pyruvate to form Endocrine Biochemistr 1 ES
glycolysis lactate and regenerate NAD*. NAD+ is required to convert glyceraldehyde- , Diabetes y (Bioc)
3-phosphate to 1-3-bisphosphoglycerate in glycolysis. &
1019
Metabolis
m (ES)
 Maple syrup Maple syrup urine disease classically presents with irritability, dystonia, Endocrine Biochemistr 2 ES
urine disease poor feeding, and a "maple syrup" scent to the patient's urine within the , Diabetes y (Bioc)
first few days of life. Dietary restriction of branched-chain amino acids (eg. &
1335
leucine, isoleucine, valine) is the hallmark of treatment. Metabolis
m (ES)

Maple syrup Branched-chain a-ketoacid dehydrogenase requires several coenzymes: Endocrine Biochemistr 2 ES
urine disease Thiamine. Lipoate, Coenzyme A, FAD, NAD (mnemonic: Tender Loving , Diabetes y (Bioc)
Care For Nancy). Some patients with maple syrup urine disease improve &
1336
with high-dose thiamine treatment, but most require lifelong restriction of Metabolis
leucine, isoleucine, and valine. m (ES)

Niacin Hartnup disease is caused by impaired transport of neutral amino acids in Endocrine Biochemistr 3 ES
deficiency the small intestine and proximal tubule of the kidney. Symptoms include , Diabetes y (Bioc)
pellagra-like skin eruptions and cerebellar ataxia, which occur as a result of &
1334
niacin deficiency. The diagnosis can be confirmed through detection of Metabolis
excessive amounts of neutral amino acids in the urine. m (ES)

Niemann-Pick Niemann-Pick disease is an autosomal recessive disorder that is common in Endocrine Biochemistr 2 ES
the Ashkenazi Jewish population. This disorder is characterized by , Diabetes y (Bioc)
sphingomyelinase deficiency and sphingomyelin accumulation, which &
1990
cause hepatosplenomegaly and neurologic regression in infancy. Metabolis
m (ES)

Niemann-Pick In Niemann-Pick disease, sphingomyelinase deficiency causes Endocrine Biochemistr 2 ES

accumulation of the lipid sphingomyelin. Clinical features include , Diabetes y (Bioc)
hepatosplenomegaly, neurologic regression, and a cherry-red macular spot &
1991
in infancy. Metabolis
m (ES)

PDH and Pyruvate dehydrogenase complex deficiency is an inherited inborn error of Endocrine Biochemistr 1 ES
ketogenic metabolism causing lactic acidosis and neurologic defects. Patients are , Diabetes y (Bioc)
amino acids unable to convert pyruvate to acetyl-CoA. resulting in a shunting of &
998 pyruvate to lactic acid. In these patients, metabolism of exclusively Metabolis
ketogenic amino acids (eg, lysine, leucine) can provide energy in the form m (ES)
of acetyl-CoA without increasing lactate production

Phenylketonuri Phenylketonuria (PKU) results from an inability to convert phenylalanine Endocrine Biochemistr 5 ES
a to tyrosine by the phenylalanine hydroxylase system, making tyrosine an , Diabetes y (Bioc)
essential amino acid in these patients. Classic clinical features of &
1484
untreated PKU include intellectual disability, seizures, light pigmentation, Metabolis
and a "musty" odor m (ES)

Phenylketonuri Dihydrobiopterin reductase deficiency results in impaired Endocrine Biochemistr 5 ES

a tetrahydrobiopterin (BH4) levels. BH4 is an important cofactor for both , Diabetes y (Bioc)
phenylalanine hydroxylase and tyrosine hydroxylase. Although &
1501
phenylalanine levels can be corrected with dietary restriction, downstream Metabolis
deficiencies of dopamine, norepinephrine, epinephrine, and serotonin lead m (ES)
to progressive neurologic deterioration.
Pheochromocyt Cortisol ↑ the conversion of NE to EPI in the AM by ↑ the expression of Endocrine Biochemistr 4 ES
oma PNMT. , Diabetes y (Bioc)
&
602
Metabolis
m (ES)

Principles of Cellular compartmentalization allows multiple biochemical processes to Endocrine Biochemistr 1 ES

cell biology occur simultaneously at maximum efficiency. Beta-oxidation of fatty acids, , Diabetes y (Bioc)
the TCA cycle, and the carboxylation of pyruvate (gluconeogenesis) all &
occur within the mitochondria. The enzymes responsible for glycolysis, Metabolis
1119
fatty acid synthesis, and the pentose phosphate pathway reside in the m (ES)
cytosol. enzymes will most likely be detectable in the supernatant of
healthy liver cells--> Transketolase

Protein Integral membrane proteins contain transmembrane domains composed of Endocrine Biochemistr 1 ES
structure alpha helices with hydrophobic amino acid residues (eg, alanine, valine, , Diabetes y (Bioc)
leucine, isoleucine, phenylalanine, tryptophan, methionine, proline, &
1383
glycine). These transmembrane domains help anchor the protein to the Metabolis
phospholipid bilayer of the cell membrane. m (ES)
 Protein Orotic aciduria is a rare autosomal recessive disorder of de novo Endocrine Biochemistr 2 ES
synthesis pyrimidine synthesis that occurs due to a defect in uridine 5'- , Diabetes y (Bioc)
monophosphate (UMP) synthase. Children typically present with physical &
2066 and mental retardation, megaloblastic anemia, and large amounts of urinary Metabolis
orotic acid. Uridine supplementation can improve symptoms as undine is m (ES)
converted to UMP via nucleoside kinases.

Second Protein kinase A is responsible for the intracellular effects of the G Endocrine Biochemistr 2 ES
messengers protein-mediated adenylate cyclase second messenger system. Hormone , Diabetes y (Bioc)
receptors that use this system include the TSH. glucagon, and PTH &
994
receptors. Metabolis
m (ES)

Steroid The initial step in the synthesis of steroid hormones is the conversion of Endocrine Biochemistr 1 ES
hormones cholesterol to pregnenolone in the mitochondria. The remainder of , Diabetes y (Bioc)
steroidogenesis occurs in the smooth endoplasmic reticulum. Steroid- &
2016
producing cells contain a well-developed smooth endoplasmic reticulum. Metabolis
Promotion of male-pattern hair growth and virilization m (ES)

Transcription Zinc-finger motifs are composed of chains of amino acids bound together Endocrine Biochemistr 7 ES
around a zinc atom via linkages with cysteine and histidine residues. They , Diabetes y (Bioc)
recognize specific DNA sequences and are used by many transcription &
#### factors to bind DNA and alter activity of target genes. Intracellular Metabolis
receptors that bind steroids, thyroid hormone, and fat-soluble vitamins act m (ES)
directly as transcription factors and contain zinc-finger binding domains.

Triglyceride Glycerol produced by the degradation of triglycerides in adipose tissue Endocrine Biochemistr 2 ES
metabolism can be used by glycerol kinase in the liver and kidney to synthesize , Diabetes y (Bioc)
glucose during gluconeogenesis. &
1889
Metabolis
m (ES)

Triglyceride Hormone-sensitive lipase is found in adipose tissue, where it functions to Endocrine Biochemistr 2 ES
metabolism drive the breakdown of stored triglycerides into free fatty acids and , Diabetes y (Bioc)
glycerol. During times of starvation, this enzyme provides substrates for &
####
hepatic gluconeogenesis and ketone body formation Metabolis
m (ES)

Turner Growth hormone binds to cell surface receptors, leading to intracellular Endocrine Biochemistr 8 ES
syndrome activation of the JAK-STAT pathway. Cytokines (eg, interferon) and , Diabetes y (Bioc)
hematopoietic growth factors (eg. erythropoietin, G-CSF) also use this &
1720
pathway. Metabolis
m (ES)

Urea cycle Patients with urea cycle disorders typically have discrete episodes of Endocrine Biochemistr 3 ES
vomiting, tachypnea, and confusion/coma secondary to hyperammonemia , Diabetes y (Bioc)
(a metabolic emergency). Ornithine transcarbamylase deficiency is the &
1370
most common disorder of the urea cycle and is characterized by Metabolis
hyperammonemia and elevated urinary orotic acid. m (ES)

Diabetes Smoking cessation is by far the most effective preventive intervention in Endocrine Biostatistics 31 ES
mellitus almost all patients, and this is especially true in those with diabetes. , Diabetes (Bios)
&
1013
Metabolis
m (ES)

DiGeorge DiGeorge syndrome results from maldevelopment of the third (inferior Endocrine Embryology 2 ES
syndrome parathyroid and thymus) and fourth (superior parathyroid) , Diabetes (Embr)
pharyngeal/branchial pouches. Subsequent parathyroid and thymic &
543
hypoplasia results in hypocalcemia and T cell deficiency. Metabolis
m (ES)

Ectopic thyroid The thyroid gland is formed from evagination of the pharyngeal epithelium Endocrine Embryology 1 ES
and desc to the lower neck. Due to failure of migration, the thyroid can , Diabetes (Embr)
reside anywhere along the thyroglossal duct's usual path, incl the tongue &
763
(lingual thyroid). Metabolis
m (ES)

771 Pheochromocyt Neural crests are embryological structures composed of parallel strips of Endocrine Embryology 4 ES
 Hypothyroidis Congenital hypothyroidism is usually asymptomatic at birth. After Endocrine Genetics 14 ES
m maternal T4 wanes, infants develop constipation, lethargy, hypotonia, , Diabetes (Gene)
macroglossia, an umbilical hernia, and a large anterior fontanelle. &
1407
Metabolis
m (ES)

Phenylketonuri Intellectual disability, gait or posture abnormality, eczema, and a musty Endocrine Genetics 5 ES
a body odor in a toddler are signs of phenylketonuria (PKU). Most infants , Diabetes (Gene)
with PKU are born to 2 heterozygous carrier parents. The probability that &
1789
heterozygous carrier parents will transmit an autosomal recessive disease Metabolis
such as PKU to a child is 1/4. m (ES)

Pheochromocyt Chromaffin cells are modified neuroendocrine cells derived from the Endocrine Histology 4 ES
oma neural crest. Chromaffin cells in the adrenal medulla are stimulated by , Diabetes (Hist)
acetylcholine released by sympathetic preganglionic neurons and secrete &
8424
catecholamines directly into the bloodstream to amplify sympathetic Metabolis
nervous system activity. m (ES)

Adrenal Meningococcal septicemia can cause bilateral hemorrhagic infarction of Endocrine Pathology 5 ES
insufficiency the adrenal glands, leading to acute adrenal crisis (Waterhouse- , Diabetes (Path)
Friderichsen syndrome). &
931
Metabolis
m (ES)

#### Adrenal Primary adrenal insufficiency (PAI) is characterized by weight loss, Endocrine Pathology 5 ES
Androgenic Androgenic steroid abuse may lead to erythrocytosis, testicular atrophy, Endocrine Pathology 2 ES
steroids acne, and virilization in women (eg, clitoromegaly, hirsutism). , Diabetes (Path)
&
1901
Metabolis
m (ES)

1839 Anorexia Distorted body image, inadequate diet, dry skin, and lanugo hair in a Endocrine Pathology 3 ES
Congenital Deficiency of 21-hydroxylase causes adrenal cortical hyperplasia due to Endocrine Pathology 6 ES
adrenal excess stimulation of the adrenal cortex by ACTH. The classic, non-salt- , Diabetes (Path)
hyperplasia wasting form presents in boys age 2-4 with early virilization, accelerated &
2080
linear growth, and elevated levels of 17-hydroxyprogesterone and Metabolis
androgens. m (ES)

Congenital Treatment of congenital adrenal hyperplasia due to 21-hydroxylase Endocrine Pathology 6 ES

adrenal deficiency involves low doses of exogenous corticosteroids to suppress , Diabetes (Path)
hyperplasia excess ACTH secretion, which reduces production of androgens by the &
2081
adrenal cortex. Metabolis
m (ES)

Craniopharyngi 1. The anterior pituitary is formed from an out-pouching of the pharyngeal Endocrine Pathology 2 ES
omas roof and is called Rathke's pouch. The posterior pituitary gland arises from , Diabetes (Path)
an extension of the hypothalamic neurons. &
2. Craniopharyngiomas are tumors arising from Rathke's pouch remnants Metabolis
221
in the anterior pituitary. They characteristically have three components: m (ES)
solid, cystic, and calcified. They present during childhood, usually, with
mass effect and visual deficits.

Cushing Cushing syndrome caused by a pituitary adenoma or ectopic Endocrine Pathology 5 ES

syndrome (paraneoplastic) ACTH secretion is associated with elevated ACTH levels. , Diabetes (Path)
High-dose dexamethasone suppresses ACTH and cortisol secretion when &
927
Cushing syndrome is caused by a pituitary adenoma (Cushing disease) but Metabolis
not when it is caused by ectopic ACTH secretion (eg, small cell lung m (ES)
cancer).
Cushing Paraneoplastic hypercortisolism, most commonly caused by small cell lung Endocrine Pathology 5 ES
syndrome cancer, is due to ectopic ACTH secretion. Clinical features include , Diabetes (Path)
hypertension, hyperglycemia, edema, and hyperpigmentation. Unlike &
1921
nonparaneoplastic Cushing syndrome, central obesity is uncommon. Metabolis
m (ES)

Diabetes Pancreatic islet amyloid deposition (non-healing foot ulcer) is Endocrine Pathology 31 ES
mellitus characteristic of type 2 diabetes mellitus. A strong linkage with HLA class , Diabetes (Path)
II gene makeup, pancreatic islet infiltration with leukocytes (insulitis), and &
848
antibodies against islet antigens are frequently seen in type 1 diabetes. Metabolis
m (ES)
 Diabetes Patients with noncoronary atherosclerotic disease, diabetes mellitus, or Endocrine Pathology 31 ES
mellitus chronic kidney disease are at the same risk of cardiovascular events (eg, , Diabetes (Path)
myocardial infarction, stroke) as patients with known coronary heart &
1011
disease. Coronary heart disease is the most common cause of death in Metabolis
patients with diabetes mellitus. m (ES)

Diabetes Autoimmune insulitis (leukocytic infiltration) with progressive beta cell Endocrine Pathology 31 ES
mellitus loss is the most common cause of type 1 diabetes mellitus. Insulin , Diabetes (Path)
resistance accompanied by relative insulin deficiency is the main cause of &
1012
type 2 diabetes mellitus. Metabolis
m (ES)

Diabetes Hemoglobin A1c is produced by nonenzymatic glycosylation of the Endocrine Pathology 31 ES

mellitus hemoglobin molecule. A hemoglobin A1 c assay provides an estimate of , Diabetes (Path)
chronic glycemic control over the life span of circulating erythrocytes (-3 &
1996 months). However, rapid erythrocyte turnover (eg, hemolytic anemia, Metabolis
beta thalassemia) can give a misleadingly low hemoglobin A1c in m (ES)
relation to glycemic status. high hemoglobin A2

Dyslipidemia Xanthelasmas, a type of xanthoma, are yellowish macules/papules found on Endocrine Pathology 11 ES
the medial eyelids. They are dermal accumulations of macrophages , Diabetes (Path)
containing cholesterol and triglycerides, and are generally associated with &
191
a primary or secondary hyperlipidemia or dyslipidemia An LDL receptor Metabolis
abnormality is the most common cause. m (ES)

DyslipidemiaFamilial chylomicronemia syndrome frequently presents in childhood with Endocrine Pathology 11 ES

recurrent episodes of acute pancreatitis. Patients with this disorder are , Diabetes (Path)
not usually at increased risk for premature coronary artery disease. &
782
Eruptive skin xanthomas may be present in hypertriglyceridemia, but Metabolis
tendon xanthomas and xanthelasmas are primarily seen with m (ES)
hypercholesterolemia
7651 Growth Acromegaly is caused by excessive production of growth hormone, usually Endocrine Pathology 2 ES
Hypercalcemia Thiazide diuretics cause hypercalcemia by increasing the distal tubular Endocrine Pathology 5 ES
reabsorption of Ca2+. The increased circulating calcium levels result in , Diabetes (Path)
suppression of parathyroid hormone, which distinguishes this effect from &
980
hyperparathyroidism. Metabolis
m (ES)

Hypoglycemia Sulfonylurea use make Hypoglycemia is characterized by tremor, Endocrine Pathology 6 ES

diaphoresis, and confusion in association with a low blood glucose level , Diabetes (Path)
and resolution of symptoms when the blood glucose level is corrected. &
8531
Hypoglycemia with elevated insulin and low C-peptide levels suggests Metabolis
exogenous insulin injection, whereas elevated C-peptide suggests an m (ES)
insulin secretagogue or insulin-secreting tumor.
Hypopituitaris High estrogen levels during pregnancy cause enlargement of the pituitary Endocrine Pathology 2 ES
m gland without a proportional increase in blood supply. Peripartum , Diabetes (Path)
hypotension can cause ischemic necrosis of the pituitary leading to &
220
panhypopituitarism (Sheehan syndrome). Patients commonly develop Metabolis
failure of lactation due to deficiency of prolactin. m (ES)

Hypothyroidis Chronic lymphocytic (Hashimoto) thyroiditis is the most common cause of Endocrine Pathology 14 ES
m hypothyroidism. Histopathology characteristically shows an intense , Diabetes (Path)
lymphocytic infiltrate, often with germinal centers. Residual follicles &
769
may be surrounded by Horthle cells (large oxyphilic cells filled with Metabolis
granular cytoplasm). m (ES)

Kallmann In Kallmann syndrome, there is an absence of GnRH secretory neurons in Endocrine Pathology 1 ES
syndrome the hypothalamus due to defective migration from the olfactory placode. , Diabetes (Path)
These patients have central hypogonadism and anosmia, and often present &
579
with delayed puberty. Metabolis
m (ES)

Multiple Multiple endocrine neoplasia type 1 consists of hyperparathyroidism (eg, Endocrine Pathology 5 ES
endocrine hypercalcemia, constipation, kidney stones (nephrolithiasis)), pituitary , Diabetes (Path)
neoplasia tumors, and pancreatic endocrine tumors (eg, gastrinoma). The genetic &
986
defect involves mutations of the MEN1 gene. Metabolis
m (ES)

Multiple Multiple endocrine neoplasia type 2B is characterized by medullary Endocrine Pathology 5 ES

endocrine thyroid cancer pheochromocytoma. marfanoid habitus, and oral and , Diabetes (Path)
neoplasia intestinal mucosal neuromas. &
1844
Metabolis
m (ES)
 Neuroendocrin Glucagonoma presents with hyperglycemia (often as newly diagnosed Endocrine Pathology 1 ES
e tumors diabetes mellitus) and necrolytic migratory erythema (blistering , Diabetes (Path)
erythematous plaques with central clearing) affecting the groin, face, and &
585
extremities. The diagnosis is made by detecting elevated glucagon Metabolis
levels. m (ES)

Pituitary Prolactinomas are the most common pituitary adenoma (lactotrophs) Endocrine Pathology 8 ES
adenoma and can cause galactorrhea, menstrual irregularities, and infertility in , Diabetes (Path)
premenopausal women. Large pituitary adenomas can cause headaches &
1262
from mass effect and bitemporal hemianopsia from compression of the Metabolis
optic chiasm. m (ES)

Pituitary Acute pituitary hemorrhage (pituitary apoplexy) is characterized by Endocrine Pathology 1 ES

apoplexy severe headaches, bitemporal hemianopsia (compression of the optic , Diabetes (Path)
chiasm), and ophthalmoplegia (compression of the oculomotor nerve). It &
225 usually occurs in a preexisting pituitary adenoma. Pituitary apoplexy is a Metabolis
medical emergency that requires urgent treatment with glucocorticoids to m (ES)
prevent acute adrenal crisis and circulatory collapse

Subacute Subacute granulomatous (de Quervain) thyroiditis is characterized by Endocrine Pathology 1 ES

thyroiditis decreased Radioiodine uptake, painful thyroid enlargement and usually , Diabetes (Path)
follows a viral illness. Biopsy shows a mixed inflammatory infiltrate &
768
with macrophages and multinucleated giant cells. Metabolis
m (ES)

Thyroid cancer Papillary thyroid cancer is the most common type of thyroid cancer. Endocrine Pathology 6 ES
Characteristic findings on histopathology include large cells with nuclei , Diabetes (Path)
containing finely dispersed chromatin, giving an empty or ground-glass &
1658
appearance (Orphan Annie eye), and intranuclear inclusions or grooves. Metabolis
m (ES)

Thyroid cancer Medullary thyroid cancer is a neuroendocrine tumor that arises from Endocrine Pathology 6 ES
parafollicular calcitonin-secreting C cells It is characterized by nests or , Diabetes (Path)
sheets of polygonal or spindle-shaped cells with extracellular amyloid &
1659
deposits derived from calcitonin. Metabolis
m (ES)

Thyroid cancer Medullary thyroid cancer is a neuroendocrine tumor that arises from Endocrine Pathology 6 ES
calcitonin-secreting C (parafollicular) cells. It is often seen in the context of , Diabetes (Path)
multiple endocrine neoplasia type 2 (A and B); although the majority of &
1660
cases are sporadic. Both sporadic and familial medullary thyroid cancers Metabolis
are associated with mutations in the RET proto-oncogene. m (ES)

Thyroid cancer Foll neoplasms typically present as slowly enlarging, painless thyroid Endocrine Pathology 6 ES
nodules. diff b/w a foll adenoma and FTC isn't possible using only FNA , Diabetes (Path)
results. Histo evidence of invasion of the tumour capsule a/o surrounding &
####
blood vessels is needed to Dx FTC. Metabolis
m (ES)

Adrenal Administration of metyrapone will cause a decrease in cortisol synthesis Endocrine Pathophysiol 5 ES
insufficiency via inhibition of 11-p-hydroxylase. In patients with an intact hypothalamic- , Diabetes ogy (Patp)
pituitary-adrenal axis, this will cause a reactive increase in ACTH &
608
(ACTH surge), 11-deoxycortisol, and urinary 17-hydroxycorticosteroid Metabolis
levels. m (ES)

Adrenal Patients with type 1 diabetes mellitus are at increased risk for other Endocrine Pathophysiol 5 ES
insufficiency autoimmune endocrinopathies, including primary adrenal insufficiency , Diabetes ogy (Patp)
(Addison disease). Electrolyte abnormalities in primary adrenal &
924
insufficiency include hyponatremia hyperkalemia, hyperchloremia, Metabolis
and nonanion gap metabolic acidosis. m (ES)

Adrenal Patients with adrenal insufficiency are not able to increase glucocorticoid Endocrine Pathophysiol 5 ES
insufficiency production in response to acute stress (eg, illness, surgery). Adrenal crisis , Diabetes ogy (Patp)
is characterized by severe hypotension, abdominal pain, vomiting, &
932
weakness, and fever. In addition to aggressive fluid resuscitation, Metabolis
treatment requires immediate glucocorticoid supplementation m (ES)
(Dexamethasone).
Amenorrhea Functional hypothalamic amenorrhea results from loss of pulsatile Endocrine Pathophysiol 2 ES
gonadotropin-releasing hormone release from the hypothalamus and is , Diabetes ogy (Patp)
caused by weight loss, strenuous exercise, systemic illness, or abnormal &
925 eating habits. Loss of cyclic gonadotropin release leads to a decrease in LH Metabolis
and FSH secretion from the pituitary, which in turn causes low circulating m (ES)
estrogen levels.
 Congenital Deficiency of 17 alpha-hydroxylase is a rare form of congenital adrenal Endocrine Pathophysiol 6 ES
adrenal hyperplasia characterized by impaired synthesis of androgens, estrogens, , Diabetes ogy (Patp)
hyperplasia and cortisol with excess production of mineralocorticoids. Genetic males &
610
with this deficiency may have phenotypically female external genitalia and Metabolis
present with hypertension and hypokalemia around the expected time of m (ES)
puberty.
Congenital 11β-hydroxylase deficiency typically results in excessive adrenal Endocrine Pathophysiol 6 ES
adrenal androgen and mineralocorticoid (11-deoxycorticosterone) production. , Diabetes ogy (Patp)
hyperplasia Genetically female infants are born with ambiguous genitalia, and affected &
611
individuals develop hypertension and hypokalemia early in life. Metabolis
m (ES)

Congenital The most common form of congenital adrenal hyperplasia is 21- Endocrine Pathophysiol 6 ES
adrenal hydroxylase deficiency. Genetically female infants typically have , Diabetes ogy (Patp)
hyperplasia ambiguous genitalia (virilization) at birth, whereas males have &
793
phenotypically normal genitalia, with salt-wasting or precocious puberty Metabolis
appearing later. Elevated 17-hydroxyprogesterone is diagnostic. m (ES)
Progesterone --> 11-deoxycorticosterone
Congenital Classic 21-hydroxylase deficiency causes decreased cortisol and Endocrine Pathophysiol 6 ES
adrenal aldosterone production with increased adrenal androgen production , Diabetes ogy (Patp)
hyperplasia (17- hydroxyprogesterone). In boys, this deficiency presents 1-2 weeks &
930
after birth with vomiting, hypotension, hyponatremia, and Metabolis
hyperkalemia due to salt wasting; genitalia are normal. In girls, it presents m (ES)
at birth with ambiguous genitalia.
Cushing In Cushing syndrome due to an ACTH-secreting pituitary adenoma Endocrine Pathophysiol 5 ES
syndrome (Cushing disease), ACTH is high and cortisol production can be , Diabetes ogy (Patp)
suppressed by high-dose, but not low-dose, dexamethasone. In ptswith &
612
ectopic ACTH production (e.g. from malignant tumours), cortisol and Metabolis
ACTH production aren't suppressed by low- or high-dose dexamethasone. m (ES)

Cushing Long-term use of supraphysiologic doses of glucocorticoids causes Endocrine Pathophysiol 5 ES

syndrome suppression of the hypothalamic-pituitary-adrenal axis, which in turn leads , Diabetes ogy (Patp)
to bilateral adrenocortical atrophy involving the zona fasciculata and &
928
reticularis. Sudden cessation of the exogenous corticosteroids can Metabolis
precipitate adrenal crisis. m (ES)

Cushing ACTH is the major trophic hormone of the zona fasciculata and reticularis, Endocrine Pathophysiol 5 ES
syndrome whereas the zona glomerulosa is primarily regulated by angiotensin II. , Diabetes ogy (Patp)
Excess production of ACTH causes increased cortisol synthesis within the &
1163 zona fasciculata (Cushing's manifestations) and increased androgen Metabolis
production within the zona reticularis (irregular menstruation, hirsutism in m (ES)
women). Hyperplasia of the zona fasciculata and reticularis

Diabetes Type 1 diabetes mellitus typically presents subacutely with polyuria and Endocrine Pathophysiol 31 ES
mellitus polydipsia accompanied by fatigue and weight loss. The diagnosis can be , Diabetes ogy (Patp)
confirmed with a fasting blood glucose or hemoglobin A1c measurement. &
921
Metabolis
m (ES)

Diabetes Phosphorylation of serine and threonine residues of insulin receptor Endocrine Pathophysiol 31 ES
mellitus and insulin receptor substrate by serine kinase leads to insulin resistance , Diabetes ogy (Patp)
This type of phosphorylation can be induced by TNF-a, catecholamines, &
1326
glucocorticoids, and glucagon. Metabolis
m (ES)

Diabetic Most patients with diabetic ketoacidosis have normal to increased serum Endocrine Pathophysiol 6 ES
ketoacidosis potassium levels despite a total body potassium deficit. Replacement of , Diabetes ogy (Patp)
potassium is a crucial step in the management of patients with diabetic &
985
ketoacidosis. Metabolis
m (ES)

Gastrointestinal Reduced gallbladder contractility, due to decreased cholecystokinin Endocrine Pathophysiol 2 ES

hormones secretion, is responsible for biliary stones in patients with somatostatinoma. , Diabetes ogy (Patp)
&
601
Metabolis
m (ES)

Gestational Maternal hyperglycemia causes increased transplacental glucose delivery Endocrine Pathophysiol 2 ES
diabetes to the infant, fetal hyperglycemia, and, ultimately, β cell hyperplasia. The , Diabetes ogy (Patp)
resulting hyperinsulinemia caused by islet cell hyperplasia is associated &
922
with fetal macrosomia and hypoglycemia after delivery. Metabolis
m (ES)
 Gluconeogenes Ethanol inhibits gluconeogenesis and can cause hypoglycemia once Endocrine Pathophysiol 4 ES
is hepatic glycogen stores are depleted. , Diabetes ogy (Patp)
&
1866
Metabolis
m (ES)

Growth Gigantism is caused by excess growth hormone (GH) during childhood and Endocrine Pathophysiol 2 ES
hormone is characterized by accelerated linear growth, prognathism, and bony , Diabetes ogy (Patp)
enlargement of the hands and feet. GH excess after closure of the &
224 epiphysial growth plates causes acromegaly. GH has direct effects on target Metabolis
tissues and indirect effects mediated by insulin-like growth factor-1 (IGF- m (ES)
1) secretion from the liver.

#### Gynecomastia 5-α reductase inhibitors (eg. finasteride dutasteride) are used in the Endocrine Pathophysiol 3 ES
Hyperaldostero Hypersecreting adrenocortical tumors can have functionality resembling Endocrine Pathophysiol 5 ES
nism the outer (aldosterone/Conn syndrome), middle (cortisol/Cushing , Diabetes ogy (Patp)
syndrome), or inner (androgens/hirsutism and virilization) layers of the &
454
adrenal cortex. Paresthesias and muscle weakness Metabolis
m (ES)

Hyperaldostero Primary hyperaldosteronism is caused by excessive aldosterone secretion, Endocrine Pathophysiol 5 ES

nism typically as a result of bilateral nodular hyperplasia of the zona , Diabetes ogy (Patp)
glomerulosa or an aldosterone-producing adrenal adenoma. Clinical &
547
findings include hypertension, low plasma renin activity, hypokalemia, and Metabolis
metabolic alkalosis m (ES)

Hyperaldostero Primary hyperaldosteronism causes increased Na+ reabsorption in the Endocrine Pathophysiol 5 ES
nism renal collecting tubules, leading to increased urinary excretion of K+ and , Diabetes ogy (Patp)
&
929 H+. Patients typically have secondary hypertension as well as
Metabolis
hypokalemia and metabolic alkalosis. The serum Na+ concentration
m (ES)
remains normal due to aldosterone escape.
631 Hyperparathyro Increased bone resorption in primary hyperparathyroidism leads to Endocrine Pathophysiol 2 ES
Hyperprolactin The release of prolactin is under inhibitory control by dopamine secretion Endocrine Pathophysiol 1 ES
emia from the hypothalamus. Disruption of dopaminergic pathways or blockade , Diabetes ogy (Patp)
of dopamine D2 receptors can cause hyperprolactinemia. &
214
Metabolis
m (ES)

Hyperthyroidis Pretibial myxedema and Graves ophthalmopathy are specific features of Endocrine Pathophysiol 8 ES
m Graves disease. They are caused by an autoimmune response directed , Diabetes ogy (Patp)
against the TSH receptor that results in the accumulation of &
623
glycosaminoglycans within the affected tissues (Skin thickening and Metabolis
induration over the shin). m (ES)

Hyperthyroidis Exogenous hyperthyroidism is characterized by elevated free thyroxine Endocrine Pathophysiol 8 ES

m (T4); suppressed TSH. and low/undetectable thyroglobulin. It can occur , Diabetes ogy (Patp)
with surreptitious levothyroxine abuse, use of animal-sourced thyroid &
#### supplements, and erroneous dosing of thyroid replacement therapy. Over Metabolis
time, the lack of TSH stim causes the thyroid follicles to become m (ES)
atrophic decreased colloid.

Hypoglycemia Glucagon increases serum glucose by increasing (liver) hepatic Endocrine Pathophysiol 6 ES
glycogenolysis and gluconeogenesis Glucagon also stimulates insulin , Diabetes ogy (Patp)
secretion from the pancreas Unlike epinephrine, glucagon has an &
849
insignificant effect on glucose homeostasis in the skeletal muscle, adipose Metabolis
tissue, and renal cortex. m (ES)

Hypoparathyroi Hypocalcemia can cause muscle cramps, perioral paresthesias, Endocrine Pathophysiol 1 ES
dism hypotension, and neuromuscular hyperexcitability. Injury to the , Diabetes ogy (Patp)
parathyroid glands during thyroid surgery is a common cause of &
1656
hypoparathyroidism and acute hypocalcemia. Metabolis
m (ES)

Hypopituitaris Suppression of the hypothalamus-pituitary-adrenal axis by glucocorticoid Endocrine Pathophysiol 2 ES

m therapy is the most common cause of adrenal insufficiency. In these , Diabetes ogy (Patp)
patients, adrenal crisis can be precipitated by stressful situations (eg, &
609
infections, surgery) if the glucocorticoid dose is not increased Metabolis
appropriately. Decreased CTH, ACTH, Cortisol m (ES)
 Hypothyroidis The thyroid releases thyroid hormone (triiodothyronine [T3] and thyroxine Endocrine Pathophysiol 14 ES
m [T4]) in response to TSH from the pituitary, which is regulated by , Diabetes ogy (Patp)
thyrotropin-releasing hormone (TRH) from the hypothalamus. Thyroid &
764 hormone suppresses the secretion of TSH and TRH via negative feedback, Metabolis
and small changes in thyroid hormone levels cause large changes in TSH. m (ES)
Serum TSH is the most sensitive test for primary hypothyroidism.

Hypothyroidis Hypothyroid myopathy presents with myalgias, proximal muscle weakness, Endocrine Pathophysiol ES
m elevated creatine kinase levels, and delayed relaxation of deep tendon , Diabetes ogy (Patp)
reflexes. The diagnosis can be confirmed with an elevated TSH level. &
765
Other common causes of myopathy with elevated creatine kinase levels Metabolis
include inflammatory myopathies, muscular dystrophies, and HMG-CoA m (ES)
reductase inhibitors.
Hypothyroidis The thyroid gland is formed from evagination of the pharyngeal epithelium Endocrine Pathophysiol 14 ES
m and descends to the lower neck. Due to failure of migration, the thyroid , Diabetes ogy (Patp)
can reside anywhere along the thyroglossal duct's usual path, including the &
763
tongue (lingual thyroid). Metabolis
m (ES)

Hypothyroidis Thyrotoxicosis, whether due to endogenous hyperthyroidism or over- Endocrine Pathophysiol 14 ES

m replacement with thyroid hormone in patients with hypothyroidism, , Diabetes ogy (Patp)
causes a hyperadrenergic state that can lead to atrial fibrillation, high- &
####
output heart failure, and worsening of angina pectoris. Metabolis
m (ES)

Hypothyroidis Central (secondary) hypothyroidism is characterized by low serum TSH Endocrine Pathophysiol 14 ES
m and thyroxine (T4) levels and is due to hypothalamic-pituitary dysfunction. , Diabetes ogy (Patp)
Sheehan syndrome is ischemic necrosis of the pituitary gland and is &
#### typically caused by systemic hypotension during delivery. In addition to Metabolis
central hypothyroidism, patients may also develop deficiencies of other m (ES)
pituitary hormones (eg, ACTH, prolactin, gonadotropins).

Klinefelter Klinefelter syndrome (47,XXY) causes infertility characterised by 1° Endocrine Pathophysiol 3 ES

syndrome hypogonadism (↑ FSH and LH, low testosterone) and azoospermia. , Diabetes ogy (Patp)
Other findings incl long lower extremities; small, firm testes; and &
582
gynecomastia. Metabolis
m (ES)

Metabolic Normally, metabolic acidosis is partially compensated for by respiratory Endocrine Pathophysiol 4 ES
acidosis alkalosis. When the steady-state PaC02 persists above the range given by , Diabetes ogy (Patp)
the Winter formula (PaC02 = [1.5* HC03_] + 8 ± 2), the patient has a &
1979
superimposed respiratory acidosis (respiratory failure). Metabolis
m (ES)

Metabolic Visceral obesity as measured by waist circumference or waist-to-hip ratio Endocrine Pathophysiol 2 ES
syndrome is an important predictor of insulin resistance. , Diabetes ogy (Patp)
&
1327
Metabolis
m (ES)

Metabolic Type 2 diabetes mellitus is due to insulin resistance and relative insulin Endocrine Pathophysiol 2 ES
syndrome deficiency. Chronically elevated free fatty acid levels contribute to insulin , Diabetes ogy (Patp)
resistance by impairing insulin-dependent glucose uptake and increasing &
1328
hepatic gluconeogenesis. Metabolis
m (ES)

Multiple Multiple endocrine neoplasia type 2B (increased calcitonin) is Endocrine Pathophysiol 5 ES

endocrine characterized by medullary thyroid cancer pheochromocytomas (Episodic , Diabetes ogy (Patp)
neoplasia headache), mucosal neuromas, and marfanoid habitus (The arm span &
988
exceeds his height and the patient has long fingers). Metabolis
Hyperparathyroidism is not a feature of this syndrome. m (ES)

Multiple Multiple endocrine neoplasia type 1 syndrome is characterized by tumors Endocrine Pathophysiol 5 ES
endocrine of the pituitary, parathyroid gland, and pancreas (the "3 Ps"). , Diabetes ogy (Patp)
neoplasia &
1845
Metabolis
m (ES)

#### Multiple Multiple endocrine neoplasia type 2 is caused by germline activating Endocrine Pathophysiol 5 ES
endocrine mutations in the RET proto-oncogene and frequently results in both , Diabetes ogy (Patp)
 Osteoporosis The nuclear factor kappa В (RANK)/RANK-ligand (RANK-L) interaction Endocrine Pathophysiol 10 ES
is essential for the formation and differentiation of osteoclasts. , Diabetes ogy (Patp)
Osteoprotegerin (OPG) blocks binding of RANK-L to RANK and reduces &
#### formation of mature osteoclasts, leading to decreased bone resorption. Metabolis
Denosumab is a monoclonal antibody used in the treatment of m (ES)
postmenopausal osteoporosis that works in a manner similar to OPG.

Pheochromocyt Pheochromocytoma is a tumor arising from the chromaffin cells of the Endocrine Pathophysiol 4 ES
oma adrenal medulla characterized by excess production of catecholamines. , Diabetes ogy (Patp)
Clinical features include episodic hypertension. diaphoresis; and &
926 palpitations. Microscopic examination of the tumor cells shows electron- Metabolis
dense, membrane-bound secretory granules, and immunohistochemistry is m (ES)
positive for synaptophysin, chromogranin. and neuron-specific enolase.

Pituitary Pituitary tumors can present with headaches, bitemporal hemianopsia, and Endocrine Pathophysiol 8 ES
adenoma hypopituitarism; the most common hormonally active (functional) , Diabetes ogy (Patp)
adenomas are prolactin-secreting adenomas (prolactinomas). Prolactinomas &
210
can cause galactorrhea and amenorrhea in women. In men, they often Metabolis
present with hypogonadism (Decreased libido). m (ES)

Pituitary Large prolactin-secreting pituitary tumors can compress the optic chiasm, Endocrine Pathophysiol 8 ES
adenoma causing bitemporal hemianopsia. In addition, elevated prolactin levels , Diabetes ogy (Patp)
suppress release of GnRH leading to decreased LH secretion and &
213
subsequently impaired testosterone production in men Metabolis
m (ES)

218 Pituitary In patients with prolactinoma, high levels of circulating prolactin suppress Endocrine Pathophysiol 8 ES
Pituitary Hyperprolactinemia suppresses secretion of GnRH, which leads to Endocrine Pathophysiol 8 ES
adenoma reduced estrogen in women. Low estrogen levels are a risk factor for , Diabetes ogy (Patp)
accelerated bone loss. &
223
Metabolis
m (ES)

Polycystic Hypocalcemia can cause muscle cramps, perioral paresthesias, Endocrine Pathophysiol 4 ES
ovary disease hypotension, and neuromuscular hyperexcitability. Injury to the parathyroid , Diabetes ogy (Patp)
glands during thyroid surgery is a common cause of hypoparathyroidism &
656
and acute hypocalcemia. Metabolis
m (ES)

Precocious Sex hormones promote (Estrogen) both growth and epiphyseal plate Endocrine Pathophysiol 1 ES
puberty closure: hence, precocious puberty may result in a shorter stature, despite , Diabetes ogy (Patp)
an initial growth spurt. Gigantism is caused by excessive pituitary &
698
production of growth hormone; these patients achieve enormous heights Metabolis
because, unlike excessive sex steroids, excessive IGF-1 does not lead to m (ES)
premature closure of the epiphysis.
Primary Primary (psychogenic) polydipsia is characterized by excessive intake of Endocrine Pathophysiol 1 ES
polydipsia free water, leading to hyponatremia and production of large volumes of , Diabetes ogy (Patp)
dilute urine. Water restriction normalizes serum sodium levels and &
212
increases urine osmolality. Metabolis
m (ES)

SIADH The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is Endocrine Pathophysiol 3 ES
characterized by low plasma sodium and osmolality, inappropriately , Diabetes ogy (Patp)
concentrated urine, and clinically normal volume status (euvolemic &
226
hyponatremia). An important cause of SIADH is a paraneoplastic effect Metabolis
secondary to small cell carcinoma of the lung. m (ES)

SIADH Vasopressin and oxytocin are synthesized within neurons found in the Endocrine Pathophysiol 3 ES
paraventricular and supraoptic nuclei and are released into the circulation , Diabetes ogy (Patp)
from axon terminals in the posterior pituitary. Neurophysins are involved &
1561
in the posttranslational processing and stabilization of oxytocin and Metabolis
vasopressin within neurosecretory vesicles during transport to the posterior m (ES)
pituitary.
Vitamin D Malabsorption caused by celiac disease can lead to vitamin D deficiency. Endocrine Pathophysiol 4 ES
deficiency Patients have decreased serum phosphorus, increased serum , Diabetes ogy (Patp)
parathyroid hormone (secondary hyperparathyroidism), and low (or &
981
normal) serum calcium. Metabolis
m (ES)
 Acute In patients with severe hypertriglyceridemia, pancreatic lipases can cause Endocrine Pharmacolog 9 ES
pancreatitis toxic levels of free fatty acids to be released within the pancreatic tissue, , Diabetes y (Phar)
leading to acute pancreatitis. Fibrates (eg, fenofibrate) are the most &
166
effective agents for the treatment of hypertriglyceridemia. Metabolis
m (ES)

584 Aromatase Estrogen is the main hormone responsible for the growth and development Endocrine Pharmacolog 1 ES
Benign 5-alpha-reductase inhibitors (eg, finasteride) reduce conversion of Endocrine Pharmacolog 6 ES
prostatic testosterone to dihydrotestosterone. In men with benign prostatic , Diabetes y (Phar)
hyperplasia hyperplasia, these agents reduce prostate volume and alleviate obstruction &
658
of urinary flow. However, they are associated with androgen-deficiency Metabolis
effects, including decreased libido, erectile dysfunction, and decreased m (ES)
ejaculate volume.
Corticosteroids Glucocorticoids are predominantly catabolic, causing muscle weakness, Endocrine Pharmacolog 3 ES
skin thinning, impaired wound healing, osteoporosis, and , Diabetes y (Phar)
immunosuppression. However, they also cause increased hepatic &
548
synthesis of gluconeogenic and glycogenic proteins to increase glucose Metabolis
availability. This, along with peripheral antagonism of insulin, contributes m (ES)
to the development of hyperglycemia.
Corticosteroids The acute effects of corticosteroids on the white blood cell count include Endocrine Pharmacolog 3 ES
an increased neutrophil count and decreased lymphocyte, monocyte, , Diabetes y (Phar)
basophil, and eosinophil counts. The increase in the neutrophil count &
549
results from "demargination" of neutrophils previously attached to the Metabolis
vessel wall. m (ES)

Diabetes Thiazolidinediones (eg pioglitazone) can cause fluid retention, leading to Endocrine Pharmacolog 31 ES
mellitus peripheral edema and weight gain. The excess fluid can potentially , Diabetes y (Phar)
exacerbate underlying congestive heart failure. &
599
Metabolis
m (ES)

Diabetes Diabetic ketoacidosis is initially treated with an intravenous infusion of Endocrine Pharmacolog 31 ES
mellitus regular insulin, which allows for rapid adjustments in dose based on , Diabetes y (Phar)
blood glucose levels. When given subcutaneously, regular insulin starts &
600
working within 30 minutes, peaks in 2-4 hours, and lasts 5-8 hours. Metabolis
m (ES)

Diabetes Sodium-glucose cotransporter 2 inhibitors (eg canagliflozin, dapagliflozin) Endocrine Pharmacolog 31 ES

mellitus decrease renal reabsorption of glucose, leading to urinary glucose loss and , Diabetes y (Phar)
decreased blood glucose levels. In patients with chronic kidney disease, &
604
these medications are less effective. Therefore, serum creatinine should Metabolis
be measured prior to therapy. m (ES)

Diabetes Sulfonylureas inhibit the ATP-sensitive potassium channel on the Endocrine Pharmacolog 31 ES
mellitus pancreatic beta cell membrane, inducing depolarization and L-type , Diabetes y (Phar)
calcium channel opening. The increased Ca2* influx stimulates beta cell &
606 insulin release independent of blood glucose concentrations. Sulfonylureas Metabolis
induce hypoglycemia because they stimulate insulin secretion even when m (ES)
blood glucose levels are normal.

Diabetes Metformin inhibits hepatic gluconeogenesis and increases peripheral Endocrine Pharmacolog 31 ES
mellitus glucose utilization Lactic acidosis is a rare complication of metformin , Diabetes y (Phar)
therapy, but its risk is increased in patients with underlying renal &
607
insufficiency. (should use serum creatinine measurement) Metabolis
m (ES)

Diabetes Long-acting insulin analogs (eg, degludec, detemir, glargine) have an Endocrine Pharmacolog 31 ES
mellitus extended duration of action without a noticeable peak in activity and are , Diabetes y (Phar)
typically given once daily to mimic basal insulin secretion. Rapid-acting &
850
insulins (eg. aspart, lispro. glulisine) are quickly absorbed from the Metabolis
injection site and are given at mealtimes to replicate postprandial insulin m (ES)
secretion.
Diabetes Thiazolidinediones (TZDs) lower blood glucose by decreasing insulin Endocrine Pharmacolog 31 ES
mellitus resistance. TZDs activate peroxisome proliferator-activated receptor , Diabetes y (Phar)
gamma, a nuclear receptor that alters the transcription of genes involved in &
920
glucose and lipid metabolism. Metabolis
m (ES)

Diabetes Alpha-2 adrenergic receptors inhibit insulin secretion, and beta-2 Endocrine Pharmacolog 31 ES
mellitus adrenergic receptors stimulate insulin secretion. The alpha-2-mediated , Diabetes y (Phar)
inhibitory effect is generally predominant, causing sympathetic stimulation &
1324
to lead to overall inhibition of insulin secretion. Metabolis
m (ES)
 Diabetes Proinsulin is cleaved into mature insulin and C-peptide, which are co- Endocrine Pharmacolog 31 ES
mellitus secreted from pancreatic beta cells in equimolar amounts. Circulating , Diabetes y (Phar)
levels of C-peptide can be used as a marker of endogenous insulin &
1655 secretion. Sulfonylureas (Glyburide) and meglitinides lower blood glucose Metabolis
by stimulating pancreatic insulin secretion; hypoglycemia due to these m (ES)
agents is associated with elevated C-peptide levels.

Diabetes Sulfonylureas (eg, glyburide, glimepiride) increase insulin secretion by Endocrine Pharmacolog 31 ES
mellitus pancreatic beta cells independent of blood glucose concentration. These , Diabetes y (Phar)
medications have a high incidence of hypoglycemia, especially in the &
####
elderly. Metabolis
m (ES)

Diabetes Glucagon-like peptide-1 (GLP-1) is secreted by intestinal L cells in Endocrine Pharmacolog 31 ES

mellitus response to food intake and regulates glucose levels by slowing gastric , Diabetes y (Phar)
emptying, suppressing glucagon secretion, and increasing glucose- &
#### dependent insulin release. GLP-1 agonists are parenteral antidiabetic Metabolis
agents that can improve glycemic control with low risk of hypoglycemia. m (ES)
They are also associated with significant weight loss unlike many other
antidiabetic agents.
Diabetes Sodium-glucose cotransporter 2 inhibitors (eg. canagliflozia dapagliflozin) Endocrine Pharmacolog 31 ES
mellitus decrease renal reabsorption of glucose and sodium, leading to lower blood , Diabetes y (Phar)
glucose levels. The decreased reabsorption of sodium and glucose also &
####
induces osmotic diuresis, which causes a decrease in blood pressure. Metabolis
Excess urinary glucose also leads to an increased risk for genitourinary m (ES)
tract infections.
Diabetes Physiologic insulin secretion can be approximated by a combination of Endocrine Pharmacolog 31 ES
mellitus long-acting and rapid-acting insulin analogs. Long-acting preparations (eg, , Diabetes y (Phar)
glargine) are released from the injection site slowly throughout the day and &
replicate basal insulin secretion. Boluses of a rapid-acting insulin (eg, Metabolis
####
lispro) with quick absorption are given with meals to control postprandial m (ES)
glucose elevations. (Insulin glargine once daily plus insulin lispro
before each meal)

Diabetes Sulfonylureas inhibit the ATP-sensitive potassium channel on the Endocrine Pharmacolog 31 ES
mellitus pancreatic beta cell membrane, inducing depolarization and L-type calcium , Diabetes y (Phar)
channel opening. The increased Ca2* influx stimulates beta cell insulin &
####
release independent of blood glucose concentrations. Sulfonylureas Metabolis
stimulate insulin secretion, even when blood glucose levels are normal, m (ES)
which can lead to sympathic hypoglycemia.
Diabetes Glucagon-like peptide-1 (GLP-1) regulates glucose by slowing gastric Endocrine Pharmacolog 31 ES
mellitus emptying, suppressing glucagon secretion and increasing glucose- , Diabetes y (Phar)
dependent insulin release. Dipeptidyl peptidase-4 inhibitors (eg, &
#### sitagliptin, saxagliptin) decrease the breakdown of GLP-1 and improve Metabolis
glycemic control in patients with type 2 diabetes Because the effect on m (ES)
insulin is glucose-dependent, these medications have a low risk of
hypoglycemia.
Drug induced Statins inhibit the intracellular rate-limiting step of cholesterol biosynthesis Endocrine Pharmacolog 3 ES
myopathy via competitive inhibition of HMG-CoA reductase. This leads to enhanced , Diabetes y (Phar)
hepatic LDL receptor recycling and increased LDL clearance from the &
712
circulation. Statin-induced myopathy (eg, myalgia, elevated creatine Metabolis
kinase) is the most common complication of statin use. m (ES)

Dyslipidemia Bile acid-binding resins (Cholestyramine) inhibit the enterohepatic Endocrine Pharmacolog 11 ES
circulation of bile acids. This leads to diversion of hepatic cholesterol to , Diabetes y (Phar)
synthesis of new bile acids, increased uptake of cholesterol from the &
163
circulation, and reduced blood LDL levels However, bile acid-binding Metabolis
resins increase hepatic production of triglycerides and can cause m (ES)
hypertriglyceridemia
Dyslipidemia Ezetimibe reduces intestinal absorption of cholesterol. As a result, the Endocrine Pharmacolog 11 ES
amount of dietary cholesterol reaching the liver decreases. To compensate, , Diabetes y (Phar)
the liver increases LDL receptor expression, which draws cholesterol out &
####
of the circulation. Metabolis
m (ES)

167 Gout Gout occurs in the setting of hyperuricemia and causes an inflammatory Endocrine Pharmacolog 11 ES
Gynecomastia Gynecomastia is the development of glandular breast tissue in males and is Endocrine Pharmacolog 3 ES
commonly seen in men receiving androgen deprivation therapy for prostate , Diabetes y (Phar)
cancer. Tamoxifen inhibits the effect of estrogen on breast tissue and can &
####
reduce the risk of gynecomastia in these patients. Metabolis
m (ES)
 Hyperthyroidis Graves ophthalmopathy is caused by stimulation of orbital fibroblasts by Endocrine Pharmacolog 8 ES
m thyrotropin receptor antibodies and cytokines released by activated T-cells. , Diabetes y (Phar)
Excess deposition of extracellular glycosaminoglycans and inflammatory &
infiltration lead to expansion of extraocular Muscles and retro orbital Metabolis
622
tissues. Glucocorticoids improve Graves ophthalmopathy by decreasing the m (ES)
severity of inflammation and reducing the excess extraocular volume.

Hyperthyroidis Thioamides (eg, methimazole, propylthiouracil) decrease the formation of Endocrine Pharmacolog 8 ES
m thyroid hormones via inhibition of thyroid peroxidase, the enzyme , Diabetes y (Phar)
responsible for both iodine organification and coupling of iodotyrosines. &
626
Propylthiouracil also decreases the peripheral conversion of T4 to T3. Metabolis
m (ES)

Hyperthyroidis Agranulocytosis is a serious complication of antithyroid drugs (eg, Endocrine Pharmacolog 8 ES

m methimazole, propylthiouracil) that results from drug-induced , Diabetes y (Phar)
granulocyte destruction and consequent neutropenia. Initial &
637 manifestations often include fever, sore throat, and oral ulcerations. If Metabolis
drug-induced agranulocytosis is suspected, the drug should be m (ES)
discontinued immediately and a complete blood count with differential
should be obtained to help confirm the diagnosis.
Hyperthyroidis Hyperthyroidism causes upregulation of beta-adrenergic receptor Endocrine Pharmacolog 8 ES
m expression, leading to increased catecholamine effect. Beta blockers , Diabetes y (Phar)
(propranolol) are used to blunt the adrenergic manifestations of &
1213
hyperthyroidism. In addition, lipid-soluble beta blockers reduce Metabolis
conversion of T4 to T3 by inhibiting 5'-monodeiodinase in peripheral m (ES)
tissues.
Hyperthyroidis Hyperthyroidism causes a hyperadrenergic state characterized by Endocrine Pharmacolog 8 ES
m hypertension, palpitations/tachycardia, sweating, heat intolerance, tremor, , Diabetes y (Phar)
and hyperreflexia. Beta blockers can relieve these symptoms. &
1945
Exophthalmos in Graves disease is due to an immune-mediated increase Metabolis
in orbital soft tissue mass and does not improve with beta blockers. m (ES)

Hyperthyroidis Postoperative hypoparathyroidism with resultant hypocalcemia is a Endocrine Pharmacolog 8 ES

m common complication of thyroidectomy due to inadvertent injury or , Diabetes y (Phar)
removal of the parathyroid glands. Postoperative supplementation with &
####
oral calcium (calcitirol) and vitamin D can be used to treat and prevent Metabolis
postoperative hypocalcemia. m (ES)

Hypoglycemia Nonselective β blockers (Propanolol) exacerbate hypoglycaemia and mask Endocrine Pharmacolog 6 ES
hypoglycaemic symptoms mediated by norepinephrine/epinephrine. , Diabetes y (Phar)
&
1492
Metabolis
m (ES)

Hypoglycemia Severe hypoglycemia causing impaired conciousness can be treated by a Endocrine Pharmacolog 6 ES
caregiver or bystander with injectable or intranasal glucagon. Glucagon , Diabetes y (Phar)
rapidly corrects hypoglycemia by increasing hepatic glycogenolysis, &
1984
resulting in the release of glucose from preexisting hepatic glycogen stores. Metabolis
m (ES)

Hypothyroidis An increase in estrogen activity, as seen in pregnancy or postmenopausal Endocrine Pharmacolog 14 ES

m estrogen replacement therapy (menopausal hot flashes), increases the , Diabetes y (Phar)
level of thyroxine-binding globulin. This leads to an increase in total &
772
thyroid hormone levels, but feedback control maintains normal levels of Metabolis
free (biologically active) thyroid hormone. m (ES)

Lipodystrophy Highly-active antiretroviral therapy (HAART) for HIV is commonly Endocrine Pharmacolog 1 ES
associated with body fat redistribution. Subcutaneous lipoatrophy , Diabetes y (Phar)
involving the face and extremities is associated with nucleoside reverse &
1673
transcriptase inhibitors (especially stavudine and zidovudine) and protease Metabolis
inhibitors. Central fat accumulation in the trunk and viscera can occur with m (ES)
any HAART regimen.
Osteoporosis Medication-induced esophagitis is a common adverse effect of Endocrine Pharmacolog 10 ES
bisphosphonates Bisphosphonates are also associated with increased risk of , Diabetes y (Phar)
osteonecrosis of the jaw and atypical femoral fractures. &
####
Metabolis
m (ES)
 Osteoporosis Long-term use of GnRH agonists (eg, leuprolide) suppresses pituitary LH Endocrine Pharmacolog 10 ES
release and leads to the reduced production of testosterone (and , Diabetes y (Phar)
estrogen). The lower levels of circulating testosterone produce a clinical &
####
effect similar to that of surgical orchiectomy and can lead to accelerated Metabolis
bone loss and increased risk for osteoporosis. m (ES)

Pituitary Galactorrhea is abnormal secretion of breast milk not associated with Endocrine Pharmacolog 8 ES
adenoma pregnancy or breastfeeding. It is most commonly due to excess prolactin, as , Diabetes y (Phar)
seen in prolactin-secreting pituitary adenomas. Prolactin is under negative &
#### regulation by hypothalamic dopaminergic neurons, and dopamine agonists Metabolis
can be used to treat hyperprolactinemia. (Stimulation of pituitary m (ES)
dopamine receptors)

Prostate cancer Leuprolide is a GnRH agonist that causes a transient ↑ in pituitary LH Endocrine Pharmacolog 10 ES
secretion, which leads to a rise in testosterone lvls. However, continuous , Diabetes y (Phar)
use of leuprolide suppresses LH release and leads to a ↓ in testosterone &
209
production. Metabolis
m (ES)

Radiation Potassium iodide competitively inhibits thyroid uptake of radioactive Endocrine Pharmacolog 1 ES
injury iodine isotopes and is often administered following nuclear accidents to , Diabetes y (Phar)
protect the thyroid and prevent development of radiation-induced thyroid &
767
carcinoma. Metabolis
m (ES)

821 Brown adipose Brown adipose tissue is found in newborns and in hibernating mammals. Endocrine Physiology 1 ES
Cellular Transport of glucose into the cells of most tissues occurs by means of Endocrine Physiology 2 ES
transports facilitated diffusion. Glucose moves from areas of high concentration to , Diabetes (Phys)
areas of low concentration with the help of transmembrane glucose &
1355
transporter proteins (GLUT). These carrier proteins (Carrier-mediated Metabolis
transport) are stereoselective and have preference for D-glucose. m (ES)

Cryptorchidism Inhibin В is produced by the Sertoli cells and is the physiological Endocrine Physiology 2 ES
inhibitor of FSH secretion. LH concentration is controlled primarily , Diabetes (Phys)
by testosterone feedback. &
217
Metabolis
m (ES)

Diabetes Neurophysins are carrier proteins for oxytocin and vasopressin (ADH). Endocrine Physiology 5 ES
insipidus Oxytocin and vasopressin are carried by unique neurophysins from their , Diabetes (Phys)
site of production in the cell bodies of the paraventricular and supraoptic &
nuclei to their site of release in the axon terminals of the posterior pituitary. Metabolis
1562
Point mutations in neurophysin II underlie most cases of hereditary m (ES)
hypothalamic diabetes insipidus, a disorder resulting from insufficient
ADH release into the systemic circulation.

Diabetes Cleavage of proinsulin in pancreatic β-cell secretory granules(Storage in Endocrine Physiology 31 ES

mellitus secretory granules) yields insulin and C-peptide, which are stored in the , Diabetes (Phys)
granules until they’re secreted in equimolar amounts. &
1768
Metabolis
m (ES)

6803 Diabetes Incretin functions by stimulat fig insulin release following oral Endocrine Physiology 31 ES
Diabetes Insulin has both renal and hepatic clearance. In patients with advanced Endocrine Physiology 31 ES
mellitus chronic kidney disease and diabetes mellitus, decreased renal clearance , Diabetes (Phys)
of insulin can lead to symptomatic hypoglycemia if exogenous insulin &
####
doses are not adjusted based on the change in renal function. Metabolis
m (ES)

1540 Diabetic Normal blood glucose levels are maintained by opposing effects of insulin Endocrine Physiology 6 ES
Hypercalcemia Parathyroid hormone (PTH) causes increased bone resorption, increased Endocrine Physiology 5 ES
serum calcium levels, and increased renal phosphate excretion. Chronically , Diabetes (Phys)
high levels of PTH increase the rek of osteoporosis However, intermittent &
641 administration of recombinant PTH analogs (eg, teriparatide) induces a Metabolis
greater increase in osteoblast activity in proportion to osteoclast activity m (ES)
and a net increase in bone formation.

Hypercalcemia Calcium-sensing receptors are G protein-coupled receptors that Endocrine Physiology 5 ES

regulate the secretion of parathyroid hormone in response to changes in , Diabetes (Phys)
circulating calcium levels. Familial hypocalciuric hypercalcemia is a &
992
benign autosomal dominant disorder caused by defective calcium-sensing Metabolis
receptors in the parathyroid gland and kidneys. m (ES)

#### Hypocalcemia Postoperative hypoparathyroidism is common after thyroidectomy. Endocrine Physiology 1 ES

 Hypoglycemia Oxidative metabolism of glucose in pancreatic beta cells generates ATP. Endocrine Physiology 6 ES
ATP-induced closure of the ATP-sensitive K+ channel leads to membrane , Diabetes (Phys)
depolarization and subsequent insulin release. &
1009
Metabolis
m (ES)

1325 Hypoglycemia Hypoglycemia can be precipitated by exercise in patients with insulin- Endocrine Physiology 6 ES
Hypothyroidis Thyroid peroxidase (TPO) catalyzes the oxidation of iodide to iodine, the Endocrine Physiology 14 ES
m iodination of thyroglobulin tyrosine residues, and the iodotyrosine , Diabetes (Phys)
coupling reaction that forms T3 and T4 Antibodies against TPO are present &
770
in >90% of patients with chronic lymphocytic (Hashimoto) thyroiditis. Metabolis
m (ES)

Hypothyroidis Primary hypothyroidism is characterized by decreased T4 levels and Endocrine Physiology 14 ES

m increased TSH. T3 (normal) is primarily produced by conversion from , Diabetes (Phys)
T4 in peripheral tissues; serum levels widely fluctuate due to its short half &
983
life, and can often be within the normal range in patients with Metabolis
hypothyroidism. m (ES)

Hypothyroidis TSH from the anterior pituitary stimulates the thyroid to produce thyroxine Endocrine Physiology 14 ES
m (T4) and a small amount of triiodothyronine (T3). T4 is converted in , Diabetes (Phys)
peripheral tissues to T3 (active form) and reverse T3 (inactive form) TSH &
1615
secretion is under negative feedback by thyroid hormone on the Metabolis
hypothalamus and pituitary. m (ES)

Hypothyroidis Hypothyroidism causes decreased expression of LDL receptors in the Endocrine Physiology 14 ES
m liver, leading to decreased clearance of LDL and increased blood LDL , Diabetes (Phys)
levels. It also causes hypertriglyceridemia due to decreased expression of &
####
lipoprotein lipase. The adverse effects of hypothyroidism on lipid levels Metabolis
can increase the risk of coronary atherosclerosis. m (ES)

Infertility LH stimulates the release of testosterone from the Leydig cells of the testes; Endocrine Physiology 3 ES
FSH stimulates the release of inhibin В from the Sertoli cells in the , Diabetes (Phys)
seminiferous tubules. Testosterone and inhibin В induce negative feedback &
216
on LH and FSH production, respectively. Metabolis
m (ES)

Sexual 5a-reductase converts testosterone to dihydrotestosterone, which mediates Endocrine Physiology 2 ES

differentiation development of the external genitalia in the male fetus. Male neonates with , Diabetes (Phys)
5a-reductase deficiency are born with feminized external genitalia that &
954
typically masculinize at puberty A small phallus and hypospadias are Metabolis
common. m (ES)

Vitamin D Sunlight exposure catalyzes conversion of 7-dehydrocholesterol to Endocrine Physiology 4 ES

deficiency cholecalciferol (vitamin D3) in the skin. Subsequent 25-hydroxylation in , Diabetes (Phys)
the liver and 1-hydroxylation in the kidneys produce 1,25- &
990
dihydroxyvitamin D, the active form. Inadequate exposure to sunlight can Metabolis
lead to vitamin D deficiency. m (ES)

Vitamin D In chronic kidney disease, conversion of 25-hydroxyvitamin D to 1,25- Endocrine Physiology 4 ES

deficiency dihydroxyvitamin D is impaired. In addition, failure of glomerular and , Diabetes (Phys)
tubular function results in phosphate retention and hypocalcemia. This &
991 leads to a compensatory rise in parathyroid hormone (secondary Metabolis
hyperparathyroidism) that can present with weakness, muscle and joint m (ES)
pain, defective bone mineralization, and increased fracture risk.

Vitamin D Excessive vitamin D intake can lead to hypercalcemia and cause mental Endocrine Physiology 1 ES
toxicity status changes, muscle weakness, constipation, and , Diabetes (Phys)
polyuria/polydipsia. Activated macrophages in sarcoidosis and other &
1065
granulomatous diseases express 1-a-hydroxylase, leading to excess Metabolis
production of 1,25-dihydroxyvitamin D and hypercalcemia. m (ES)

Anesthesia A pudendal nerve block is performed by injecting an anesthetic Female Anatomy 9 FR

intravaginally, medial to the ischial spine, through the sacrospinous Reproduct (Anat)
1739 ligament. This provides anesthesia to most of the perineum. ive &
Breast
(FR)
Breast cancer Invasive breast carcinoma typically presents as an irregularly shaped, Female Anatomy 7 FR
adherent breast mass, most commonly in the upper outer quadrant. Reproduct (Anat)
1056 Malignant infiltration of suspensory ligaments of the breast can cause ive &
skin retractions. Breast
(FR)
 Hypothyroidis Prolactin production is regulated primarily by inhibitory effects of Female Anatomy 14 FR
m hypothalamic dopaminergic pathways. However, prolactin secretion is Reproduct (Anat)
stimulated by thyrotropin-releasing hormone (TRH). In patients with ive &
####
primary hvpothyroidism. the increased production of TRH bv the Breast
hypothalamus can lead to hyperprolactinemia. (FR)

Imperforate Imperforate hymen is caused by incomplete degeneration of the central Female Anatomy 1 FR
hymen portion of the fibrous tissue band connecting the walls of the vagina. Reproduct (Anat)
Adolescent patients typically present with primary amenorrhea, normal ive &
8390
secondary sexual characteristics, and cyclic abdominal or pelvic pain Breast
due to accumulation of menstrual blood in the vagina and uterus (eg, (FR)
hematocolpos).
Ovarian cancer Female Anatomy 9 FR
The suspensory ligament of the ovary contains the ovarian artery, vein,
Reproduct (Anat)
lymphatics and nerves. The ovarian artery is the major blood supply to the
1632 ive &
ovary and must be ligated during an oophorectomy to prevent heavy
Breast
bleeding
(FR)
Ovarian torsion Female Anatomy 1 FR
Ovarian torsion typically involves twisting of the infundibulopelvic
Reproduct (Anat)
ligament, often due to the weight of a large adnexal mass The resulting
#### ive &
occlusion of the blood and nerve supply to the ovary results in severe, acute
Breast
pelvic pain and ovarian ischemia.
(FR)
Ovarian vein Venous stasis and hypercoagulability from pregnancy in addition to Female Anatomy 1 FR
thrombosis endothelial damage from delivery can cause ovarian vein thrombosis in Reproduct (Anat)
the puerperium. Symptoms include fever and localized abdominal or ive &
####
flank pain. Most thrombosis is right-sided and can extend to the Breast
inferior vena cava however, left ovarian vein thrombosis can extend to (FR)
the left renal vein.
Perineal The perineal body is a fibromuscular tissue between the urogenital and Female Anatomy 1 FR
lacerations anal triangle. A midline episiotomy is a vertical incision from the Reproduct (Anat)
#### posterior vaginal opening to the perineal body. It transects the vaginal ive &
submucosal tissue but not the external anal sphincter or the rectal Breast
mucosa (FR)
Postpartum Female Anatomy 1 FR
Postpartum hemorrhage is an obstetrical emergency Bilateral ligation
hemorrhage Reproduct (Anat)
of the internal iliac artery can decrease uterine blood flow and control
#### ive &
postpartum hemorrhage that is unresponsive to medical management (eg
Breast
uterine massage, uterotonic medications).
(FR)
Ureter injury Female Anatomy 3 FR
The ureter can be injured during hysterectomy due to its close
Reproduct (Anat)
proximity to the uterine structures. The distal ureter may be severed
ive &
#### during ligation of the uterine vessels because the ureter passes inferior
Breast
and lateral to the uterine artery at the level of the internal cervical is
(FR)
prior to entering the bladder (eg, "water under the bridge").
Urinary Female Anatomy 7 FR
Stress urinary incontinence is defined as involuntary urine loss with
incontinence Reproduct (Anat)
increased intra-abdominal pressure Pelvic floor strengthening (eg.
#### ive &
Kegel exercises) targets the levator ani to improve support around the
Breast
urethra and bladder
(FR)
Endometrial Female Pathology FR
Endometrial hyperplasia and cancer often present with postmenopausal
hyperplasia Reproduct (Path)
bleeding( dark red). A common risk factor for endometrial cancer is
ive &
#### obesity due to the increased peripheral aromatization of androgens to
Breast
estrogens in adipose tissue, which leads to chronic unopposed estrogen
(FR)
exposure and uncontrolled endometrial tissue proliferation
Uterine Female Anatomy 1 FR
Subserosal leiomyomas (fibroids) often cause irregular uterine
fibroids Reproduct (Anat)
enlargement, resulting in pelvic pressure. Fibroids arising from the
#### ive &
posterior subserosal surface of the uterus can cause constipation due to
Breast
pressure on the colon
(FR)
Amenorrhea Female Embryology 2 FR
Patients with Mullerian aplasia (ie, Mayer-Rokitansky-Kuster-Hauser
Reproduct (Embr)
syndrome) have no upper vagina (eg, short vagina) and variable
1809 ive &
uterine development. These patients are 46.XX females with normal
Breast
ovaries and secondary sexual characteristics.
(FR)
Mullerian In females, the paramesonephric ducts fuse to form the fallopian tubes, Female Embryology 1 FR
anomalies uterus, cervix, and upper vagina. Disruptions of this process can lead to Reproduct (Embr)
a variety of mullerian tract anomalies, and renal anomalies are a common ive &
1831
comorbidity. Incomplete lateral fusion of the paramesonephric ducts Breast
results in a bicornuate uterus characterized by an indentation in the (FR)
center of the fundus
 Gestational Female Genetics 3 FR
trophoblastic A complete mole usually results when an empty ovum is fertilized by a Reproduct (Gene)
1830 disease haploid sperm. Subsequent duplication of the paternal genetic complement ive &
(23X) results in the characteristic 46,XX genotype. Breast
(FR)
Mosaicism Mosaicism is defined as the presence of multiple, genetically different cell Female Genetics 1 FR
lines within the body. It can result from several processes, including Reproduct (Gene)
chromosomal nondisjunction or a mutation during the first stages of ive &
####
embryonic development. Somatic mosaicism results in a mixture of Breast
normal and mutated somatic cells, often leading to a milder form of the (FR)
disease.
Turner Female Genetics 8 FR
Streak ovaries, amenorrhea, and infertility are the gynecologic
syndrome Reproduct (Gene)
complications of Turner syndrome (TS). In addition, patients with TS
256 ive &
usually have short stature, webbed neck, shield chest, and low posterior
Breast
hairline. Bicuspid aortic valve is the most common cardiac comorbidity.
(FR)
Uterine Female Pathology
Uterine leiomyoma (ie, fibroids) can present with bulk symptoms (eg.
leiomyoma Reproduct (Path)
pelvic pressure, urinary frequency) and an irregularly enlarged uterus.
#### ive &
African American (race) women are at increased risk of developing
Breast
fibroids
(FR)
Turner Female Genetics 8 FR
syndrome Turner syndrome (45,X)-loss of paternal chromosome X manifests in Reproduct (Gene)
339 the neonate with lymphedema and cystic hygromas. Short stature, primary ive &
amenorrhea, and aortic anomalies are the other important clinical features. Breast
(FR)
Turner Female Genetics 8 FR
Patients with Turner syndrome may have karyotype 45,X (complete
syndrome Reproduct (Gene)
monosomy), 45,X/46,XX (mosaicism), or 46,XX (with partial deletion of
1810 ive &
one X chromosome). Complete monosomy X usually results from meiotic
Breast
nondisjunction during gametogenesis.
(FR)
Turner Female Genetics 8 FR
Common manifestations of Turner syndrome include primary amenorrhea,
syndrome Reproduct (Gene)
short stature, a high arched palate, and widely spaced nipples. Primary
7489 ive &
amenorrhea occurs in these patients due to in utero degeneration of the
Breast
ovarian follicles (gonadal dysgenesis).
(FR)
Turner In vitro fertilization using a donated ovum is the most promising means Female Genetics 8 FR
syndrome of achieving pregnancy in a woman with Turner syndrome. Pregnancy can Reproduct (Gene)
#### occasionally occur spontaneously in some patients with Turner syndrome, ive &
but the risk of spontaneous abortion, Down syndrome and Turner Breast
syndrome are all increased in such cases. (FR)
Adenomyosis Female Histology 1 FR
Adenomyosis is the abnormal presence of endometrial glands and
Reproduct (Hist)
stroma within the uterine myometrium. Affected patients are typically
1957 ive &
multiparous women with dysmenorrhea, heavy menses, and a uniformly
Breast
enlarged uterus.
(FR)
Intraductal Female Histology 1 FR
Intraductal papilloma is characterized by epithelial and myoepithelial
papilloma Reproduct (Hist)
cells lining fibrovascular cores in a cyst wall or duct. It is the most
#### ive &
common cause of bloody nipple discharge and typically presents without
Breast
breast masses or skin changes.
(FR)
Labor Female Histology 1 FR
Gap junctions facilitate communication and coordination between cells
management Reproduct (Hist)
and play an important role in labor contractions. Connexins are proteins
#### ive &
that assemble into gap junctions and their density increases in the uterus
Breast
before delivery in response to rising estrogen levels.
(FR)
Abortion Septic abortion typically presents with fever, abdominal pain, uterine Female Microbiolog 3 FR
tenderness, and/or foul-smelling discharge after pregnancy termination. Reproduct y (Micr)
#### Common offending pathogens include Staphylococcus aureus and ive &
Escherichia соli due to seeding of the uterine cavity during Breast
instrumentation. (FR)
Bacterial Bacterial vaginosis is associated with a grayish-white, malodorous vaginal Female Microbiolog 3 FR
vaginosis discharge due to an overgrowth of Gardnerella vaginalis, a facultative Reproduct y (Micr)
1929 anaerobic, gram-variable rod. Clue cells (squamous epithelial cells ive &
covered with bacterial organisms) are seen on wet mount microscopy or Breast
cytology. (FR)
Bacterial Female Microbiolog 3 FR
Bacterial vaginosis is caused by a disruption of the vaginal bacterial flora
vaginosis Reproduct y (Micr)
and is characterized by a thin, gray-white, malodorous vaginal discharge.
#### ive &
Clue cells (squamous epithelial cells with adherent bacteria) are seen
Breast
on wet mount microscopy.
(FR)
 Cervicitis Female Microbiolog 1 FR
Neisseria gonorrhoeae and Chlamydia trachomatis cause mucopurulent Reproduct y (Micr)
1008 cervicitis, which can progress to PID if untreated. PID can cause scarring ive &
of the fallopian tubes, leading to ectopic pregnancy and infertility. Breast
(FR)
HSV infection Female Microbiolog 9 FR
Primary infection with herpes simplex virus type 2 (HSV-2) typically
Reproduct y (Micr)
presents with fever and a painful vesicular genital rash. HSV-2
1549 ive &
primarily infects the sacral dorsal root ganglia and can be reactivated to
Breast
cause recurrent genital lesions.
(FR)
Mucocutaneou Antibiotics suppress the normal vaginal flora and facilitate Candida Female Microbiolog 3 FR
s candidiasis overgrowth. Antibiotic use is the most common cause of Candida vaginitis. Reproduct y (Micr)
110 Other potential causes include pregnancy, systemic corticosteroid use, ive &
diabetes mellitus, and immunosuppression. (Decreased number of gram- Breast
positive bacteria in the vagina) (FR)
Pelvic Female Microbiolog 2 FR
A ruptured ectopic pregnancy can cause abdominal pain, vaginal bleeding,
inflammatory Reproduct y (Micr)
and hemodynamic instability. A common risk factor is tubal scarring from
1932 disease ive &
a prior upper genital tract infection (ie, pelvic inflammatory disease) due to
Breast
Neisseria gonorrhoeae or Chlamydia trachomatis.
(FR)
Vulvovaginitis Female Microbiolog 1 FR
Trichomonas vaginalis is a sexually transmitted motile protozoan which Reproduct y (Micr)
#### can be seen on wet mount microscopy of vaginal discharge. It presents ive &
with yellow-green, frothy vaginal discharge and vulvovaginal erythema. Breast
(FR)
1992 Cervical cancer Human papillomavirus (HPV) infection, especially with strain 16 or 18, Female Pathology 3 FR
Ductal Female Pathology 1 FR
Ductal carcinoma in situ is characterized by ducts distended by
carcinoma in Reproduct (Path)
pleomorphic cells with prominent central necrosis that do not penetrate the
1057 situ ive &
basement membrane. It is the precursor to invasive ductal carcinoma, the
Breast
most common type of breast cancer.
(FR)
Endometriosis Female Pathology 1 FR
Endometriosis refers to the presence of endometrial glands and stroma Reproduct (Path)
333 outside the uterus (Ectopic endometrial tissue). It may be asymptomatic ive &
or present with dysmenorrhea, dyspareunia, and/or infertility. Breast
(FR)
Female genital Female Pathology 1 FR
The uterine mucosa is covered by endometrium, and abnormal
tract histology Reproduct (Path)
implantation of endometrial glands/stroma is referred to as endometriosis.
ive &
2056 The ovary is covered by a simple cuboidal epithelium involved in
Breast
surface repair of defects from ovulation. Endometriosis commonly
(FR)
affects the ovary and results in infertility.
Fibroadenoma Female Pathology 1 FR
Fibroadenomas are the most common benign tumor of the breast. They
breast Reproduct (Path)
are characterized histologically by a cellular or myxoid stroma that
1109 ive &
encircles and sometimes compresses epithelium-lined glandular and cystic
Breast
spaces.
(FR)
Human Female Pathology 4 FR
Human papillomavirus (HPV) infection causes cutaneous and genital warts
papillomavirus Reproduct (Path)
as well as benign and malignant intraepithelial neoplasia. Koilocytosis is a
ive &
1015 hallmark sign of HPV infection. Koilocytes are pyknotic, superficial or
Breast
immature squamous cells with a dense, irregularly staining cytoplasm
(FR)
and perinuclear halo-like clearing.
Human Female Pathology 4 FR
Human papillomavirus infection of basal cervical cells can progress to
papillomavirus Reproduct (Path)
premalignant and cancerous lesions. Cervical intraepithelial neoplasia
ive &
refers to atypical squamous cells and is classified as low-grade squamous
Breast
#### intraepithelial lesions (if extending <1/3 of the epithelium) or high-grade
(FR)
squamous intraepithelial lesions (if extending beyond). (Expansion of
immature basal cells to the epithelial surface) Basement membrane
breach signifies invasive disease
Human Human papillomavirus (HPV) oncogenicity relies on the inhibitory effects Female Pathology 4 FR
papillomavirus of viral proteins E6 and E7 on cell cycle regulatory proteins p53 and Reproduct (Path)
#### Rb. This allows cells infected with HPV to undergo unchecked cellular ive &
proliferation and evasion of apoptosis, promoting genomic instability and Breast
malignant transformation. (FR)
Ovarian cancer A Krukenberg tumor is a gastric tumor that has metastasized to the ovary Female Pathology 9 FR
and can present with unintentional weight loss, epigastric pain, and Reproduct (Path)
127 adnexal masses. Histologically, the metastatic tumor cells have large ive &
amounts of mucin with apically displaced nuclei, resulting in a signet Breast
ring appearance. (FR)
 Ovarian cancer Granulosa cell tumors are sex-cord stromal tumors of the ovary that secrete Female Pathology 9 FR
estrogen and can cause endometrial hyperplasia Call-Exner bodies Reproduct (Path)
1158 (cells arranged in a microfollicular or rosette pattern) are seen on ive &
microscopy. On gross pathology, the tumor appears yellow due to the Breast
lipid content in theca cells. (FR)
Ovarian cancer Female Pathology 9 FR
Epithelial ovarian cancer is the most common ovarian malignancy.
Reproduct (Path)
Histologic findings include anaplasia of epithelial cells with invasion into
ive &
1837 the stroma along with multiple papillary formations with cellular
Breast
atypia. Epithelial ovarian tumors produce CA-125, which can be used as
(FR)
a serum marker for this condition.
Ovarian cancer Female Pathology 9 FR
Sertoli-Leydig cell tumors of the ovary arise from the sex cord stroma
Reproduct (Path)
and secrete testosterone Typical features include a large ovarian mass
ive &
1928 and signs of virilization (clitoromegaly with a large adnexal mass, new
Breast
facial hair). Tubular structures lined by round Sertoli cells and surrounded
(FR)
by a fibrous stroma are seen on pathology.
Ovarian cancer Female Pathology 9 FR
Teratomas are the most common subtype of germ cell tumor. Ovarian
Reproduct (Path)
teratomas occur most frequently in females age 10-30. They are divided
#### ive &
into mature (cell lines of >1 germ layer, commonly including hair, teeth,
Breast
and skin) and immature types.
(FR)
Pituitary Prolactinomas are the most common hormonally active pituitary Female Pathology 8 FR
adenoma adenomas. The excess prolactin produced by these tumors can cause Reproduct (Path)
1917 galactorrhea and amenorrhea in premenopausal women. With a large ive &
mass, visual changes and headaches may occur due to compression of the Breast
optic chiasm. (FR)
Cervical cancer Consistent use of barrier contraceptives is extremely important for Female Pathophysiol 3 FR
preventing sexually transmitted infections, including human papillomavirus Reproduct ogy (Patp)
869 (HPV). Patients infected with carcinogenic strains of HPV (ie, 16, 18, and ive &
31 (Cervical, vaginal, vulvar & anal neoplasia)) are at risk of squamous Breast
cell carcinoma of the cervix. (FR)
Ovarian cancer The pathogenesis of epithelial ovarian cancer is linked to the frequency of Female Pathophysiol 9 FR
trauma and repair at the ovarian surface. Oral contraceptives, Reproduct ogy (Patp)
578 multiparity, and breastfeeding are protective by decreasing the ive &
frequency of ovulation. Risk factors include BRCA mutation, nulliparity, Breast
and infertility. (FR)
Pelvic Pelvic inflammatory disease (PID) is most frequently caused by Neissena Female Pathophysiol 2 FR
inflammatory gonorrhoeae and Chlamydia trachomatis. Severe or inadequately treated Reproduct ogy (Patp)
disease PID can result in fallopian tube scarring, which in turn can lead to ive &
1027
infertility. Treatment must always include coverage of both organisms Breast
with a third-generation cephalosporin (eg, ceftriaxone) + azithromycin (FR)
or doxycycline.
Polycystic Female Pathophysiol 4 FR
Polycystic ovary syndrome is characterized by elevated LH levels,
ovary disease Reproduct ogy (Patp)
excess androgen production, and insulin resistance. Clinical features
2094 ive &
include obesity, menstrual irregularities, hirsutism, enlarged ovaries, and
Breast
an increased risk of diabetes mellitus and endometrial hyperplasia.
(FR)
Polycystic Patients with polycystic ovary syndrome who desire fertility can be Female Pathophysiol 4 FR
ovary disease treated with clomiphene. Clomiphene is an estrogen receptor Reproduct ogy (Patp)
2095 modulator that decreases negative feedback inhibition on the ive &
hypothalamus by circulating estrogen, thereby increasing gonadotropin Breast
production. (FR)
Urinary A common symptom during pregnancy is stress urinary incontinence, Female Pathophysiol 7 FR
incontinence which occurs due to increased intraabdominal pressure from the gravid Reproduct ogy (Patp)
uterus that exceeds the pressure point that maintains closure of the urethral ive &
####
valve. Pregnancy hormones decrease urethral tone and relax the pelvic Breast
floor muscles (levator ani, coccygeus), which maintain closure of the (FR)
urethral valve.
Abortion Female Pharmacolog 3 FR
Progesterone is necessary for implantation and maintenance of pregnancy. Reproduct y (Phar)
583 Mifepristone is a progesterone antagonist that is used with misoprostol ive &
(a prostaglandin-E1 agonist) to terminate a first-trimester pregnancy. Breast
(FR)
Selective estrogen receptor modulators (eg, tamoxifen, raloxifene) are
581 Breast cancer Female Pharmacolog 7 FR
competitive inhibitors of estrogen binding to estrogen receptors They can
Contraception Female Pharmacolog 3 FR
All hormone-containing contraceptives prevent pregnancy through the
Reproduct y (Phar)
actions of progestins. The main mechanism of contraceptives with
ive &
879 systemically active progestins (eg, combined hormonal oral contraceptives)
Breast
is inhibiting ovulation by decreasing FSH and LH synthesis in the
(FR)
anterior pituitary (Reduction of serum gonadotropin levels).
 Metronidazole Female Pharmacolog 1 FR
Metronidazole is used to treat trichomonal vaginitis and bacterial
Reproduct y (Phar)
vaginosis It can cause disulfiram-like effects (eg, abdominal cramps,
1447 ive &
nausea headache) when combined with alcohol due to acetaldehyde
Breast
accumulation.
(FR)
Apoptosis Female Physiology 4 FR
Progesterone is the primary hormone responsible for stimulating the
Reproduct (Phys)
endometrium so that it is suitable for implantation. Progesterone
299 ive &
withdrawal causes endometrial cells to undergo apoptosis, resulting in
Breast
menstrual bleeding.
(FR)
Dysfunctional Female Physiology 1 FR
uterine Anovulation is common in the first several years after menarche and the Reproduct (Phys)
1899 bleeding, last few years before menopause. It manifests with marked menstrual cycle ive &
anovulation variability. Breast
(FR)
Estrogen LH stimulates the theca interna cells of the ovarian follicle to produce Female Physiology 1 FR
synthesis androgens. Aromatase within the follicle's granulosa cells subsequently Reproduct (Phys)
1560 converts these androgens to estradiol under FSH stimulation. The ive &
theca externa cells serve as a connective tissue support structure for the Breast
follicle. (FR)
Infertility Female Physiology 3 FR
Anovulation is a common cause of infertility. Menotropin (human
Reproduct (Phys)
menopausal gonadotropin) is a treatment option that acts like FSH and
207 ive &
triggers the formation of a dominant ovarian follicle. Ovulation is then
Breast
induced by administration of hCG, which mimics the LH surge.
(FR)
Infertility Female Physiology 3 FR
Pulsatile administration of GnRH stimulates FSH and LH release and
Reproduct (Phys)
is useful for the treatment of infertility. Nonpulsatile (constant)
208 ive &
infusion of GnRH, or a long-acting analog, suppresses FSH and LH
Breast
release and subsequently suppresses gonadal function.
(FR)
Menopause Female Physiology 1 FR
Menopause occurs on average at age 51 and is diagnosable retrospectively Reproduct (Phys)
215 after 12 months of amenorrhea. An elevated serum FSH level confirms ive &
the diagnosis. Breast
(FR)
Menstrual Female Physiology 2 FR
cycle Of all hormones influencing the menstrual cycle (LH, FSH, estrogen, Reproduct (Phys)
progesterone), progesterone increases the most in concentration after ive &
1317 ovulation. During the latter half of the menstrual cycle, the corpus luteum Breast
secretes high levels of progesterone, which thickens the endometrium and (FR)
prepares it to receive and nourish a blastocyst. Progesterone to increase
chance of conceiving
Menstrual The secretory phase of the menstrual cycle occurs between ovulation and Female Physiology 2 FR
cycle menses, from days 15-28 of the normal menstrual cycle. Progesterone Reproduct (Phys)
released by the corpus luteum causes the uterine glands to coil and secrete ive &
1986 glycogen-rich mucus in preparation for embryo implantation. The Breast
endometrial stroma becomes edematous and completely traversed by (FR)
tortuous spiral arteries that extend from the deeper layers to the uterine
lumen.
Polycystic Female Physiology 4 FR
Polycystic ovary syndrome (PCOS) is associated with oligomenorrhea,
ovary disease Reproduct (Phys)
hirsutism, and polycystic ovaries. Disruption in intraovarian
ive &
258 steroidogenesis causes anovulatory cycles and results in chronic estrogen
Breast
stimulation with decreased progesterone secretion, placing PCOS patients
(FR)
at risk for endometrial hyperplasia/carcinoma
#### Anterior Horizontal transection of the rectus abdominis muscle must be performed Gastrointe Anatomy 1 GI
Aortic The superior mesenteric artery and inferior mesenteric artery are the 2 Gastrointe Anatomy 6 GI
aneurysm main vessels supplying the small and large intestines They are connected stinal & (Anat)
#### by a pair of anastomoses the marginal artery of Drummond, which is the Nutrition
principal anastomosis, and the inconsistently present arc of Riolan (GI)
(mesenteric meandering artery).
Appendicitis Appendicitis causes dull visceral pain at the umbilicus due to afferent Gastrointe Anatomy 5 GI
pain fibers entering at the T10 level in the spinal cord. Progressive stinal & (Anat)
inflammation in the appendix irritates the parietal pentoneum and Nutrition
#### abdominal wall to cause more severe somatic pain shifting from the (GI)
umbilicus to McBurney's point (two-thirds of the distance from the
umbilicus to the anterior superior iliac spine).

#### Appendicitis The teniae coli are 3 separate smooth muscle ribbons that travel Gastrointe Anatomy 5 GI
Cholecystitis Gallstone ileus results from passage of a large gallstone through a Gastrointe Anatomy 5 GI
cholecystenteric fistula into the small bowel, where it ultimately causes stinal & (Anat)
1525 obstruction at the ileum. Patients typically present with symptoms/signs of Nutrition
small bowel obstruction, and an abdominal x-ray may reveal gas within the (GI)
gallbladder and biliary tree.
 Chronic Chronic pancreatitis often presents with epigastric pain and pancreatic Gastrointe Anatomy 3 GI
pancreatitis exocrine insufficiency resulting in fat malabsorption/steatorrhea. On stinal & (Anat)
abdominal CT scan, the pancreas can be identified by its head in close Nutrition
1738
association with the second part of the duodenum; its body overlying the (GI)
aorta, left kidney, and renal vessels: and its tail lying within the splenorenal
ligament.
Chronic The short gastric veins drain blood from the gastric fundus into the splenic Gastrointe Anatomy 3 GI
pancreatitis vein. Pancreatic inflammation (eg. pancreatitis, pancreatic cancer) can stinal & (Anat)
#### cause a blood clot within the splenic vein, which can increase pressure in Nutrition
the short gastric veins and lead to gastric varices only in the fundus. (GI)

Cirrhosis In cirrhosis portal hypertension arises from increased resistance to portal Gastrointe Anatomy 7 GI
flow at the hepatic sinusoids. This causes increased pressure in the stinal & (Anat)
portosystemic collateral veins within the lower end of the esophagus Nutrition
8547 anterior abdomen and lower rectum. Dilation of these collateral vessels is (GI)
responsible for the esophageal varices, caput medusae, and anorectal
varices commonly seen in patients with cirrhosis. (Left gastric)

Constipation Dyssynergic defecation occurs when the puborectalis muscle or the Gastrointe Anatomy 3 GI
internal or external anal sphincter fails to relax during defecation, leading stinal & (Anat)
to chronic constipation. Dyssynergic defecation is usually considered a Nutrition
####
functional disorder and occurs more commonly in the elderly but may also (GI)
occur with certain neurologic disorders (eg, Parkinson disease, multiple
sclerosis) or trauma
Constipation Gastrointe Anatomy 3 GI
The pelvic splanchnic nerves (S2-S4) provide parasympathetic
stinal & (Anat)
innervation to the bowel and bladder, and their impairment in cauda equina
Nutrition
#### syndrome can cause constipation and difficulty urinating. Other signs of
(GI)
cauda equina syndrome include radicular low back pain and leg weakness
(sciatic nerve) as well as saddle anesthesia (pudendal, ilioinguinal nerves).
Duodenum and The third part of the duodenum courses horizontally across the abdominal Gastrointe Anatomy 1 GI
superior aorta and inferior vena cava at the level of the third lumbar vertebra. The stinal & (Anat)
1832
mesenteric superior mesenteric vessels lie anterior to the duodenum at this Nutrition
artery location. (GI)
Gastroesophag Gastrointe Anatomy 7 GI
The esophagus is located between the trachea and the vertebral bodies in
eal reflux stinal & (Anat)
1706 the superior thorax. It is typically collapsed with no visible lumen on CT
disease Nutrition
images of the chest.
(GI)
1744 Gastrointestinal The hindgut encompasses the distal one-third of the transverse colon, the Gastrointe Anatomy 1 GI
Groin hernias Femoral hernias can present with groin discomfort and a tender bulge on Gastrointe Anatomy 3 GI
the upper thigh inferior to the inguinal ligament, lateral to the pubic stinal & (Anat)
417 tubercle and lacunar ligament. The structure that lies immediately lateral to Nutrition
the hernia within the femoral sheath is the femoral vein. Incarceration (GI)

Groin hernias The inferior epigastric vessels are useful as a landmark during Gastrointe Anatomy 3 GI
laparoscopic hernia repair to classify the type of inguinal hernia. Indirect stinal & (Anat)
inguinal hernias protrude through the deep inguinal ring into the inguinal Nutrition
418
canal lateral to the inferior epigastric vessels. In contrast, direct inguinal (GI)
hernias protrude through Hesselbach's triangle medial to the inferior
epigastric vessels.
Groin hernias Direct inguinal hernias occur most commonly in older men due to Gastrointe Anatomy 3 GI
weakness of the transversalis fascia. They protrude medial to the inferior stinal & (Anat)
8669 epigastric vessels into the Hesselbach triangle and pass only through the Nutrition
superficial inguinal ring with no direct route to the scrotum. (GI)

Hemorrhoids External hemorrhoids, which originate below the dentate line, are covered Gastrointe Anatomy 2 GI
by modified squamous epithelium and have cutaneous (somatic) nervous stinal & (Anat)
####
innervation from the inferior rectal nerve, a branch of the pudendal Nutrition
nerve. (GI)
Hemorrhoids Hemorrhoids result from abnormal distension of a portion of the anal Gastrointe Anatomy 2 GI
arteriovenous plexus The vascular components of internal hemorrhoids stinal & (Anat)
drain into the superior rectal vein, which subsequently drains into the Nutrition
####
inferior mesenteric vein. Band ligation of hemorrhoids cuts off their (GI)
blood supply, causing them to degenerate.
The celiac trunk is the first main branch of the abdominal aorta, it 5 GI
#### Hepatocellular Gastrointe Anatomy
cancer provides oxygenated blood to the spleen, stomach, liver, abdominal stinal & (Anat)
Hiatal hernia Hiatal hernias occur when contents of the abdominal cavity herniate Gastrointe Anatomy 1 GI
through the diaphragm at the esophageal hiatus into the thoracic cavity. stinal & (Anat)
Sliding hiatal hernias occur due to laxity of the phrenoesophageal Nutrition
#### membrane, leading to herniation of the gastroesophageal junction and (GI)
proximal stomach, whereas paraesophageal hernias occur due to defects in
the membrane, resulting in the gastric fundus herniation.
 Ischemic Organ susceptibility to infarction after occlusion of a feeding artery is Gastrointe Anatomy 1 GI
hepatitis ranked from greatest to least as follows: central nervous system, stinal & (Anat)
myocardium, kidney, spleen, and liver. The presence of a dual and/or Nutrition
1875 collateral blood supply (as seen in the liver, which is supplied by the (GI)
hepatic artery and portal vein) enables an organ to tolerate arterial
occlusion better than those with end-arterial circulations.

Lesser The lesser omentum is a double layer of peritoneum that extends from the Gastrointe Anatomy 1 GI
omentum liver to the lesser curvature of the stomach and the beginning of the stinal & (Anat)
8587
duodenum. It is divided into the hepatogastric and hepatoduodenal Nutrition
ligaments (GI)
Lymphatic Lymphatic drainage of the rectum proximal to the anal dentate line occurs Gastrointe Anatomy 2 GI
drainage via the inferior mesenteric and internal iliac lymph nodes. Areas distal to stinal & (Anat)
####
the dentate line drain primarily into the inguinal nodes. Nutrition
(GI)
Penetrating Occlusion of the portal triad can be used to distinguish the source of right Gastrointe Anatomy 1 GI
abdominal upper quadrant bleeding. If the bleeding subsides following occlusion, the stinal & (Anat)
#### trauma source is likely to be the hepatic artery or portal vein. If hepatic bleeding Nutrition
persists after occlusion, the inferior vena cava or hepatic veins are likely (GI)
to be injured.
Peptic ulcer Gastrointe Anatomy 10 GI
The gastroduodenal artery lies along the posterior wall of the duodenal
disease stinal & (Anat)
291 bulb and is likely to be eroded by posterior duodenal ulcers. Ulceration into
Nutrition
the gastroduodenal artery can be a source of life-threatening hemorrhage.
(GI)
Peptic ulcer Most gastric ulcers arise along the lesser curvature of the stomach, usually Gastrointe Anatomy 10 GI
disease at the transitional zone between the gastric corpus (body) and antrum. The stinal & (Anat)
292 left and right gastric arteries run along the lesser curvature and are likely Nutrition
to be penetrated by ulcers, causing gastric bleeding (GI)

Perforated Pneumoperitoneum is air or gas in the peritoneal cavity: it can be seen as Gastrointe Anatomy 1 GI
viscus free air under the diaphragm in an upright chest x-ray. The most common stinal & (Anat)
cause is a perforated duodenal ulcer (viscus) but perforation can occur Nutrition
#### anywhere along the gastrointestinal (or female reproductive) tract (GI)
Subsequent peritonitis can lead to diffuse abdominal pain with rebound
and guarding, sometimes with referred shoulder pain due to diaphragmatic
irritation.
Portal The portal vein can be identified on cross-sectional scans lying medial to
Gastrointe Anatomy 1 GI
hypertension (or just within) the right lobe of the liver and anterior to the inferior vena
stinal & (Anat)
1537
cava. The pressure in the portal system is elevated in liver cirrhosis. Nutrition
(GI)
Retroperitoneal Retroperitoneal hematoma is a common complication of abdominal and Gastrointe Anatomy 1 GI
hematoma pelvic trauma. The pancreas is a retroperitoneal organ, and pancreatic stinal & (Anat)
838
injury is frequently a source of retroperitoneal bleeding. Nutrition
(GI)
Spleen rupture Any abdominal process (eg ruptured spleen, peritonitis, hemoperitoneum) Gastrointe Anatomy 2 GI
irritating the phrenic nerve sensory fibers around the diaphragm can cause stinal & (Anat)
####
referred pain to the C3-C5 shoulder region (Kehr sign). Nutrition
(GI)
Splenic artery The splenic artery originates from the celiac artery and gives off several Gastrointe Anatomy 1 GI
branches to the stomach and pancreas (pancreatic, short gastric, and left stinal & (Anat)
gastroepiploic arteries) before finally reaching the spleen. Due to poor Nutrition
8574
anastomoses, the gastric tissue supplied by the short gastric arteries is (GI)
vulnerable to ischemic injury following splenic artery blockage.

Submucosal Gastric acid is neutralized by bicarbonate from the submucosal glands of Gastrointe Anatomy 1 GI
glands of the first part of the duodenum (Brunner glands) and from pancreatic stinal & (Anat)
129
Brunner duct secretions. Chronic overproduction of gastric acid can lead to Nutrition
hyperplasia of the submucosal glands. (GI)
Superior Superior mesenteric artery syndrome occurs when the transverse portion Gastrointe Anatomy 1 GI
mesenteric of the duodenum is entrapped between the SMA and aorta, causing stinal & (Anat)
artery symptoms of partial intestinal obstruction. This syndrome occurs when the Nutrition
303
syndrome aortomesenteric angle critically decreases, secondary to diminished (GI)
mesenteric fat, pronounced lordosis, or surgical correction of scoliosis.

Base excision BER is used to correct single-base DNA defects induced spontaneously or Gastrointe Biochemistr 1 GI
repair by exogenous chemicals. In this process, glycosylases remove the defective stinal & y (Bioc)
base, and the corresponding empty sugar-P site is cleaved and removed by Nutrition
1475
the action of endonuclease and lyase. DNA pol then replaces the missing (GI)
nucleotide, and ligase seals the final remaining nick.
 Colorectal Regulation of the Ras-MAPK signal transduction pathway requires a Gastrointe Biochemistr 15 GI
cancer balance b/w active (GTP-bound) and inactive (GDP-bound) Ras proteins. stinal & y (Bioc)
790 RAS gene muts, which result in constitutively activated Ras proteins, are Nutrition
implicated in the development of malignant tumors. (GI)

Fructose Dietary fructose is phosphorylated in the liver to F1P and is rapidly Gastrointe Biochemistr 4 GI
metabolism metabolized b/c it bypasses PFK-1, the major RLE of glycolysis. Other stinal & y (Bioc)
1068
sugars (e.g. Glc, Gal, mannose) enter glycolysis prior to PFK-1 and as a Nutrition
result are metabolized more slowly. (GI)
Galactosemia Classic galactosemia results from deficiency of galactose-1-phosphate Gastrointe Biochemistr 2 GI
uridyl transferase. Clinical features include vomiting, lethargy, stinal & y (Bioc)
1071 jaundice, and Escherichia coli sepsis. Cessation of breastfeeding and Nutrition
switching to soy milk-based formula is recommended. (GI)

Galactosemia Lenticular accumulation of galactitol in the lenses of ptswith galactosemia Gastrointe Biochemistr 2 GI
can cause osmotic damage and development of cataracts. Cataracts may be stinal & y (Bioc)
1074
the only MFx of galactokinase deficiency. Nutrition
(GI)
Gallstone Fibrate medications (eg, fenofibrate, gemfibrozil) inhibit cholesterol 7a- Gastrointe Biochemistr 8 GI
disease hydroxylase, which catalyzes the rate-limiting step in the synthesis of bile stinal & y (Bioc)
67 acids. The reduced bile acid production results in decreased cholesterol Nutrition
solubility in bile and favors the formation of cholesterol gallstones. (GI)

Gallstone Brown pigment gallstones are composed of Ca salts of unconjugated Gastrointe Biochemistr 8 GI
disease bilirubin and arise 2° to bacterial or helminthic infection of the biliary tract. stinal & y (Bioc)
β-glucuronidase released by injured hepatocytes and bacteria hydrolyzes Nutrition
70 bilirubin glucuronides to unconjugated bilirubin. The liver fluke (GI)
Clonorchis sinensis has a high prevalence in East Asian countries and is a
common cause of pigment stones.

Hepatic Hyperammonemia in advanced liver failure occurs as a direct result of the Gastrointe Biochemistr 2 GI
encephalopathy cirrhotic liver's inability to metabolize nitrogenous waste products. stinal & y (Bioc)
Ammonia crosses the blood-brain barrier and causes excess glutamine to Nutrition
8578
accumulate within astrocytes. This decreases the amount of glutamine (GI)
available for conversion to glutamate in the neurons, resulting in disruption
of excitatory neurotransmission.
Homocysteine Homocystinuria is most commonly caused by a defect in cystathionine Gastrointe Biochemistr 2 GI
synthase, resulting in an inability to form cysteine from homocysteine. stinal & y (Bioc)
Cysteine becomes essential in affected pts, and homocysteine buildup leads Nutrition
1332
to ↑ methionine. Homocysteine is prothrombotic, resulting in premature TE (GI)
events (e.g. atherosclerosis, ACS) in these pts.

Lac operon The lac operon is regulated by 2 distinct mechs: (-) by binding of the Gastrointe Biochemistr 2 GI
repressor protein to the operator locus and (+) by cAMP-CAP binding stinal & y (Bioc)
upstream from the promoter region. Constitutive expression of the structure Nutrition
1479
genes of the lac operon occurswith muts that impair the binding of the (GI)
repressor protein (Lac I) to its regulatory sequences in the operator region.

Lac operon Bacterial mRNA can be polycistronic, meaning that one mRNA codes for Gastrointe Biochemistr 2 GI
several proteins. An example of polycistronic mRNA is the bacterial lac stinal & y (Bioc)
operon, which codes for the proteins necessary for lactose metabolism by Nutrition
1485
E. coli; the transcription and translation of these bacterial proteins is (GI)
regulated by a single promoter, operator, and set of regulatory elements

Lactose Secondary lactase deficiency can occur after inflammatory (eg, celiac Gastrointe Biochemistr 3 GI
intolerance disease) or infectious (eg. giardiasis) processes damage the microvilli of stinal & y (Bioc)
1072
the small intestines. Clinical presentation includes abdominal distension Nutrition
and cramping, flatulence, and diarrhea. (GI)
Mismatch Lynch syndrome is an AD disease caused by abnormal nucleotide Gastrointe Biochemistr 1 GI
repair mismatch repair. The mismatch repair system involves several genes, stinal & y (Bioc)
2028 including MSH2 and MLH1, which code for components of the human Nutrition
MutS and MutL homologs. Mutations in these 2 genes account for around (GI)
90% of cases of Lynch syndrome.
Nutrition, Metabolism of 1 g of protein or carbohydrate produces 4 Calories of Gastrointe Biochemistr 1 GI
protein energy; metabolism of 1 g of fat produces 9 Calories. stinal & y (Bioc)
755
Nutrition
(GI)
Obesity Obesity Leptin is a protein hormone produced by adipocytes in proportion Gastrointe Biochemistr 2 GI
to the quantity of fat stored. Leptin acts on the arcuate nucleus of the stinal & y (Bioc)
8425 hypothalamus to inhib production of NPY (↓ appetite) and stim production Nutrition
of α-MSH (↑ satiety). Muts in the leptin gene or receptor result in (GI)
hyperphagia and profound obesity.
 TCA cycle Vit B2 is a precursor of the coenzymes FMN and FAD. FAD participates in Gastrointe Biochemistr 2 GI
the TCA cycle and ETC by acting as an electron acceptor for succinate stinal & y (Bioc)
1807
dehydrogenase (complex II), which converts succinate into fumarate. Nutrition
(GI)
Positive (+) and (-) predictive values depend on disease prevalence in the tested Gastrointe Biostatistics 1 GI
predictive pop. The sens and spec of a Dx test aren’t affected by disease prevalence. stinal & (Bios)
1169
value Nutrition
(GI)
Acute The dorsal pancreatic bud forms the majority of pancreatic tissue (body, Gastrointe Embryology 9 GI
pancreatitis tail, and most of the head). The ventral pancreatic bud is a precursor of the stinal & (Embr)
uncinate process, inf/post portion of the head, and major pancreatic duct Nutrition
437 (of Wirsung). Failure of the dorsal and ventral pancreatic buds to fuse (GI)
leads to pancreas divisum. In this condition, the pancreatic ductal systems
remain separate,with the accessory duct draining the majority of the
pancreas.
Acute Annular pancreas, or pancreatic tissue encircling the desc duodenum, is Gastrointe Embryology 9 GI
pancreatitis caused by failure of the ventral pancreatic bud to properly migrate and stinal & (Embr)
438 fusewith the dorsal bud during the 7th and 8th wk of fetal development. Nutrition
Annular pancreas is usually aSSx but may Pxwith duodenal obstruction or (GI)
pancreatitis.
Embryologic The spleen is a large, wedge-shaped lymphatic organ that is situated in the Gastrointe Embryology 2 GI
derivatives posterior superior portion of the left abdominal cavity. It is derived from stinal & (Embr)
####
mesoderm in the dorsal mesentery during embryonic development. Nutrition
(GI)
Embryology, A # of ectopic tissues are found in Meckel diverticulum - most commonly, Gastrointe Embryology 1 GI
Meckel gastric epithelium. Gastric mucosa is present in 80% of cases of SSx stinal & (Embr)
321
Meckel diverticulum. Gastric acid production leads to ulceration and Nutrition
subsequent bleeding. (GI)
Hirschsprung Hirschsprung disease is a result of abnormal migration of neural crest cells Gastrointe Embryology 2 GI
disease during embryogenesis. These cells are the precursors of ganglion cells of stinal & (Embr)
330 intestinal wall plexi. Since neural crest cells migrate caudally, the rectum is Nutrition
always affected in Hirschsprung disease. (GI)

Intestinal Intestinal atresia distal to the duodenum occurs due to vascular accidents in Gastrointe Embryology 1 GI
atresia utero. "Apple-peel" atresia occurs when the superior mesenteric artery is stinal & (Embr)
319 obstructed. The result is a blind-ending proximal jejunum; a length of Nutrition
absent bowel and mesentery: and, finally, a terminal ileum spiraled around (GI)
an ileocolic vessel.
Malrotation Intestinal malrotation results when the midgut undergoes incomplete Gastrointe Embryology 1 GI
embryological counterclockwise rotation. It can Px as intestinal obstruction stinal & (Embr)
318 (due to compression by the adhesive bands) and midgut volvulus (intestinal Nutrition
ischemia due to twisting around the blood vessels). (GI)

Meckel The omphalomesenteric (vitelline) duct normally obliterates during the 7th Gastrointe Embryology 3 GI
diverticulum week of embryonic development. Both enterocysts and Meckel diverticula stinal & (Embr)
322
result from a failure of obliteration involving the omphalomesenteric duct. Nutrition
(GI)
Meckel Meckel’s diverticulum is a remnant of the omphalomesenteric (vitelline) Gastrointe Embryology 3 GI
diverticulum duct. It is connected to the ileum and is located 2 feet proximal to the stinal & (Embr)
ileocecal valve. It often contains acid-secreting ectopic gastric tissue, Nutrition
328 which may cause ulceration of the adjacent mucosa and lower Gl bleeding (GI)
(melena/hematochezia). Meckel’s diverticulum is a true diverticulum and
consists of all parts of the intestinal wall (Mucosa, submucosa, and
muscular layers).
Meckel Meckel diverticulum results from failed obliteration of the vitelline Gastrointe Embryology 3 GI
diverticulum (omphalomesenteric) duct and usually presents with spontaneous but stinal & (Embr)
329 painless lower gastrointestinal bleeding. "mTc-pertechnetate localizes Nutrition
ectopic gastric mucosa, and its increased uptake is diagnostic for Meckel (GI)
diverticulum.
Spleen rupture The spleen is of mesodermal origin (the dorsal mesentery). Although it is Gastrointe Embryology 2 GI
supplied by the splenic artery (a branch of the major foregut vessel, the stinal & (Embr)
2022
celiac trunk), It is not a foregut derivative. Nutrition
(GI)
Tracheoesopha TEF/EA results from failure of the primitive foregut to appropriately divide Gastrointe Embryology 1 GI
geal fistula into separate trachea and esophageal structures. Infants Px shortly after stinal & (Embr)
####
birthwith excessive secretions and choking/cyanosis during feeds. Nutrition
(GI)
Umbilical Umbilical hernias are caused by a defect in the linea alba and Px as Gastrointe Embryology 1 GI
hernia protrusions at the umbilicus that are soft, reducible, and benign. They can stinal & (Embr)
####
occur in isolation or in a/w other conditions, such as DS. Nutrition
(GI)
 Celiac disease
Celiac disease (gluten-sens enteropathy) classically Px b/w age 6-24 Gastrointe Histology 2 GI
moswith abdo pain, diarrhea, vomiting, and weight loss. Duodenal Bx stinal & (Hist)
324 reveals crypt hyperplasia, villous atrophy, and intraepithelial lymphocyte Nutrition
infiltration. Txwith a gluten-free diet resolves SSx and normalizes sero and (GI)
histo.
Nonalcoholic Stellate (Ito) cells are the primary cells involved in hepatic fibrosis. In Gastrointe Histology 1 GI
fatty liver response to hepatic injury, the stellate cells are activated and transform into stinal & (Hist)
#### disease myofibroblasts capable of proliferating, promoting chemotaxis, and Nutrition
producing large quantities of collagen. Collagen stains blue with Masson (GI)
trichrome stain.
Vitamin B12 Pernicious anemia is an autoimmune disorder caused by the cell-mediated Gastrointe Histology 9 GI
deficiency destruction of parietal cells in the superficial upper glandular layer of the stinal & (Hist)
gastric body and fundus. Parietal cells are responsible for the secretion of Nutrition
124
hydrochloric acid and intrinsic factor, a glycoprotein involved in the (GI)
absorption of B12. Deficiency leads to megaloblastic anemia and
neurologic dysfunction.
Immunizations The live attenuated oral (Sabin) poliovirus vaccine produces a Gastrointe Immunology 4 GI
stronger mucosal secretory IgA immune response than does the stinal & (Immu)
1467 inactivated poliovirus (Salk) vaccine. This increase in mucosal IgA Nutrition
offers immune protection at the site of viral entry by inhibiting attachment (GI)
to intestinal epithelial cells. (Duodenal luminal lgA)
Inflammatory Of the cytokines released in the setting of tissue injury, IL-10 plays Gastrointe Immunology 9 GI
bowel disease important anti-inflammatory and immunomodulatory roles, especially in the stinal & (Immu)
pathogenesis of inflammatory bowel disease. IL-10 attenuates the Nutrition
1597 immune response through the inhibition of Th1 cytokines, reduction of (GI)
major histocompatibility complex class Il expression, and suppression of
activated macrophages and dendritic cells.

Achalasia Chagas disease is caused by a chronic infection by Trypanosoma cruzi and Gastrointe Microbiolog 3 GI
causes secondary achalasia due to destruction of the submucosal stinal & y (Micr)
278 (Meissner) and myenteric (Auerbach) plexus. Other manifestations can Nutrition
include nonischemic cardiomyopathy and megacolon. (GI)

Acute diarrhea Shiga-like tox (Vero cytotox), prod by EHEC, are nearly identical to the Gastrointe Microbiolog 13 GI
Shiga tox prod by S. dysenteriae. They inhib the 60S ribosomal subunit in stinal & y (Micr)
1098
human cells, thereby blocking protein synth by preventing binding of Nutrition
tRNA. (GI)
Acute diarrhea EHEC O157:H7 infec is a common cause of bloody diarrhea and can lead Gastrointe Microbiolog 13 GI
to HUS. It’s a/w consumption of undercooked ground beef and elabs a stinal & y (Micr)
1100 Shiga-like tox capable of inhib protein synth in colonic mucosal cells and Nutrition
renal endothelial cells. This particular strain of E. coli is unable to ferment (GI)
sorbitol and doesn’t prod a glucuronidase.
Acute diarrhea Depending on the age and condition of the host and the species of Shigella, Gastrointe Microbiolog 13 GI
as few as 10-500 cells can cause infec. stinal & y (Micr)
1136
Nutrition
(GI)
Acute diarrhea Campylobacter infection is a common cause of GE and is typically Gastrointe Microbiolog 13 GI
acquired from contaminated food (eg, undercooked poultry) or stinal & y (Micr)
domesticated animals (eg, household dogs). MFx usually include fever, Nutrition
1422
cramping abdominal pain, and watery diarrhea that may be bloody. Stool (GI)
studies typically show blood and leukocytes. Campylobacter infection is
a/w GBS.
Acute diarrhea Campylobacter jejuni is an oxidase-positive, curved, gram-negative rod Gastrointe Microbiolog 13 GI
that is a leading cause of gastroenteritis. The pathogen is a zoonotic stinal & y (Micr)
6731 organism most commonly contracted by consuming contaminated, Nutrition
undercooked poultry. Cases are marked by fever, abdominal pain, and (GI)
diarrhea that may be bloody.
Appendicitis Intra-abdo infecs are polymicro,with B. fragilis and E.coli being the most Gastrointe Microbiolog 5 GI
prominent organisms isolated. stinal & y (Micr)
7573
Nutrition
(GI)
Botulism Infant bot is freq due to honey consumption. More than 12% of honey Gastrointe Microbiolog 4 GI
samples contain low # of C. botulinum spores. Whereas infant bot results stinal & y (Micr)
from consuming C. botulinum spores, adult bot results from consuming Nutrition
1400
preformed tox, typically in canned food. SSx of infant bot incl constipation, (GI)
mild weakness, lethargy, and poor feeding.

Clostridium C. difficile toxs A and B exert their effects by disrupting the actin CSK Gastrointe Microbiolog 7 GI
difficile structure and intracellular signaling. Although the toxs have overlapping stinal & y (Micr)
1397
infection effects, tox A causes relatively more intestinal inflam and fluid secretion, Nutrition
and tox B is more cytotox. (GI)
 Clostridium In the absence of normal intestinal microbial flora (as may be the case after Gastrointe Microbiolog 7 GI
difficile a course of antibiotics), Clostridium difficile can overgrow and produce stinal & y (Micr)
1398 infection enterotoxin (toxin A) and cytotoxin (toxin B). Clinical disease resulting Nutrition
from C difficile overgrowth can range from transient diarrhea to severe (GI)
pseudomembranous colitis.
Clostridium Clostridium difficile infection is associated with white, patchy Gastrointe Microbiolog 7 GI
difficile pseudomembranes on the bowel mucosa. These pseudomembranes consist stinal & y (Micr)
infection of a neutrophil-predominant inflammatory infiltrate, fibrin, bacteria, and Nutrition
6510
necrotic epithelium. Patients may develop a nonobstructive colonic dilation (GI)
known as toxic megacolon, which can lead to colonic perforation.

Clostridium C. difficile commonly Pxwith diarrhea and abdo pain; hosp and Abx use ↑ Gastrointe Microbiolog 7 GI
difficile the risk of contracting the disease. A NAAT is considered the most sens stinal & y (Micr)
####
infection method for Dx of C. difficile infec in ptswith CFx. Nutrition
(GI)
Cryptosporidio Cryptosporidium is a common cause of self-lim diarrhea in immcom hosts, Gastrointe Microbiolog 1 GI
sis but may cause life-thr diarrhea in immsup patients (e.g. adv AIDS). Dx is stinal & y (Micr)
7642 usually made when oocysts are visualizedwith modded acid-fast stain in Nutrition
stool or Bx (oocysts lining the brush-border). (GI)

Esophagitis Infec esophagitis is common in ptswith HIV. The most common cause is C. Gastrointe Microbiolog 3 GI
albicans, although CMV and HSV are also freq implicated. Dx is based on stinal & y (Micr)
283
endoscopic and micro findings. Nutrition
(GI)
Foodborne Staphylococcal food pois is mediated by the ingestion of a preformed, heat- Gastrointe Microbiolog 2 GI
illness stable enterotox that induces rap-on (<6 hrs) nausea and vomiting. Most stinal & y (Micr)
644 cases arise due to improper food handling and storage. Common culprit Nutrition
foods incl eggs, dairy prods, and mayonnaise-based salads. (GI)

Hepatitis A Transmission of the HAV occurs thru the fecal-oral route and is common Gastrointe Microbiolog 4 GI
in areaswith overcrowding and poor sanitation. Outbreaks freq result from stinal & y (Micr)
372
contam water or food, and raw or steamed shellfish is a common culprit in Nutrition
the US. (GI)
Hepatitis B The main modes of transmission of HBV incl sexual (among both Gastrointe Microbiolog 14 GI
heterosex partners and MSM) and percutaneous (e.g. IVDU, needlestick stinal & y (Micr)
386
accidents, blood transfusions). The risk of sexual transmission of HCV is Nutrition
low. (GI)
Hepatitis C The HCV is genetically unstable b/c it lacks proofreading 3’ → 5’ Gastrointe Microbiolog 4 GI
exonuclease activity in its RNA pol. Its env GP seqs also contain an HVR stinal & y (Micr)
388
prone to freq genetic mut. Nutrition
(GI)
Hepatitis C Chronic HCV infec is Txwith DAA Rx such as ledipasvir and sofosbuvir. Gastrointe Microbiolog 4 GI
These Rx target spec HCV enzymes (e.g. protease, NS5A, RNA pol), stinal & y (Micr)
####
which inhibs viral replication and assembly. Txwith DAAs results in cure Nutrition
in >97% of pts. (GI)
Hepatitis D The hepatitis В surface antigen of hepatitis В virus must coat the hepatitis Gastrointe Microbiolog 2 GI
D antigen of hepatitis D virus before it can infect hepatocytes and multiply. stinal & y (Micr)
47
Nutrition
(GI)
Liver abscess S. aureus can cause hepatic abscesses via hematogenous seeding of the Gastrointe Microbiolog 1 GI
liver. Enteric bacteria (eg, Escherichia coli, Klebsiella, and enterococci) stinal & y (Micr)
62 can cause hepatic abscesses by ascending the biliary tract (ie, ascending Nutrition
cholangitis), portal vein pyemia, or direct invasion from an adjacent area (GI)
(eg, cholecystitis).
Strongyloides S. stercoralis infec begins following skin penetration by filariform (infec) Gastrointe Microbiolog 1 GI
larva and can be Dx by finding rhabditiform (noninfec) larvae in the stool. stinal & y (Micr)
Rhabditiform larvae can mature into filariform larva in the human HIT, Nutrition
8873 precip an autoinfec cycle that occurs entirelywithi the affected indiv. This (GI)
can result in a hyperinfec syndrome char by massive dissem of the
organism, leading to MOD and septic shock.

Abetalipoprotei Abetalipoproteinaemia is an inherited inability to synthesise apoB, an Gastrointe Pathology 1 GI

nemia important component of chylomicrons and VLDL. Lipids absorbed by the stinal & (Path)
327 small intestine can't be transported into the blood and accumulate in the Nutrition
intestinal epithelium, resulting in enterocyteswith clear or foamy (GI)
cytoplasm.
Acute diarrhea Gastrointe Pathology 13 GI
Shigellosis is an infectious disease that can be caused by variety of Shigella
stinal & (Path)
species: S sonnei is the most common cause of shigellosis in industrialized
Nutrition
nations. Shigella invades the gastrointestinal mucosa by gaining access to
1143 (GI)
microfold (M) cells in ileal Peyer patches through endocytosis. Shigella
subsequently lyses the endosome and spreads laterally into other epithelial
cells, causing cell death and ulceration with hemorrhage and diarrhea.
 Acute heart Gastrointe Pathology 7 GI
Congestive hepatopathy is a common complication of right-sided heart
failure stinal & (Path)
failure (CAD). Patchy hemorrhage and necrosis predominantly affect the
Nutrition
centrilobular regions (zone 3) where hepatic congestion is most prominent.
#### (GI)
The centrilobular necrosis, combined with relatively normal-appearing
periportal regions (zone 1), creates an overall heterogenous appearance
sometimes referred to as 'nutmeg liver'.
Acute After gallstones, alcohol abuse is the second most common cause of acute Gastrointe Pathology 9 GI
pancreatitis pancreatitis. Macrocytosis (MCV 180) and an AST:ALT ratio >2 are stinal & (Path)
434 indirect indicators of chronic alcohol consumption Alcohol-related Nutrition
macrocytosis can occur independently of folate deficiency (GI)

Acute Pancreatic pseudocyst is a common complication of acute pancreatitis. It is Gastrointe Pathology 9 GI

pancreatitis a collection of fluid rich in enzymes and inflammatory debris. Its walls stinal & (Path)
435
consist of granulation tissue and fibrosis. Unlike true cysts pseudocysts Nutrition
are not lined by epithelium. (GI)
Acute In acute interstitial pancreatitis the pancreas is grossly edematous Focal Gastrointe Pathology 9 GI
pancreatitis areas of fat necrosis, calcium deposition and interstitial edema are seen on stinal & (Path)
439 light microscopy. In necrotizing (hemorrhagic) pancreatitis, chalky-white Nutrition
areas of fat necrosis interspersed with hemorrhage are seen on (GI)
macroscopic examination.
Acute Eighty percent of acute pancreatitis that resolves rapidly on fasting Gastrointe Pathology 9 GI
pancreatitis cases are caused by gallstones and chronic alcoholism Less common causes stinal & (Path)
440 account for the other 20%. Inherited or acquired hypertriglyceridemia Nutrition
can cause acute pancreatitis if the serum level of triglycerides exceeds (GI)
1000 mg/dL.
Alcoholic liver The pathogenesis of alcohol-induced hepatic steatosis appears related Gastrointe Pathology 1 GI
disease primarily to a decrease in free fatty acid oxidation secondary to excess stinal & (Path)
370 NADH production by the 2 major alcohol metabolism enzymes, alcohol Nutrition
dehydrogenase and aldehyde dehydrogenase. (GI)

Alpha1 Alpha-1 antitrypsin (AAT) is a serine protease inhibitor that regulates the Gastrointe Pathology 8 GI
antitrypsin activity of elastase in the lung. Inherited deficiency of AAT (serine stinal & (Path)
deficiency protease inhibitor) leads to alveolar destruction and panacinar Nutrition
400
emphysema: in addition, accumulation of improperly folded AAT proteins (GI)
in hepatocytes can lead to liver dysfunction and cirrhosis in some patients.

Anal fissure Anal fissures are longitudinal tears in the mucosa. They are usually due to Gastrointe Pathology 1 GI
passage of hard stool in patients with chronic constipation. Most fissures stinal & (Path)
255 occur at the posterior midline distal to the dentate line, likely due to Nutrition
decreased blood flow in this area. Fissures in other areas may be due to less (GI)
common causes.
Antiretroviral The HIV genome contains 3 major structural genes that are translated as Gastrointe Pathology 7 GI
therapy polyproteins and subsequently cleaved by host protease (env gene stinal & (Path)
products) or viral protease (gag-pol gene products) into the individual Nutrition
proteins that compose the HIV virus. Protease inhibitors block viral (GI)
7229
protease (viral-encoded enzyme) from cleaving gag-pol polyproteins,
(medication) which results production of immature, noninfectious
virions containing large polyproteins.

Appendicitis Gastrointe Pathology 5 GI

Obstruction of the lumen of the appendix is the first event in
stinal & (Path)
pathogenesis of acute appendicitis. Fecaliths, hyperplastic lymphoid
Nutrition
426 follicles, foreign bodies, or tumors may cause the obstruction. Right lower
(GI)
quadrant abdominal pain, nausea vomiting, diarrhea, and fever are the
typical manifestations of acute appendicitis.
Atherosclerosis Familial hypercholesterolemia, one of the most common autosomal Gastrointe Pathology 8 GI
dominant disorders, is the result of heterozygous or homozygous LDL stinal & (Path)
190 receptor gene mutations, which cause hepatocyte under-expression of Nutrition
functional LDL receptors. This condition can lead to accelerated (GI)
atherosclerosis and early-onset coronary artery disease.
Barrett Barrett esophagus is a metaplastic condition in which the normal squamous Gastrointe Pathology 2 GI
esophagus epithelium of the distal esophagus is replaced by intestinal-type columnar stinal & (Path)
282 epithelium. It occurs most often in longstanding acid reflux, dry cough, Nutrition
obesity are associated with an increased risk of adenocarcinoma (GI)

Biliary A moderately elevated alkaline phosphatase of unclear etiology should be Gastrointe Pathology 1 GI
excretory followed up with y-glutamyl transpeptidase. stinal & (Path)
99
function Nutrition
(GI)
Bowel Gallstone ileus is a mechanical bowel obstruction caused when a large Gastrointe Pathology 1 GI
obstruction gallstone erodes into the intestinal lumen. Pneumobilia (air in the biliary stinal & (Path)
88
tract) is a common finding Nutrition
(GI)
 Carcinoid Carcinoid tumors are composed of islands or sheets of uniform cells with Gastrointe Pathology 4 GI
tumors eosinophilic cytoplasm and oval-to-round stippled nuclei. These tumors are stinal & (Path)
often derived from neuroendocrine cells in the gastrointestinal tract. Nutrition
424
Appendiceal carcinoids typically have a benign course but may cause (GI)
appendicitis or, rarely, carcinoid syndrome (eg, with liver metastasis).

Celiac disease Celiac disease is caused by an immune-mediated reaction to gluten and can Gastrointe Pathology 2 GI
present with bloating, diarrhea, and flatulence, as well as short stature stinal & (Path)
and weight loss. Screening tests show an elevated level of IgA against Nutrition
326
tissue transglutaminase. Duodenal biopsy is confirmatory, showing (GI)
villus flattening and intraepithelial lymphocyte infiltration.

Cholecystitis Acute calculous cholecystitis is an acute inflammation of the gallbladder Gastrointe Pathology 5 GI
initiated by gallstone obstruction of the cystic duct. Subsequent steps in stinal & (Path)
pathogenesis include mucosal disruption by lysolecithins. bile salt irritation Nutrition
of the luminal epithelium, prostaglandin release with transmural (GI)
79
inflammation, gallbladder hypomotility, increased intraluminal pressure
causing ischemia, and bacterial invasion, RUQ tenderness, pain after
fatty meals, patchy necrosis

Cholecystitis Acute acalculous cholecystitis is an acute inflammation of the Gastrointe Pathology 5 GI

gallbladder in the absence of gallstones. It typically occurs in critically ill stinal & (Path)
patients (eg. those with sepsis, severe burns, trauma, immunosuppression) Nutrition
81 due to gallbladder stasis and ischemia (necrotizing fasciitis of the gluteal (GI)
region). Clinical findings may be subtle and include fever, right upper
quadrant pain, and leukocytosis

Cholestasis Cholestatic liver disease (itching. mild hepatomegaly. increase in serum Gastrointe Pathology 1 GI
alkaline phosphatase, with moderate elevations in bilirubin and stinal & (Path)
hepatic transaminases. Liver biopsy reveals dilated bile canaliculi with Nutrition
364 green-brown plugs and yellowish-green accumulations of pigment (GI)
within the hepatic parenchyma) can cause malabsorption and nutritional
deficiencies of fat-soluble vitamins

Chronic Diarrhea, weight loss, and epigastric calcifications in a patient with chronic Gastrointe Pathology 3 GI
pancreatitis alcoholism suggest chronic pancreatitis with resulting stinal & (Path)
1547
(Digestive)pancreatic exocrine insufficiency and malabsorption Nutrition
(GI)
Cirrhosis Hyperestrinism in liver cirrhosis likely arises due to increases in Gastrointe Pathology 7 GI
androstenedione production, androgen aromatization. and sex hormone- stinal & (Path)
binding globulin concentration (preferentially binds testosterone). Impaired Nutrition
100 estrogen metabolism by the liver may also be a contributing factor A (GI)
decreased free testosterone/estrogen ratio leads to gynecomastia,
testicular atrophy, decreased body hair, and spider angiomata.

Cirrhosis Cirrhosis is characterized by diffuse hepatic fibrosis with replacement of Gastrointe Pathology 7 GI
the normal lobular architecture by fibrous-lined parenchymal nodules. stinal & (Path)
368 Chronic viral hepatitis (eg, hepatitis В and C), alcohol, hemochromatosis, Nutrition
and nonalcoholic fatty liver disease are the most common causes of (GI)
cirrhosis in the United States.
Cirrhosis Increased aspartate aminotransferase and alanine aminotransferase are Gastrointe Pathology 7 GI
indicators of hepatocellular damage, and increased alkaline phosphatase stinal & (Path)
and gamma-glutamyl transpeptidase indicate biliary injury. Serum albumin Nutrition
1423
levels, bilirubin levels, and prothrombin time are reflective of liver (GI)
function and are of greatest prognostic significance in patients with
cirrhosis.
Cirrhosis Portal hypertension, as seen in alcoholic liver disease, produces Gastrointe Pathology 7 GI
splenomegaly by causing congestion of blood within the spleen, which stinal & (Path)
7214
produces expansion of the red pulp expansion Nutrition
(GI)
Clostridium Antibiotics disrupt the normal intestinal flora and which can allow for Gastrointe Pathology 7 GI
difficile overgrowth of Clostridium difficile, an anaerobic, gram-positive, spore- stinal & (Path)
infection forming bacillus. C difficile produces 2 toxins that penetrate colonic Nutrition
1396 epithelial cells leading to watery diarrhea, abdominal cramping, and colitis. (GI)
The presence of a pseudomembrane (exudate on colonic mucosa consisting
of fibrin and inflammatory cells) is highly suggestive of C difficile
infection.
Colonic The splenic flexure and rectosigmoid junction lie between regions of Gastrointe Pathology 1 GI
ischemia perfusion of major arteries. These "watershed" areas are susceptible to stinal & (Path)
413
ischemic damage during hypotensive states, especially in patients with Nutrition
underlying arterial insufficiency. (GI)
 Colonic polyps Gastrointe Pathology 2 GI
Villous Adenomatous and serrated polyps (ie sessile serrated polyp,
stinal & (Path)
traditional serrated adenoma) are neoplastic polyps that have malignancy
427 Nutrition
potential. Increasing polyp size is the most important risk factor for cancer;
(GI)
villous histology and high-grade dysplasia are additional risk factors
Colonic polyps Adenomatous polyps are either tubular, villous, or tubulovillous. depending Gastrointe Pathology 2 GI
on their histologic appearance. Villous adenomas tend to be larger, sessile stinal & (Path)
and more severely dysplastic than tubular adenomas. Villous adenomas can Nutrition
430
cause a secretory diarrhea from increased mucin production patients (GI)
may develop hypoproteinemia and hypokalemia.

Colorectal Carcinoembryonic antigen (CEA) levels are increased in colon cancer but Gastrointe Pathology 15 GI
cancer are also elevated in a number of other conditions (eg, pancreatic cancer, stinal & (Path)
253 COPD, cirrhosis). CEA cannot be used to diagnose colon cancer, but it is Nutrition
helpful for detecting residual disease and recurrence. (GI)

Colorectal Colon adenocarcinoma is the most common gastrointestinal malignancy. Gastrointe Pathology 15 GI
cancer Right-sided (ascending) lesions are more likely to bleed and cause iron stinal & (Path)
257 deficiency anemia, left-sided lesions tend to present with obstructing Nutrition
symptoms (eg, altered bowel habits, constipation, abdominal distension, (GI)
nausea and vomiting).
Colorectal Inflammatory bowel disease especially ulcerative pancolitis, is associated Gastrointe Pathology 15 GI
cancer with a significant risk for colorectal carcinoma. Compared with sporadic stinal & (Path)
colorectal cancer, ulcerative colitis-associated colorectal cancer is more Nutrition
likely to occur at a younger age. is typically more aggressive with a higher (GI)
411
histopathologic grade, often evolves from flat (nonpolypoid) lesions, and is
frequently multifocal origin. Patients should be monitored regularly via
colonoscopy with random biopsies.

Colorectal The adenoma to carcinoma sequence is a series of gene mutations that Gastrointe Pathology 15 GI
cancer leads to the development of colon adenocarcinoma. TP53 tumor suppressor stinal & (Path)
420 gene mutation is part of the final step in the sequence and leads to Nutrition
malignant transformation of preexisting large adenomatous polyps. (GI)

Colorectal The size of adenomatous polyps determines their malignant potential. Gastrointe Pathology 15 GI
cancer Adenomas <1 cm are unlikely to undergo malignant transformation, stinal & (Path)
421 whereas those >4 cm are very likely to progress to adenocarcinoma. KRAS Nutrition
protooncogene mutation facilitates the growth of adenomas by causing (GI)
uncontrolled cell proliferation.
Colorectal Mutation of the APC tumor suppressor gene is the first step in the Gastrointe Pathology 15 GI
cancer classic adenoma-to-carcinoma sequence; it is found in most cases of stinal & (Path)
sporadic colon cancer and in all patients with familial adenomatous Nutrition
428 polyposis. The microsatellite instability pathway is characterized by (GI)
mutations in DNA mismatch repair genes and is implicated in the
development of hereditary nonpolyposis colorectal cancer (Lynch
syndrome).
Colorectal Adenomatous polyps contain dysplastic mucosa and are premalignant. Gastrointe Pathology 15 GI
cancer Regular screening with timely excision of polyps is effective for prevention stinal & (Path)
of colon adenocarcinoma. Studies have linked increased activity of Nutrition
431
cyclooxygenase-2 to some forms of colon adenocarcinoma and suggest (GI)
that regular aspirin use decreases adenomatous polyp formation.

Colorectal Right-sided colon cancers usually grow as exophytic masses and present Gastrointe Pathology 15 GI
cancer with occult bleeding and symptoms of iron deficiency anemia. Left-sided stinal & (Path)
colon cancers tend to infiltrate the intestinal wall and encircle the lumen, Nutrition
432
causing constipation and symptoms of intestinal obstruction. Rectosigmoid (GI)
involvement often causes hematochezia. It causes (Weight loss and
progressive fatigue)
Colorectal Tumor stage (degree of invasion/spread) is the most important prognostic Gastrointe Pathology 15 GI
cancer determinant for colorectal cancer. Tumors confined to the basement stinal & (Path)
membrane and lamina propria are early stage and have the best prognosis. Nutrition
#### Outcomes generally deteriorate as the stage advances: spread of tumor (GI)
into the muscularis propria —»regional lymph nodes (last stage) —>
distant sites. mass in the ascending colon. Biopsy shows
adenocarcinoma. HTN
Colorectal Most hepatic neoplasms are due to metastatic disease from a distant site. Gastrointe Pathology 15 GI
cancer Colorectal cancer is the most common cause of hepatic metastases due to stinal & (Path)
####
direct blood flow from the colon (and superior rectum) to the liver via the Nutrition
portal venous circulation. (GI)
Colorectal Familial adenomatous polyposis (FAP) is an autosomal dominant disorder Gastrointe Pathology 15 GI
cancer caused by germline mutation to the tumor suppressor gene adenomatous stinal & (Path)
#### polyposis coli. Patients with FAP develop hundred or thousands of colonic Nutrition
polyps: lifetime risk of colon cancer is close to 100%. (GI)
 Cystic fibrosis The most common gastrointestinal disorder in patients with cystic fibrosis Gastrointe Pathology 11 GI
is pancreatic insufficiency. Mutations in the cystic fibrosis transmembrane stinal & (Path)
conductance regulator gene lead to thick, viscous secretions in the lumens Nutrition
358 of the pancreas, resulting in obstruction of pancreatic ducts, (GI)
inflammation, and subsequent fibrosis Clinical manifestations include
steatorrhea failure to thrive, and deficiency of fat-soluble vitamins

Cytomegalovir Cytomegalovirus (CMV) is a common cause of colitis in patients with Gastrointe Pathology 9 GI
us advanced AIDS. It is the second most common CMV reactivation (of a stinal & (Path)
herpesvirus) disease in this population (CMV retinitis is the most Nutrition
common) Patients with CMV colitis often have abdominal pain, fever, (GI)
7228
diarrhea, and weight loss. Colonoscopy usually shows erythema,
erosions, and ulcerations; colonic biopsy typically reveals large cells with
prominent basophilic intranuclear inclusions.

Cytomegalovir Cytomegalovirus esophagitis can occur in transplant patients and usually Gastrointe Pathology 9 GI
us presents with odynophagia or dysphagia that can be accompanied by stinal & (Path)
fever or burning chest pain. ESRD, HTN. Endoscopy typically shows Nutrition
####
linear and shallow ulcerations in the lower esophagus, and histology (GI)
usually shows enlarged cells with intranuclear inclusions.

Diffuse Diffuse esophageal spasm is characterized by periodic, simultaneous, and Gastrointe Pathology 1 GI
esophageal non-peristaltic contractions of the esophagus due to impaired inhibitory stinal & (Path)
spasm innervation within the esophageal myenteric plexus. Patients typically Nutrition
280
present with liquid/solid dysphagia and chest pain due to inefficient (GI)
propulsion of food into the stomach.

Diverticular Colonic diverticula often involve the sigmoid colon and develop due to Gastrointe Pathology 3 GI
disease exaggerated contractions of colonic smooth muscle segments. This results stinal & (Path)
in increased intraluminal pressure, causing outpouching of the mucosa Nutrition
and submucosa through the musculans (sigmoid colon )(false (GI)
415 diverticula). Individuals (typically age >60) may be asymptomatic or have
hematochezia or diverticulitis. (Absence of muscularis propria) bright
red blood per rectum. HTN, obesity, smoker, red meat frequently.
Abdominal examination shows no abnormalities

Diverticular Colonic diverticulosis refers to multiple sac-like outpouchings within the Gastrointe Pathology 3 GI
disease sigmoid colon. Complications include diverticular bleeding and stinal & (Path)
#### diverticulitis. Risk factors for diverticulosis include a diet high in red Nutrition
meat and fat and low in fiber, as well as obesity, physical inactivity, and (GI)
smoking.
Diverticular Acute Diverticulitis is characterized by inflammation of colonic Gastrointe Pathology 3 GI
disease diverticula. Patients have abdominal pain, nausea, vomiting, and stinal & (Path)
#### changes in bowel habits. Low-grade fever and leukocytosis are common, Nutrition
and physical examination may demonstrate a tender mass in the left (GI)
lower quadrant.
Esophageal Major risk factors for esophageal squamous cell carcinoma include Gastrointe Pathology 4 GI
cancer smoking, excessive alcohol consumption, and intake of foods containing stinal & (Path)
122
N- nitroso compounds. Dysphagia (swallow only liquid), tumor cells Nutrition
with keratin nests and pearls (GI)
Esophageal The histopathologic features of esophageal squamous cell carcinoma with Gastrointe Pathology 4 GI
cancer poor prognosis include solid nests of neoplastic squamous cells with stinal & (Path)
abundant eosinophilic cytoplasm and distinct borders. Areas of Nutrition
287 keratinization and the presence of intercellular bridges are also (GI)
characteristic. Patients typically present with progressive solid and
eventually liquid dysphagia and weight loss, via smoking

Esophageal Esophageal squamous cell carcinoma presents mostly in the proximal two- Gastrointe Pathology 4 GI
cancer thirds of the esophagus and frequently metastasizes to the mediastinal stinal & (Path)
#### lymph nodes. Histology characteristically shows sheets of pleomorphic Nutrition
squamous cells with keratin pearls and intercellular bridges. (GI)

Esophageal Esophageal adenocarcinoma usually occurs in the distal esophagus due to Gastrointe Pathology 4 GI
cancer underlying Barrett esophagus. Long-standing gastroesophageal reflux stinal & (Path)
disease is the most important risk factor. Obesity, smoking, use of Nutrition
####
medications that lower esophageal sphincter pressure, and (GI)
consumption of foods containing nitroso compounds also increase the risk.

Esophageal Portal vein thrombosis causes portal hypertension, splenomegaly, and Gastrointe Pathology 2 GI
varices varicosities at portocaval anastomoses. It does not cause histologic stinal & (Path)
1701 changes to the hepatic parenchyma. Ascites is uncommon as the Nutrition
obstruction is presinusoidal: ascites typically only develops in conditions (GI)
that cause sinusoidal hypertension. Vomiting red blood
 Esophageal Acute management of variceal hemorrhage requires rapid lowering of Gastrointe Pathology 2 GI
varices portal pressure Somatostatin and octreotide (a long-acting somatostatin stinal & (Path)
7215 analog) inhibit the release of hormones that induce splanchnic vasodilation, Nutrition
indirectly causing splanchnic vasoconstriction and reduced portal blood (GI)
flow.
Esophagitis Herpes simplex virus esophagitis is most common in those with impaired Gastrointe Pathology 3 GI
cell-mediated immunity Endoscopy typically reveals small vesicles and stinal & (Path)
"punched-out" ulcers. Findings on biopsy usually include multinucleated Nutrition
####
giant cells and eosinophilic intranuclear inclusions (Cowdry type A (GI)
inclusion bodies). Acyclovir is the Tx of choice.

Esophagitis Eosinophilic esophagitis is a Th2 cell-mediated disorder leading to Gastrointe Pathology 3 GI

eosinophilic infiltration of the esophageal mucosa. It occurs most stinal & (Path)
commonly males with a history of atopic conditions and typically presents Nutrition
#### with solid food dysphagia, reflux, and occasionally food impaction. Classic (GI)
endoscopic findings include stacked, circular, ringlike indentations; linear
furrowing; and scattered, small, whitish papules (ie eosinophilic
microabscesses).
Familial Familial adenomatous polyposis is an autosomal-dominant hereditary Gastrointe Pathology 1 GI
adenomatous disorder that results in the formation of innumerable colonic polyps and a stinal & (Path)
#### polyposis nearly 100% risk of colorectal cancer. It arises due to germline mutation Nutrition
to the tumor suppressor gene (loss of functional APC protein), (GI)
adenomatous polyposis coli.
Focal nodular Focal nodular hyperplasia is a benign liver tumor marked by a central Gastrointe Pathology 1 GI
hyperplasia stellate scar containing an abnormally large artery. It usually arises instinal & (Path)
####
young women and most cases are asymptomatic and found incidentally. Nutrition
(GI)
Gallstone The gallbladder functions to actively absorb water from bile. Gallbladder Gastrointe Pathology 8 GI
disease hypomotility causes the bile to become concentrated, promoting stinal & (Path)
precipitation and accumulation of particulate material. This forms a Nutrition
71
viscous biliary sludge that can cause transient bile duct obstruction (GI)
(biliary colic) and promote cholesterol gallstone formation. RUQ pain
after fatty meals calm in 1-2h
Gastric cancer There are 2 morphological variants of gastric adenocarcinoma. The Gastrointe Pathology 1 GI
intestinal type forms a solid mass that projects into the stomach lumen and stinal & (Path)
307 is composed of glandular-forming cuboidal or columnar cells. In contrast, Nutrition
diffuse carcinoma (linitis plastica) infiltrates the stomach wall and (GI)
displays signet-ring cells on light microscopy.
Gastroesophag Gastroesophageal reflux disease is caused primarily by gastroesophageal Gastrointe Pathology 7 GI
eal reflux junction incompetence and can be associated with extraesophageal stinal & (Path)
disease symptoms (eg, nocturnal cough) in the absence of heartburn. Acidic Nutrition
286 gastric contents irritate the esophageal mucosa, leading to characteristic (GI)
histologic findings that include basal zone hyperplasia elongation of the
lamina propria papillae, and scattered eosinophils.

Gastroesophag Pregnant women often develop gastroesophageal reflux disease (GERD) Gastrointe Pathology 7 GI
eal reflux due to elevated levels of estrogen and progesterone, which relax the stinal & (Path)
disease smooth muscle of the lower esophageal sphincter (LES). Later in Nutrition
#### pregnancy, GERD can also develop when the gravid uterus presses on the (GI)
stomach and leads to an altered LES angle or increased gastric pressure,
burning squeezing pain of chest after meal

Gilbert Gilbert syndrome is the likely diagnosis in patients with no apparent liver Gastrointe Pathology 1 GI
syndrome disease who have mild unconjugated hyperbilirubinemia that appears stinal & (Path)
362
provoked by one of the classic triggers (symptoms after fasting) Nutrition
(GI)
Hemangioma Gastrointe Pathology 6 GI
Cavernous hemangioma is the most common benign liver tumor
stinal & (Path)
Microscopically, these tumors consist of cavernous, blood-filled vascular
Nutrition
54 spaces of variable size lined by a single epithelial layer. The biopsy of a
(GI)
suspected hemangioma is not advisable, as the procedure has been known
to cause fatal hemorrhage and is of low diagnostic yield
Hemochromato Hereditary hemochromatosis is most commonly caused by a missense Gastrointe Pathology 5 GI
sis mutation in the HFE gene, resulting in excessive intestinal iron stinal & (Path)
393 absorption and organ damage (eg, cirrhosis, diabetes mellitus, Nutrition
cardiomyopathy, arthropathy) due to iron accumulation within (GI)
parenchymal tissues.
Hemochromato Hereditary hemochromatosis is characterized by excessive intestinal iron Gastrointe Pathology 5 GI
sis absorption with deposition of iron in parenchymal tissues. Cardiac stinal & (Path)
394 (manifestations include diastolic dysfunction (initial), dilated Nutrition
cardiomyopathy (later), and conduction system disease (eg. sinus node (GI)
dysfunction), dark skin
 Hepatitis A Acute hepatitis A is a self-limited infection that typically presents acutely Gastrointe Pathology 4 GI
with prodromal symptoms (eg, fever, malaise, anorexia, nausea-vomiting, stinal & (Path)
366 right upper quadrant pain) followed by signs of cholestasis (eg, jaundice, Nutrition
pruritus, dark-colored urine clay-colored stool). (GI)

Hepatitis A Acute hepatitis due to most hepatotropic viruses (Mexico) causes Gastrointe Pathology 4 GI
hepatocyte (swelling) ballooning degeneration and apoptosis with stinal & (Path)
1863
mononuclear cell infiltration. anorexia, nausea, and dark-colored urine, Nutrition
fever (GI)
Hepatitis B Hepatitis В infection causes the hepatocellular cytoplasm to fill with Gastrointe Pathology 14 GI
hepatitis В surface antigen. These inclusions are highly specific for stinal & (Path)
367
hepatitis В infection and have a finely granular, pale eosinophilic, ground- Nutrition
glass appearance. (GI)
Hepatitis C Intravenous drug use is a major risk factor for hepatitis В and C viral Gastrointe Pathology 4 GI
infection. Acute viral hepatitis is marked by panlobular inflammation and stinal & (Path)
1927 hepatocyte necrosis and ballooning. Cytotoxic T-cell-mediated signals Nutrition
also cause hepatocyte apoptosis with the formation of intensely (GI)
eosinophilic Councilman bodies.
Hepatocellular Gastrointe Pathology 5 GI
Alpha-fetoprotein is a serum tumor marker that is often moderately
cancer stinal & (Path)
elevated in patients with chronic viral hepatitis. However it can be
56 Nutrition
strikingly elevated in those with hepatocellular carcinoma, and a sudden
(GI)
rise can be a sign that a patient with chronic liver disease is harboring HCC
Hepatocellular High levels of dietary aflatoxin exposure is associated with a G:C —► T: Gastrointe Pathology 5 GI
cancer A transversion in codon 249 of the p53 gene, a mutation thought to stinal & (Path)
57
greatly increase the risk of developing hepatocellular carcinoma. China Nutrition
(GI)
Hepatocellular Hepatic angiosarcoma is associated with exposure to carcinogens such as Gastrointe Pathology 5 GI
cancer arsenic, thorotrast, and polyvinyl chloride. Tumor cells express CD 31, stinal & (Path)
471
an endothelial cell marker. Nutrition
(GI)
Hirschsprung Submucosal (Meissner) and myenteric (Auerbach) autonomic plexi are Gastrointe Pathology 2 GI
disease absent in the affected segment of the bowel in Hirschsprung disease. The stinal & (Path)
331
submucosa of the narrowed area is the most superficial layer where the Nutrition
absence of ganglion cells can be seen. (GI)
Hypertrophic Congenital pyloric stenosis arises secondary to hypertrophy of (smooth Gastrointe Pathology 1 GI
pyloric stenosis muscle) the pyloric muscularis mucosae, non-bilious vomiting after stinal & (Path)
128 every meal. prominent peristalsis in the epigastrium and an olive- Nutrition
sized mass on the right upper abdomen. (GI)

Inflammatory Crohn disease typically presents with prolonged diarrhea and abdominal Gastrointe Pathology 9 GI
bowel disease pain. Constitutional symptoms (eg, low-grade fever, fatigue), stinal & (Path)
malabsorption, and weight loss are also common Transmural inflammation Nutrition
404
of the bowel wall may result in the formation of fistulas (eg, (GI)
enteroenteric, enterocutaneous), abscesses, and fibrotic strictures

Inflammatory Noncaseating granulomas are a hallmark of Crohn disease and can help Gastrointe Pathology 9 GI
bowel disease distinguish it from ulcerative colitis, which does not form granulomas. stinal & (Path)
405 Histopathology in Crohn disease also demonstrates transmural Nutrition
inflammation, distortion of the normal architecture, and Paneth cell (GI)
metaplasia.
Inflammatory Granulomas are characterized by a large number of epithelioid Gastrointe Pathology 9 GI
bowel disease macrophages that may fuse together to form multinucleated cells stinal & (Path)
406 (Langhans giant cells) surrounded by a band of lymphocytes Granuloma Nutrition
formation involves chronic Th1 and macrophage activation in response to (GI)
a difficult-to- eradicate antigen.
Inflammatory Crohn disease is an inflammatory bowel disease characterized by patchy Gastrointe Pathology 9 GI
bowel disease inflammation that can occur throughout the entire gastrointestinal tract. stinal & (Path)
407 Gross pathology demonstrates skip lesions, cobblestoning of the mucosa, Nutrition
bowel wall thickening, and creeping fat. (GI)

Inflammatory Crohn disease is characterized by patchy, transmural inflammation of the Gastrointe Pathology 9 GI
bowel disease gastrointestinal tract. It can affect any part of the tract from the mouth to stinal & (Path)
the anus. Complications include strictures (due to bowel wall edema, Nutrition
409
obstruction, fibrosis, and thickening of the muscularis mucosae), (GI)
fistulas (due to penetration of ulcers through the intestinal wall), and
abscesses.
Inflammatory Crohn disease typically presents with the insidious onset of abdominal Gastrointe Pathology 9 GI
bowel disease pain, diarrhea, and constitutional symptoms (eg. weight loss, fever). stinal & (Path)
1783 Patients are prone to developing fistulas/abscesses as the lesions affect the Nutrition
entire thickness of the bowel wall. Perianal disease (eg, skin tags, fissures) (GI)
is also common.
 Intussusception intussusception most often occurs in children younger than 2 years of Gastrointe Pathology 1 GI
age and in the region of the ileocecal valve It manifests with intermittent, stinal & (Path)
416 severe, colicky abdominal pain, "currant jelly" stools, and sometimes a Nutrition
palpable mass in the right lower abdominal quadrant. (GI)

Lynch Hereditary nonpolyposis colon cancer (HNPCC), or Lynch syndrome, leads Gastrointe Pathology 1 GI
syndrome to occurrence of colonic adenocarcinomas at a young age (age <50) stinal & (Path)
429 along with a predisposition for extraintestinal malignancies. Mutations of Nutrition
DNA mismatch repair genes (MSH2) are responsible for HNPCC. Family (GI)
members with cancers
Mallory-Weiss Mallory-Weiss tears account for about 10% of cases of upper Gl Gastrointe Pathology 2 GI
syndrome hemorrhage They occur due to increased intraluminal gastric pressure stinal & (Path)
281
due to retching, vomiting, or other abdominal straining. Nutrition
(GI)
Mesenteric Chronic mesenteric ischemia is characterized by atherosclerosis (HTN, Gastrointe Pathology 1 GI
ischemia hyperlipidemia) of the mesenteric arteries resulting in diminished blood stinal & (Path)
flow to the intestine after meals. This causes postprandial epigastric pain Nutrition
414
(intestinal angina) with associated food aversion/weight loss Its (GI)
pathogenesis is similar to angina (stable) pectoris.

Metastatic liver Malignant hepatic lesions most often represent metastasis from another Gastrointe Pathology 1 GI
disease primary site (eg, breast, lung, colon); primary liver neoplasms (eg, stinal & (Path)
59
hepatocellular carcinoma) are much less common. Nutrition
(GI)
Necrotizing Gastrointe Pathology 1 GI
Necrotizing enterocolitis is one of the most common gastrointestinal
enterocolitis stinal & (Path)
emergencies affecting newborns. It is characterized by bacterial invasion
Nutrition
9920 and ischemic necrosis of the bowel wall, and is associated with prematurity
(GI)
and initiation of enteral feeding. Abdominal x-ray showing pneumatosis
intestinalis (ie. air in the bowel wall) confirms the diagnosis
Pancreatic Gastrointe Pathology 1 GI
Smoking is the most important environmental risk factor for pancreatic
cancer stinal & (Path)
436 cancer. Other risk factors include advanced age chronic pancreatitis, and
Nutrition
genetic predisposition (eg, Peutz-Jeghers syndrome).
(GI)
Peptic ulcer Duodenal ulcers are not associated with an increased risk of carcinoma in Gastrointe Pathology 10 GI
disease the same location. In contrast, ulcers located in the esophagus, stomach stinal & (Path)
130
(gastric), and colon may be malignant, and biopsy is required. Fecal blood Nutrition
test positive (GI)
Peptic ulcer Helicobacter pylori antral gastritis is associated with the formation of Gastrointe Pathology 10 GI
disease duodenal ulcers due to increased gastric acid production. This increase in stinal & (Path)
1603 acidity is caused by unchecked gastrin production due to the destruction Nutrition
of somatostatin-secreting cells in the gastric antrum (GI)

Peptic ulcer Helicobacter pylori produces the enzyme urease, which splits urea into C02 Gastrointe Pathology 10 GI
disease and ammonia and neutralizes the local acidic gastric pH. Active infection stinal & (Path)
can be confirmed through rapid urease testing, in which gastric mucosa is Nutrition
1604 (GI)
evaluated in the presence of urea and a pH indicator. Evidence of
alkalization (due to ammonia formation) is confirmatory

Peptic ulcer Acute Helicobacter pylori infection initially causes nonatrophic antral Gastrointe Pathology 10 GI
disease gastritis and an increased risk for duodenal ulcers. Chronic infection stinal & (Path)
results in patchy, multifocal, atrophic gastritis with loss of parietal cells Nutrition
and G cells in the gastric body; this is associated with decreased acid (GI)
1918 secretion and an increased risk of gastric ulcers, gastric adenocarcinoma,
and MALT lymphoma. mild anemia. Upper gastrointestinal endoscopy
shows diffuse erythema of the antral mucosa. Biopsy reveals an
inflammatory cell infiltrate involving the superficial mucosal layers.

Peptic ulcer Helicobacter pylori is a common cause of peptic ulcers. Duodenal ulcers Gastrointe Pathology 10 GI
disease are associated with heavy colonization in the gastric antrum, whereas stinal & (Path)
7710
colonization in the gastric corpus is associated with gastric ulcers Nutrition
(GI)
Peptic ulcer Peptic ulcers are most commonly caused by Helicobacter pylori infection or Gastrointe Pathology 10 GI
disease nonsteroidal anti-inflammatory drug (NSAID) use. NSAIDs inhibit cyclo- stinal & (Path)
oxygenase-1, leading to increased gastric acid formation, decreased Nutrition
####
mucosal bicarbonate production, and decreased mucosal blood flow, which (GI)
promote mucosal injury and ulcer formation. Duodenal ulcer, mild
gastric erythema
Polymyositis Dermatomyositis is characterized by proximal muscle weakness Gastrointe Pathology 5 GI
and resembling polymyositis (esophageal muscularis propria), with stinal & (Path)
dermatomyositi additional inflammatory features affecting the skin (eg, heliotrope rash, Nutrition
####
s Gottron papules) In both conditions, involvement of striated muscle in (GI)
the oropharynx and heart can lead to dysphagia, pulmonary aspiration, and
myocarditis.
 Porcelain Porcelain gallbladder is a potential manifestation of chronic cholecystitis Gastrointe Pathology 1 GI
gallbladder and is often found in association with multiple gallstones. It is due to stinal & (Path)
dystrophic intramural deposition of calcium salts in the setting of chronic Nutrition
87 inflammation. Porcelain gallbladder is associated with an increased risk of (GI)
adenocarcinoma of the gallbladder. HTN, RUQ mass,
hypercholesterolemia, weight loss

Primary biliary Primary biliary cholangitis is a chronic liver disease characterized by Gastrointe Pathology 4 GI
cholangitis autoimmune destruction of the intrahepatic bile ducts and cholestasis stinal & (Path)
401 (elevated alkaline phosphatase) The condition is most common in middle- Nutrition
aged women, with severe pruritus (especially at night) often one of the first (GI)
reported symptoms.
Primary biliary Gastrointe Pathology 4 GI
Primary biliary cholangitis is an autoimmune disorder that most
cholangitis stinal & (Path)
commonly affects middle-aged women and is characterized by fatigue,
Nutrition
pruritus, jaundice, cholestasis (eg, elevated alkaline phosphatase,
(GI)
403 elevated gamma-glutamyl transferase, direct hyperbilirubinemia), and
antimitochondrial antibodies Histologic findings include dense
lymphocytic portal tract inflammation with granulomatous destruction of
interlobular bile ducts (ie, florid duct lesions).
Reye syndrome Reye syndrome occurs in children with febrile illness treated with Gastrointe Pathology 1 GI
salicylates (aspirin). It consists of hepatic failure and encephalopathy. Fail stinal & (Path)
881 in coma ,Vomiting. The characteristic histological finding is Nutrition
microvesicular steatosis of hepatocytes without inflammation and (GI)
cerebral edema.
Short bowel Short bowel syndrome typically occurs in patients with massive small Gastrointe Pathology 1 GI
syndrome bowel resection and/or Crohn disease due to loss of intestinal absorptive stinal & (Path)
surface area and a decrease in intestinal transit time. Patients usually Nutrition
#### present with postprandial voluminous diarrhea and weight loss due to (GI)
malabsorption. Loss of functional distal ileum may result in vitamin B12
deficiency.

Stress gastric Stress-related mucosal disease is usually caused by local ischemia in the Gastrointe Pathology 1 GI
ulcer setting of severe physiologic stress (eg, shock, extensive burns, sepsis, stinal & (Path)
severe trauma). Ulcers arising in the setting of severe traumaburns are Nutrition
125
called Curling ulcers Ulcers arising from intracranial injury are caused by (GI)
direct vagal stimulation and are called Cushing ulcers.

Systemic Systemic sclerosis may result in esophageal dysmotility and incompetence Gastrointe Pathology 4 GI
sclerosis of the lower esophageal sphincter atrophy and fibrous replacement of stinal & (Path)
284 the esophageal muscularis. This can cause gastroesophageal reflux with Nutrition
an increased risk of Barrett’s esophagus and stricture formation. (GI)

Toxic Toxic megacolon is a well-recognized complication of ulcerative colitis. Gastrointe Pathology 1 GI

megacolon Patients typically present with abdominal pain/distension, bloody diarrhea, stinal & (Path)
410 fever, and signs of shock. Plain abdominal x-ray is the preferred Nutrition
diagnostic imaging study. Barium contrast studies and colonoscopy are (GI)
contraindicated due to the risk of perforation
Vitamin E Vitamin E deficiency can occur in individuals with fat malabsorption Gastrointe Pathology 2 GI
deficiency Deficiency of this fat-soluble vitamin is associated with increased stinal & (Path)
susceptibility of the neuronal and erythrocyte membranes to oxidative Nutrition
1806
stress. Clinical manifestations include ataxia, impaired proprioception (GI)
and vibratory sensation, and hemolytic anemia

Whipple Caused by the gram-positive actinomycete Tropheryma whippelii. Whipple Gastrointe Pathology 2 GI
disease disease is a rare systemic illness that involves the small intestine, joints, stinal & (Path)
and central nervous system. Classic histologic findings include small Nutrition
131
intestine mucosa containing enlarged, foamy macrophages packed with (GI)
both rod-shaped bacilli and PAS-positive. diastase-resistant granules.
(Antibiotics are the Tx)
Whipple The glycoprotein in the cell walls of the actinomycete. Tropheryma Gastrointe Pathology 2 GI
disease whippelii colors magenta with PAS and is diastase-resistant, making this stinal & (Path)
132
stain an excellent choice in evaluating tissue for Whipple disease. Stool Nutrition
loose and weight loss (GI)
Zollinger- Patients with Zollinger-Ellison syndrome develop peptic ulcer disease and Gastrointe Pathology 3 GI
Ellison parietal cell hyperplasia with gastric fold enlargement due to gastrin stinal & (Path)
304
syndrome hypersecretion. Nutrition
(GI)
Zollinger- Zollinger-Ellison syndrome is caused by gastrinomas (neoplasm) located Gastrointe Pathology 3 GI
Ellison in the small intestine/pancreas and presents with peptic ulcers (especially stinal & (Path)
syndrome distal duodenal ulcers), heartburn, and diarrhea. Patients typically have Nutrition
305
elevated gastrin levels that rise in response to exogenous secretin (GI)
administration. In contrast, secretin inhibits release of gastrin from
normal gastric G cells.
 Zollinger- Zollinger-Ellison syndrome is caused by gastrin-secreting tumors Gastrointe Pathology 3 GI
Ellison (gastrinomas) involving the small intestine or pancreas. Patients typically stinal & (Path)
586 syndrome have peptic ulcers (often beyond the duodenal bulb), abdominal Nutrition
pain/acid reflux, and diarrhea. The condition is frequently associated (GI)
with multiple endocrine neoplasia type 1.
Achalasia Gastrointe Pathophysiol 3 GI
Achalasia is caused by reduced numbers of inhibitory ganglion cells in the
stinal & ogy (Patp)
esophageal wall. Esophageal manometry in achalasia shows decreased
828 Nutrition
amplitude of peristalsis in the mid esophagus, with increased tone and
(GI)
incomplete relaxation at the lower esophageal sphincter.
Acute liver Gastrointe Pathophysiol 2 GI
Inhaled anesthetics, such as halothane, can be associated with a highly
failure stinal & ogy (Patp)
lethal fulminant hepatitis that cannot be distinguished histologically from
Nutrition
369 acute viral hepatitis. Patients have significantly elevated aminotransferase
(GI)
levels due to massive hepatocellular injury and a prolonged prothrombin
time due to failure of hepatic synthetic function
Acute Multiple inhibitory mechanisms exist to prevent premature activation of Gastrointe Pathophysiol 9 GI
pancreatitis trypsinogen before it reaches the duodenal lumen, including cleavage stinal & ogy (Patp)
inactivation of trypsin by trypsin itself and production of trypsin inhibitors Nutrition
433
(eg, SPINK1). Gene mutations that render trypsin insensitive to cleavage (GI)
inactivation cause hereditary pancreatitis

Acute Pancreatic zymogens are normally converted into their active form by Gastrointe Pathophysiol 9 GI
pancreatitis trypsin in the duodenal lumen. Premature cleavage of trypsinogen to stinal & ogy (Patp)
441 trypsin within the pancreas leads to uncontrolled activation of these Nutrition
zymogens, causing pancreatic autodigestion and acute pancreatitis. (GI)

Biliary atresia Biliary atresia, or obstruction of extrahepatic bile ducts, presents with Gastrointe Pathophysiol 1 GI
jaundice, dark urine and acholic stools in the first 2 months of life due to stinal & ogy (Patp)
317
conjugated hyperbilirubinemia. Biopsy reveals intrahepatic bile duct Nutrition
proliferation, portal tract edema, and fibrosis. (GI)
Cholecystitis Acute cholecystitis is most often caused by gallstones obstructing the Gastrointe Pathophysiol 5 GI
cystic duct. The diagnosis can be made by identifying signs of gallbladder stinal & ogy (Patp)
inflammation (eg, wall thickening pericholecystic fluid) on Nutrition
80
ultrasonography. When ultrasound is inconclusive, nuclear medicine (GI)
hepatobiliary scanning (ie, cholescintigraphy) can be used to assess
cystic duct patency and make the diagnosis.
Copper Wilson disease is caused by defective copper transport within hepatocytes, Gastrointe Pathophysiol 1 GI
excretion which leads to impaired biliary excretion of copper. Hepatic copper stinal & ogy (Patp)
396 accumulation eventually results in the release of free copper into the Nutrition
bloodstream and copper deposition into extrahepatic tissues (eg, basal (GI)
ganglia, cornea).
Gallstone The absence of normal enteral stimulation in patients receiving total Gastrointe Pathophysiol 8 GI
disease parenteral nutrition leads to decreased cholecystokinin release, biliary stinal & ogy (Patp)
77 stasis, and increased risk of gallstones. Resection of the ileum can also Nutrition
increase the risk of gallstones due to disruption of normal enterohepatic (GI)
circulation of bile acids.
Gallstone Elevated cholesterol concentrations increase the likelihood of cholesterol Gastrointe Pathophysiol 8 GI
disease precipitation and gallstone formation. High levels of bile salts and stinal & ogy (Patp)
78
phosphatidylcholine increase cholesterol solubility and decrease the risk of Nutrition
gallstones. (GI)
Gallstone Patients with Crohn disease affecting the terminal ileum (most common Gastrointe Pathophysiol 8 GI
disease site of involvement, increased bile acid wasting) are prone to developing stinal & ogy (Patp)
412 gallstones. Decreased bile acid reabsorption by the inflamed terminal ileum Nutrition
promotes cholesterol supersaturation of the bile, resulting in gallstone (GI)
formation.
Gastrectomy Intrinsic factor (IF) is a glycoprotein that is normally secreted by parietal Gastrointe Pathophysiol 1 GI
cells in the stomach and is necessary for the absorption of vitamin B12 stinal & ogy (Patp)
1605 (water soluble) in the ileum. Patients who have undergone a total Nutrition
gastrectomy require lifelong vitamin Bi2 supplementation due to inability to (GI)
produce IF.
Gastroesophag Gastrointe Pathophysiol 7 GI
New-onset odynophagia in the setting of chronic gastroesophageal reflux
eal reflux stinal & ogy (Patp)
#### disease should raise suspicion for erosive esophagitis with esophageal
disease Nutrition
ulcers. Diagnosis is made by upper endoscopy.
(GI)
Gastroparesis Diabetic gastroparesis results from the destruction of enteric neurons due Gastrointe Pathophysiol 2 GI
to chronic hyperglycemia, leading to impaired relaxation and disordered stinal & ogy (Patp)
#### and ineffective peristalsis. This causes delayed gastric emptying, which Nutrition
presents as postprandial fullness, regurgitation of undigested food nausea, (GI)
and vomiting.
 Hemochromato Hereditary hemochromatosis is characterized by increased intestinal iron Gastrointe Pathophysiol 5 GI
sis absorption with deposition of excess iron in parenchymal tissues Men stinal & ogy (Patp)
typically develop manifestations in their 30s and 40s. However, Nutrition
391
premenopausal women have ongoing blood and iron losses due to (GI)
menstruation, which partially offsets the excess iron absorption and
delays the onset of symptoms
Hepatic Hepatic encephalopathy is caused by increased levels of ammonia and Gastrointe Pathophysiol 2 GI
encephalopathy other neurotoxins in the circulation that lead to increased inhibitory stinal & ogy (Patp)
neurotransmission and impaired excitatory neurotransmitter release. Nutrition
102
Hepatic encephalopathy is frequently precipitated by a stressor (eg. (GI)
gastrointestinal bleeding infection) that increases blood ammonia levels

Hepatitis B Acute hepatitis В infection can cause a serum sickness-like syndrome Gastrointe Pathophysiol 14 GI
with joint pain, lymphadenopathy, and a pruritic urticarial rash Other stinal & ogy (Patp)
365
features may include right upper quadrant pain, hepatomegaly, and Nutrition
elevated hepatic transaminase levels. (GI)
Hepatitis B Hepatitis В virus does not have a cytotoxic effect itself; however, the Gastrointe Pathophysiol 14 GI
presence of viral HBsAg and HBcAg on the cell surface stimulate the stinal & ogy (Patp)
375
host’s cytotoxic CD8+ T lymphocytes to destroy infected hepatocytes. Nutrition
(GI)
Hereditary Dubin-Johnson syndrome is a benign disorder characterized by defective Gastrointe Pathophysiol 1 GI
hyperbilirubine hepatic excretion of bilirubin glucuronides across the canalicular stinal & ogy (Patp)
mia membrane, resulting in direct hyperbilirubinemia and jaundice. Grossly, Nutrition
101
the liver appears black due to impaired excretion of epinephrine (GI)
metabolites, which histologically appear as dense pigments within
lysosomes.
Inflammatory Crohn disease is associated with oxalate kidney stones. Impaired bile acid Gastrointe Pathophysiol 9 GI
bowel disease absorption in the terminal ileum leads to loss of bile acids in feces with stinal & ogy (Patp)
subsequent fat malabsorption. Intestinal lipids then bind calcium ions, and Nutrition
408 the resulting soap complex is excreted Free oxalate (normally bound by (GI)
calcium to form an unabsorbable complex) is absorbed and forms
urinary calculi (enteric oxaluria).

Kernicterus Crigler-Najjar syndrome is an autosomal recessive disorder of bilirubin Gastrointe Pathophysiol 1 GI

metabolism caused by a genetic lack of the UGT enzyme needed to stinal & ogy (Patp)
363 catalyze bile glucuronidation. Unconjugated hyperbilirubinemia develops Nutrition
in these infants, causing kernicterus and often death (GI)

Lactose Lactose intolerance presents with flatulence, crampy abdominal pain, and Gastrointe Pathophysiol 3 GI
intolerance watery diarrhea after dairy product consumption. It can be acquired by stinal & ogy (Patp)
inflammatory/infectious conditions that injure the mucosal brush border of Nutrition
133
the small intestine where lactase is expressed. Studies can show increased (GI)
breath hydrogen content, reduced stool pH, and elevated stool osmolality

Lactose The small bowel mucosa of patients with primary lactase deficiency is Gastrointe Pathophysiol 3 GI
intolerance normal on histologic examination. stinal & ogy (Patp)
134
Nutrition
(GI)
Malabsorption Malabsorption is a syndrome of impaired intestinal digestion and Gastrointe Pathophysiol 4 GI
absorption. Fats are typically the most severely affected macronutrient in stinal & ogy (Patp)
323 gen malabsorption, and testing the stool for fat (e.g.with Sudan III stain) is Nutrition
the most sensitive strategy for screening for malabsorptive disorders. (GI)

Malabsorption Monosaccharides can be absorbed directly. D-xylose is a monosaccharide Gastrointe Pathophysiol 4 GI

whose absorption is not affected by exocrine pancreatic insufficiency, and stinal & ogy (Patp)
1907
can be used to differentiate between pancreatic versus mucosal causes of Nutrition
malabsorption. (GI)
Malabsorption Crohn disease with ileal resection or extensive ileal involvement can Gastrointe Pathophysiol 4 GI
cause bile acid malabsorption, which may lead to impaired absorption stinal & ogy (Patp)
of fat- soluble vitamins (A, D. E. K). Vitamin К deficiency can result in Nutrition
#### impaired coagulation with easy bruising, large hematoma formation in (GI)
deep tissues and joints (eg hemarthrosis) after minor trauma, and
prolonged bleeding after surgery

Mallory-Weiss A Mallory-Weiss tear is a tear in the gastric mucosa near the Gastrointe Pathophysiol 2 GI
syndrome gastroesophageal junction. It typically results from repetitive forceful stinal & ogy (Patp)
1662
vomiting, which can also cause metabolic alkalosis Nutrition
(GI)
Mastocytosis Systemic mastocytosis is characterized by the abnormal proliferation of Gastrointe Pathophysiol 1 GI
mast cells and increased histamine release Histamine causes stinal & ogy (Patp)
306 hypersecretion of gastric acid by parietal cells in the stomach as well as a Nutrition
variety of other symptoms (eg, hypotension, flushing, pruritus) (GI)
 Primary biliary PBC is a chronic AI liver disease Chx by lymphocytic infiltrates and Gastrointe Pathophysiol 4 GI
cholangitis destruction of small and mid-sized intrahepatic bile ducts. Similar findings stinal & ogy (Patp)
402
are seen in hepatic GVHD, highlighting the immunologic etiology of the Nutrition
disorder. (GI)
Small intestinal Gastric bypass surgery can cause small intestinal bacterial overgrowth Gastrointe Pathophysiol 1 GI
bacterial (SIBO) due to excessive bacterial proliferation in the blind-ended stinal & ogy (Patp)
#### overgrowth gastroduodenal segment. SIBO results in deficiency of most vitamins (B12, Nutrition
A, D and E) and iron, but increased production of folic acid and vitamin (GI)
K.
Vitamin A Vitamin A deficiency causes night blindness and hyperkeratosis. Gastrointe Pathophysiol 1 GI
deficiency Deficiency of this fat-soluble vitamin can develop in patients with biliary stinal & ogy (Patp)
1581
disorders, exocrine pancreatic insufficiency, or intestinal malabsorption. Nutrition
(GI)
Vitamin B12 Pernicious anemia is an autoimmune disease characterized by CD4+ cell- Gastrointe Pathophysiol 9 GI
deficiency mediated destruction of parietal cells. As parietal cells are destroyed, stinal & ogy (Patp)
their ability to secrete hydrochloric acid decreases, resulting in an elevated Nutrition
#### intraluminal pH that leads to upregulation of gastrin secretion. Patients (GI)
also develop vitamin B12 deficiency as a result of decreased intrinsic factor
secretion.
Zenker Gastrointe Pathophysiol 1 GI
Diminished relaxation of cricopharyngeal muscles during swallowing
diverticulum stinal & ogy (Patp)
results in increased intraluminal pressure in the oropharynx. This may
Nutrition
eventually cause the mucosa to herniate through a zone of muscle
279 (GI)
weakness in the posterior hypopharynx, forming a Zenker (false)
diverticulum, which presents in elderly patients with oropharyngeal
dysphagia, halitosis, regurgitation, and recurrent aspiration.
Achalasia Achalasia is caused by loss of inhibitory ganglion cells in the distal Gastrointe Pharmacolog 3 GI
esophageal wall and is characterized by the absence of esophageal stinal & y (Phar)
peristalsis and incomplete relaxation of a hypertonic lower esophageal Nutrition
####
sphincter. Botulinum toxin prevents acetylcholine release into the (GI)
neuromuscular synapse, resulting in inhibition of cholinergic neurons and
lower esophageal sphincter relaxation
Acute diarrhea Children with watery diarrhea should be treated with oral rehydration Gastrointe Pharmacolog 13 GI
solutions containing hypotonic, equimolar concentrations of sodium and stinal & y (Phar)
####
glucose solution to help prevent dehydration and electrolyte abnormalities. Nutrition
(GI)
Antiemetics 5-HT3 receptor antagonists are useful for the treatment of visceral nausea Gastrointe Pharmacolog 1 GI
due to gastrointestinal insults, such as gastroenteritis, chemotherapy, and stinal & y (Phar)
#### general anesthesia Antihistamines and anticholinergics are recommended Nutrition
for vestibular nausea Dopamine antagonists are useful for nausea (GI)
associated with migraine
Carcinoid Carcinoid syndrome may accompany extraintestinal metastases of Gastrointe Pharmacolog 4 GI
tumors gastrointestinal carcinoid tumors. Octreotide is a synthetic somatostatin stinal & y (Phar)
309
analog used to control the symptoms of carcinoid syndrome Nutrition
(GI)
Cirrhosis Treatments for hepatic encephalopathy include lactulose (increases Gastrointe Pharmacolog 7 GI
conversion of ammonia to ammonium) and rifaximin (decreases stinal & y (Phar)
####
intraluminal ammonia production). Nutrition
(GI)
Clostridium Closthdium difficile infection can be treated with oral vancomycin or Gastrointe Pharmacolog 7 GI
difficile fidaxomicin. Fidaxomicin is a macrocyclic antibiotic that inhibits RNA stinal & y (Phar)
####
infection polymerase It is bactericidal against C difficile. Nutrition
(GI)
Constipation Polyethylene glycol is an osmotic laxative. Diarrhea associated with Gastrointe Pharmacolog 3 GI
lactase deficiency is also osmotic and occurs due to accumulation of stinal & y (Phar)
nonabsorbable lactose in the intestinal lumen. Magnesium hydroxide (and Nutrition
865 other magnesium-containing compounds, such as magnesium citrate) is (GI)
another osmotic laxative that is often used, although its efficacy is
questionable and there is not enough evidence to support its widespread
use
Cystic fibrosis In a young Caucasian patient, the combination of recurrent respiratory Gastrointe Pharmacolog 11 GI
infections with Pseudomonas aeruginosa, diarrhea, and failure to thrive stinal & y (Phar)
suggests a diagnosis of cystic fibrosis Cystic fibrosis causes steatorrhea and Nutrition
808
failure to thrive due to malabsorption secondary to pancreatic (GI)
insufficiency, which can be corrected by pancreatic enzyme
supplementation.
Dyslipidemia Gemfibrozil (and other fibrates) can reduce cholesterol solubility and Gastrointe Pharmacolog 11 GI
promote gallstone formation by reducing bile acid synthesis. Caution stinal & y (Phar)
164
should be used when prescribing fibrate therapy to patients with underlying Nutrition
gallbladder disease. (GI)
 Gallstone Gastrointe Pharmacolog 8 GI
Medical therapy (Bile acid supplement) to dissolve cholesterol
disease stinal & y (Phar)
gallstones is an option in patients refusing cholecystectomy or with high
Nutrition
#### surgical risk. Hydrophilic bile acids (eg, ursodeoxycholic acid) improve
(GI)
cholesterol solubility by reducing the amount of cholesterol secreted into
the bile and increasing biliary bile acid concentration
Gastroesophag Gastrointe Pharmacolog 7 GI
Management of gastroesophageal reflux disease includes lifestyle and
eal reflux stinal & y (Phar)
dietary modifications (eg. weight loss, tobacco avoidance) and medications
disease Nutrition
#### such as proton pump inhibitors (PPIs) (eg. pantoprazole, omeprazole) or
(GI)
histamine 2 receptor antagonists (eg, ranitidine). PPIs irreversibly inhibit
the H7K+ ATPase on parietal cells, which decreases gastric acid secretion.
Gastroesophag Magnesium salts and aluminum hydroxide are basic mineral salts used to Gastrointe Pharmacolog 7 GI
eal reflux neutralize gastric acid and relieve gastroesophageal reflux symptoms. Side stinal & y (Phar)
#### disease effects include diarrhea and constipation, respectively. Therefore, these Nutrition
medications are often combined to offset (reduce) the adverse effects of (GI)
the individual medications.
Gastroparesis Erythromycin stimulates upper gastrointestinal motility by acting as an Gastrointe Pharmacolog 2 GI
agonist on motilin receptors in the muscularis externa Therefore, it can stinal & y (Phar)
6705 be used to treat gastroparesis (ie. delayed gastric emptying), a condition Nutrition
that frequently occurs in patients with long standing diabetes mellitus (GI)

GI surgery Gastrointe Pharmacolog 1 GI

Iron absorption occurs predominantly in the duodenum and proximal
stinal & y (Phar)
jejunum Bypass of this segment of small bowel by gastrojejunostomy
Nutrition
results in iron deficiency anemia that can be corrected with pharmacologic
7584 (GI)
iron supplementation Malabsorption of vitamin B12: folate fat-soluble
vitamins (especially vitamin D), and calcium may also be observed
following gastric bypass procedures.
Irritable bowel Diphenoxylate is an opioid antidiarrheal drug that binds mu opiate Gastrointe Pharmacolog 1 GI
syndrome receptors in the gut to slow motility. Overuse can lead to euphoria and stinal & y (Phar)
1290 physical dependence. To discourage abuse, diphenoxylate is combined Nutrition
with atropine, which induces adverse effects if taken in high doses. (GI)

Liver Simvastatin decreases hepatic cholesterol production, while Gastrointe Pharmacolog 1 GI

cholesterol cholestyramine increases hepatic cholesterol and bile acid synthesis. stinal & y (Phar)
165
production Combination therapy results in a synergistic reduction in plasma LDL Nutrition
level. (GI)
Motion Antimuscarinic agents and antihistamines with antimuscarinic action are Gastrointe Pharmacolog 1 GI
sickness most effective for motion sickness prevention.(Dry mouyh) stinal & y (Phar)
175
Nutrition
(GI)
Nausea and Ondansetron inhibits serotonin (5-HT3) receptors and is used primarily to Gastrointe Pharmacolog 2 GI
vomiting treat nausea and vomiting following chemotherapy. 5-HT3 receptors are stinal & y (Phar)
located peripherally in the presynaptic nerve terminals of the vagus nerve Nutrition
1817
in the gastrointestinal tract. These receptors are also present centrally in the (GI)
chemoreceptor trigger zone and the solitary nucleus and tract.

Opioids Opioid analgesics can cause contraction of smooth muscles in the sphincter Gastrointe Pharmacolog 14 GI
of Oddi, leading to ↑ pressures in the CBD and the gallbladder. stinal & y (Phar)
1258
Nutrition
(GI)
Peptic ulcer Proton pump inhibitors (eg. omeprazole, lansoprazole) block the final Gastrointe Pharmacolog 10 GI
disease common pathway of gastric acid secretion from parietal cells, which is stinal & y (Phar)
1766
stimulated by acetylcholine, histamine and gastrin. Nutrition
(GI)
Peptic ulcer Most duodenal peptic ulcers are caused by Helicobacter pylori infection. Gastrointe Pharmacolog 10 GI
disease The most effective method to prevent disease recurrence is to eradicate the stinal & y (Phar)
infection with antibiotics (eg tetracycline, metronidazole), typically in Nutrition
1778
combination with proton pump inhibitors (eg, omeprazole) and. often, (GI)
bismuth subsalicylate (quadruple therapy).

Route of Bioavailability refers to the fraction of administered drug that reaches the Gastrointe Pharmacolog 2 GI
administration systemic circulation in a chemically unchanged form. Bioavailability for a stinal & y (Phar)
& drug administered by a non-intravenous route is always less than 1. It can Nutrition
1709
bioavailability be determined by examining a graph of plasma concentration versus time (GI)
and then applying the formula: F = (AUC oral x dose IV) / (AUC IV x dose
oral)
 Active Parietal cells release hydrogen ions into the gastric lumen by means of the Gastrointe Physiology 1 GI
transport H/K ATPase which requires hydrolysis of ATP and is therefore an active stinal & (Phys)
transpoit mechanism. Omeprazole and other proton pump inhibitors Nutrition
1358
suppress the activity of the gastric parietal cell H/K ATPase leading to an (GI)
increase in the pH of the gastric lumen

Breastfeeding The breast milk content of vitamins D and К is typically insufficient for Gastrointe Physiology 1 GI
the nutritional needs of the newborn. Vitamin К is given parenterally to stinal & (Phys)
all newborns at birth to prevent hemorrhagic disease of the newborn. Nutrition
1926
Exclusively breastfed infants require vitamin D supplementation due to (GI)
lack of sunlight exposure and to prevent rickets

Cholecystitis Gastrointe Physiology 5 GI

Cholecystokinin (CCK) is the hormone responsible for gallbladder
stinal & (Phys)
1319 contraction It is made in the duodenum and jejunum in response to fatty
Nutrition
acids and amino acids
(GI)
Gastrointestinal Secretin is produced by S cells in the duodenal mucosa in response to Gastrointe Physiology 2 GI
hormones stimulation by intraluminal acidity Secretin stimulates the release of stinal & (Phys)
1546 bicarbonaterch secretions from the exocrine pancreas which is the major Nutrition
source of acid-neutralizing bicarbonate enteiing the duodenum. (GI)

Intestinal phase The cephalic and gastric phases stimulate gastric acid secretion, while Gastrointe Physiology 1 GI
intestinal influences tend to reduce gastric acid secretion. stinal & (Phys)
126
Nutrition
(GI)
Malabsorption The duodenal brush border enzyme enteropeptidase activates triypsin from Gastrointe Physiology 4 GI
its inactive precursor, trypsinogen. Triypsin degrades complex polypeptides stinal & (Phys)
to dipeptides, tripeptides, and amino acids while activating other pancreatic Nutrition
1251
enzymes. Enteropeptidase deficiency impairs both protein and fat (GI)
absorption, leading to diarrhea, failure to thrive, and
hypoproteinemia
Pancreatic Duodenal S-cells secrete secretin in response to increasing H' Gastrointe Physiology 1 GI
secretion concentrations. Secretin increases pancreatic bicarbonate secretion. stinal & (Phys)
1971
The chloride content of pancreatic secretions decreases in proportion to Nutrition
bicarbonate concentration increases (GI)
PPI Elevated gastric pH stimulates secretion of gastrin, a polypeptide hormone Gastrointe Physiology 1
that increases gastric acid production. Proton pump inhibitors block stinal & (Phys)
gastric acid production by parietal cells; the resultant increase in pH Nutrition
####
leads to hypergastrinemia, which can cause rebound hypersecretion of (GI)
gastric acid when the drug is withdrawn.

VIPoma VIPomas are pancreatic islet cell tumors that hypersecrete vasoactive Gastrointe Physiology 1 GI
intestinal peptide (VIP), which increases intestinal chloride loss into the stinal & (Phys)
stool and causes excess losses of the accompanying water, sodium, and Nutrition
1938
potassium. VIP also inhibits gastric acid secretion. Somatostatin (GI)
inhibits the secretion of VIP and is used to treat the symptoms of
VIPoma
Lymphatic In the lower extremities, the superficial lymphatic system is divided into General Anatomy 2 GP
drainage medial and lateral tracks. The medial track runs up to the superficial Principles (Anat)
inguinal lymph nodes, bypassing the popliteal nodes. Consequently, lesions (GP)
####
on the medial foot cause inguinal lymphadenopathy, whereas lateral lesions
are more likely to cause lymphadenopathy in both the popliteal and
inguinal areas.
Health Capitation is an arrangement in which a payor pays a fixed, predetermined General Behavioral 3 GP
insurance fee to provide all the services required by a patient. Payors may negotiate a Principles Science
8456 capitated contract with an insurance company that then pays the providers, (GP) (Beha)
or a large medical group may negotiate directly with the payor.

Interviewing Open-ended questions are the most effective way to begin a medical General Behavioral 1 GP
technique interview. Once the patient provides an initial history, the physician can Principles Science
1432
use closed-ended and follow-up questions to clarify certain points and fill (GP) (Beha)
gaps in the history.
Medical errors Risk of wrong-site surgery can be reduced by requiring "dual identifiers" General Behavioral 8 GP
(usually a nurse and physician) to independently confirm that they have the Principles Science
####
correct patient, site, and procedure. Checks must be truly independent to (GP) (Beha)
ensure patient safety.
Medical errors A preventable adverse event is defined as injury to a patient due to failure General Behavioral 8 GP
#### to follow evidence-based best practice guidelines. Principles Science
(GP) (Beha)
Calcium and Synchronization of glycogen degradation with skeletal muscle contraction General Biochemistr 1 GP
glycogen occurs due to release of sarcoplasmic calcium following neuromuscular Principles y (Bioc)
1028 phosphorylase stimulation. Increased intracellular calcium causes activation of (GP)
phosphorylase kinase, stimulating glycogen phosphorylase to increase
glycogenolysis.
 Collagen Glycine is the most abundant amino acid in collagen. The triple helical General Biochemistr 1 GP
structure conformation of collagen molecules occurs due to the repetitive amino Principles y (Bioc)
1248
acid sequence within each alpha chain, in which glycine (Gly) occupies (GP)
every third amino acid position (Gly-X-Y).
Compartment As an antioxidant, superoxide dismutase neutralizes reactive oxygen General Biochemistr 2 GP
syndrome species, preventing cell injury. In a pathologic state such as post-ischemic Principles y (Bioc)
#### reperfusion, oxidative stress is high and reactive oxygen species production (GP)
exceeds the neutralizing capability of antioxidants, leading to increased cell
damage and death.
DNA DNA replication occurs in the 5'+3' direction on both strands. In contrast to General Biochemistr 3 GP
replication the continuous synthesis of the leading strand, lagging strand synthesis Principles y (Bioc)
occurs discontinuously and is composed of short stretches of RNA primer (GP)
1419
plus newly synthesized DNA segments (Okazaki fragments). As a result,
lagging strand synthesis requires the repetitive action of DNA primase and
DNA ligase.
DNA Bloom syndrome is a rare autosomal recessive condition caused by General Biochemistr 3 GP
replication mutations in the BLM gene encoding helicase, an enzyme that unwinds the Principles y (Bioc)
double helix during DNA replication. Patients typically present with (GP)
1436
growth retardation, facial anomalies, photosensitive skin rash, and
immunodeficiency due to chromosomal instability and breakage.

Enzyme Competitive inhibitors compete with substrate for active binding sites on General Biochemistr 1 GP
kinetics enzymes. Additional substrate is required to achieve the same rate of Principles y (Bioc)
reaction, increasing the measured value of the Michaelis constant (Km). (GP)
####
Competitive inhibitors do not affect enzyme function; therefore, maximal
velocity (Vmax) is unchanged in their presence.

Eukaryotic Multiple origins of replication make eukaryotic DNA replication quick and General Biochemistr 1 GP
1437 DNA effective despite the large size and complexity of the genome compared to Principles y (Bioc)
replication that of prokaryotic organisms. (GP)
Exonuclease In prokaryotes, DNA polymerase I has 5' to 3' exonuclease activity in General Biochemistr 2 GP
addition to 5' to 3' polymerase and 3 to 5' exonuclease activities. This 5' to Principles y (Bioc)
1434 3' exonuclease activity functions to remove the RNA primer created by (GP)
RNA primase and repair damaged DNA sequences.

Exonuclease All 3 prokaryotic DNA polymerases can remove mismatched nucleotides General Biochemistr 2 GP
via their 3 to 5 exonuclease ("proofreading") activity. Only DNA Principles y (Bioc)
1435
polymerase i has 5' to 3' exonuclease activity. which is used to remove the (GP)
RNA primer synthesized by RNA primase.
Lactic acidosis In the presence of oxygen, Pyruvate produced during glycolysis is General Biochemistr 1 GP
converted by Pyruvate dehydrogenase to acetyl coenzyme A, which is Principles y (Bioc)
subsequently metabolized by oxidative phosphorylation. However, if (GP)
996
inadequate oxygen is present in the tissues, pyruvate is converted to lactate
by lactate dehydrogenase, leading to lactic acidosis.

Lysosomal Protein targeting is the process by which proteins with different intra- and General Biochemistr 1 GP
storage extracellular fates reach their destination. Proteins destined for the Principles y (Bioc)
#### disorder lysosome require phosphorylation of specific mannose residues to ensure (GP)
proper transit through the Golgi apparatus.

mRNA When mRNA is first transcribed from DNA, it is in an unprocessed form General Biochemistr 1 GP
processing and called pre-mRNA or heterogeneous nuclear mRNA (hnRNA). Several Principles y (Bioc)
regulation processing steps are required before finalized mRNA molecules can (GP)
2035 leave the nucleus, including 5'-capping, poly A tail addition, and intron
splicing. Cytoplasmic P bodies play an important role in mRNA
translation regulation and mRNA degradation.

Polymerase Reverse transcription polymerase chain reaction (RT-PCR) is used to General Biochemistr 2 GP
chain reaction detect and quantify levels of mRNA in a sample. It uses reverse Principles y (Bioc)
transcription to create a complementary DNA template that is then (GP)
#### amplified using the standard PCR procedure. RT-PCR can be used to
diagnose chronic myelogenous leukemia by identifying an mRNA
transcript containing both BCR and ABL exons in affected cells.

RNA structure The 3' CCA tail of tRNA serves as the amino acid binding site. Aminoacyl General Biochemistr 2 GP
& function tRNA synthetase is the enzyme responsible for "loading" the appropriate Principles y (Bioc)
1428
amino acid to the 3' terminal hydroxyl group of the CCA tail. (GP)

Second After a ligand binds to a G protein-coupled receptor that activates General Biochemistr 2 GP
messengers phospholipase C, membrane phospholipids are broken down into Principles y (Bioc)
995 diacylglycerol (DAG) and inositol triphosphate (IP3). Protein kinase C is (GP)
subsequently activated by DAG and calcium; the latter is released from the
endoplasmic reticulum under the influence of IP3.
 Southwestern Southwestern blotting is used to detect DNA-binding proteins such as General Biochemistr 1 GP
2044 blot transcription factors, nucleases, and histones. Principles y (Bioc)
(GP)
Transamination Transamination reactions typically occur between an amino acid and an a- General Biochemistr 1 GP
keto acid. The amino group from the amino acid is transferred to the a-keto Principles y (Bioc)
acid, and the a-keto acid in turn becomes an amino acid. Pyridoxal (GP)
1482
phosphate( Pyridoxine) (active vitamin B ) serves as a cofactor in amino
acid transamination and decarboxylation reactions.

Translation Short non-coding RNA sequences (eg, microRNA and small interfering General Biochemistr 1 GP
RNA) induce posttranscriptional gene silencing by base-pairing with Principles y (Bioc)
####
complementary sequences within target mRNA molecules. (GP)

tRNA structure Transfer RNA (tRNA) is a small, noncoding form of RNA that contains General Biochemistr 1 GP
chemically modified bases (eg, dihydrouridine, ribothymidine, Principles y (Bioc)
pseudouridine). tRNA has a CCA sequence at its 3'-end that is used as a (GP)
2037
recognition sequence by proteins. The 3' terminal hydroxyl group of the
CCA tail serves as the amino acid binding site.

tRNA wobble The genetic code is considered "degenerate" because more than 1 codon General Biochemistr 1 GP
can code for a particular amino acid. Some of this degeneracy is explained Principles y (Bioc)
by the wobble hypothesis, which states that the first 2 nucleotide positions (GP)
1424 on the mRNA codon require traditional (Watson-Crick) base pairing,
whereas the third "wobble" nucleotide position may undergo less stringent
(nontraditional) base pairing.

Predictive NPV is the probability of not having a disease when the test result is (-). General Biostatistics 3 GP
values The NPV will varywith the pretest probability of a disease. A ptwith a high Principles (Bios)
1190 probability of having a disease will have a low NPVwith a (-) test, but a (GP)
ptwith a low probability of having a disease will have a high NPVwith a (-)
test.
Achondroplasia Achondroplasia is an AD disorder that results in a GOF mut in the FGFR3 General Genetics 2 GP
gene. Most individuals affected by AD disorders are heterozyg and have a Principles (Gene)
701
50% chance of transmitting the mut to their offspring. (GP)

Aging Crit shortening in telomere length can signal for programmed cell death. General Genetics 8 GP
Telomerase is a reverse transcriptase (RNA-dependent DNA polymerase) Principles (Gene)
that lengthens telomeres by adding TTAGGG repeats to the 3' end of (GP)
1438
chroms. SCs have long telomeres due to high telomerase activity, allowing
them to proliferate indefinitely in a controlled manner.

Aneuploidy Common findings in DS include cognitive impairment, facial General Genetics 1 GP

dysmorphism, and cardiac defects; 95% of cases are caused by the Principles (Gene)
1610 presence of an extra chromosome 21 (trisomy) resulting from (GP)
nondisjunction. Unbalanced Robertsonian translocations or mosaicism are
less common causes.
Autosomal The prob that an AR disease will be transmitted to a child can be calculated General Genetics 5 GP
recessive based on the maternal and paternal pedigrees. An unaffected individual (w/ Principles (Gene)
1790 inheritance unaffected parents) who has a sibling affected by an AR condition has a (GP)
2/3 chance of being a carrier for that condition.

Autosomal SCA is an AR disease that results in recurrent episodes of anemia, General Genetics 5 GP
recessive jaundice, and painful swelling of the hands and feet. Offspring of carrier Principles (Gene)
#### inheritance parents have a 25% chance of being affected and a 50% chance of being (GP)
heterozyg carriers, resulting in a 75% change of inheriting at least 1 mut
allele.
Cell cycle Nondisjxn is the failure of chrom pairs to separate properly during cell General Genetics 2 GP
division. This could be due to a failure of homologous chroms to separate Principles (Gene)
8328
in meiosis I or a failure of sister chromatids to separate during meiosis II or (GP)
mitosis.
DNA Genomic imprinting refers to the phenomenon in which an offspring's General Genetics 1 GP
methylation genes are expressed in a parent-specific manner. Genomic imprinting is Principles (Gene)
7791 caused by DNA meth, an epigenetic process in which genes can be (GP)
silenced by attaching methyl groups to cytosine residues in the DNA
molecules.
DNA DNA synth can occur only in the 5' --> 3' direction. Okazaki fragments are General Genetics 3 GP
replication short stretches of newly synth DNA that're separated by RNA primers. Principles (Gene)
1418
They're formed by the discontinuous synth of DNA on the lagging strand (GP)
during replication.
DNA structure Nucleosomes are composed of DNA wrapped around a core of 8 histone General Genetics 2 GP
& function proteins (2 molecules each of H2A, H2B, H3, and H4). H1 histone is Principles (Gene)
1472 located outside of this histone core and helps package nucleosomes into (GP)
more compact structures by binding and linking the DNA b/w adjacent
nucleosomes.
 DNA structure X-inact occurs in genetically normal females and results in conversion of General Genetics 2 GP
& function the inact X chrom into compact heterochrom (Barr body). Heterochrom is Principles (Gene)
condensed chromatin composed of heavily meth DNA in tight a/w deacet (GP)
1486
histones. It has a low lvl of transcriptional activity. In contrast, euchrom
is loosely arranged and exhibits a high lvl of transcriptional activity.

Enhancer Enhancers and silencers may be located upstream, downstream, or within a General Genetics 1 GP
sequence transcribed gene; these gene sequences function to increase and decrease Principles (Gene)
2025 the rate of transcription, respectively. In contrast, promoter regions are (GP)
typically located 25 or 75 bases upstream from their associated genes and
function to initiate transcription.
Huntington An increased number of trinucleotide repeats on the HTT gene is General Genetics 5 GP
disease associated with Huntington disease. The larger the number of repeats, the Principles (Gene)
633 earlier the onset of the disease. Trinucleotide expansion occurs more (GP)
frequently during paternal transmission, causing a genetic phenomenon
called anticipation.
Mitochondrial Mitochondrial dysfxn freq Pxwith myopathy, NS dysfxn, lactic acidosis, General Genetics 4 GP
disorders and ragged red fibers on muscle Bx. Mitochondrial myopathies due to Principles (Gene)
#### mtDNA muts are inherited solely in a maternal fashion (i.e. maternal (GP)
inheritence). Therefore, transmission occurs only thru affected females and
never thru males.
Multifactorial Many freq encountered diseases (e.g. HTN, spinal bifida) display General Genetics 1 GP
inheritance multifactorial inheritance, which involves the complex interaction of Principles (Gene)
numerous genetic and environmental factors to determine phenotypically (GP)
####
expression. Although the exact inheritance risk can't be determined, the
closer a relative is to the affected person, the more likely the relative is to
develop the trait.
Mutations Deletion or addn of a # of bases that's not divisible by 3 in the coding General Genetics 3 GP
region of a gene will cause a frameshift mut. Frameshift muts alter the Principles (Gene)
1412
reading frame of the genetic code, resulting in the formation of nonfxnal (GP)
proteins.
Mutations DMD Pxwith progr prox muscle weakness in young boys due to incr General Genetics 3 GP
muscle fiber degen. It's caused by frameshift muts (most common) or Principles (Gene)
nonsense muts in the dystrophin gene that lead to the formation of a (GP)
1487
truncated, defective protein. Nonsense muts intro premature stop codons
(e.g. UAA, UAG, UGA) in the coding seq of mRNA.

Mutations A frameshift mutation occurs with the deletion/addition of a number of General Genetics 3 GP
bases not divisible by 3 in the coding region of a gene. Frameshift Principles (Gene)
2027 mutations alter the reading frame of the genetic code, dramatically (GP)
changing the protein structure and often resulting in the formation of a
premature stop codon.
Pleiotropy Pleiotropy describes instances where multiple phenotypic manifestations General Genetics 1 GP
1970 result from a single genetic mutation. Most syndromic genetic illnesses Principles (Gene)
exhibit pleiotropy. (GP)
Poly A tail The poly-A tail isn't transcribed from DNA; instead, it's added as a PTM General Genetics 1 GP
downstream of the consensus seq (AAUAAA) located near the 3' end of Principles (Gene)
2033
the mRNA molecule. This tail protects mRNA from degradationwithi the (GP)
cytoplasm after it exits the nucleus.
Releasing RFs recog stop codons (e.g. UAA, UAG, and UGA) and terminate protein General Genetics 1 GP
factors synthesis. They facilitate release of the polypeptide chain from the Principles (Gene)
2029
ribosome and dissolution of the ribosome-mRNA complex. (GP)

TATA box The TATA box is a promoter region that binds TFs and RNA polymerase II General Genetics 1 GP
mutations during the initiation of transcription. It is located approximately 25 bases Principles (Gene)
2030
upstream from the beginning of the coding region. (GP)

Transcription Homeobox genes encode DNA-binding transcription factors General Genetics 7 GP

2015 (regulators) that play an important role in the segmental organization of Principles (Gene)
the embryo along the cranio-caudal axis. (GP)
Transcription DNA-binding proteins incl TFs (Myc, CREB), steroid receptors (cort, aldo, General Genetics 7 GP
2031 progest), TH receptor, fat-sol vit receptors (vit D, retinoic acid), and DNAPrinciples (Gene)
transcription and replication proteins. (GP)
Transcription Northern blots detect target mRNA in a sample and can be used to Ax the General Genetics 7 GP
2042 degree of gene transcription. Principles (Gene)
(GP)
Transcription Alt splicing is a process by which a single gene can code for various General Genetics 7 GP
#### unique proteins by selectively incl or excl diff DNA coding regions (exons) Principles (Gene)
into mature mRNA. (GP)
Transcription The TATA and CAAT boxes are promoters of transcription in eukaryotic General Genetics 7 GP
cells and are located approximately 25 and 75 bases upstream from the Principles (Gene)
#### transcription start site, respectively. They promote initiation of (GP)
transcription by serving as binding sites for transcription factors and RNA
polymerase II.
 X-linked In XLR inheritance, 1) affected males will always produce unaffected sons General Genetics 2 GP
inheritance and carrier daughters, and 2) carrier females have a 50% chance of Principles (Gene)
1727 producing affected sons and carrier daughters. G6PD defic follows this (GP)
inheritance pattern and causes acute HA in response to ox drugs.

Mitochondrial Mitochondrial DNA (mtDNA) is the most common non-nuclear DNA General Histology 4 GP
disorders found in eukaryotic cells. It resembles prokaryotic DNA and is maternally Principles (Hist)
1473 derived. Mutations involving mtDNA or nuclear DNA that codes for (GP)
mitochondrial proteins can cause a variety of mitochondrial disorders,
including Leigh syndrome and MELAS.
RNA structure The nucleolus is a dense intranuclear body visible by light and electron General Histology 2 GP
& function microscopy that functions as the primary site of ribosome synthesis and Principles (Hist)
1417
assembly. All ribosomal RNA except 5S rRNA is transcribed in the (GP)
nucleolus.
Apoptosis Apoptosis can occur through either the intrinsic (mitochondria-mediated) General Immunology 4 GP
pathway or the extrinsic (receptor-initiated) pathway. Both pathways Principles (Immu)
1756
converge in the activation of caspases. Caspases are proteolytic enzymes (GP)
that cleave cellular proteins.
Immunology CD8+ cells recognize foreign antigens presented with MHC class I General Immunology 2 GP
746 principles proteins. Each MHC class I molecule consists of a heavy chain and a β2- Principles (Immu)
microglobulin. (GP)
Immunology A radioimmunoassay uses specific antibodies and a fixed quantity of General Immunology 2 GP
principles radiolabeled antigen to determine the amount of antigen present in an Principles (Immu)
####
unknown sample. This is done by measuring the amount of radiolabeled (GP)
antigen displaced from the antibodies in the system.
Major MHC class II is expressed on the surface of antigen presenting cells General Immunology 1 GP
histocompatibil (APC) and presents extracellular antigens to T cells after extracellular Principles (Immu)
ity class protein is degraded within acidified lysosomes. Failure to acidify (GP)
542
lysosomes would lead to deficient expression of MHC class II-antigen
complexes with subsequent impaired interaction between APCs and T
cells.
Ubiquitin An essential step in the activation of the cellular immune response to a General Immunology 2 GP
proteasome virus is the breakdown of intracellular viral proteins by the ubiquitin Principles (Immu)
pathway proteasome pathway. This pathway is initiated by ubiquitin ligases, (GP)
which recognize specific protein substrates and attach a ubiquitin tag. The
####
target proteins are then degraded by a proteasome into peptide fragments,
which are coupled with major histocompatibility complex class I
proteins and presented on the cell surface for surveillance by cytotoxic
CD8+ lymphocytes.
Cytomegalovir Cytomegalovirus (CMV) is typically associated with subclinical infection General Microbiolog 9 GP
us in the immunocompetent, with the occasional individual developing a Principles y (Micr)
mononucleosis-like syndrome that is heterophile antibody (Monospot) (GP)
1592
negative. In the immunocompromised, primary or reactivated CMV
infection can result in severe retinitis, pneumonia, esophagitis, colitis, or
hepatitis.
Apoptosis Cytochrome c is a mitochondrial enzyme that activates caspases and General Pathology 4 GP
297 indirectly brings about cell death through intrinsic pathway apoptosis. Principles (Path)
(GP)
Inflammatory Chronic inflammation is associated with increased circulating pro- General Pathology 9 GP
bowel disease inflammatory cytokines (eg, IL-1, IL-6, tumor necrosis factor-alpha), Principles (Path)
which stimulates the liver to release acute-phase reactants (eg, C reactive (GP)
1801
protein, fibrinogen). The presence of acute-phase reactants increases the
erythrocyte sedimentation rate, a nonspecific marker for inflammation.

Adverse drug Most adverse drug reactions are predictable and due to the known General Pharmacolog 2 GP
reaction pharmacologic properties of the drug. Unpredictable reactions are less Principles y (Phar)
####
common and are due to genetic differences, immune interactions, or other (GP)
mechanisms.
Allergic rhinitis First-generation antihistamines are nonspecific and interact with multiple General Pharmacolog 2 GP
receptors, including the muscarinic receptor. This leads to anticholinergic Principles y (Phar)
1869
effects (eg, fever, flushing, mydriasis, urinary retention, tachycardia, (GP)
altered mental status).
Anesthesia Following intravenous administration, a highly lipophilic drug will be General Pharmacolog 9 GP
rapidly distributed to organs with high blood flow (eg, brain, liver, kidneys, Principles y (Phar)
lungs). The drug is then redistributed to tissues with relatively lower blood (GP)
852
flow (eg, skeletal muscle, fat, bone). This accounts for the short duration of
action of many commonly used anesthetics, such as propofol.

Biologic agents Monoclonal antibodies (mAbs) are not eliminated by hepatic or renal General Pharmacolog 2 GP
clearance. Therefore, no dose adjustment is necessary with impaired Principles y (Phar)
####
hepatic/renal function or use of cytochrome P450 inducers or inhibitors. (GP)
 Dose response Efficacy is a measure of the maximum pharmacodynamic effect achievable General Pharmacolog 4 GP
curves with a drug. Potency refers to the dose of drug that is required to produce a Principles y (Phar)
1707 given effect. Drugs that bind their receptors with a higher affinity or are (GP)
better able to gain access to their target tissues will have greater potency
(lower ED50).
Dose response The changes in the log dose-response curve expected for the effect of a General Pharmacolog 4 GP
curves reversible competitive antagonist added to a full agonist are: 1) a parallel Principles y (Phar)
shift to the right in the log-dose response curve, illustrating an increase in (GP)
1708
the ED50, and 2) no change in the maximum effect (Emax).
Competitive=change ED50=shift right; noncompetitive=change
Emax=shift down.
Drug The Beers criteria identify drugs that should be used with caution in General Pharmacolog 2 GP
interaction geriatric patients. Common drugs to avoid include anticholinergics (eg, Principles y (Phar)
#### first-generation antihistamines), alpha blockers, tricyclic antidepressants, (GP)
benzodiazepines (and other sedating medications), antipsychotics, most
antiarrhythmics, and skeletal muscle relaxants.
Drug Cytochrome P450 enzymes found in the liver are responsible for the General Pharmacolog 2 GP
metabolism and majority of drug metabolism. Polymorphisms occurring in the genes coding Principles y (Phar)
1711 clearance for these enzymes result in various phenotypes that differ in their rates of (GP)
metabolism; individual differences in phenotype alter treatment efficacy
and drug toxicity.
Drug In first-order kinetics, a constant fraction (or proportion) of drug is General Pharmacolog 2 GP
metabolism and metabolized per unit of time, so the amount metabolized changes based on Principles y (Phar)
1716 clearance the serum concentration. In zero-order kinetics, a constant amount of drug (GP)
is metabolized per unit of time, independent of serum levels.

Drug structure Characteristics of a drug such as high molecular weight, high plasma General Pharmacolog 3 GP
1710 and properties protein binding, high charge, and hydrophilicity tend to trap the drug in the Principles y (Phar)
plasma compartment resulting in a low Vd (3-5 L). (GP)
Drug structure While the kidney is the primary site of elimination of most drugs, the liver General Pharmacolog 3 GP
and properties is the main site of biotransformation of these agents in preparation for Principles y (Phar)
elimination. Drugs that are more lipophilic (high Va good penetration into (GP)
CNS) are preferentially processed by the liver into more polar compounds
1715
for easier elimination in the bile and urine. Liver disease (e.g., cirrhosis) or
the concomitant use of other drugs may limit or enhance the clearance of
drugs metabolized in the liver.

Drug structure The suffix of a biological agent indicates whether a medication is a General Pharmacolog 3 GP
and properties monoclonal antibody (mab), a receptor molecule (cept), or a kinase Principles y (Phar)
8523 inhibitor (nib). Monoclonal antibodies also include in their names the type (GP)
of target (eg, bacterial or immune system) and their origin (eg, human or
mouse).
Pharmacogeno Isoniazid is metabolized by acetylation. The speed with which a patient is General Pharmacolog 1 GP
mics able to acetylate drugs depends on whether they are genetically "fast" or Principles y (Phar)
"slow" acetylators. The presence of fast and slow acetylators within the (GP)
1712
same population results in a bimodal distribution of the speed of isoniazid
metabolism. Slow acetylators are at increased risk of adverse side effects.

Route of Bioavailability is the fraction of an administered drug that reaches the General Pharmacolog 2 GP
administration systemic circulation unchanged. Drugs administered orally enter the portal Principles y (Phar)
& circulation and are subject to first-pass metabolism. Rectal administration (GP)
bioavailability is capable of partially bypassing first-pass metabolism as a proportion of
1713
rectal blood flow enters the systemic circulation directly. Drugs that
undergo extensive first-pass metabolism have increased bioavailability
when administered rectally.

Serum drug The half-life (t[½]) is a measure of how quickly a drug with first-order General Pharmacolog 3 GP
levels and half- kinetics is eliminated from the body. A drug is almost completely Principles y (Phar)
1714 life eliminated after 5 half-life intervals. The half-life can be calculated from (GP)
the drug's volume of distribution (Vd) and clearance rate (CL) using the
equation: t[½] = (0.7 x Vd) / CL.
Serum drug During continuous infusion of a drug metabolized by first-order kinetics, General Pharmacolog 3 GP
2112 levels and half- the steady state concentration is reached in 4 to 5 half-lives. Principles y (Phar)
life (GP)
Serum drug The half-life (t[½]) of a drug is the time required to lower its concentration General Pharmacolog 3 GP
levels and half- by 50%. The volume of distribution (Vd) refers to how well the drug Principles y (Phar)
life distributes into tissues compared to plasma; the higher the Vd, the greater (GP)
####
the drug distribution into the tissues. The drug concentration (mg/L) is
equal to drug dose (mg) divided by Vd (L).
 Sympathomime Low-dose dopamine infusion stimulates Di receptors in the renal and General Pharmacolog 5 GP
tic agents mesenteric vasculature, resulting in vasodilation and increased blood flow Principles y (Phar)
to these sites. Increasing doses of dopamine stimulate B, and a receptors, (GP)
1365
resulting in increased cardiac output and elevated systemic vascular
resistance. At the higher end of the dose range, the increase in afterload
can result in decreased cardiac output.
Cellular Carrier-mediated transport includes facilitated diffusion and active General Physiology 2 GP
transports transport. Movement of substrate across the cell membrane by these Principles (Phys)
1378
mechanisms depends on the presence of carrier proteins that can become (GP)
saturated at high substrate concentrations.
Flow/resistance The total resistance for a group of vessels arranged in parallel is equal to General Physiology 1 GP
one divided by the sum of the inverse values for resistance of each of the Principles (Phys)
contributing vessels as follows: 1/TPR = 1/R1+1/R2 + 1/R3 + ... 1/Rn. (GP)
1616
Total body circulation can be best described as a parallel circuit, whereas
circulation in an individual organ is often best described by a series
arrangement.
High altitude People traveling to elevations >2500 m (8000 ft) can develop high- General Physiology 3 GP
illness altitude illness, characterized by hypobaric hypoxia with the potential to Principles (Phys)
develop life-threatening cerebral and/or pulmonary edema. Key (GP)
#### adaptive responses to hypoxemia include hyperventilation to increase
blood oxygenation and increased synthesis of 2,3-bisphosphoglycerate in
erythrocytes (facilitating oxygen offloading into peripheral tissues).

Rough ER The rough endoplasmic reticulum (RER) is covered with ribosomes and is General Physiology 1 GP
protein involved in the transfer of proteins to the cell membrane and extracellular Principles (Phys)
synthesis space. The RER is well developed in protein secreting cells. The smooth (GP)
757
ER lacks surface ribosomes and functions in lipid synthesis, carbohydrate
metabolism, and detoxification of harmful substances.

Lymphadenopa Most of the cutaneous lymph from the umbilicus down, including the anus Hematolo Anatomy 2 HO
thy below the dentate line, drains to the superficial inguinal lymph nodes. gy & (Anat)
1631
Exceptions are the glans penis and posterior calf, which drain to the deep Oncology
inguinal nodes. (HO)
2,3- 2,3-BPG decreases hemoglobin's affinity for oxygen. Therefore, in the Hematolo Biochemistr 1 HO
bisphosphoglyc presence of lower blood oxygen concentrations, higher 2,3-BPG levels gy & y (Bioc)
erate within erythrocytes enable increased oxygen delivery in the peripheral Oncology
1029 metabolism tissues . 2,3-BPG is produced from 1,3-BPG by the enzyme (HO)
bisphosphoglyce rate mutase. This reaction bypasses an ATP-generating
step of glycolysis of a single glucose molecule always yields pyruvate,
causing no net gain in ATP.
ALA synthase Acute intermittent porphyria attacks are due to the accumulation of Hematolo Biochemistr 1 HO
aminolevulinate (ALA) and porphobilinogen (PBG), resulting from gy & y (Bioc)
inherited PBG deaminase deficiency combined with ALA synthase Oncology
1338
induction (typically due to certain medications, alcohol use, or a low- (HO)
calorie diet). Management with glucose or hemin inhibits ALA
synthase activity.
Alternative Alternative splicing is a process where the exons of a gene are Hematolo Biochemistr 1 HO
splicing reconnected in multiple ways during post-transcriptional processing. This gy & y (Bioc)
creates different mRNA sequences and subsequently, different protein Oncology
8276
isoforms. It is a normal phenomenon in eukaryotes that greatly increases (HO)
the biodiversity of proteins encoded by the genome.

Beta- HbF contains y-globin instead of B-globin. Patients with homozygotic B- Hematolo Biochemistr 1 HO
thalassemia thalassemia (B-thalassemia major) are asymptomatic at birth due to the gy & y (Bioc)
1243 presence of y-globins and HbF. Switching to HbA production and the Oncology
cessation of y-globin synthesis precipitates the symptoms of B-thalassemia. (HO)

Carbon Carbon monoxide binds heme iron in hemoglobin with an affinity much Hematolo Biochemistr 2 HO
monoxide greater than oxygen, generating carboxyhemoglobin. Remaining binding gy & y (Bioc)
poisoning sites on carboxyhemoglobin have an increased affinity for oxygen that Oncology
1240
causes the oxygen dissociation curve to shift to the left, impeding oxygen (HO)
delivery to tissues. (Competitive binding to heme)

Cyanide Nitrites are oxidizing agents that are effective in treating cyanide Hematolo Biochemistr 2 HO
poisoning poisoning due to their ability to induce methemoglobinemia. gy & y (Bioc)
Methemoglobin contains ferric (Fe3• ) rather than ferrous iron (Fe2• ) . Oncology
1415
Cyanide binds to ferric iron more avidly than to mitochondrial cytochrome (HO)
enzymes , diminishing cyanide's toxic effect.
 Fetal Hemoglobin F (Hb F) is the predominant hemoglobin type in the second Hematolo Biochemistr 1 HO
hemoglobin and third trimesters of pregnancy and during the first few months after gy & y (Bioc)
birth. Hb F consists of 2 alpha and 2 gamma protein subunits (a2y2) Oncology
868
and has a high affinity for oxygen, which facilitates oxygen transport (HO)
across the placenta to the fetus. Hb A (a2B2) is the major hemoglobin in
adults.
Folic acid Folate deficiency inhibits the synthesis of nucleic acids, particularly the Hematolo Biochemistr 1 HO
deficiency formation of deoxythymidine monophosphate {dTMP). This leads to gy & y (Bioc)
defective DNA synthesis that characteristically causes increased apoptosis Oncology
1847
of hemopoietic cells and megaloblastic anemia. Thymidine (HO)
supplementation bypasses this enzyme and can reduce erythroid cell
apoptosis.
G6PD The pentose phosphate pathway consists of an oxidative (irreversible) Hematolo Biochemistr 5 HO
deficiency branch and a nonoxidative (reversible) branch, and each can function gy & y (Bioc)
independently based on cellular requirements. Transketolase, an enzyme Oncology
1035 of the nonoxidative branch, is responsible in part for the (HO)
interconversion of ribose-5-phosphate (nucleotide precursor) and
fructose-6-phosphate (glycolytic intermediate).

G6PD Glucose-6-phosphate dehydrogenase (G6PD) is the rate-limiting enzyme Hematolo Biochemistr 5 HO

deficiency of the pentose phosphate pathway. G6PD deficiency is a common X Iinked gy & y (Bioc)
1036 recess ive disorder resulting in episodes of hemolytic anemia during times Oncology
of increased oxidative stress (eg, use of antimalarials/sulfonamide, (HO)
infections).
G6PD Glucose 6-phosphate dehydrogenase deficiency causes hemolytic anemia Hematolo Biochemistr 5 HO
deficiency and jaundice secondary to increased oxidative stress due to the lack of gy & y (Bioc)
1037 NADPH. Glutathione reductase deficiency has a similar clinical Oncology
consequence as its absence results in an inability to utilize NADPH to (HO)
reduce glutathione.
Heme Maturing erythrocytes lose their ability to synthesize heme when they Hematolo Biochemistr 2 HO
metabolism lose their mitochondria, which are necessary for the first and final 3 steps
gy & y (Bioc)
1455
of heme synthesis. Oncology
(HO)
Heme Heme oxygenase converts heme to biliverdin, a pigment that causes the Hematolo Biochemistr 2 HO
metabolism greenish color to develop in bruises several days after an injury. gy & y (Bioc)
1456
Oncology
(HO)
Hemoglobin C Hemoglobin C is caused by a missense mutation that results in a Hematolo Biochemistr 1 HO
disease glutamate residue being substituted by lysine in the beta globin chain gy & y (Bioc)
(sickle cell disease). This results in an overall decrease in negative charge Oncology
1470
for the hemoglobin molecule. The speed of hemoglobin movement during (HO)
gel electrophoresis hemoglobin A > hemoglobin S > hemoglobin C.

Hemoglobin P50 refers to the partial pressure of oxygen at which hemoglobin is 50% Hematolo Biochemistr 4 HO
properties saturated. Hemoglobins with high oxygen affinity have a decreased P50 gy & y (Bioc)
that is represented by a leftward shift of the oxygen dissociation curve. The Oncology
1384
reduced ability to release oxygen within the peripheral tissues leads to (HO)
renal hypoxia, increased erythropoietin synthesis, and compensatory
erythrocytosis.
Hemoglobin A left shift of the hemoglobin oxygen dissociation curve indicates Hematolo Biochemistr 4 HO
properties increased hemoglobin 02 affinity and can be caused by increased pH, gy & y (Bioc)
1385 decreased 2,3-bisphosphoglycerate, and decreased temperature. Leftward Oncology
shifts of the curve inhibit the release of 02 within peripheral tissues. (HO)

Hemoglobin 2,3-bisphosphoglycerate (2,3-BPG) normally forms ionic bonds with the Hematolo Biochemistr 4 HO
properties beta subunits of deoxygenated hemoglobin A, facilitating oxygen release in gy & y (Bioc)
the peripheral tissues. Mutations that result in loss of the 2,3- BPG Oncology
1387
binding pocket's positive charge cause hemoglobin A to resemble fetal (HO)
hemoglobin (HbF), which binds oxygen with a higher affinity due to its
inability to interact with 2,3-BPG.
Hemoglobin The individual subunits of the hemoglobin molecule are structurally Hematolo Biochemistr 4 HO
properties analogous to myoglobin. If separated, the monomeric subunits will gy & y (Bioc)
1413
demonstrate a hyperbolic oxygen-dissociation curve similar to that of Oncology
myoglobin. (HO)
Laboratory Fluorescence in situ hybridization (FISH) can identify specific Hematolo Biochemistr 1 HO
techniques chromosomal translocations, duplications, or deletions using a single- gy & y (Bioc)
stranded, complementary DNA segment that is tagged with a radiotracer. Oncology
#### FISH is rapid, highly sensitive and specific, and can be used on tissues (HO)
with low mitotic rates . Hov,ever, the targeted chromosomal abnormality
must be somewhat large in order to be identified.
 Methemoglobin Methemoglobinemia causes dusky discoloration of the skin (similar to Hematolo Biochemistr 1 HO
emia cyanosis), and because methemoglobin is unable to carry oxygen, a state of gy & y (Bioc)
functional anemia is induced . However, the blood partial pressure of Oncology
1416
oxygen will be unchanged as it is a measure of oxygen dissolved in (HO)
plasma and is unrelated to hemoglobin function.

Mischarged The sequence of amino acids in a growing polypeptide chain is dictated by Hematolo Biochemistr 1 HO
tRNA the interaction of the mRNA codon with the tRNA anticodon. tRNA that is gy & y (Bioc)
mischarged with the incorrect amino acid (and not corrected by aminoacyl- Oncology
2032
tRNA synthetase proofreading) will incorporate the wrong amino acid (HO)
into the growing polypeptide chain at a site requiring cysteine)

Polymerase Polymerase chain reaction is used to amplify small fragments of DNA (eg, Hematolo Biochemistr 2 HO
chain reaction genes, exons, noncoding regions) by repeated replication. It requires gy & y (Bioc)
primers that are complementary to the regions of DNA flanking the Oncology
2043
segment of interest. Thermostable DNA polymerase, deoxynucleotide (HO)
triphosphates, and a source DNA template strand are also necessary.

Porphyria Enzyme deficiencies (Uroporphyrinogen decarboxylase) of the early Hematolo Biochemistr 1 HO

cutanea tarda steps in porphyrin synthesis cause neuropsychiatric manifestations without gy & y (Bioc)
photosensitivity, whereas late step derangements lead to photosensitivity. Oncology
1337
Photosensitivity manifests as vesicle and blister formation on sun-exposed (HO)
areas as well as edema, pruritus, pain, and erythema.

Pyruvate kinase Pyruvate kinase deficiency causes hemolytic anemia due to failure of Hematolo Biochemistr 1 HO
deficiency glycolysis and resultant failure to generate sufficient ATP to maintain gy & y (Bioc)
erythrocyte structure. In this case, splenic (red pulp) hyperplasia results Oncology
1020
from increased work of the splenic parenchyma, which must remove these (HO)
deformed erythrocytes from the circulation.

SCA mutation Exertional dyspnea, pneumonia resulting in life-threatening acute chest Hematolo Biochemistr 1 HO
syndrome, and recurrent abdominal and bone pain are clinical features gy & y (Bioc)
of sickle cell anemia. Sickle cell anemia results from a point mutation that Oncology
1905
causes valine to substitute for glutamic acid in the sixth position of the b- (HO)
globin chain of hemoglobin.

Sickle cell Hemoglobin S (HbS) aggregates in the deoxygenated state (Oxygen Hematolo Biochemistr 13 HO
unloading). HbS polymers form fibrous strands that reduce red blood cell gy & y (Bioc)
membrane flexibility and promote sickling. Sickling occurs under Oncology
1241 conditions associated with anoxia including low, pH and high levels of 2,3- (HO)
bisphosphoglyce rate. These inflexible erythrocytes predispose to
microvascular occlusion and microinfarcts.

Sickle cell Hemoglobin S (HbS) contains valine in place of glutamic acid at the sixth Hematolo Biochemistr 13 HO
amino acid position of the beta globin chain. This promotes hydrophobic gy & y (Bioc)
1242
interaction among Hb molecules and results in HbS polymerization and Oncology
erythrocyte sickling. (HO)
Sideroblastic Isoniazid inhibits pyridoxine phosphokinase, leading to pyridoxine Hematolo Biochemistr 1 HO
anemia (vitamin B3) deficiency. Pyridoxine's active form is the cofactor for б- gy & y (Bioc)
#### aminolevulinate synthase, the enzyme that catalyzes the rate-limiting step Oncology
of heme synthesis. Inhibition of this step can result in sideroblastic (HO)
anemia.
Vitamin B12 Vitamin Bt2 is obtained through the diet solely from animal sources, which Hematolo Biochemistr 9 HO
deficiency places strict vegans at risk for dietary deficiency. This deficiency takes gy & y (Bioc)
years to develop due to the large hepatic B12 reserve, and presents with Oncology
1838
megaloblastic anemia and potentially irreversible neurologic deficits (eg, (HO)
paresthesias, weakness, ataxic gait).

von Willebrand Following endothelial damage, von Willebrand factor (vWF) binds Hematolo Biochemistr 7 HO
disease glycop rotein lb receptors on platelets to mediate platelet adherence. The gy & y (Bioc)
ristocetin cofactor assay measures platelet agglutination via binding of Oncology
346
glycoprotein lb receptors to vWF; it will be abnormal in vWF deficiency (HO)
but will correct with the addition of normal (vWF-containing) plasma.

Prevalence and According to 2019 estimates, the most common cancers (excluding basal Hematolo Biostatistics 3 HO
incidence and squamous cell skin cancer) in women by order of incidence are breast, gy & (Bios)
1206 lung, and colorectal cancer. In terms of mortality, lung cancer claims the Oncology
most lives, followed by breast and colorectal cancer. (HO)

Prospective Prospective cohort studies are organized by selecting a group of individuals Hematolo Biostatistics 1 HO
cohort study (i.e., cohort), determining their exposure status, and then following them gy & (Bios)
1203
over time for development of the disease of interest. Oncology
(HO)
 Down Trisomy 21 is detectable by cytogenetic karyotype analysis and is the most Hematolo Genetics 6 HO
syndrome common genetic cause of congenital intellectual disability. Patients with gy & (Gene)
1599
Down Syndrome are at increased risk of developing acute lymphoblastic Oncology
leukemia and acute megakaryoblastic leukemia. (HO)
Ovarian cancer Telomerase is an RNA-dependent DNA polymerase that synthesizes Hematolo Genetics 9 HO
telomeric DNA sequences that can replace the lost chromosomal ends of gy & (Gene)
####
the telomeres. Cancer cells typically contain increased telomerase activity Oncology
to allow for continued proliferation. (HO)
Prion disease Western blotting is used to identify proteins, Northern blotting identifies Hematolo Genetics 3 HO
specific RNA sequences, and Southern blotting identifies specific DNA gy & (Gene)
2041
sequences in an unknown sample. Oncology
(HO)
Protein The nucleolus is the site of ribosomal subunit maturation and assembly. Hematolo Genetics 2 HO
synthesis RNA polymerase I functions exclusively within the nucleolus to transcribe gy & (Gene)
2039 the 45S pre-rRNA gene, which codes for most of the ribosomal RNA Oncology
components (18S, 5.8S, and 28S rRNAs). (HO)

Radiation Direct factor Xa inhibitors (eg. apixaban) are anticoagulants that block the Hematolo Genetics 1 HO
therapy active site of factor Xa, which leads to reduced conversion of gy & (Gene)
1474 prothrombin to thrombin. This class of medications is administered Oncology
orally and requires no drug level monitoring. (HO)

Sickle cell Sickle cell anemia is an autosomal recessive hemoglobinopathy. In order Hematolo Genetics 13 HO
for a child to have sickle cell disease, both parents must be carriers. gy & (Gene)
2040 Hemoglobin electrophoresis can be used to determine the carrier status of Oncology
a prospective parent who has no history of sickle cell anemia. (HO)

Sickle cell Sickle cell disease is the result of a missense mutation that causes valine to
Hematolo Genetics 13 HO
replace glutamic acid at position 6 in the hemoglobin beta-globin chain. gy & (Gene)
####
RNA contains the pyrimidine base uracil, whereas DNA contains the base Oncology
thymidine (GAGGTG). (HO)
Thalassemia The Kozak consensus sequence occurs on eukaryotic mRNA and helps Hematolo Genetics 3 HO
initiate protein translation by identifying the proper methionine start gy & (Gene)
2086
codon (AUG). Oncology
(HO)
Thalassemia B thalassemia results in hypochromic, microcytic anemia due to decreased Hematolo Genetics 3 HO
p globin chain synthesis. Unpaired a chains precipitate within red cells and gy & (Gene)
2087
cause membrane damage, leading to ineffective erythropoiesis and Oncology
hemolysis (microcytosis). (HO)
X-linked Given phenotypically normal parents, the probability that a female sibling Hematolo Genetics 2 HO
inheritance of a male affected by an X linked recessive disease will give birth to an gy & (Gene)
1788
affected child is 1/8. Oncology
(HO)
Cell mediated Immature T-lymphocytes express both the CD4 and CD8 cell surface Hematolo Immunology 5 HO
immunity antigens in addition to a complete TCR or a pro-TCR. These lymphocytes gy & (Immu)
559 exist in the thymic cortex where they undergo positive selection and in Oncology
the thymic medulla where they undergo negative selection. (HO)

Immunotherapy The binding of programmed cell death protein 1 (PD-1) to one of its Hematolo Immunology 2 HO
ligands (programmed death-ligand 1 [PD-L1]) downregulates the immune gy & (Immu)
response by inhibiting cytotoxic T cells. Many types of cancers evade Oncology
####
immunodetection by increasing expression of PD-L1 on their surface. (HO)
Monoclonal antibodies against PD-1 upregulate the T-cell response and
promote tumor cell apoptosis.
Inflammation Inflammation is characterized by the passage of circulating inflammatory Hematolo Immunology 3 HO
leukocytes into the inflamed tissue. The steps involved include gy & (Immu)
margination, rolling (P, E selection), activation (ICAM 1), tight adhesion Oncology
8480
and crawling, and transmigration (deletion in the platelet endothelial (HO)
cell adhesion molecule 1 (PECAM-1) gene).

Multiple Multiple myeloma is associated with the clonal proliteration ot plasma cells Hematolo Immunology 9 HO
myeloma in the none marrow. I his prevents normal В-cell lymphogenesis and gy & (Immu)
####
increases the risk of bacterial infection due to decreased production of Oncology
normal immunoglobulins. (HO)
Primary DiGeorge syndrome causes an extreme deficiency in the number of mature Hematolo Immunology 7 HO
immunodeficie T lymphocytes, leading to poor development of the lymph node gy & (Immu)
8532 ncy disorder paracortex. In contrast, agammaglobulinemia causes an absence of В Oncology
cells, preventing primary lymphoid follicles and germinal centers from (HO)
forming in the lymph node cortex.
 Rhesus Hemolytic disease of the newborn most commonly occurs from maternal Hematolo Immunology 2 HO
alloimmunizati sensitization to Rh antigens during a prior pregnancy with an Rh(D)+ gy & (Immu)
on fetus. In subsequent Rh(D)+ pregnancies, maternal anti-Rh(D) IgG Oncology
545
antibodies cross the placenta and cause a severe autoimmune hemolytic (HO)
anemia in the fetus and life-threatening hydrons fetalis

Rhesus With maternal blood types A or B, hemolytic disease of the fetus and Hematolo Immunology 2 HO
alloimmunizati newborn very rarely occurs because maternal antibodies (anti-A or anti-B) gy & (Immu)
on are of the IgM type and cannot cross the placenta. In contrast, mothers Oncology
8261
with blood type О also produce IgG antibodies (anti-A and anti-B), which (HO)
can cross the placenta and cause fetal hemolysis.

Rhogam (anti- Anti-Rh immunoglobulin consists of anti-D IgG antibodies that bind to Hematolo Immunology 1 HO
D IgG) Rh-positive fetal erythrocytes, promoting clearance by maternal gy & (Immu)
1683 reticuloendothelial macrophages and preventing maternal Rh sensitization. Oncology
It is routinely administered to Rh-negative women during gestation and (HO)
immediately postpartum.
Tuberculosis The caseating granulomas of tuberculosis are almost always surrounded by Hematolo Immunology 18 HO
large epithelioid macrophages with pale pink granular cytoplasm. CD14 is gy & (Immu)
1598
a surface marker specific to the monocyte-macrophage cell lineage. Oncology
(HO)
Wiskott- Wiskott-Aldrich syndrome is characterized by the triad of eczema, Hematolo Immunology 1 HO
Aldrich thrombocytopenia, and combined В and T cell deficiency. Patients can gy & (Immu)
syndrome have thrombocytopenia at birth, with eczema and repeated infections due Oncology
537
to encapsulated and/or opportunistic organisms usually developing later (HO)
around 6 to 12 months of age.

X-linked X-linked (Bruton) agammaglobulinemia is caused by a defect in В cell Hematolo Immunology 2 HO

agammaglobuli maturation, resulting in absent mature В cells and severely low gy & (Immu)
1134 nemia immunoglobulin levels. T cell numbers and function remain intact. Due to Oncology
the absence of В cells, primary lymphoid follicles and germinal centers do (HO)
not form within lymph nodes.
Acute diarrhea Enterohemorrhagic Escherichia coli (EHEC) is primarily contracted after Hematolo Microbiolog 13 HO
eating undercooked ground beef. EHEC produces Shiga toxin, which gy & y (Micr)
causes hemorrhagic colitis and can lead to hemolytic uremic syndrome Oncology
1097
(HUS). HUS is characterized by acute renal failure, thrombocytopenia, and (HO)
microangiopathic hemolytic anemia; children age <10 are at greatest risk.

Community Mycoplasma pneumoniae binds an oligosaccharide on the respiratory Hematolo Microbiolog 21 HO

acquired epithelium that is also present on erythrocytes, leading to the generation of gy & y (Micr)
pneumonia cross-reacting IgM antibodies (cold agglutinins). Patients with M Oncology
pneumoniae infections often develop mild, transient hemolytic anemia that (HO)
957 resolves as IgM antibody titers decline (6-8 weeks after infection begins).
elevated serum lactate dehydrogenase level, nonproductive cough, low-
grade, fever, headache, Fading of immune response against the
bacteria

Epstein Barr The initial attachment of the virion envelope or capsid surface proteins to Hematolo Microbiolog 1 HO
virus the complementary host cell surface receptors is essential to viral tropism gy & y (Micr)
for specific tissues and invasion of cells. Many viruses bind to normal host Oncology
cell plasma membrane receptors to enter host cells. Known host cell (HO)
1375
receptor and virion/virion protein binding specificities include: CD4 with
HIV gp120, CD21 with Epstein-Barr virus gp350, and erythrocyte P
antigen with parvovirus B19.

Sickle cell Patients with sickle cell disease become functionally asplenic within the Hematolo Microbiolog 13 HO
first few years of life due to repeated microinfarction of splenic vascular gy & y (Micr)
beds. This dramatically increases the risk for fulminant infections with Oncology
896 encapsulated bacterial organisms, particularly Streptococcus (HO)
pneumoniae. Patients with sickle cell disease are also at increased risk for
other bacterial infections, most notably salmonella osteomyelitis.

Sickle cell In patients with sickle cell anemia and other chronic hemolytic disorders, Hematolo Microbiolog 13 HO
the most common viral cause of an aplastic crisis is infection of erythroid gy & y (Micr)
1496
progenitor cells with parvovirus B19, a nonenveloped single- stranded Oncology
DNA virus. (HO)
Acute liver The P450 microsomal oxidase system plays an important role in Hematolo Pathology 2 HO
failure detoxification. In carbon tetrachloride poisoning, however, it produces free gy & (Path)
314
radicals that start a vicious cycle of hepatic injury. Oncology
(HO)
 Acute Precursor B-ALL and precursor T-ALL can only be distinguished by Hematolo Pathology 3 HO
lymphoblastic immunophenotyping. The lymphoblasts in precursor B-ALL are TdT+, gy & (Path)
1571 leukemia CD10+ and CD19+, whereas the lymphoblasts in precursor T-ALL express Oncology
T-cell markers (e g. CD2, CD3, CD4, CD5, CD7 and CD8), TdT and (HO)
CD1a.
Acute Acute lymphoblastic leukemia (ALL) is marked by a high concentration Hematolo Pathology 3 HO
lymphoblastic of circulating lymphoblasts. Flow cytometry can be used to distinguish gy & (Path)
leukemia between В-cell (CD19-expressing) and T-cell (CD3-expressing) lineages. Oncology
####
T-cell ALL usually arises in teenagers or individuals in their 20s and often (HO)
presents with a large mediastinal mass.

Acute myeloid Acute promyelocytic leukemia is the М3 variant of acute myelogenous Hematolo Pathology 3 HO
leukemia leukemia. It affects adult patients and may present with disseminated gy & (Path)
intravascular coagulation. The cytogenetic abnormality t(15:17) leads to Oncology
1404 formation of the promyelocytic leukemia-retinoic acid receptor alpha (HO)
(iPML/RARa) fusion gene, which is unable to signal for proper cellular
differentiation, unlike the normal retinoic acid receptor.

Acute myeloid Auer rods are deformed azurophilic granules found in the cytoplasm of Hematolo Pathology 3 HO
leukemia myeloblasts that stain positively for myeloperoxidase. Auer rods are found gy & (Path)
1406
in abundance in AML М3 (acute promyelocytic leukemia). Oncology
(HO)
Acute myeloid The finding of Auer rods (linear purple-red inclusions within immature Hematolo Pathology 3 HO
leukemia myeloid precursors) is helpful in making the diagnosis of acute myeloid gy & (Path)
1570 leukemia Auer rods are not found in acute lymphoblastic leukemia. In Oncology
chronic myelogenous leukemia, there are more mature cells and fewer (HO)
blasts.
Acute The cytogenetic defect t( 15:17) is associated with acute promyelocytic Hematolo Pathology 3 HO
promyelocytic leukemia (APML). A translocation involving the retinoic acid receptor gy & (Path)
leukemia alpha (RARA) gene from chromosome 17 and the promyelocytic leukemia Oncology
1403 (PML) gene on chromosome 15 leads to the formation of PML/RARA. a (HO)
fusion gene whose product inhibits differentiation of myeloblasts and
triggers the development of APML

Acute The presence of rod-shaped intracytoplasmic inclusions known as Auer Hematolo Pathology 3 HO
promyelocytic rods is characteristic of many forms of acute myeloblastic leukemia gy & (Path)
1405
leukemia (AML). The М3 variant of AML, acute promyelocytic leukemia, is Oncology
associated with the cytogenetic abnormality t(15;17). (HO)
Acute Acute promyelocytic leukemia (APL, М3 acute myeloid leukemia) can Hematolo Pathology 3 HO
promyelocytic present with persistent infection and coagulopathy causing hemorrhagic gy & (Path)
leukemia signs and symptoms. Bone marrow biopsy classically reveals Oncology
1963 promyelocytes with intracytoplasmic Auer rods. APL is associated with a (HO)
t(15:17) chromosomal translocation that causes fusion of the retinoic acid
receptor-a gene and promyelocyte leukemia gene.

Alcohol use The key growth factors that promote angiogenesis in neoplastic and Hematolo Pathology 3 HO
disorder granulation tissue are vascular endothelial growth factor (VEGF) and gy & (Path)
fibroblast growth factor. Proinflammatory cytokines (eg. interleukin-1, Oncology
873 interferon-y) can indirectly promote angiogenesis through increased VEGF (HO)
expression. The laminin in basement membranes may pose a physical
barrier to the sprouting of new blood vessels.

ALL and T Acute lymphoblastic leukemia (ALL) is the most common malignancy of Hematolo Pathology 1 HO
cells childhood. В-cell ALL is responsible for approximately 70-80% of all cases gy & (Path)
of ALL, whereas T-cell ALL accounts for 15-17% of all cases of ALL. T- Oncology
1798
cell ALL often presents as a mediastinal mass that can cause respiratory (HO)
symptoms, dysphagia, or superior vena cava syndrome.

Anaplasia Undifferentiated (anaplastic) tumors bear no resemblance to the tissue of Hematolo Pathology 1 HO
origin. They are composed of pleomorphic cells with large, hyperchromatic gy & (Path)
1759 nuclei that grow in a disorganized fashion. Anaplastic tumors may also Oncology
contain numerous, abnormal mitoses and giant tumor cells. (HO)

Anticoagulants Warfarin inhibits proteins C and S (natural anticoagulants present in Hematolo Pathology 8 HO
blood), which can lead to skin necrosis, particularly in patients with protein gy & (Path)
1088
C or S deficiency. This complication is usually seen in the first few days of Oncology
warfarin therapy. (HO)
Antiphospholip Glomerulonephritis, a photosensitive skin rash, and arthralgias in a young Hematolo Pathology 1 HO
id syndrome woman are suggestive of systemic lupus erythematosus (SLE). Up to 30% gy & (Path)
of patients with SLE have antiphospholipid antibodies, which can cause Oncology
742 paradoxical aPTT prolongation and a false-positive RPR/VDRL. Patients (HO)
with antiphospholipid antibodies are at risk for venous and arterial
thromboembolism and unexplained, recurrent pregnancy loss.
 Aplastic Aplastic anemia causes pancytopenia as the bone marrow is replaced by Hematolo Pathology 3 HO
anemia fat cells and marrow stroma. The absence of splenomegaly on physical gy & (Path)
1785
examination is characteristic. A bone marrow biopsy can be extremely Oncology
useful in making the diagnosis. (HO)
Aplastic Idiopathic aplastic anemia is most commonly due to a toxic effect or Hematolo Pathology 3 HO
anemia autoimmune response causing apoptosis of pluripotent stem cells gy & (Path)
1787
(pancytopenia). Bone marrow biopsy reveals hypocellularity with an Oncology
abundance of fat cells. (HO)
Aplastic The triad of low hemoglobin, thrombocytopenia, and absent hematopoietic Hematolo Pathology 3 HO
anemia cells in the bone marrow is consistent with aplastic anemia. A gy & (Path)
1861 compensatory increase in circulating erythropoietin levels would be Oncology
expected in individuals with aplastic anemia and normal renal function. (HO)

Autoimmune Iron overload (hemosiderosis) is a common and serious complication of Hematolo Pathology 1 HO
hemolytic chronic hemolytic anemia and frequent blood transfusions Hemosiderin gy & (Path)
294 anemia accumulation is the cardinal histologic finding. Chelation therapy is Oncology
indicated to reduce parenchymal iron deposition. (HO)

Bladder cancer Urothelial (transitional cell) carcinoma is the most common type of bladder Hematolo Pathology 4 HO
cancer Tumor stage is the most important factor for determining prognosis gy & (Path)
and is based on the depth of invasion into the bladder wall and the degree Oncology
336
of spread to other tissues. Tumor invasion into the muscular layer of the (HO)
bladder wall carries an unfavorable prognosis.

Bone tumor Ewing sarcoma is the second most common malignant bone tumor of Hematolo Pathology 3 HO
childhood (after osteosarcoma). It most commonly involves the lower gy & (Path)
#### extremity and pelvis and often metastasizes to the lungs. Histopathology is Oncology
characterized by uniform, small, round, cells; fibrous septae; and patches of (HO)
necrosis and hemorrhage
Bone tumor Osteosarcoma is the most common primary bone malignancy in children Hematolo Pathology 3 HO
and young adults. It occurs most frequently at the metaphyses of long bones gy & (Path)
and presents with local pain and swelling. Most cases are associated with Oncology
####
sporadic or inherited mutations in RB1 (hereditary retinoblastoma) and (HO)
TP53 (Li-Fraumeni syndrome).

Brain tumors Pilocytic astrocytomas are the most common brain tumors in children. Hematolo Pathology 10 HO
They frequently arise in the cerebellum and can be differentiated from gy & (Path)
615
medulloblastomas by the presence of both cystic and solid components on Oncology
imaging. (HO)
Breast cancer Hereditary breast cancer is most commonly associated with mutations in Hematolo Pathology 7 HO
BRCA1 and BRCA2 These tumor suppressor genes are involved in DNA gy & (Path)
1083
repair, and their mutation increases the risk of developing breast and Oncology
ovarian cancer. (HO)
Breast cancer Estrogen- or progesterone-receptor positivity in breast cancer indicates Hematolo Pathology 7 HO
expected sensitivity to tamoxifen and aromatase inhibitor treatment.HER2 gy & (Path)
1762 overexpression in breast cancer suggests a more aggressive tumor that Oncology
typically responds to therapy with the anti-HER2 monoclonal antibody (HO)
trastuzumab.
Breast cancer Cytokeratin is a commonly used immunohistochemical marker of Hematolo Pathology 7 HO
epithelial cell carcinomas. gy & (Path)
2092
Oncology
(HO)
Breast cancer The HER2 oncogene encodes for a transmembrane glycoprotein with Hematolo Pathology 7 HO
intrinsic tyrosine kinase activity and is a member of the family of epidermal gy & (Path)
2093 growth factor receptors. Overexpression of this protein is associated with Oncology
a worse prognosis and increased risk of disease recurrence (HO)

Burkitt Histologically, Burkitt lymphoma has a "starry sky" appearance due to the Hematolo Pathology 3 HO
lymphoma presence of macrophages and apoptotic bodies in a sea of medium-sized gy & (Path)
lymphocytes. The rates of mitosis and apoptosis in the cancerous tissue are Oncology
1629 high. Almost all cases of Burkitt lymphoma are associated with (HO)
translocations of the c-Myc gene on chromosome 8, usually onto the Ig
heavy chain region of chromosome 14 [t(8; 14)].

Burkitt The Epstein-Barr virus genome is identified in approximately 50% of Hematolo Pathology 3 HO
lymphoma systemic В-cell lymphomas and almost all primary CNS lymphomas gy & (Path)
1630
occurring in the setting of HIV infection. A high mitotic index is typical of Oncology
Burkitt lymphoma (HO)
Burkitt Burkitt lymphoma is characterized by aggressive rapid growth and a Hematolo Pathology 3 HO
lymphoma "starry sky" microscopic appearance. Translocation of the с -Мус gy & (Path)
1755 oncogene on the long arm of chromosome 8 with the Ig heavy chain region Oncology
on chromosome 14 produces a nuclear phosphoprotein (c-Myc) that (HO)
functions as a transcription activator
 Cancer Tumor necrosis factor-а is thought to mediate paraneoplastic cachexia in Hematolo Pathology 2 HO
anorexia humans by suppressing appetite and increasing basal metabolic rate. gy & (Path)
1039
cachexia Oncology
syndrome (HO)
Cancer The ubiquitin-proteasome pathway mediates targeted protein degradation, Hematolo Pathology 2 HO
anorexia which allows for rapid disposal of unneeded intracellular proteins. In gy & (Path)
cachexia cancer-related cachexia, high levels of pro-inflammatory cytokines lead to Oncology
####
syndrome increased ubiquitination of sarcomeric muscle proteins, which in turn (HO)
leads to extensive skeletal muscle loss

Carcinogens Most chemical carcinogens enter the body in an inactive state (ie, as pro- Hematolo Pathology 1 HO
carcinogens). These pro-carcinogens are converted into active metabolites gy & (Path)
by the cytochrome P450 oxidase system (microsomal monooxygenese). Oncology
1797
Individual susceptibility to chemical carcinogens depends on the activity of (HO)
these P450 enzymes, which is genetically determined

Chronic Chronic lymphocytic leukemia is a chronic lymphoproliferative disorder Hematolo Pathology 1 HO

lymphocytic marked by the progressive accumulation of mature В cells. Most patients gy & (Path)
leukemia are asymptomatic for years but eventually develop anemia, Oncology
thrombocytopenia, and/or neutropenia The diagnosis is generally made (HO)
####
when complete blood count reveals dramatic leukocytosis, and flow
cytometry subsequently shows a clonal population of leukocytes with
typical B-cell markers such as CD19, CD20, and CD23.

Chronic Chronic myelogenous leukemia (CML) and leukemoid reaction can have Hematolo Pathology 2 HO
myeloid presentations similar to leukocytosis; however, leukocyte (neutrophil) gy & (Path)
leukemia alkaline phosphatase level is normal or elevated in a leukemoid reaction Oncology
1569
but decreased in CML. The definitive diagnosis of CML requires (HO)
demonstration of the Philadelphia chromosome t(9;22) or BCR-ABL fusion
gene or mRNA
Chronic Some patients with non-small cell lung carcinoma (NSCLC) harbor a Hematolo Pathology 2 HO
myeloid chromosomal rearrangement that creates a fusion gene between EML4 gy & (Path)
leukemia (echinoderm microtubule-associated protein-like 4) and ALK (anaplastic Oncology
8281 lymphoma kinase. The pathophysiology of EML4-ALK NSCLC is most (HO)
similar to the pathophysiology of chronic myelogenous leukemia (CML).
This results in a constitutive active tyrosine kinase that causes malignancy.

Colorectal Prognosis of colorectal adenocarcinoma is directly related to the stage ofHematolo Pathology 15 HO
cancer the tumor (not to the grade!) Tumor penetration into the muscularis gy & (Path)
423
propria. Oncology
(HO)
Colorectal Most tumors possess multiple cytogenetic abnormalities. Activation of Hematolo Pathology 15 HO
cancer proto-oncogenes KRAS results in stimulation of cellular proliferation. gy & (Path)
1760
Inactivation of anti-oncogenes eliminates oversight of the cell cycle. Oncology
(HO)
Colorectal Activating mutations of the KRAS gene lead to constitutive activation of Hematolo Pathology 15 HO
cancer the epidermal growth factor receptor (EGFR) pathway, promoting gy & (Path)
#### increased cell proliferation and growth. Tumors harboring these mutations Oncology
are resistant to treatment with anti-EGFR drugs (eg, cetuximab, (HO)
panitumumab).
DIC Disseminated intravascular coagulation is a common complication of gram- Hematolo Pathology 5 HO
negative bacterial sepsis due to activation of the coagulation cascade by gy & (Path)
bacterial endotoxins, oozing blood, which leads to the formation of Oncology
1295 microthrombi. Peripheral smear shows fragmented erythrocytes (HO)
(schistocytes) and thrombocytopenia. Laboratory tests show decreased
fibrinogen levels and prolonged PT and PTT.

DIC Disseminated intravascular coagulation (DIC) can occur with abruptio Hematolo Pathology 5 HO
placentae due to release of tissue factor, a procoagulant that activates the gy & (Path)
coagulation cascade, from the damaged decidua into the maternal Oncology
1296
circulation. DIC classically presents with thrombocytopenia and (HO)
bleeding from mucosal surfaces (eg, gums) and intravenous line sites.

DIC Disseminated intravascular coagulation commonly occurs in the setting of Hematolo Pathology 5 HO
sepsis and is characterized by widespread activation of the coagulation gy & (Path)
cascade with formation of microthrombi. Laboratory results reveal Oncology
1298
prolonged PT/PTT, thrombocytopenia, and low fibrinogen (ie, a (HO)
consumptive coagulopathy), and patients usually have signs of bleeding
(eg, oozing from venipuncture sites).
 DIC Acute disseminated intravascular coagulation is a consumptive Hematolo Pathology 5 HO
coagulopathy linked to severe trauma. Widespread formation of gy & (Path)
microvascular thrombi leads to consumption of platelets, coagulation Oncology
factors, and fibrinogen. Subsequent activation of anticoagulant proteins (HO)
####
leads to low protein C/S; fibrinolysis elevates D-dimer. Most patients
have bleeding complications (eg, oozing from venipuncture/catheter sites)
and end organ damage to the lungs or kidneys.

Extramedullary The presence of erythroid precursors in organs such as the liver and spleen Hematolo Pathology 1 HO
hematopoiesis is indicative of extramedullary hematopoiesis, a condition characterized by gy & (Path)
erythropoietin-stimulated, hyperplastic marrow cell invasion of Oncology
1859
extramedullary organs. Extramedullary hematopoiesis is most frequently (HO)
caused by severe chronic hemolytic anemias, such as B-thalassemia.

Fibronectin Adhesion of cells to the extracellular matrix involves integrin-mediated Hematolo Pathology 1 HO
binding to fibronectin, collagen, and laminin. Differential expression of gy & (Path)
1872 integrin subtypes affects adhesion properties of individual cells, and has Oncology
been found to correlate with malignant behavior in a number of tumors. (HO)

Folic acid The underlying biochemical feature of megaloblastosis is a defect in DNA Hematolo Pathology 1 HO
synthesis. In chronic alcoholics, megaloblastic macrocytic anemia can gy & (Path)
1580 result from a nutritional deficiency of vitamin B12 or of folate, which Oncology
impairs synthesis of purine and pyrimidine bases (thymidine synthesis) (HO)

G6PD anemia G6PD has an X-linked recessive inheritance. Hereditary spherocytosis Hematolo Pathology 1 HO
inheritance follows an autosomal dominant inheritance pattern. gy & (Path)
894
pattern Oncology
(HO)
G6PD G6PD is characterized by episodes of hemolytic anemia following Hematolo Pathology 5 HO
deficiency oxidative stress (eg, fava beans, dapsone, acute infection). Patients gy & (Path)
893 generally have jaundice, dark urine, normocytic anemia, reticulocytosis. Oncology
and evidence of bite cells and Heinz bodies on peripheral smear (HO)

G6PD G6PD is an X-linked disorder (Hereditary erythrocyte enzyme Hematolo Pathology 5 HO

deficiency deficiency) of the hexose monophosphate (pentose phosphate) pathway. In gy & (Path)
affected individuals, the amount of NADPH produced in RBCs is low, Oncology
1426
which impairs glutathione-mediated inactivation of free radicals. (HO)
Hemolytic episodes are induced by infections, medications, and other
oxidants.
Gallstone Black pigment stones arise from conditions that increase the amount of Hematolo Pathology 8 HO
disease unconjugated bilirubin in bile, which promotes calcium bilirubinate gy & (Path)
precipitation. This may occur in the setting of chronic hemolysis (eg. Oncology
69
sickle cell anemia, p-thalassemia, hereditary spherocytosis) and increased (HO)
enterohepatic cycling of bilirubin (eg. ileal disease).

Gaucher Gaucher disease is an autosomal recessive lysosomal storage disorder that Hematolo Pathology 1 HO
disease is characterized by (3-glucocerebrosidase deficiency and presents with gy & (Path)
pancytopenia and hepatosplenomegaly. Glucocerebroside accumulation Oncology
####
leads to distended macrophages with a "wrinkled tissue paper" appearance, (HO)
also known as Gaucher cells.

Hairy cell Hairy cell leukemia is an indolent В-cell neoplasm predominantly found in Hematolo Pathology 1 HO
leukemia middle-aged men and characterized by bone marrow failure and infiltration gy & (Path)
into the reticuloendothelial system, causing massive splenomegaly. Other Oncology
####
typical features include a "dry tap" (unsuccessful bone marrow aspiration) (HO)
and the presence of lymphocytes with cytoplasmic projections.

Head and neck Most OPCs (e.g. tonsil, base of tongue) are caused by HPV infection. HPV- Hematolo Pathology 1 HO
cancers 16 is particularly likely to cause malignant transformation. gy & (Path)
####
Oncology
(HO)
Hemangioma The key growth factors that promote angiogenesis in neoplastic and Hematolo Pathology 6 HO
granulation tissue are vascular endothelial growth factor (VEGF) and gy & (Path)
fibroblast growth factor. Proinflammatory cytokines (eg. interleukin-1, Oncology
1873 interferon-y) can indirectly promote angiogenesis through increased VEGF (HO)
expression. The laminin in basement membranes may pose a physical
barrier to the sprouting of new blood vessels.

Hematopoietic Vitamin B12 and folic acid deficiencies cause similar hematological Hematolo Pathology 1 HO
drugs pictures. However, neurological dysfunction is only seen in patients with gy & (Path)
789 vitamin B12 deficiency. If megaloblastic anemia due to vitamin В12 Oncology
deficiency is mistakenly treated with folate alone: the neurologic (HO)
dysfunction
 Hemochromato HFE protein mutations are the most common cause of primary Hematolo Pathology 5 HO
sis hemochromatosis. Inactivation of the HFE protein results in decreased gy & (Path)
hepcidin synthesis by hepatocytes and increased DMT 1 expression by Oncology
395
enterocytes, leading to iron overload. Patients with hemochromatosis are at (HO)
an increased risk for liver cirrhosis and hepatocellular carcinoma.

Hemolytic Schistocytes suggest microangiopathic hemolytic anemia (eg. hemolytic- Hematolo Pathology 3 HO
uremic uremic syndrome [HUS], thrombotic thrombocytopenic purpura [ТТР]. gy & (Path)
syndrome disseminated intravascular coagulation [DIC]) or mechanical damage [eg. Oncology
1294 prosthetic valve]). In childhood, HUS is often preceded by bloody diarrhea (HO)
Coagulation studies (prothrombin time and partial thromboplastin time) are
normal in HUS-TTP but abnormal in DIC.

Hemophiliacs Bleeding after a tooth extraction and history of hemarthrosis are suggestive Hematolo Pathology 2 HO
of hemophilia. Decreased levels of factor VIII or IX lead to failure to gy & (Path)
941 convert prothrombin into thrombin and deficient thrombus formation The Oncology
addition of thrombin to the blood of a patient with hemophilia results in (HO)
clotting.
Hemophiliacs Hemophilia is an X-linked recessive coagulopathy that presents with Hematolo Pathology 2 HO
intramuscular hemorrhage, hemarthroses, and delayed bleeding after gy & (Path)
1953 procedures. Laboratory results show partial thromboplastin time Oncology
prolongation; other tests of hemostatic function are generally normal. (HO)

Heparin Heparin-induced thrombocytopenia and thrombosis results from the Hematolo Pathology 1 HO
induced production of IgG antibodies against complexes of heparin and platelet gy & (Path)
#### thrombocytope factor 4. The Fc component of these antibodies binds to platelets, resulting Oncology
nia in widespread platelet activation and a prothrombotic state (HO)

Hepatocellular Both hepatitis В (HBV) and hepatitis C virus infections increase the risk Hematolo Pathology 1 HO
carcinoma of hepatocellular carcinoma due to chronic hepatic inflammation and cell gy & (Path)
58 turnover. HBV is also carcinogenic due to the production of oncogenic Oncology
proteins and the insertion of the HBV genome into host chromosomes. (HO)

Hereditary Hereditary spherocytosis results from red cell cytoskeleton Hematolo Pathology 3 HO
spherocytosis abnormalities, most commonly spectrin and ankyrin. Hemolytic anemia, gy & (Path)
889
jaundice, and splenomegaly are classic manifestations. Spherocytes are Oncology
seen on peripheral blood smear (HO)
Hereditary Hereditary spherocytosis results from red cell cytoskeleton abnormalities, Hematolo Pathology 3 HO
spherocytosis most commonly in the proteins spectrin and ankyrin. Increased osmotic gy & (Path)
fragility on acidified glycerol lysis testing confirms the diagnosis. Oncology
891 Hemolytic anemia, jaundice, and splenomegaly are classic manifestations. (HO)
Complications include pigmented gallstones and aplastic crises from
parvovirus B19 infection

HIV Patients with HIV have much higher rates of lymphoma than the general Hematolo Pathology 11 HO
population. Many cases are due to underlying Epstein-Barr virus infection. gy & (Path)
1724
Oncology
(HO)
Hodgkin The presence of Reed-Sternberg (RS) cells on lymph node biopsy is Hematolo Pathology 2 HO
lymphoma diagnostic of classic Hodgkin lymphoma. RS cells have abundant gy & (Path)
1626
cytoplasm, bilobed or double nuclei, and inclusion-like eosinophilic Oncology
nucleoli. (HO)
Hodgkin Reed-Sternberg cells are large binucleated cells with an "owl's eyes" Hematolo Pathology 2 HO
lymphoma appearance that appear on a background of (lymphoid tissue)lymphocytic gy & (Path)
1864 infiltrates. Reed- Sternberg cells must be present histopathologically in Oncology
order to make the diagnosis of Hodgkin lymphoma. (HO)

Infectious Epstein-Вагт virus causes infectious mononucleosis in teenagers and Hematolo Pathology 5 HO
mononucleosis young adults. It is also associated with a number of malignant conditions,
gy & (Path)
1757
including Burkitt lymphoma and nasopharyngeal carcinoma Oncology
(HO)
Infectious The primary immune response to Epstein-Barr virus is mediated by CD8+ Hematolo Pathology 5 HO
mononucleosis T lymphocytes, which are activated through the presentation of viral gy & (Path)
7643 antigens on infected CD21+ В lymphocytes These reactive (atypical) CD8+ Oncology
T lymphocytes can be observed in the peripheral blood smears of patients (HO)
with infectious mononucleosis.
Inherited Inherited causes of hypercoagulability should be considered in patients Hematolo Pathology 2 HO
thrombophilia younger than age 50 who present with thrombosis and no obvious gy & (Path)
explanation for an acquired prothrombotic state. The factor V Leiden Oncology
465
mutation, which causes factor Va resistance to inactivation by activated (HO)
protein C, may account for approximately 20% of cases of atypical venous
thrombosis.
 Inherited One to nine percent of Caucasians worldwide are heterozygote carriers of Hematolo Pathology 2 HO
thrombophilia factor V Leiden, which is modified to resist activated protein C. The gy & (Path)
1879
resulting hypercoagulable state predisposes to deep vein thromboses, which Oncology
are the source of most pulmonary emboli (HO)
Iron deficiency Plummer-Vinson syndrome is characterized by dysphagia (esophageal web Hematolo Pathology 7 HO
anemia formation) and iron deficiency anemia. Findings associated with iron gy & (Path)
1075 deficiency include koilonychia (spoon-shaped nails) and a shiny red Oncology
tongue. Most symptoms resolve following iron supplementation. (HO)

Iron deficiency Hypochromic, microcytic anemia is most commonly due to iron deficiency. Hematolo Pathology 7 HO
anemia Blood loss, especially occult loss from the gastrointestinal tract, must be gy & (Path)
1793
ruled out in a patient with iron deficiency anemia. Oncology
(HO)
Iron deficiency Anemia in a woman of childbearing age is most commonly caused by iron Hematolo Pathology 7 HO
anemia deficiency secondary to menstrual blood loss. Iron deficiency is associated gy & (Path)
1794 with decreased serum ferritin, increased total ironbinding capacity Oncology
(transferrin), and microcytic, hypochromic red blood cells. (HO)

Iron deficiency Increased bone marrow erythropoiesis results in an accelerated release of

Hematolo Pathology 7 HO
anemia immature red blood cells (reticulocytes) into the bloodstream. gy & (Path)
1796
Reticulocytes contain bluish cytoplasm and reticular precipitates of Oncology
residual ribosomal RNA. (HO)
ITP Autoimmune platelet destruction is a common cause of Hematolo Pathology 1 HO
thrombocytopenia and should be suspected in patients with ecchymoses, gy & (Path)
1954
petechiae, mucosal bleeding, and no other obvious causes of Oncology
thrombocytopenia (eg. medications, bone marrow failure). (HO)
Kaposi Kaposi's sarcoma typically presents as blue-violet or brownish skin plaques
Hematolo Pathology 2 HO
sarcoma on the extremities and mucous membranes of HIV-positive patients. This gy & (Path)
1761
tumor arises from primitive mesenchymal cells and is strongly associatedOncology
with human herpes virus type 8. (HO)
Keratin as a Keratin is a marker of epithelial cell origin. Hematolo Pathology 1 HO
marker gy & (Path)
1160
Oncology
(HO)
Lead poisoning Coarse erythrocyte basophilic stippling and microcytic hypochromic Hematolo Pathology 4 HO
anemia are common peripheral blood smear findings in lead poisoning. gy & (Path)
1865
High risk groups include young children ingesting paint chips and Oncology
industrial workers inhaling particulate lead. (HO)
Leukocytosis Leukemoid reaction is a benign leukocytosis (>50.000/mm3) that occurs in Hematolo Pathology 1 HO
response to an underlying condition such as severe infection/hemorrhage, gy & (Path)
malignancy (eg, leukemia), or acute hemolysis. Leukocyte alkaline Oncology
#### phosphatase levels are normal or increased. Peripheral smear can show (HO)
increased bands, early mature neutrophil precursors (eg, basophilic,
myelocytes), and granules (eg, Dohle bodies) in the neutrophils.

Li-Fraumeni Li-Fraumeni syndrome is caused by an autosomal dominant mutation in the Hematolo Pathology 1 HO
syndrome tumor suppressor gene TP53 Leukemia, sarcomas, and tumors of the gy & (Path)
345
breast, brain, and adrenal cortex are most common. Oncology
(HO)
Lung cancer Between 1950 and 2000, rising rates of tobacco use resulted in an increase Hematolo Pathology 9 HO
in female lung cancer incidence and mortality. Lung cancer is currently the gy & (Path)
1286
most common cause of cancer death in both women and men in the United Oncology
States (HO)
Lung cancer Melanoma is a highly aggressive malignancy that often metastasizes early Hematolo Pathology 9 HO
in the disease course. Patients may be asymptomatic for years prior to onset gy & (Path)
of metastatic manifestations. Diagnosis is generally made when a Oncology
#### histopathologic sample shows cellular atypia with cells containing brown (HO)
pigment (melanin granules); immunostaining for melanin/melanoma
markers (eg S-100, HMB-45) is generally positive

Matrix Metalloproteinases are zinc-containing enzymes that degrade the Hematolo Pathology 1 HO
metalloproteina extracellular matnx They participate in normal tissue remodeling and in gy & (Path)
1084
se tumor invasion through the basement membrane and connective tissue Oncology
(HO)
Multiple Amyloid light-chain amyloidosis is associated with multiple myeloma Hematolo Pathology 9 HO
myeloma and other monoclonal plasma cell dyscrasias due to the deposition of gy & (Path)
insoluble immunoglobulin light-chain fibrils in major organs (eg, kidneys, Oncology
872
heart, neurologic system). A bone marrow sample with >10% plasma cells (HO)
is strongly suggestive of multiple myeloma.
 Multiple The finding of a high peak in the gamma-globulin region on serum protein Hematolo Pathology 9 HO
myeloma electrophoresis (SPEP) usually represents an M protein consisting of an gy & (Path)
overproduced monoclonal immunoglobulin. Multiple myeloma (plasma Oncology
1964 cell neoplasm) causes an M protein peak on SPEP as well as anemia (HO)
(weakness), lytic bone lesions (back pain, pathologic fractures), and renal
insufficiency (related to amyloid deposition and hypercalcemia).

Multiple Multiple myeloma is associated with elevated circulating paraproteins Hematolo Pathology 9 HO
myeloma (monoclonal immunoglobulins), which causes erythrocytes to stack like gy & (Path)
6530 coins (rouleaux formation). Patients classically have normocytic anemia, Oncology
hypercalcemia, bone pain, and renal insufficiency. (HO)

Multiple Multiple myeloma is a plasma cell malignancy that replicates in the bone Hematolo Pathology 9 HO
myeloma marrow and causes osteolytic bone lesions, bone destruction, gy & (Path)
#### hypercalcemia, and pathologic fractures. Histopathology will show Oncology
replacement of the normal bone marrow with plasma cells and blasts (HO)

Myelofibrosis The chronic myeloproliferative disorders (polycythemia vera. essential Hematolo Pathology 3 HO
thrombocytosis, and primary myelofibrosis) often have a mutation in gy & (Path)
Janus kinase 2 (JAK2), a cytoplasmic tyrosine kinase. This results in Oncology
8540 constitutive tyrosine kinase activity, and consequently, in the cytokine- (HO)
independent activation of signal transducers and activators of transcription
(STAT) proteins (JAK-STAT signaling pathway).

Myelofibrosis Primary myelofibrosis is a myeloproliferative disorder associated with the Hematolo Pathology 3 HO
clonal expansion of megakaryocytes. Bone marrow fibrosis accounts for gy & (Path)
most of the major manifestations, including hepatosplenomegaly, Oncology
#### cytopenias, and blood smear evidence of dacrocytes Bone marrow (HO)
aspiration is usually dry. but bone marrow biopsy will show marked
fibrosis with occasional clusters of atypical megakaryocytes

Nasopharyngea Nasopharyngeal cancer is endemic in southern China due to genetic and Hematolo Pathology 1 HO
l carcinoma dietary factors that promote nasopharyngeal epithelial pre-malignant gy & (Path)
1572 lesions In almost all cases, malignant transformation occurs due to Oncology
infection of premalignant cells with Epstein-Barr virus and the (HO)
subsequent expression of oncogenic viral proteins.
Non-Hodgkin Follicular lymphoma is the most common indolent non-Hodgkin Hematolo Pathology 6 HO
lymphoma lymphoma in adults. It is of В-cell origin and presents with painless waxing gy & (Path)
1086 and waning (ie, fluctuating) lymphadenopathy. The cytogenetic change Oncology
t(14;18) is characteristic and results in overexpression of the BCL2 (HO)
oncogene.
Non-Hodgkin Follicular lymphoma is characterized by aggregates of packed follicles that Hematolo Pathology 6 HO
lymphoma obscure the normal lymph node architecture. Ninety percent of patients gy & (Path)
1627 with follicular lymphoma have the t(14:18) translocation, which causes Oncology
overexpression of the antiapoptotic BCL-2 protein. (HO)

Non-Hodgkin Benign lymph node enlargement in response to antigenic stimulation is Hematolo Pathology 6 HO
lymphoma associated with a polyclonal proliferation of lymphocytes. A monoclonal gy & (Path)
1754
lymphocytic proliferation is strong evidence of malignancy. Oncology
(HO)
Non-Hodgkin Overexpression of bcl-2 leads to increased secretion of Bcl-2 protein, Hematolo Pathology 6 HO
lymphoma which inhibits apoptosis (cell death) and promotes survival of tumor gy & (Path)
cells. This overexpression occurs in follicular lymphoma secondary to Oncology
1758
translocation of the bcl-2 oncogene from chromosome 18 to the Ig heavy (HO)
chain locus on chromosome 14 [t(14;18)j.

Non-Hodgkin Follicular lymphoma is a non-Hodgkin lymphoma of follicular B- Hematolo Pathology 6 HO

lymphoma lymphocytes. Patients with follicular lymphoma characteristically have a gy & (Path)
1911 translocation between chromosomes 14 and 18 which causes Bel-2 Oncology
overexpression. Bel-2 is considered a protooncogene because it has anti- (HO)
apoptotic effects.
Oncogenes and p53 is a tumor suppressor gene that controls cell division and apoptosis. It Hematolo Pathology 1 HO
tumor is inactivated in many tumors. gy & (Path)
313
suppressor Oncology
genes (HO)
Paroxysmal Paroxysmal nocturnal hemoglobinuria is due to a gene defect that leads to Hematolo Pathology 2 HO
nocturnal uncontrolled complement-mediated hemolysis. The classic triad includes gy & (Path)
#### hemoglobinuria hemolytic anemia (hemoglobinuria), pancytopenia, and thrombosis at Oncology
atypical sites. Chronic hemolysis can cause iron deposition in the kidney (HO)
(hemosiderosis).
Polycythemia Renal cortical cells sense hypoxia and respond by synthesizing and Hematolo Pathology 5 HO
releasing erythropoietin. Erythropoietin stimulates the production of gy & (Path)
1941
erythrocytes in the bone marrow. Oncology
(HO)
 Polycythemia Polycythemia vera (PV) is a clonal myeloproliferative disease characterize Hematolo Pathology 5 HO
by an increased RBC mass, increased plasma volume, and low gy & (Path)
erythropoietin levels. PV can be differentiated from secondary Oncology
8559 polycythemia by the presence of leukocytosis, thrombocytosis, and/or (HO)
splenomegaly. The majority of patients with PV have a JAK2 mutation
rendering hematopoietic stem cells more sensitive to growth factors.

Polycythemia Polycythemia vera is a myeloproliferative disorder characterized by Hematolo Pathology 5 HO

uncontrolled erythrocyte production. Virtually all patients with gy & (Path)
8591 polycythemia vera have a mutation in JAK2, a non-receptor Oncology
(cytoplasmic) tyrosine kinase associated with the erythropoietin receptor. (HO)

Prostate cancer CFx that suggest a malignant cause of back pain incl occurrence at night, Hematolo Pathology 10 HO
not relievedwith rest or analgesics, advanced age, and systemic SSx. gy & (Path)
341
Common malignancieswith a propensity for bony mets incl prostate, breast, Oncology
kidney, thyroid, and lung. (HO)
Prostate cancer Imaging of bone metastases assists in cancer diagnosis. Bone metastases Hematolo Pathology 10 HO
are charactenzed as osteolytic or osteoblastic. Bony pain in an older man gy & (Path)
####
with osteoblastic lesions on imaging is highly suspicious for prostate Oncology
cancer (HO)
Pulmonary Saddle pulmonary embolism straddles the bifurcation of the main Hematolo Pathology 13 HO
embolism pulmonary artery. Venous thromboembolism (ie, pulmonary embolism or gy & (Path)
deep vein thrombosis) arises due to the Virchow triad of endothelial injury, Oncology
1880
venous stasis, and a hypercoagulable state. Malignancy causes a (HO)
hvoercoaqulable state and is a strong risk factor for venous
thromboembolism.
Pure red cell Pure red cell aplasia is a rare form of marrow failure characterized by Hematolo Pathology 1 HO
aplasia severe hypoplasia of marrow erythroid elements in the setting of normal gy & (Path)
1786 granulopoiesis and thrombopoiesis. Pure red cell aplasia is associated with Oncology
thymoma, lymphocytic leukemias, and parvovirus B19 infection. (HO)

Rb protein Proliferation signals activate CDK4 (cyclin-dependent kinase-4) resulting Hematolo Pathology 1 HO
in hyperphosphorylation of the Rb protein. Because gy & (Path)
1718
hyperphosphorylated Rb is inactive, cells are allowed to transition Oncology
unchecked from the G1 phase to the S phase in the cell cycle (HO)
Renal vein Nephrotic syndrome is a hypercoagulable state. Sudden-onset abdominal or Hematolo Pathology 1 HO
thrombosis flank pain, hematuria, and left-sided varicoceles suggest renal vein gy & (Path)
thrombosis, a well-known complication of nephrotic syndrome. Loss of Oncology
26
anticoagulant factors, especially antithrombin III, is responsible for the (HO)
thrombotic and TE complications of nephrotic syndrome.

Retinoblastoma The Rb tumor suppressor gene encodes the Rb protein, which regulates the Hematolo Pathology 1 HO
(Rb) protein cell cycle. Active (hypophosphorylated) Rb protein prevents damaged cells gy & (Path)
from proceeding past the G1 to S checkpoint, while the inactive Oncology
1717
(hyperphosphorylated) Rb protein allows the damaged cell to enter mitosis. (HO)
Abnormal phosphorylation of Rb protein results in its inactivation.

Sickle cell Patients with sickle cell trait are typically asymptomatic and have relative Hematolo Pathology 13 HO
protection from malaria caused by Plasmodium falciparum. These gy & (Path)
895 patients usually have normal hemoglobin, reticulocyte, and red blood cell Oncology
index values. Life expectancy is the same as that of the general population (HO)

Sickle cell The major chronic pathologic changes in the spleens of patients with sickle Hematolo Pathology 13 HO
cell anemia result from repetitive splenic infarctions caused by splenic gy & (Path)
1842
microvessel occlusion. Fibrosis, brownish discoloration, and eventual Oncology
autosplenectomy ultimately result. (HO)
Sickle cell Sickle cell disease is characterized by repeated splenic infarctions that Hematolo Pathology 13 HO
ultimately result in splenic atrophy and fibrosis, a process that is typically gy & (Path)
2084 complete by late childhood/adolescence. After autosplenectomy, patients Oncology
are predisposed to infections with encapsulated bacterial organisms. (HO)

Sickle cell An MCV >110 pm3 is highly suggestive of megaloblastic anemia, such as Hematolo Pathology 13 HO
that caused by folic acid or vitamin Bi2 deficiency. Patients with chronic gy & (Path)
2085 hemolytic anemia have increased folic acid requirements due to increased Oncology
erythrocyte turnover and are predisposed to developing macrocytosis. (HO)

Sickle cell Parvovirus B19 infection can cause transient aplastic crisis, particularly Hematolo Pathology 13 HO
in those with underlying hemoglobin disorders such as sickle cell anemia. gy & (Path)
Patients develop symptomatic anemia (eg, exertional dyspnea, fatigue, low Oncology
####
hematocrit) due to inhibition of erythropoiesis by the virus. Bone marrow (HO)
examination will show giant pronormoblasts with glassy, intranuclear viral
inclusions.
 SLE Systemic lupus erythematosus is an autoimmune disorder that occurs Hematolo Pathology 7 HO
most commonly in women. Hematologic abnormalities are common; gy & (Path)
autoantibodies against blood cell antigens (ie, type II hypersensitivity) can Oncology
875 cause pancytopenia (ie, anemia, thrombocytopenia, leukopenia). In (HO)
contrast, lupus nephritis is caused by immune complex deposition (ie, type
III hypersensitivity) in the glomeruli.

Thrombotic Thrombotic thrombocytopenic purpura results from impaired function of Hematolo Pathology 3 HO
thrombocytope the von Willebrand factor (vWF)-cleaving protease ADAMTS13. gy & (Path)
nic purpura resulting in uncleaved vWF multimers that are significantly more Oncology
####
prothrombotic and cause diffuse microvascular thrombosis, (HO)
microangiopathic hemolytic anemia, and thrombocytopenia.

Traumatic Schistocytes (helmet cells) are fragmented erythrocytes. They occur Hematolo Pathology 2 HO
hemolytic secondary to mechanical trauma from microangiopathic hemolytic anemias gy & (Path)
829 anemia or prosthetic cardiac valves. Intravascular hemolytic anemias are Oncology
characterized by decreased serum haptoglobin levels as well as increased (HO)
LDH and bilirubin.
Traumatic RBC fragments, burr cells, and helmet cells are a/w either MAHA or mech Hematolo Pathology 2 HO
hemolytic red cell destruction. In ptswith prosthetic valves, RBCs are exposed to gy & (Path)
1297
anemia excessive shear and turbulence in the circulation, causing damage from Oncology
mech trauma. (HO)
Uremic platelet Abnormal bleeding in patients with uremia is due to a qualitative platelet Hematolo Pathology 1 HO
dysfunction disorder that causes prolonged bleeding time with normal platelet gy & (Path)
1293
count, prothrombin time, and activated partial thromboplastin time. Oncology
(HO)
Vitamin B12 Deficiency of vitamin B12 (cobalamin) is associated with both Hematolo Pathology 9 HO
deficiency megaloblastic anemia and neurologic dysfunction, while folate deficiency gy & (Path)
is associated with megaloblastic anemia alone. Moderate improvement in Oncology
1792 the hemoglobin level often occurs when a deficiency in vitamin B12 is (HO)
treated with folate, or vice versa. Treatment of vitamin B12 deficiency with
folate alone can actually worsen neurologic dysfunction.

Vitamin B12 Atrophic gastritis can result in profound hypochlorhydria, inadequate Hematolo Pathology 9 HO
deficiency intrinsic factor production, vitamin Bi2 deficiency, and elevated gy & (Path)
methylmalonic acid levels. The reticulocyte count increases dramatically Oncology
1848 once vitamin B,2 replacement therapy is initiated in an individual with (HO)
pernicious anemia Hemoglobin and erythrocyte count levels rise more
gradually and take up to 8 weeks to normalize.

Vitamin K Vitamin К is necessary for the gamma carboxylation and functionality of Hematolo Pathology 2 HO
deficiency coagulation factors II, VII, IX. and X. Newborns who do not receive gy & (Path)
prophylactic supplementation are at risk for bleeding complications. Oncology
710
Patients with cystic fibrosis are also at risk for vitamin К deficiency due (HO)
to poor absorption of fat-soluble vitamins.

von Willebrand von Willebrand disease is the most common inherited bleeding disorder. Hematolo Pathology 7 HO
disease It has an autosomal dominant pattern of inheritance and variable gy & (Path)
penetrance. Absence of von Willebrand factor leads to impaired platelet Oncology
1923
function (prolonged bleeding time) and coagulation pathway abnormalities (HO)
due to decreased factor VIII activity (prolonged partial thromboplastin
time).
Acute Acute intermittent porphyria is an autosomal dominant condition caused by Hematolo Pathophysiol 1 HO
intermittent porphobilinogen deaminase deficiency. Most patients remain gy & ogy (Patp)
porphyria asymptomatic, but a minority present with acute attacks characterized by Oncology
abdominal pain and vomiting, peripheral neuropathy, neuropsychological (HO)
1339
symptoms and reddish-brown urine. Treatment consists of intravenous
glucose or heme preparations, which downregulate ALA synthase activity
(Porphyrin synthesis).

Asplenia Target cells form when erythrocytes have reduced cell volume (eg, Hematolo Pathophysiol 2 HO
thalassemia, iron deficiency) or excessive membrane (eg, obstructive liver gy & ogy (Patp)
disease, postsplenectomy). Patients who undergo splenectomy usually Oncology
####
develop target cells because the spleen is the primary organ that prunes (HO)
excessive red cell membrane (surface area to volume ratio).

Atrial Patients started on warfarin develop a transient hypercoagulable state due Hematolo Pathophysiol 5 HO
fibrillation to the short half-life of protein C. This hypercoagulability is further gy & ogy (Patp)
exaggerated by preexisting protein C deficiency and can result in Oncology
1292 thrombotic occlusion of the microvasculature with skin necrosis.Treatment (HO)
of warfarin-induced skin necrosis includes discontinuing warfarin and
administering fresh frozen plasma or protein C concentrate.
 Breast cancer Peau d'orange is an erythematous, itchy breast rash with skin texture Hematolo Pathophysiol 7 HO
changes that resemble an orange peel. It is the key dermatologic gy & ogy (Patp)
1877 presentation of inflammatory breast cancer and is caused by cancerous Oncology
cells spreading to the dermal lymphatic spaces and obstructing lymphatic (HO)
drainage.
Carcinoid Carcinoid tumors confined to the intestine do not cause carcinoid Hematolo Pathophysiol 4 HO
tumors syndrome as their secretory products are metabolized by the liver before gy & ogy (Patp)
entering the systemic circulation. In contrast, intestinal carcinoids that Oncology
425 metastasize to the liver and extraintestinal (eg, bronchial) carcinoids (HO)
release vasoactive substances that avoid first-pass metabolism, resulting in
carcinoid syndrome (eg, flushing, diarrhea, bronchospasm).

Cirrhosis Vitamin К-dependent coagulation factors (II, VII, IX, and X) are Hematolo Pathophysiol 7 HO
synthesized in the liver. Factor VII has the shortest half-life of the gy & ogy (Patp)
1291 coagulation factors. Failure of the prothrombin time to correct with vitamin Oncology
К supplementation indicates factor VII deficiency, which is often due to (HO)
underlying liver disease.
DIC Disseminated intravascular coagulation is marked by widespread activation Hematolo Pathophysiol 5 HO
of the coagulation cascade leading to excessive thrombin production and gy & ogy (Patp)
formation of microthrombi. Subsequent conversion of plasminogen to Oncology
plasmin results in increased fibrinolysis to clear the thrombi. Laboratory (HO)
####
studies show a consumption of clotting factors (prolonged PT/PTT) and
platelets (thrombocytopenia) and signs of excessive fibrinolysis (eg,
elevated D-dimer).

Direct factor Direct factor Xa inhibitors (eg. apixaban. rivaroxaban) increase the Hematolo Pathophysiol 1 HO
Xa inhibitors prothrombin and activated partial thromboplastin times but do not affect gy & ogy (Patp)
2133
the thrombin time. Unfractionated heparin and direct thrombin inhibitors Oncology
(eg, dabigatran) prolong the thrombin time. (HO)
Factor VII A normal bleeding time indicates adequate platelet hemostatic function. A Hematolo Pathophysiol 1 HO
deficiency normal activated partial thromboplastin time (aPTT) indicates an intact gy & ogy (Patp)
intrinsic coagulation system. Prolonged prothrombin time in the setting of Oncology
1903
normal aPTT indicates a defect in the extrinsic coagulation system(factor (HO)
VII) at a step that is not shared with the intrinsic system.

Hemolytic Hemolytic uremic syndrome (HUS) manifests with acute kidney injury, Hematolo Pathophysiol 3 HO
uremic microangiopathic hemolytic anemia, and thrombocytopenia. Characteristic gy & ogy (Patp)
syndrome laboratory abnormalities include decreased hemoglobin and platelet Oncology
1851
count and increased bleeding time, lactate dehydrogenase, bilirubin, (HO)
blood urea nitrogen, and creatinine

Hereditary In spherocytosis, mean corpuscular hemoglobin concentration Hematolo Pathophysiol 3 HO

spherocytosis(MCHC) is increased due to mild dehydration of the red blood cell. gy & ogy (Patp)
890
Markers of hemolysis are often evident and include elevated lactate Oncology
dehydrogenase, reticulocytosis. and decreased haptoglobin. (HO)
Lead poisoning Lead poisoning in adults typically occurs through occupational exposure. Hematolo Pathophysiol 4 HO
Symptoms include colicky abdominal pain, constipation, lead lines on the gy & ogy (Patp)
gum, peripheral neuropathy, and anemia. Laboratory testing shows Oncology
1156
microcytic anemia with normal iron studies, and peripheral blood smear (HO)
may reveal basophilic stippling

Multiple Multiple myeloma should be suspected in elderly patients who have any Hematolo Pathophysiol 9 HO
myeloma combination of osteolytic lesions, hypercalcemia, anemia, or acute kidney gy & ogy (Patp)
injury. Renal disease is most commonly caused by light chain cast Oncology
#### nephropathy, in which free lambda light chains form obstructive casts in (HO)
the renal tubules. Monoclonal paraproteins are not detected by urine
dipstick (which detects only albumin), but both spot and 24-hour protein
concentrations will be elevated.
Multiple Multiple myeloma is a plasma cell malignancy associated with purely Hematolo Pathophysiol 9 HO
myeloma radiolucent (osteolytic) bone lesions due to the stimulation of osteoclasts gy & ogy (Patp)
and the inhibition of osteoblasts. Myeloma cells stimulate osteoclast Oncology
####
development by secreting RANK-ligand and destroying osteoprotegerin, (HO)
which increases RANK activity and results in osteoclast differentiation.

Myelofibrosis Primary myelofibrosis is a chronic myeloproliferative disorder associated Hematolo Pathophysiol 3 HO

with bone marrow fibrosis. Extramedullary hematopoiesis leads to marked gy & ogy (Patp)
expansion of the splenic red pulp with hematopoietic progenitor cells and Oncology
#### results in massive splenomegaly. Patients also usually have hepatomegaly, (HO)
cytopenias, and peripheral smear abnormalities (eg, dacrocytes, nucleated
red cells, immature granulocytes).
 Paroxysmal The triad of hemolytic anemia, hypercoagulability, and pancytopenia Hematolo Pathophysiol 2 HO
nocturnal suggests paroxysmal nocturnal hemoglobinuria (PNH) PNH results from gy & ogy (Patp)
hemoglobinuria an acquired mutation in the PIGA gene that causes absence of the Oncology
897
glycosylphosphatidylinositol anchor and associated deficiency of CD55 (HO)
and CD59 complement inhibitor proteins (complement activation).

Sickle cell Dactylitis (painful swelling of the hands and feet) is a common Hematolo Pathophysiol 13 HO
presentation of sickle cell disease (SCD) in young children It is one of gy & ogy (Patp)
many vasoocclusive manifestations of SCD Sickling episodes result in Oncology
1855
hemolysis, which leads to increased indirect bilirubin and lactate (HO)
dehydrogenase and decreased levels of haptoglobin.

Thalassemia Beta-thalassemia is caused by mutations that result in defective Hematolo Pathophysiol 3 HO

transcription, processing, and translation of beta-globin mRNA. This gy & ogy (Patp)
1940
leads to deficiency of the beta-globin chains required for normal Oncology
hemoglobin synthesis. (HO)
Thrombotic Thrombotic thrombocytopenic purpura is one of several primary Hematolo Pathophysiol 3 HO
thrombocytope thrombotic microangiopathies resulting in microangiopathic hemolytic gy & ogy (Patp)
#### nic purpura anemia and thrombocytopenia, which are essential to the diagnosis. Oncology
Plasma exchange therapy has prompted more rapid diagnosis and is life- (HO)
saving.
Vitamin B12 Vitamin B12 is an essential cofactor in the recycling of 5MTHF to THF, Hematolo Pathophysiol 9 HO
deficiency which is req for AA, purine, and thymidine synth. Deficiency 1arily affect gy & ogy (Patp)
HPO cell maturation and is marked by increase nuclear-cytoplasmic ratio, Oncology
####
leading to macrocytic RBCs and hypersegment neutrophils; increase (HO)
apoptosis (impaired DNA synthesis) often also leads to anemia and
mild thrombocytopenia/leukopenia.
von Willebrand Patients with von Willebrand disease often present with a lifelong history Hematolo Pathophysiol 7 HO
disease of mucosal bleeding, including gingival bleeding, epistaxis, and/or gy & ogy (Patp)
2097 menorrhagia. These patients have normal platelet levels but typically Oncology
have a prolonged bleeding time due to impaired platelet functioning, (HO)
decreased level Hb,MCV, ferritin .
von Willebrand von Willebrand factor (vWF) functions as a promoter of platelet adhesion Hematolo Pathophysiol 7 HO
disease at sites of vascular injury by binding platelet glycoproteins to gy & ogy (Patp)
2098
subendothelial collagen on injured blood vessel walls. It also acts as a Oncology
protective carrier protein for circulating factor VIII. (HO)
von Willebrand Von Willebrand disease is the most common inherited bleeding disorder Hematolo Pathophysiol 7 HO
disease and is usually transmitted in an autosomal dominant fashion. Symptomatic gy & ogy (Patp)
patients typically present with easy bruising and mucosal bleeding. Oncology
####
Laboratory evaluation will show normal platelets, normal PT, and either (HO)
normal or prolonged PTT due to low levels of factor VIII.

Acute 6-mercaptopurine (6-MP) is an immunosuppression drug that is inactivated Hematolo Pharmacolog 3 HO

lymphoblastic by 2 enzymes, xanthine oxidase and thiopurine methyltransferase. gy & y (Phar)
1890 leukemia Reduced function of either enzyme causes increased levels of the active Oncology
metabolites of 6-MP, leading to increased immunosuppression and risk of (HO)
toxicity.
Anticoagulants Heparin is commonly used for the prevention of deep venous thrombosis in Hematolo Pharmacolog 8 HO
nonambulatory patients or those undergoing elective surgery, especially hip gy & y (Phar)
1077
and knee surgery. Heparin increases the effect of the naturally occurring Oncology
anticoagulant antithrombin III. (HO)
Anticoagulants Heparin-induced thrombocytopenia (HIT) is treated with direct thrombin Hematolo Pharmacolog 8 HO
inhibitors (DTIs) such as argatroban. It binds to the thrombin active site. gy & y (Phar)
1078
Both high molecular weight heparin and LMWH should be avoided in Oncology
these patients. (HO)
Anticoagulants Protamine sulfate binds to heparin, causing chemical inactivation. Hematolo Pharmacolog 8 HO
Vitamin К and fresh frozen plasma can be used to reverse warfarin effects. gy & y (Phar)
1087
Oncology
(HO)
Anticoagulants Rifampin, phenobarbitaf and phenytoin are potent enhancers of the Hematolo Pharmacolog 8 HO
cytochrome P-450 pathway; concurrent use of warfarin with these gy & y (Phar)
medications results in decreased efficacy of warfarin. In contrast, Oncology
1090
cimetidine, amiodarone, and trimethoprim-sulfamethoxazole inhibit (HO)
warfarin metabolism, increasing the risk of bleeding.

Anticoagulants Enoxaparin is a low-molecular-weight heparin (LMWH) that functions like Hematolo Pharmacolog 8 HO
heparin in that it binds and activates antithrombin III (AT III). Activated gy & y (Phar)
AT III binds to factor Xa and stops factor Xa from converting prothrombin Oncology
1784
to thrombin. Due to its fewer number of molecules, LMWH acts primarily (HO)
on factor Xa, not thrombin.
 Anticoagulants Both unfractionated heparin and LMWH can bind to antithrombin to Hematolo Pharmacolog 8 HO
increase its activity against Factor Xa. Only unfractionated heparin is able gy & y (Phar)
2132
to bind to both antithrombin and thrombin to allow antithrombin to Oncology
inactivate thrombin. (HO)
BCL 2 Chronic lymphocytic leukemia is associated with overexpression of BCL-2, Hematolo Pharmacolog 1 HO
an anti-apoptotic protein, on the mitochondrial membrane. Treatment with gy & y (Phar)
#### a BCL inhibitor causes cancer cell death by promoting cytochrome c Oncology
release from the mitochondria, which subsequently activates caspases. (HO)

Cell cycle Cyclin-dependent kinases (CDKs) 4/6 regulate the movement of cells from Hematolo Pharmacolog 2 HO
Gi—>S phase. Cancers often have mutations that enhance the activity or gy & y (Phar)
downstream effects of CDK 4/6, which contribute to unregulated cellular Oncology
growth. Inhibitors to CDK 4/6 can be used to treat certain forms of cancer. (HO)
####
However, they can inhibit cellular replication in other rapidly dividing cells
such as the hematologic cells in the bone marrow (eg, neutropenia,
anemia, or thrombocytopenia).

Chemotherapy The human multidrug resistance (MDR1) gene codes for P-glycoprotein, a Hematolo Pharmacolog 3 HO
transmembrane ATP-dependent efflux pump protein that has a broad gy & y (Phar)
specificity for hydrophobic compounds This protein can both reduce the Oncology
1819
influx of drugs into the cytosol and can increase efflux from the cytosol, (HO)
thereby preventing the action of chemotherapeutic agents.

Chemotherapy Methotrexate and 5-FU both effectively inhibit thymidylate formation, Hematolo Pharmacolog 3 HO
but the chemotherapeutic effect of methotrexate is overcome by N 5
-formyl- gy & y (Phar)
1892 Oncology
tetrahydrofolate (folinic acid, leucovorin) supplementation.
(HO)
Chemotherapy Neurotoxicity is the dose-limiting side effect of vincristine therapy. This Hematolo Pharmacolog 3 HO
toxicity results from failure of microtubule polymerization in neuronal gy & y (Phar)
axons (like finger numbness and tingling). Other notable adverse effects Oncology
1894 classically associated with chemotherapeutic agents include pulmonary (HO)
fibrosis and flagellate skin discoloration with bleomycin use; congestive
heart failure with doxorubicin; and hemorrhagic cystitis with
cyclophosphamide
Chemotherapy Chemotherapy-induced nausea and vomiting is mediated by penpheral Hematolo Pharmacolog 1 HO
induced nausea and central mechanisms. It can be treated with serotonin receptor gy & y (Phar)
and vomiting antagonists (eg, ondansetron) to prevent serotonin stimulation of afferent Oncology
####
vagal fibers in the bowel wall (peripheral cause) and neurokinin-1 receptor (HO)
antagonists (eg. aprepitant) to prevent the effects of substance P in the
brainstem (central cause).
Etoposide Etoposide is a chemotherapeutic agent that inhibits the sealing activity of Hematolo Pharmacolog 1 HO
topoisomerase II. Treatment with etoposide causes chromosomal breaks gy & y (Phar)
2018
to accumulate in dividing cells, ultimately causing cell death. Oncology
(HO)
Glanzmann Abciximab is a blocker of glycoprotein (GP) llb/llla receptor, which Hematolo Pharmacolog 1 HO
thrombasthenia normally promotes platelet binding to fibrinogen. GP llb/llla is either gy & y (Phar)
1079
deficient or defective in patients with Glanzmann thrombasthenia Oncology
(HO)
Hemophilias Hemophilia A is an X-linked disorder associated with a deficiency of factor Hematolo Pharmacolog 1 HO
VIII. Emicizumab—a bispecific, monoclonal antibody—mimics the activity gy & y (Phar)
####
of factor VIII by binding to both factor IXa and factor X, to create Oncology
activated factor X. (HO)
Immunotherapy Cancer cells avoid immune recognition by overexpressing programmed Hematolo Pharmacolog 2 HO
death-ligand 1 (PD-L1), which binds to the programmed cell death-1 (PD- gy & y (Phar)
1) receptor on cytotoxic T cells and inhibits their response (T-cell Oncology
#### exhaustion). Monoclonal antibodies that block PD-L1 and PD-1 are (HO)
effective against ca that express high levels of neo-Ags on their surface
b/c these tumors are particularly susceptible to immune recognition by Tc
cells.
Interstitial lung Bleomycin is an antineoplastic agent that binds to iron and oxygen Hematolo Pharmacolog 8 HO
disease molecules to create free radicals that cause DNA strand breaks. The gy & y (Phar)
most clinically important adverse effect of bleomycin is lung toxicity, Oncology
#### usually manifesting as pulmonary fibrosis. Patients develop dyspnea and (HO)
nonproductive cough, and pulmonary function testing shows a restrictive
pattern with reduced diffusion capacity for carbon monoxide (DLCO).

Methotrexate Folinic acid (leucovorin) can reverse the toxicity of methotrexate in non- Hematolo Pharmacolog 2 HO
cancerous cells in the gastrointestinal mucosa and bone marrow if gy & y (Phar)
1818 administered at the appropriate time. Leucovorin serves as a reduced form Oncology
of folic acid that does not require the action of dihydrofolate reductase. (HO)
 Methotrexate Methotrexate is a folic acid antagonist used to treat ectopic pregnancy. It Hematolo Pharmacolog 2 HO
competitively inhibits the enzyme dihydrofolate (DHF) reductase, which gy & y (Phar)
1857 catalyzes the synthesis of tetrahydrofolate DHF reductase inhibition causes Oncology
the intermediate DHF to accumulate intracellularly. (HO)

Multiple In multiple myeloma, neoplastic plasma cells synthesize large amounts of Hematolo Pharmacolog 9 HO
myeloma monoclonal immunoglobulin or immunoglobulin fragments. These cells are gy & y (Phar)
particularly susceptible to proteasome inhibition due to the large amount of Oncology
####
proteins that they manufacture. The resulting accumulation of toxic (HO)
intracellular and proapoptotic proteins increases cellular apoptosis.

Non-Hodgkin Rituximab is a monoclonal antibody directed against the CD20 antigen. Its Hematolo Pharmacolog 6 HO
lymphoma introduction has improved the prognosis of some lymphomas. gy & y (Phar)
1628
Oncology
(HO)
NSAIDs Aspirin (acetylsalicylic acid) is a nonsteroidal anti-inflammatory drug Hematolo Pharmacolog 4 HO
(NSAID) that irreversibly inhibits cyclooxygenase-1 and -2 (COX-1 and - gy & y (Phar)
714 2) enzymes via acetylation. In contrast, other NSAIDs (eg, diclofenac, Oncology
ibuprofen, indomethacin) reversibly inhibit COX-1 and COX-2. (HO)

Opioids Chronic opioid use leads to the development of tolerance to analgesic Hematolo Pharmacolog 14 HO
effects and most side effects, with the exception of constipation and gy & y (Phar)
1257 miosis. To prevent bowel complications, it is recommended that patients be Oncology
treated prophylactically with adequate fluid intake and daily laxatives. (HO)

Ovarian cancer Vomiting is a reflex regulated mainly by 5 receptors, including muscarinic, Hematolo Pharmacolog 9 HO
D2 dopaminergic, H, histaminic, 5-HT3 serotonergic, and neurokinin 1 gy & y (Phar)
#### (NK1) receptors. 5-HT3 and NK1 receptor antagonists are particularly Oncology
useful for chemotherapy-induced vomiting. (HO)

Sickle cell Hydroxyurea is used in patients with sickle cell disease to increase Hematolo Pharmacolog 13 HO
expression of gamma globin chains, which leads to increased circulating gy & y (Phar)
892
fetal hemoglobin (Hb F) concentration. This reduces vasoocclusive Oncology
crises and symptomatic anemia episodes (HO)
Trastuzumab Human epidermal growth factor receptor 2 (HER2) is a tyrosine kinase Hematolo Pharmacolog 1 HO
receptor that is overexpressed in 20% of breast cancer patients. In such gy & y (Phar)
#### patients, HER2 blockade with the monoclonal antibody trastuzumab Oncology
downregulates cellular proliferation and promotes apoptosis. (HO)

Tumor lysis Tumor lysis syndrome primarily develops during chemotherapy for cancers Hematolo Pharmacolog 1 HO
syndrome with rapid cell turnover, substantial tumor burden, or high sensitivity to gy & y (Phar)
chemotherapy. It is characterized by hyperphosphatemia, hypocalcemia, Oncology
hyperkalemia, and hyperuricemia. Prevention involves intravenous fluids (HO)
8542
to flush the kidneys and the use of hypouricemic agents (Converting
uric acid into more soluble metabolites) (eg, rasburicase, allopurinol,
febuxostat).

Urinary tract Hemorrhagic cystitis during therapy with cyclophosphamide or ifosfamide Hematolo Pharmacolog 12 HO
infection is caused by the urinary excretion of the toxic metabolite acrolein. It can be gy & y (Phar)
1816 prevented by aggressive hydration, bladder irrigation, and administration Oncology
of mesna, a sulfhydryl compound that binds acrolein in the urine. (HO)

Venous Rivaroxaban is an oral anticoagulant that directly inhibits factor Xa. It is Hematolo Pharmacolog 2 HO
thromboemboli used in venous thromboembolism and atrial fibrillation. gy & y (Phar)
####
sm Oncology
(HO)
Vincristine The vinca alkaloids are cell cycle-specific agents that prevent proper Hematolo Pharmacolog 1 HO
separation of chromosomes into daughter cells during the M phase of the gy & y (Phar)
1893 cell cycle The main dose-limiting side effect of vincristine is neurotoxicity, Oncology
which commonly manifests as peripheral neuropathy. (HO)

von Willebrand The von Willebrand factor (vWF) enhances clotting through both Hematolo Pharmacolog 7 HO
disease augmentation of platelet binding and stabilization of factor VIII. Patients gy & y (Phar)
with von Wiliebrand disease are deficient in functional vWF and present Oncology
219
with increased bruisability and prolonged mucosal bleeding. Desmopressin (HO)
can alleviate bleeding through increase in endothelial protein releaseof
vWF.
von Willebrand Patients with symptomatic von Willebrand disease can be treated with Hematolo Pharmacolog 7 HO
disease desmopressin (DDAVP), a synthetic antidiuretic hormone analogue that gy & y (Phar)
has no vasoconstrictive effects. DDAVP transiently increases von Oncology
942
Willebrand factor and factor VIII release from endothelial cell storage (HO)
through indirect mechanisms; it can be used prophylactically prior to
procedures or to treat minor bleeding.
 Warfarin Both vitamin К and fresh frozen plasma are used for reversing warfarin- Hematolo Pharmacolog 1 HO
reversal induced anticoagulation. Fresh frozen plasma rapidly reverses warfarin's gy & y (Phar)
709
effects whereas vitamin К requires time for clotting factor re-synthesis. Oncology
(HO)
Anemia of Erythropoietin (EPO) is produced by peritubular fibroblast cells in the Hematolo Physiology 2 HO
chronic disease renal cortex in response to decreased renal oxygen delivery. EPO acts on gy & (Phys)
erythrocyte precursors in the bone marrow to increase red blood cell Oncology
####
production. Patients with chronic kidney disease often have damage to (HO)
renal EPO-producing cells, which results in normocytic anemia.

Blood Citrate anticoagulants in high-volume blood transfusion can chelate Hematolo Physiology 2 HO
transfusion plasma calcium, leading to hypocalcemia which causes peripheral gy & (Phys)
neuromuscular excitability (eg. paresthesia, muscle spasms). This is most Oncology
1654
common with very rapid transfusion rates, but it can also be seen at lower (HO)
rates in patients with hepatic insufficiency because citrate is metabolized
by the liver.
Carbon Carbon monoxide (CO) binds to hemoglobin with much higher affinity Hematolo Physiology 2 HO
monoxide than oxygen, thereby preventing oxygen binding to hemoglobin. It also gy & (Phys)
poisoning reduces oxygen unloading from hemoglobin in the tissues. CO poisoning Oncology
1545
increases carboxyhemoglobin concentrations but does not affect the (HO)
partial pressure of oxygen and does not precipitate
methemoglobinemia.
Chronic kidney Chronic kidney disease is commonly associated with normocytic anemia Hematolo Physiology 8 HO
disease due to reduced production of erythropoietin by the kidneys. Erythropoietin gy & (Phys)
signal transduction is primarily mediated by the Janus kinase 2/signal Oncology
####
transducers and activators of transcription (JAK2/STAT) pathway, (HO)
which promotes erythrocyte precursor survival.

Iron deficiency Hepcidin is a polypeptide synthesized by the liver (hepatic parenchymal Hematolo Physiology 7 HO
anemia cels) that acts as the central regulator of iron homeostasis. High iron levels gy & (Phys)
and inflammatory conditions increase the synthesis of hepcidin; hypoxia Oncology
787
and increased erythropoiesis act to lower hepcidin levels. Low hepcidin (HO)
levels increase intestinal iron absorption and stimulate iron release by
macrophages.
Vitamin K Vitamin К deficiency results in impaired clotting factor carboxylation. Hematolo Physiology 2 HO
deficiency Newborns are at risk for vitamin К deficiency due to poor transplacental gy & (Phys)
1062 transfer of vitamin К and low content in breast milk. All newborns should Oncology
receive vitamin К prophylaxis to prevent bleeding complications. (HO)

Escherichia During bacterial DNA replication, DNA polymerase I functions to Infectious Biochemistr 1 ID
coli remove RNA primers (via 5' to 3' exonuclease activity) and replace them Diseases y (Bioc)
1471 with DNA (via 5' to 3' polymerase activity). DNA polymerase I is the only (ID)
bacterial DNA polymerase that possesses 5' to 3' exonuclease activity.

Viral genetics Viruses with segmented genomes (eg, orthomyxoviruses, rotaviruses) are Infectious Genetics 4 ID
capable of genetic shifts through reassortment. Reassortment (genetic shift) Diseases (Gene)
1469 involves exchange of entire genomic segments, a far more dramatic process (ID)
than the point mutations responsible for genetic drift.

Human HPV is a small DNA viruswith a tropism for stratified squamous Infectious Histology 4 ID
papillomavirus epithelium, which protectively lines anatomical areas that undergo frequent Diseases (Hist)
483 friction and abrasion, including the true vocal cords, cervix, and anus. (ID)
Infants can acquire resp papillomatosis via passage through an HPV-
infected birth canal.
Complement Deficiency of the complement factors that form the membrane attack Infectious Immunology 1 ID
deficiency complex (i.e., C5b-C9) results in recurrent infections by Neisseria species. Diseases (Immu)
739
(ID)

Febrile Local defense against Candida is performed by T cells, whereas systemic Infectious Immunology 4 ID
neutropenia infection is prevented by neutrophils. For this reason, localized candidiasis Diseases (Immu)
112 is common in patients who have HIV, but neutropenic individuals are more (ID)
likely to have the systemic form of the disease.

Hepatitis B The presence of anti-HBc and anti-HBs antibodies in the serum without Infectious Immunology 14 ID
detectable viral antigens indicates recovery from acute hepatitis B Diseases (Immu)
infection. In contrast, patients vaccinated against hepatitis B will have anti- (ID)
380
HBs antibodies without detectable levels of anti-HBc. Chronic hepatitis B
is indicated by persistent levels of HBsAg and HBV DNA in the serum.

Hepatitis B Immunization against hepatitis B virus uses recombinant HBsAg to Infectious Immunology 14 ID
generate anti-HBs antibodies. These antibodies prevent infection by Diseases (Immu)
####
binding to the envelope of circulating virus and inhibiting viral entry. (ID)
 Immunizations Inactivated (killed or component) viral vaccines primarily generate a Infectious Immunology 4 ID
humoral immune response against extracellular viral antigens, Diseases (Immu)
preventing viral entry into the cell. In contrast, live attenuated viral (ID)
1466
vaccines can generate a strong cell-mediated immune response that can kill
virally-infected cells, in addition to providing humoral immunity.

Infectious Reactive (atypical) lymphocytes (contain cytotoxic granules com posed Infectious Immunology 5 ID
mononucleosis of perforin) are activated, pathogen-specific cytotoxic T cells or natural Diseases (Immu)
killer cells that form in response to certain intracellular infections. In (ID)
#### contrast to normal lymphocytes, reactive lymphocytes are large, scalloped,
and have abundant cytoplasm. Reactive lymphocytosis is a diagnostic
feature of infectious mononucleosis.

Tetanus Clostridium tetani produces the neurotoxin tetanospasmin, which blocks Infectious Immunology 5 ID
inhibitory neurotransmission in the spinal cord and leads to tonic muscular Diseases (Immu)
760 contraction. Tetanus is prevented by immunization with an inactivated (ID)
toxoid that triggers the production of antitoxin antibodies (active
immunity).
Toxic shock Superantigens (eg, toxic shock syndrome toxin) interact with major Infectious Immunology 2 ID
syndrome histocompatibility complex molecules on antigen-presenting cells and the Diseases (Immu)
variable region of the T lymphocyte receptor to cause nonspecific, (ID)
676 widespread activation of T cells. This results in the release of interleukin
(IL)-2 from the T cells and IL-1 and tumor necrosis factor from
macrophages. This immune cascade is responsible for the manifestations of
toxic shock syndrome.
Toxic shock Toxic shock syndrome is typically associated with the prolonged use of Infectious Immunology 2 ID
syndrome tampons or wound packing, which allows Staphylococcus aureus to Diseases (Immu)
replicate locally and release pyrogenic toxic superantigens (eg, toxic (ID)
shock syndrome toxin-1) into the blood. Superantigens bind to the MHC-II
#### complex of antigen-presenting cells without processing and nonspecifically
activate T cells (Binding of T-cell receptors by bacterial secretory
products). This leads to a dramatic release of inflammatory cytokines,
which causes the manifestations of the disease (eg, hypotension; high
fever: organ failure; diffuse, erythematous rash).
Actinomycosis Actinomyces species are gram (+), branching, filamentous bacteria that Infectious Microbiolog 2 ID
may cause cervicofacial infections when introduced to the submucosa Diseases y (Micr)
during mech trauma (e.g. tooth extraction). MFxs incl a slowly enlarging, (ID)
1678
nonpainful, chronic mandibular mass that evolves into multi abscesses and
sinus tracts draining yellow-orange sulphur granules.

Acute diarrhea Traveller's diarrhoea is most freq due to ETEC. This pathogen produces Infectious Microbiolog 13 ID
plasmid-encoded, heat-labile (LT, choleragen-like) and heat-stable (ST) Diseases y (Micr)
enterotoxins. LT activates adenylate cyclase, leading to ↑ intracellular (ID)
1099
cAMP; ST activates guanylate cyclase leading to ↑ intracellular cGMP.
Both cause water and electrolyte loss and watery diarrhoea.

Acute diarrhea Shigella is a non-motile, non-lactose fermenting organism that doesn't Infectious Microbiolog 13 ID
produce H2S when grown on triple sugar Fe agar. Mucosal invasion of the Diseases y (Micr)
M cells that overlie Peyer's patches is an essential pathogenic mech for (ID)
1135
Shigella infection. Shigella then escapes the phagosome and spreads
laterally to other epithelial cells via actin polymerisation.

Acute diarrhea Norovirus is the most common cause of viral GE. Outbreaks (eg, schools, Infectious Microbiolog 13 ID
cruise ships, nursing homes) are common, and SSx include vomiting and Diseases y (Micr)
1498
watery diarrhea. (ID)

Acute diarrhea Nontyphoidal Salmonella is a leading cause of foodborne gastroenteritis. Infectious Microbiolog 13 ID
Most cases are marked by 3-4days of self-limited fever, nausea, vomiting, Diseases y (Micr)
and watery diarrhoea. A minority of individuals develop subseq invasive (ID)
#### diseasewith spread to the long bones (osteomyelitis), vasculature (mycotic
aneurysm), or heart (endocarditis). Risk of invasion is greatest in thosewith
SCD or impaired immunity or at the extremes of age.

Acute diarrhea Rotavirus is a common cause of self-limited childhood diarrhoea in un-vax Infectious Microbiolog 13 ID
individuals. It infects villous enterocytes in the duodenum and prox. Diseases y (Micr)
#### jejunum and results in villous blunting, proliferation of secretory crypt (ID)
cells, and a loss of brush border enzymes; this results in water
diarrhoeawitho faecal leucocytes.
Acute parotitis Acute bacterial parotitis occurs more commonly in elderly postoperative Infectious Microbiolog 1 ID
patients who are intubated or dehydrated. Staphylococcus aureus is the Diseases y (Micr)
most common bacterial etiology. Diagnosis can be confirmed by imaging (ID)
####
and an elevated serum amylase level (with a normal serum lipase level and
no evidence of pancreatitis).
 Acyclovir The most effective Tx for HSV encephalitis is IV acyclovir; whose MOA is Infectious Microbiolog 4 ID
complete inhib of the viral DNA polymerase (synthesises viral DNA). Diseases y (Micr)
####
(ID)

Amoebiasis Entamoeba histolytica is an amoeba that causes colitis characterised by Infectious Microbiolog 1 ID
ulcerswith undermining edges (i.e. flask-shaped) that may contain cysts Diseases y (Micr)
and trophozoites. Trophozoites can occasionally (~1%) invade the colonic (ID)
####
wall and disseminate thru the blood to the liver, brain, or lungs. Amoebic
hepatic abscess is the most common extraintestinal MFx.

Anal cancer HPV types 16 and 18 are strongly a/w anal and cervical SCC. HIV Infectious Microbiolog 1 ID
infection ↑ the prevalence of HPV infection and the risk of anal carcinoma; Diseases y (Micr)
1723
this risk is further augmented in MSM. (ID)

Animal and P. multocida is a cause of soft-tissue infection that developswithi 24hrs Infectious Microbiolog 1 ID
human bite following a dog or cat bite. Mx incls wound care and Abx targeted against Diseases y (Micr)
####
injuries this organism. (ID)

Anthrax Bacillus anthracis is a large, sporulating, gram-positive rod that is encased Infectious Microbiolog 1 ID
in an antiphagocytic polypeptide capsule composed of D-glutamic acid. Diseases y (Micr)
972 Inhalation of B anthracis spores can cause pulmonary anthrax, which is (ID)
usually characterized by nonspecific symptoms followed by hemorrhagic
mediastinitis, shock, and death.
Antibiotic The main groups of antifungal Rx are polyenes, azoles, echinocandins, and Infectious Microbiolog 8 ID
resistance pyrimidines. Polyene antifungals (eg, amphotericin B, nystatin) act by Diseases y (Micr)
271
binding ergosterol in the fungal cell membrane. (ID)

Antibiotic Echinocandins (e.g. caspofungin, micafungin) are antifungal Rx that inhib Infectious Microbiolog 8 ID
resistance synthesis of the polysaccharide glucan, an essential component of the Diseases y (Micr)
277
fungal cell wall. (ID)

Antibiotic The aminoglycoside streptomycin inhibs protein synthesis by inactivating Infectious Microbiolog 8 ID
resistance the 30S (small) ribosomal subunit. ↓ activity of bacterial catalase- Diseases y (Micr)
peroxidase is a mech of mycobacterial resistance to INH. Structural (ID)
1310
alteration of enzymes involved in RNA synthesis (DNA-dependent RNA
polymerase) is the mech thru which organisms become resistant to
rifampin.
Antibiotic A change in the structure of PBPs that prevents cephalosporin binding is 1 Infectious Microbiolog 8 ID
resistance mech of bacterial resistance to cephalosporins. Diseases y (Micr)
2111
(ID)

Antibiotic Aminoglycosides work by interferingwith the 30S ribosomal subunit and Infectious Microbiolog 8 ID
resistance causing the cell to misread mRNA, thereby halting protein synthesis. An Diseases y (Micr)
important mech of resistance is the methylation of the aminoglycoside- (ID)
####
binding portion of the ribosome, which inhibs the ability of aminoglycoside
to interferewith protein translation.

Arbovirus Arboviruses, small RNA viruses transmitted by biting arthropods, are the Infectious Microbiolog 1 ID
most common cause of encephalitis outbreaks in the US. B/c no vax are Diseases y (Micr)
####
currently available, prevention 1arily involves eliminating the vector (ID)
arthropods (e.g. infected mosquitoes).
Aspergillosis Immsup patients are at risk for A. fumigatus infection. This fungus Infectious Microbiolog 5 ID
produces thin, septate hyphaewith acute V-shaped branching. It causes Diseases y (Micr)
105
invasive aspergillosis, aspergillomas, and allergic pulm aspergillosis. (ID)

Aspergillosis Ptswith profound and prolonged neutropenia are at especially high risk for Infectious Microbiolog 5 ID
viral and fungal infections. The most common fungal causes are Diseases y (Micr)
#### Aspergillus and Candida species. Invasive pulm aspergillosis Pxwith some (ID)
combination of fever, chest pain, cough, dyspnea, and hemoptysis.

Babesiosis Babesiosis should be considered in ptswith febrile illness who reside in Infectious Microbiolog 2 ID
geographic areas where they're exposed to Ixodes ticks. Dx can be Diseases y (Micr)
####
establishedwith the ID of intraerythrocytic organisms on peri blood smear. (ID)

Babesiosis Babesiosis and Lyme disease are transmitted by the Ixodes tick and occur Infectious Microbiolog 2 ID
in similar geographic regions. Coinfection is common. Diseases y (Micr)
####
(ID)

Bacterial gene S. pneumoniae is able to undergo transformation, which allows the Infectious Microbiolog 1 ID
transfer bacterium to take up exogenous DNA fragments and express the encoded Diseases y (Micr)
736 proteins. Thru this method, strains of S. pneumoniae that don't form a (ID)
capsule can acq the genes that code for the capsule and therefore gain
virulence.
 Bartonella Bacillary angiomatosis is 1arily seen in ptswith advanced AIDS. It's caused Infectious Microbiolog 2 ID
by the gram (-) bacterium B. henselae, which is typically transmitted by a Diseases y (Micr)
cat scratch. patients usually develop highly vascular, violaceous, cutaneous (ID)
####
lesions over wks or mos. Histo of the lesions reveals large endothelial cells
forming small vascular channelswith a surrounding inflammatory infiltrate.

Bronchiolitis Viral bronchiolitis is most commonly caused by RSV and presentswith low- Infectious Microbiolog 1 ID
grade fever, cough, tachypnoea, and ↑ work of breathing. Ex shows diffuse Diseases y (Micr)
1668
wheezes and crackles. (ID)

Catheter Nosocomial bloodstream infections are usually a/w intravascular catheters, Infectious Microbiolog 3 ID
related which allow skin commensals such as S. aureus and CoNS to enter the Diseases y (Micr)
728
bloodstream bloodstream. (ID)
infection
Catheter The presence of central vascular catheter and receipt of parenteral nutrition Infectious Microbiolog 3 ID
related are RFs for candidaemia. Candida display a morphology of branching Diseases y (Micr)
####
bloodstream pseudohyphaewith blastoconidia. (ID)
infection
Cephalosporins Penicillins and cephalosporins fxn by irreversible binding to PBPs such as Infectious Microbiolog 2 ID
transpeptidases. Diseases y (Micr)
2110
(ID)

Chagas disease Chagas disease is a protozoal illness that's endemic to Latin America. Infectious Microbiolog 1 ID
patients in rural areas are at greatest risk when their houses harbor the Diseases y (Micr)
vector (Triatome bug) in adobe walls or thatched roofs. Acute infections (ID)
####
are often aSSx, but patients can develop Chagas cardiomyopathy (e.g. HF,
ventricular arrhythmias, ventricular aneurysms) several decades later.

Chancroid Chancroid, due to Haemophilus ducreyi, Px as deep, painful (you "do Infectious Microbiolog 1 ID
cry"with H ducreyi) ulcerswith ragged borders that are a/w a gray exudate Diseases y (Micr)
####
and inguinal LAD. Dx is established by Gram stain and culture of the (ID)
organism from a scraping of the ulcer base.
Chikungunya Chikungunya is an α-virus spread by mosquitos to humans in tropical and Infectious Microbiolog 1 ID
fever subtropical areas. Initial MFx incl self-limited fever, severe polyarthralgia, Diseases y (Micr)
#### and rash. Relapsed or chronic arthralgias, polyarthritis (e.g. wrist, fingers, (ID)
ankles), or tenosynovitis occur in >50% of infected individuals.

Cholera V. cholerae and ETEC cause a purely toxin-mediated watery diarrhoea. Infectious Microbiolog 2 ID
The toxins secreted by these organisms modify electrolyte handling by Diseases y (Micr)
976 enterocytes but don't cause cell death; therefore, no erythrocytes or (ID)
leucocytes are typically noted on stool micro.

Cholera V. cholerae must survive the acidic environment of the stomach to reach Infectious Microbiolog 2 ID
the small intestine and cause disease. B/c the organism is easily destroyed Diseases y (Micr)
by acid, a high burden of organisms must be ingested to cause infection. (ID)
977
However, conditions that ↓ gastric acidity (e.g. antacid use) ↓ the minimum
infectious dose of V. cholerae by multi orders of magnitude.

Clostridial Clostridium perfringens causes late-onset food poisoning and clostridial Infectious Microbiolog 3 ID
myonecrosis myonecrosis (gas gangrene). The food poisoning is toxin-mediated, late- Diseases y (Micr)
1394
onset, and causes transient watery diarrhea. (ID)

Clostridial Clostridium septicum is a spore-forming, exotoxin-producing, Gram (+) Infectious Microbiolog 3 ID

myonecrosis organism that is the most common cause of spontaneous gas gangrene (eg, Diseases y (Micr)
####
rapid-onset pain, hemorrhagic bullae, tissue crepitus). Underlying colonic (ID)
malignancy is the greatest RFx for infection.
Clostridium Clostridium difficile requires additional contact precautions, including Infectious Microbiolog 7 ID
difficile handwashingwith soap and water, a gown for any pt contact, and nonsterile Diseases y (Micr)
#### infection gloves that should be changed after contactwith contaminated secretions. (ID)
Alc-based hand sanitizers do not kill the bacterial spores.

Community The virulence of S. pneumoniae is predominantly due to its PSC, which Infectious Microbiolog 21 ID
acquired impedes phagocytosis and complement binding. Diseases y (Micr)
6643
pneumonia (ID)

Community Mycoplasma pneumoniae is a leading cause of atypical pneumonia. B/c this Infectious Microbiolog 21 ID
acquired pathogen lacks a cell wall, it does not show up on Gram stain and cannot Diseases y (Micr)
6781
pneumonia be treatedwith β-lactam Abx. PSIs (eg, macrolides, tetracycline) are the Tx (ID)
of choice.
Cystic fibrosis In ptswith CF, pathogenic bacteria colonise the resp tract early in the Infectious Microbiolog 11 ID
disease course. The leading pathogen in adults is P. aeruginosa, which Diseases y (Micr)
####
forms a thick biofilm to prevent its full elimination from the body. (ID)
 Cytomegalovir The Monospot test is positive in most cases of Epstein-Barr virus- Infectious Microbiolog 9 ID
us associated mononucleosis. In immunocompetent patients with a heterophile Diseases y (Micr)
1593
antibody-negative mononucleosis-like syndrome, the most likely diagnosis (ID)
is cytomegalovirus infection.
Dengue fever The Aedes aegypti mosquitoes can transmit the viruses that cause DF and Infectious Microbiolog 2 ID
chikungunya. Classic DF Px as an acute febrile illnesswith h/a, retro-orbital Diseases y (Micr)
#### pain, and joint and muscle pain. Chikungunya is a febrile illnesswith flu- (ID)
like SSx, prominent polyarthralgias, and diffuse macular rash.

Dengue fever Dengue viruses are ssRNA viruseswith 4 diff serotypes. 1° (1st) infection Infectious Microbiolog 2 ID
can be aSSx or cause a self-limited disease in most adults. 2° infection is Diseases y (Micr)
####
due to infectionwith a diff viral serotype and usually causes more severe (ID)
illness.
Diphtheria Toxigenic strains of C. diphtheria produce diphtheria toxin, which Infectious Microbiolog 6 ID
irreversibly inhibs host protein synthesis due to ADP-ribosylation of EF-2. Diseases y (Micr)
Local effects incl pseudomembranous pharyngitis; systemic effects incl (ID)
1092
potentially life-threatening myocarditis and neuritis. Immunisationwith
diphtheria toxoid generates protective circulating IgG against the exotoxin
B subunit.
Diphtheria Diphtheria exotoxin inhibs host cell protein synthesis by catalysing the Infectious Microbiolog 6 ID
ADP-ribosylation of host cell EF-2. Diseases y (Micr)
1093
(ID)

Diphtheria Diphtheria toxin is an AB exotoxin that ribosylates and inactivates EF-2. Infectious Microbiolog 6 ID
This action inhibits protein synthesis and ultimately leads to cell death. Diseases y (Micr)
1094
(ID)

Diphtheria Lysogenic bacteriophages are responsible for converting non-pathogenic Infectious Microbiolog 6 ID
Corynebacterium into toxigenic Corynebacterium. Toxigenic strains Diseases y (Micr)
1389 elaborate the diphtheria exotoxin, which causes pseudomembranous (ID)
pharyngitis and potentially life-threatening systemic effects (e.g.
myocarditis, neuritis).
Diphtheria Diphtheria toxin and pseudomonal exotoxin A act by ribosylating and Infectious Microbiolog 6 ID
inactivating EF-2, inhibiting host cell protein synthesis and causing cell Diseases y (Micr)
1390
death. (ID)

Ehrlichiosis Ehrlichia chaffeensis is harbored in white-tailed deer and transmitted to Infectious Microbiolog 1 ID
and humans by tick bite. It replicates in vacuoleswithi monocytes and forms Diseases y (Micr)
anaplasmosis mulberry-shaped, intraleukocytic inclusions (morulae). MFx usually (ID)
####
include nonspecific SSx (eg, fever, chills, myalgia), maculopapular rash,
and significant laboratory abnormalities, particularly lymphopenia.

Febrile Candida albicans is the most common cause of opportunistic mycosis. It Infectious Microbiolog 4 ID
neutropenia can affect any organ and cause gen candidaemia. Yeasts and pseudohyphae Diseases y (Micr)
109
on LM and a (+) germ tube test are Dx of Candida albicans infection. (ID)

Febrile Chemotherapy-assoc neutropaenic fever is most often caused by Infectious Microbiolog 4 ID

neutropenia endogenous commensal bacteria that have translocated across dmgd Diseases y (Micr)
####
mucosal sites. (ID)

Foodborne Staphylococcal foodborne illness is due to the consumption of a preformed Infectious Microbiolog 2 ID
illness enterotoxin in contaminated food. Most cases can be prevented by washing Diseases y (Micr)
#### hands thoroughly prior to food prep (prevents contamination) and ensuring (ID)
proper refrigerated storage (prevents bacterial proliferation/enterotoxin
production).
Giardia Giardia lamblia is the most common enteric parasite in the United States Infectious Microbiolog 2 ID
and Canada and is a common cause of diarrhea in campers/hikers. Iodine- Diseases y (Micr)
1574 stained stool smear classically shows pear-shaped, flagellated trophozoites (ID)
or ellipsoidal cystswith smooth, well-defined walls and 2+ nuclei.
Metronidazole is the Tx of choice.
Giardia G. lamblia causes injury to the duodenal and jejunal mucosa by adhering to Infectious Microbiolog 2 ID
the intestinal brush border and releasing molecules that induce a mucosal Diseases y (Micr)
inflammatory response. Secretory IgA, which impairs adherence, is the (ID)
1596
major component of adaptive immunity against G. lamblia infection.
Conditions causing IgA defic predispose patients to chronic giardiasis.

Gonococcal IgA protease is produced by N. meningitidis, N. gonorrhoeae, S. Infectious Microbiolog 3 ID

infection pneumoniae, and H. influenzae. This enzyme cleaves secretory IgA at its Diseases y (Micr)
hinge region, rendering it ineffective. Secretory IgA exists on mucosal (ID)
560
surfaces and in secretions and acts to bind and inhib the action of pili as
well as other cell surface Ags that normally mediate mucosal adherence
and subseq penetration.
 Gonococcal Gonococci use their pili to mediate adherence to the mucosal epithelium. Infectious Microbiolog 3 ID
infection Through Ag variation, each gonococcus can modify the pilus protein Diseases y (Micr)
1025
expressed, thereby avoiding host defenses (to some degree) and making (ID)
vax directed against the pilus protein difficult.
Gonococcal N. gonorrhoeae is spread sexually by GU secretions and can be prevented Infectious Microbiolog 3 ID
infection by the consistent use of condoms. GUIs are often aSSx, which ↑ the risk of Diseases y (Micr)
spread thru the bloodstream, leading to disseminated gonococcal infection. (ID)
####
Ptswith disseminated disease typically presentwith the triad of
polyarthralgia, tenosynovitis, and dermatitis or purulent arthritis.

Group B Streptococcus agalactiae (GBS), one of the most common causes of early Infectious Microbiolog 2 ID
streptococcal neonatal sepsis, is typically identified by the presence of a narrow zone of β- Diseases y (Micr)
#### infection hemolysis when plated on blood agar. It is also identified by the production (ID)
of CAMP factor, which enhances β-hemolysis by particular strains of
Staphylococcus aureus.
Haemophilus Haemophilus influenzae is a "blood-loving" organism that requires X Infectious Microbiolog 2 ID
influenzae (hematin) and V (NAD+) factors for growth. This can be accomplished by Diseases y (Micr)
growing H influenzae in the presence of Staphylococcus aureus and (ID)
963 demonstrating the "satellite phenomenon," whereby H influenzae grow
only near the β-hemolytic S aureus colonies that produce the needed X and
V factors.

Hand, foot, HFMD (oral ulceration and extremity rash) and herpangina (oral Infectious Microbiolog 2 ID
mouth disease ulcerationswitho rash) are the most common MFxs of enteroviral infection. Diseases y (Micr)
####
Rare but serious complications of infection incl myocarditis and CNS (ID)
disease (e.g. aseptic meningitis).
Hepatitis A HAV infection is most commonly silent or subclinical ('anicteric') in young Infectious Microbiolog 4 ID
children but can also present as an acute, self-limited illness characterised Diseases y (Micr)
373
by jaundice, malaise, fatigue, anorexia, nausea, vomiting, RUQ pain, or an (ID)
aversion to smoking.
Hepatitis B Infants born to HBeAg-positive mothers have a high risk of acquiring Infectious Microbiolog 14 ID
perinatal hepatitis B virus (HBV) infection. Infected neonates have high Diseases y (Micr)
46 levels of HBV replication and are at high risk for chronic infection, but are (ID)
usually asymptomatic or have only mildly elevated liver function tests.

Hepatitis B The HBV replicated via the following seq: dsDNA → (+)RNA template → Infectious Microbiolog 14 ID
partially dsDNA progeny. Although it's a DNA virus, HBV uses reverse Diseases y (Micr)
374
transcriptase to generate new viral DNA from a (+)-sense RNA template. (ID)

Hepatitis B Replication of the hepatitis B genome occurswithi a newly synthesized Infectious Microbiolog 14 ID
capsid through the action of reverse transcriptase on an RNA template. The Diseases y (Micr)
376
mature capsid contains partially ds circular DNA and reverse transcriptase. (ID)

Hepatitis B Individuals who are successfully immunized against HBV develop Infectious Microbiolog 14 ID
protective anti-HBs Ab. Individuals who recover from hepatitis B Diseases y (Micr)
377
infection, however, have anti-HBs as well as anti-HBc Abs. The presence (ID)
of circulating HBsAg indicates active infection.
Hepatitis B Vertical transmission of hepB from preg females to the unborn child can Infectious Microbiolog 14 ID
occur in womenwith active hepB infection. The presence of HBeAg (a Diseases y (Micr)
marker of viral replication and ↑ infectivity) in the mother greatly ↑ the risk (ID)
378 of vertical transmission of the virus. B/c of this concern, the newborns of
all motherswith active hepB are passively immunised at birthwith HBIG,
f/b active immunisationwith recombinant HBV vax.

Hepatitis B If HBeAg persists for several months and host anti-HBeAg remain at low Infectious Microbiolog 14 ID
or undetectable levels, suspect chronic hepatitis B infection with high Diseases y (Micr)
379
infectivity. (ID)

Hepatitis B The most common outcome in HBV-infected adults (>95%) is acute Infectious Microbiolog 14 ID
hepatitiswith mild or subclinical SSx that eventually completely resolve. Diseases y (Micr)
390
(ID)

Hepatitis B HBV has a partially dsDNA genome and contains a viral DNA Infectious Microbiolog 14 ID
polymerasewith reverse transcriptase activity. Reverse transcriptase serves Diseases y (Micr)
####
a crucial step in viral replication; it converts transcribed (+) sense ssRNA (ID)
into the partially dsDNA genome of viral progeny.
Hepatitis C Genetic variations created during HCV replication result in marked variety Infectious Microbiolog 4 ID
in the Agic structure of HCV envelope proteins. The production of host Diseases y (Micr)
44 Abs lags behind that of new mutant HCV strains, preventing infected (ID)
individuals from mounting an effective immune response.
 Hepatitis D HDV is a replication-defective RNA virus that's capable of causing Infectious Microbiolog 2 ID
infection only in the setting of coinfectionwith HBV. HBV provides Diseases y (Micr)
45
HBsAg for the HDV envelope. (ID)

Hepatitis E HEV is an unenveloped, ssRNA virus spread thru the faecal-oral route. Infectious Microbiolog 1 ID
The most concerning feature of hepE infection is the high mortality rate Diseases y (Micr)
48
observed in infected preg women. (ID)

Histoplasmosis TNF-α inhibs are a/w impairments to the cell-mediated immune response Infectious Microbiolog 4 ID
and ↑ the risk of infectionwith intracellular bacteria and granulomatous Diseases y (Micr)
fungi (e.g. Histoplasma capsulatum). Histoplasma replicateswithi the (ID)
####
intracellular space of macrophages and can spread from the lungs to the
LNs and the RES (liver, spleen, bone marrow).

HIV The chemokine receptor CCR5 is a coreceptor that enables the HIV virus Infectious Microbiolog 11 ID
to enter cells. Blockade of CCR5 by chemokine receptor antagonists Diseases y (Micr)
953
prevents viral entry into host cells. (ID)

HIV ART during preg ↓ the risk of perinatal transmission of HIV to 1-2% and is Infectious Microbiolog 11 ID
recommended for all preg womenwith HIV. Diseases y (Micr)
1463
(ID)

HIV In the HIV replication cycle, polyprotein precursors are encoded by the Infectious Microbiolog 11 ID
structural genes gag, pol, and env. Only the env gene polyprotein product Diseases y (Micr)
1672 (gp160) is glycosylated. This polyprotein is subseq cleaved in the GA to (ID)
form the envelope glycoproteins gp120 and gp41.

HIV HIV pol gene mutations are responsible for acquired resistance to RTIs, Infectious Microbiolog 11 ID
PIs, and integrase strand transfer inhibitors. Mutations of the env gene Diseases y (Micr)
1722
enable escape from host-neutralizing Abs. (ID)

HIV Ptswith advanced HIV and low CD4 counts are at risk for opportunistic Infectious Microbiolog 11 ID
infections and req antimicrobial prophylaxis. P. jiroveci pneumonia Diseases y (Micr)
####
prophylaxiswith TMP-SMX is indicated when CD4 count is <200/mm3. (ID)

HIV Initial HIV infection is often a/w mononucleosis-like SSx (eg, fever, LAD, Infectious Microbiolog 11 ID
sore throat) 2-4 wks after transmission. Important Dx clues are Diseases y (Micr)
oropharyngeal ulcers and a diffuse maculopapular rash. As the humoral Ab (ID)
####
response is not fully activated early in infection, LFx typically show HIV in
the serum ((+) viral load and p24 Ag) but (-) HIV serology.

HIV Tenofovir is a NRTI that's a common component of HIV therapy. This drug Infectious Microbiolog 11 ID
is gen well tolerated but may occasionally cause damage to the PCT of the Diseases y (Micr)
#### kidney, leading to AKI a/o PCT impairment (e.g. phosphoruria, glucosuria, (ID)
water retention). Bx typically reveals a normal glomerulus and renal
interstitium but damage to the PCT.
HIV Most cases of AIDS worldwide are caused by HIV-1. However, AIDS can Infectious Microbiolog 11 ID
also be caused by infectionwith HIV-2, which is endemic to West Africa. Diseases y (Micr)
HIV-2 infection is a/w lower viral loads, less risk of transmission, and a (ID)
slower progr to AIDS. The Dx is often suspected when HIV tests are
####
incongruent ((+) screening serology but indeterminate Western blot and (-)
plasma HIV-1 RNA). Confirmation can be made using HIV-1/HIV-2
immunodiff assay (IDA).

HSV infection 1° HSV-1 infection in children causes gingivostomatitis (vesicular lesions Infectious Microbiolog 9 ID
on the lips and hard palate). HSV-1 and other herpesviruses are enveloped Diseases y (Micr)
1409
dsDNA viruses. (ID)

HSV infection Herpetic gingivostomatitis is a severe vesicular or ulcerative disease Infectious Microbiolog 9 ID
following 1° infectionwith HSV-1. Involvement of the gingiva, tongue, Diseases y (Micr)
1499 palate, and pharynx alongwith systemic SSx (e.g. fever, malaise) is (ID)
common. In contrast, reactivation of a latent herpes infection in the CNV
ganglia gen results in mild perioral vesicles.
HSV infection A new-onset genital vesicular rashwith a (+) Tzanck smear in a previously Infectious Microbiolog 9 ID
aSSx pt is suggestive of 1° genital HSV infection due to HSV-2. Diseases y (Micr)
Recurrences of genital herpes can be ↓ thru daily Txwith oral valacyclovir, (ID)
1550
acyclovir, or famciclovir. Condom use can help prevent a 1° genital HSV
infection but doesn't prevent reactivation of latent infection.

HSV infection patients infectedwith HSV develop a lifelong latent infection of the sensory Infectious Microbiolog 9 ID
ganglion. Periodic viral replication can lead to SSx that flare and resolve Diseases y (Micr)
6547
over time. (ID)
 HSV infection The finding of multiple painful genital ulcers and constitutional SSx in a Infectious Microbiolog 9 ID
sexually active pt is highly suggestive of 1° genital HSV infection. Dx can Diseases y (Micr)
####
be established by PCR testing, direct fluorescence Ab testing, viral culture, (ID)
or Tzanck smear.
HSV infection HSV is a common, STI marked by the formation of painful genital ulcers. Infectious Microbiolog 9 ID
Tzanck smear can reveal the char cytopathic effects of the virus, incl Diseases y (Micr)
####
multinucleated giant cells, ground-glass opacities, acantholytic cells, (ID)
keratinocyte ballooning, and nuclear moulding.
Infection Spore-forming bacteria can survive boiling temps. Bacillus and Clostridium Infectious Microbiolog 3 ID
control species are common pathogenic spore-forming bacteria. Diseases y (Micr)
1779
(ID)

Infection HH is the single most important measure to ↓ the risk of transmission of Infectious Microbiolog 3 ID
control hospital-acquired infections. Diseases y (Micr)
####
(ID)

Infectious EBV commonly infects B cells, stim them to proliferate continuously Infectious Microbiolog 5 ID
mononucleosis ('transformation' or 'immortalisation'). EBV is an oncogenic virus that Diseases y (Micr)
1594 promotes polyclonal B cell proliferation and heterophile Ab production. (ID)
The heterophile Ab test is sensitive and highly specific for EBV infection.

Infectious Typical clinical and laboratory features of Epstein-Barr virus (EBV) Infectious Microbiolog 5 ID
mononucleosis mononucleosis include fever, pharyngitis, lymphadenopathy, splenomegaly, Diseases y (Micr)
1595 and atypical lymphocytosis. EBV is generally transmitted from an (ID)
asymptomatic virus shedder to a susceptible individual through saliva
transfer (eg, kissing).
Influenza Alc-based disinfectants kill enveloped viruses (eg, influenza) by dissolving Infectious Microbiolog 5 ID
their outer lipid envelope. Nonenveloped viruses are less susceptible to Diseases y (Micr)
1377
some Alc-based disinfectants b/c they have no lipid envelope to target. (ID)

Influenza The tissue tropism of viruses is 1arily mediated by viral surface Infectious Microbiolog 5 ID
glycoproteins that bind to specific host cell receptors. muts to viral surface Diseases y (Micr)
1411
glycoproteins can alter tissue tropism and cause noninfective viruses to (ID)
become infectious.
Intestinal Hookworms are transmitted when human skin comes into contactwith soil Infectious Microbiolog 3 ID
helminth contaminatedwith human faeces. The larvae penetrate the skin, travel to Diseases y (Micr)
parasites the lungs, are coughed up, and then subseq swallowed. Adult hookworms (ID)
####
live in the small intestine and feed on human blood. Therefore, chronic
IDA (microcytic anaemia) is the greatest complication.

Intestinal Ascaris lumbricoides is transmitted via contaminated food or water. Eggs Infectious Microbiolog 3 ID
helminth hatch into larvae in the small intestine, penetrate the intestinal wall, and Diseases y (Micr)
parasites migrate across the lung into the alveoli. Larvae are subsequently coughed (ID)
####
up and swallowed into the GIT, where they mature to adult worms. Most
patients are aSSx, but some develop early pulm MFx (Loeffler syndrome)
or later GI SSx.
Leptospirosis Leptospirosis is a zoonotic infection caused by the motile spirochete Infectious Microbiolog 1 ID
Leptospira. Transmission primarily occurs when humans come into Diseases y (Micr)
contactwith water contaminatedwith animal urine during outdoor (ID)
####
recreational or occupational activities. patients classically have a mild, self-
limited, flu-like illness but may develop more serious complications such as
renal or hepatic failure.
Lice infestation Phthirus pubis is the human pubic louse. It is transmitted sexually via skin- Infectious Microbiolog 2 ID
to-skin contact and causes intense pruritus. Louse and nits can often be Diseases y (Micr)
####
visualized on Ex, which is Dx. Txwith topical permethrin is generally (ID)
curative.
Listeria L. monocytogenes is a facultative, intracellular, gram (+) rod that produces Infectious Microbiolog 1 ID
a very narrow zone of β hemolysis on blood agar, shows tumbling motility Diseases y (Micr)
at room temp, and can grow at refrigerated temps. Intracellular pathogens (ID)
1391 such as Listeria are largely eliminated by the cell-mediated immune
response (e.g. T-cells, macrophages, cytokines). Ptswith impaired cell-
mediated immunity are at risk for invasive Listeria infections.

Lung abscess Lung abscess usually occurs in individualswith episodes of impaired Infectious Microbiolog 4 ID
consciousness (e.g. alcohol/drug abuse, dementia) or ↓ ability to swallow Diseases y (Micr)
532 (e.g. oesophageal strictures). They're gen caused by aspiration of anaerobic (ID)
and aerobic bacteria from the oral cavity into the LRT.

Lymphogranulo C. trachomatis serotypes L1 thru L3 cause LGV, an STD characterised Infectious Microbiolog 1 ID
ma venereum initially by painless ulcerswith later progr to painful inguinal LAD Diseases y (Micr)
1154
('buboes') and ulceration. Chlamydial inclusion bodies are seen in host cell (ID)
cytoplasm.
 Malaria RBCs filledwith multiple, small rings suggest Plasmodium infection Infectious Microbiolog 5 ID
(malaria). Erythrocytic forms of this parasite may be Txwith antimalarials Diseases y (Micr)
1908 such as chloroquine (in non-resistant areas), atovaquone-proguanil, and (ID)
artemisinins. Primaquine is req to kill P. vivax and P. ovale liver
hypnozoites.
Malaria P. vivax is the most common cause of malaria in non-African countries. It's Infectious Microbiolog 5 ID
transmitted by the female Anopheles mosquito and is a/w a latent liver Diseases y (Micr)
#### phase that must be Tx (w/ primaquine) independently of the erythrocytic (ID)
phase to fully eliminate the organism.

Malaria Mefloquine chemoprophylaxis for malaria must be continued for 4wks Infectious Microbiolog 5 ID
after return from an endemic region to ensure the elimination of hepatic Diseases y (Micr)
####
schizonts (which develop in the liver over 8-30days). (ID)

Malaria Malaria is Dx when intraerythrocytic diamond ring-shaped parasites are Infectious Microbiolog 5 ID
seen on peri blood smear. This disease should be suspected in travellers to Diseases y (Micr)
####
endemic regions who develop a febrile illness. (ID)

Measles VitA can be beneficial in the Tx of measles infection by ↓ comorbidities Infectious Microbiolog 3 ID
(e.g. ocular complications, diarrhoea, pneumonia), recovery time, and Diseases y (Micr)
1045
length of hospital stay. (ID)

Measles Measles Pxwith fever, cough, rhinorrhea, and conjunctivitis f/b a Infectious Microbiolog 3 ID
maculopapular rash that starts on the face and spreads downwards. Koplik Diseases y (Micr)
1670
spots are pathognomonic for measles and Chx by tiny white or blue-gray (ID)
lesions on the buccal mucosa.
Meningitis Rifampin is the most frequently used agent for chemoprophylaxis of Infectious Microbiolog 17 ID
meningococcal disease. Persons with exposure to the respiratory secretions Diseases y (Micr)
1004 of a patient with meningococcal disease require chemoprophylaxis. (ID)
Vaccination is an important public health strategy but is not useful for post
exposure prophylaxis.
Meningitis The Hib vax induces anticapsular Abs that facilitate complement-mediated Infectious Microbiolog 17 ID
phagocytosis of the bacterium. The vax series has drastically ↓ the Diseases y (Micr)
1103
incidence of invasive disease caused by Hib, such as meningitis, (ID)
bacteremia, pneumonia, and epiglottitis.
Meningitis Ampicillin is the treatment of choice for Listeria, which is not sensitive to Infectious Microbiolog 17 ID
cephalosporins. Listeria most commonly causes disease in those with Diseases y (Micr)
1393
deficient cell-mediated immunity, such as young infants or (ID)
immunocompromised patients.
Meningitis Listeria is a relatively common foodborne illness a/w outbreaks after the Infectious Microbiolog 17 ID
consumption of contaminated food, particularly processed meats and dairy Diseases y (Micr)
products. Healthy patients may develop gastroenteritis; ptswith impaired (ID)
#### cell-mediated immunity are at risk for invasive infection (e.g. sepsis,
meningoencephalitis) and listeriosis in preg is a/w adverse foetal outcomes
(e.g. foetal death, premature birth).

Meningitis N. fowleri is a free-living, motile protozoan that lives in warm water. Infectious Microbiolog 17 ID
Exposure can result in 1° amoebic encephalitis (PAM), which is Diseases y (Micr)
#### characterised by acute fever, h/a, confusion, and neck stiffness. The Dx is (ID)
confirmed when motile trophozoites are seen in CSF wet mount. Nearly all
patients die.
Meningococci The Thayer-Martin medium is used to isolate pathogenic Neisseria species Infectious Microbiolog 1 ID
such as N. meningitidis and N. gonorrhoeae. It's a chocolate sheep blood Diseases y (Micr)
agar that contains vancomycin to inhib the growth of gram (+) organisms; (ID)
1024
colistin and trimethoprim to inhib gram (-) bacteria (other than pathogenic
Neisseria); and nystatin to inhib yeasts.

Mucocutaneou Oral thrush is caused by Candida albicans infection and usually presents as Infectious Microbiolog 3 ID
s candidiasis white, plaque-like oropharyngeal lesions that're easily scraped offwith a Diseases y (Micr)
tongue depressor. Most cases arise in those who have disruptions to normal (ID)
111 flora due to Abx or impairments in cell-mediated immunity from
chemotherapy, inhaled corticosteroids, or HIV. Young, otherwise healthy
ptswith thrush should be tested for HIV, particularly if they have HIV RFs
or other SSx of the virus.
Mucormycosis Mucormycosis is an opportunistic infection caused by Rhizopus, Mucor, Infectious Microbiolog 3 ID
and Absidia species. The classic clinical picture is paranasal sinus Diseases y (Micr)
106
involvement in a diabetic or immsup pt. The fungi form broad non-septate (ID)
hyphae that branch at right angles.
Mucormycosis Facial pain, headache, and black necrotic eschar in the nasal cavity in a Infectious Microbiolog 3 ID
ptwith DKA are highly suggestive of mucormycosis. Histo Ex of the Diseases y (Micr)
107 affected tissue is necessary to confirm the Dx. The fungi show broad non- (ID)
septate hyphaewith right-angle branching. Tx consists of Sx debridement
and antifungal therapy.
 Neurocysticerc Neurocysticercosis is a relatively common cause of seizures in patients Infectious Microbiolog 1 ID
osis from Central and South America and should be considered in ptswith Diseases y (Micr)
####
suggestive SSx and imaging (e.g. cystic brain lesion) and char (ID)
epidemiological RFs.
Odontogenic Sjogren syndrome is characterized by autoimmune inflammation of Infectious Microbiolog 1 ID
infections exocrine glands (eg, salivary, lacrimal, vaginal). Patients typically have Diseases y (Micr)
severe dry mouth (xerostomia) due to reduced saliva production, which can (ID)
#### lead to an increased rate of dental caries and other oral infections (eg,
thrush) because of the loss of protective factors in saliva. Biopsy of the
salivary glands shows a lymphocytic infiltrate, often with germinal centers.

Parvovirus Infectionwith PVB19 (a nonenveloped ss DNA virus) can cause arthralgia Infectious Microbiolog 3 ID
+/- rash in adults. An infected fetus may develop hydrops fetalis (severe Diseases y (Micr)
1374
anemia, HF, pleural effusions, pericardial effusions, and ascites). (ID)

Parvovirus Erythema infectiosum (5th disease) is caused by PVB19 and Pxwith a Infectious Microbiolog 3 ID
nonspecific prodrome (eg, malaise, fever, congestion) f/b a classic "slapped- Diseases y (Micr)
1495 cheek" facial rash and a lacy, reticular body rash. Parvovirus is highly (ID)
tropic for erythroid precursor cells and replicates predominantly in the
bone marrow.
Pertussis B. anthracis oedema factor is an adenylate cyclase that ↑ intracellular Infectious Microbiolog 3 ID
cAMP, leading to neutrophil and macrophage dysfxn and tissue oedema. Diseases y (Micr)
1101
This MOA is similar to that of adenylate cyclase toxin, produced by B. (ID)
pertussis.
Pertussis B. pertussis, a small, gram (-) coccobacillus, can cause outbreaks of Infectious Microbiolog 3 ID
whooping cough in un-vax individuals. Infected infants and children gen Diseases y (Micr)
develop mucoid rhinorrhoea f/b severe, paroxysmal cough that may be a/w (ID)
7650
an inspiratory whoop and vomiting. The bacterium is largely non-invasive
and secretes several exotoxins that severely damage ciliated resp
epithelium.
Pharyngitis The major virulence factor of S. pyogenes is M protein, an α-helical coiled- Infectious Microbiolog 2 ID
coil protein that shares structural homologywith tropomyosin and myosin. Diseases y (Micr)
It extends from the cell wall and prevents phagocytosis, inhibs complement (ID)
723 binding, and mediates bacterial adherence. Abs against M protein form
shortly after acute infection and may cross-reactwith epitopes on myosin,
leading to rheumatic carditis.

Plague Bubonic plaque is a zoonotic infection that causes febrile illnesswith Infectious Microbiolog 1 ID
regional inflammatory LAD (buboes). The underlying pathogen is Y. Diseases y (Micr)
pestis, a gram (-) coccobacillus that exhibits bipolar staining (resembling a (ID)
####
close safety pin). The major environmental reservoir is rodents, and
transmission usually occurs via rodent flea bite.

Poststreptococc GN is a/w prior streptococcal pharyngeal or skin infection; acute RF is a/w Infectious Microbiolog 8 ID
al prior streptococcal pharyngitis but not skin infection. Streptococci are Diseases y (Micr)
glomerulonephr catalase (-), staphylococci are catalase (+). Streptococcus pyogenes (GAS) (ID)
722
itis is β-hemolytic, bacitracin-susceptible, and pyrrolidonyl arylamidase (+).
Streptococcus pneumoniae is bile-soluble and optochin-susceptible.

Progressive Ptswith advanced AIDS can have reactivation of JC virus, which causes Infectious Microbiolog 1 ID
multifocal PML. This condition usually presentswith slowly progr confusion, ataxia, Diseases y (Micr)
#### leukoencephalo and motor deficits. Brain MRI reveals multifocal areas of white matter (ID)
pathy demyelinationwith no mass effect or enhancement.

Q fever Q fever is a zoonotic infection that occurs in farm workers exposed to Infectious Microbiolog 1 ID
waste from cattle and sheep. Its causative agent is Coxiella burnetii. A Diseases y (Micr)
patient with exposure to waste from farm animals who develops a (ID)
#### nonspecific illness (myalgias, fatigue, fever (>10 days), retroorbital
headache) with a normal leukocyte count, thrombocytopenia, and increased
liver enzymes should be evaluated for acute Q fever infection.

Rabies In the US, bats are the main source of rabies (only transmitted by Infectious Microbiolog 2 ID
mammals). Agitation and spasms progressing to comawithi wks of Diseases y (Micr)
exposure is strongly suggestive of rabies encephalitis. Prophylactic vax is (ID)
1465 recommended for individuals at high risk for exposure to rabid animals or
their tissues. The approved rabies vax consist of various rhabdovirus
strains grown in tissue cell culture and then inactivated.
 Rocky RMSF is a tick-borne illness due to Rickettsia rickettsii, a weakly gram (-), Infectious Microbiolog 1 ID
mountain obligate intracellular organism that has an affinity for vascular endothelial Diseases y (Micr)
spotted fever cells. patients usually have non-specific SSx (e.g. fever, malaise, myalgia) (ID)
#### f/b a macular-petechial rash that begins on the ankles and wrists and
spreads to the centre of the body as well as to the palms and soles. Urgent
Txwith doxycycline, an inhib of bacterial protein synthesis, is req.

Roseola HHV-6 infection (roseola) classically presentswith fever for 3-5days f/b a Infectious Microbiolog 1 ID
infantum truncal rash. It's also the most common cause of febrile seizures. Diseases y (Micr)
####
(ID)

Scarlet fever Scarlet fever is characterised by fever, pharyngitis, sandpaper-like rash, Infectious Microbiolog 1 ID
circumoral pallor, and a strawberry tongue. It's caused by strains of GAS Diseases y (Micr)
8565
that produce pyrogenic exotoxins. Scarlet fever can predispose to acute RF (ID)
and GN.
Septic arthritis Septic arthritis in a young, sexually active adult should raise suspicion for Infectious Microbiolog 4 ID
disseminated N. gonorrhoeae infection. patients may also have the triad of Diseases y (Micr)
1007 polyarthritis, a vesiculopustular skin rash, and tenosynovitis. N. (ID)
gonorrhoeae is a gram (-) diplococci that's usually ID'd by micro, culture, or
NAAT.
Septic shock Gram (-) sepsis is caused by the release of LPSs from bacterial cells during Infectious Microbiolog 6 ID
cell division or bacteriolysis. Lipid A is the toxic component of LPSs and Diseases y (Micr)
1141 induces the widespread release of IL-1 and TNF-α from activated (ID)
macrophages. These cytokines cause the SSx of septic shock (eg, fever,
hypotension, organ dysfunction).
Skin and soft Protein A is a virulence factor found in the PGCW of S. aureus that binds Infectious Microbiolog 8 ID
tissue to the Fc portion of IgG, leading to impaired complement activation, Diseases y (Micr)
677
infections opsonisation, and phagocytosis. (ID)

Skin and soft ARF and PSGN are post-infectious complications of GAS (S pyogenes) Infectious Microbiolog 8 ID
tissue infections. PSGN can follow either streptococcal skin infection (impetigo) Diseases y (Micr)
725
infections or streptococcal pharyngitis, whereas ARF is classically associated (ID)
onlywith streptococcal pharyngitis.
Skin and soft S. aureus is the most common cause of skin and soft-tissue abscess (e.g. Infectious Microbiolog 8 ID
tissue furuncle). Tx of the abscesswith incision and drainage and Abx can Diseases y (Micr)
727 infections eliminate the local infection but doesn't eliminate colonisation of the (ID)
anterior nares and skin. Therefore, recurrent infections are common.

Staphylococci Staphylococcus epidermidis is a common cause of foreign body infections Infectious Microbiolog 1 ID
due to its ability to produce adherent biofilms. Diseases y (Micr)
8533
(ID)

Syphilis The clinical Px of 3° syphilis includes CV involvement and gummas. Infectious Microbiolog 9 ID
Gummas are necrotizing granulomas occurring on the skin, mucosa, Diseases y (Micr)
651
subcutaneous tissue, and bones andwithi other organs. Neurosyphilis can (ID)
occur at any stage of infection.
Syphilis Ptswith early syphilis (e.g. chancre) often have false (-) initial serologic Infectious Microbiolog 9 ID
testing. Direct visualisation of the organism (T. pallidum) by dark-field Diseases y (Micr)
1315
micro or fluorescent Ab testing is the gold standard for Dx but isn't widely (ID)
available.
Syphilis Syphilis is caused by the spirochete T. pallidum. Confirmation of the Dx Infectious Microbiolog 9 ID
req 2 forms of serologic testing to prevent false (+) results. Non-treponemal Diseases y (Micr)
1316 tests (e.g. RPR, VDRL) evaluate for anticardiolipin Abs (nonspecific); (ID)
treponemal tests evaluate for Abs targeted against T. pallidum.

Syphilis Penicillins, structurally similar to D-alanine-D-alanine, inhibit Infectious Microbiolog 9 ID

transpeptidase by binding covalently to its active site. The result is failed Diseases y (Micr)
1952
synthesis of the bacterial peptidoglycan cell wall. (ID)

Tetanus Neonatal tetanus can be prevented by hygienic delivery and umbilical cord Infectious Microbiolog 5 ID
care and universal immunisation of women who're preg or may become Diseases y (Micr)
968 preg. Immunised mothers provide passive immunity via transplacental IgG, (ID)
protecting infants until they receive active immunisation (vax) around age
2mos.
Toxoplasmosis Pregnant women should avoid raw or undercooked meat in order to Infectious Microbiolog 5 ID
prevent infectionwith Toxoplasma gondii, an intracellular parasite that can Diseases y (Micr)
#### spread across the placenta to the fetus. Congenital toxoplasmosis is (ID)
typically Chx by retinal lesions, hydrocephalus, jaundice, and HSM.

Tuberculosis Mycobacterial resistance to INH can be accomplished thru non-expression Infectious Microbiolog 18 ID
of the catalase-peroxidase enzyme or thru genetic mod of the INH binding Diseases y (Micr)
1223
site on the mycolic acid synthesis enzymes. (ID)
 Tuberculosis Active TB is never Txwith Rx monotherapy due to the fast emergence of Infectious Microbiolog 18 ID
mycobacterial Abx resistance from rapid, selective gene muts. INH Diseases y (Micr)
1225
monotherapy may be used for patients who have a (+) PPD and a (-) CXR (ID)
(i.e. no evidence of clinical disease).
Typhoid Typhoid strains of Salmonella contain a capsular Ag (Vi) that inhibs Infectious Microbiolog 2 ID
neutrophil phagocytosis, neutrophil recruitment, and macrophage-mediated Diseases y (Micr)
destruction. Therefore, typhoid strains are able to undergo extensive (ID)
1137
replicationwithi the intracellular space of macrophageswith subseq spread
thru the lymphatic and RES, leading to a widespread systemic disease
(typhoid fever).
Typhoid Typhoid fever is caused by S. typhi or paratyphi and presentswith Infectious Microbiolog 2 ID
escalating fever, f/b abdo pain, formation of rose spots on the chest/abdo, Diseases y (Micr)
and hemorrhagic enteritiswith possible bowel perforation. Humans are the (ID)
1138
only reservoir; transmission is faecal-oral and 1arily occurs due to
ingestion of food or water contaminatedwith faeces.

Upper Adenovirus is a self-limiting, yr-round infection that causes the acute onset Infectious Microbiolog 2 ID
respiratory tract of fever, cough, congestion, pharyngitis, and conjunctivitis. This Diseases y (Micr)
1497 infections pharyngoconjunctival disease can occur in outbreaks among those living in (ID)
close quarters (eg, camp dormitories, military barracks).

Urethritis N. gonorrhoeae has high antigenic variability of its surface molecules (e.g. Infectious Microbiolog 4 ID
porins, Opa proteins), which prevents the formation of protective immunity Diseases y (Micr)
1026
and leads to susceptibility to repeat infection. (ID)

Urethritis Urethritis in a young man is most likely to be due to Neisseria gonorrhoeae Infectious Microbiolog 4 ID
or Chlamydia trachomatis, both of which cause dysuria and mucopurulent Diseases y (Micr)
urethral discharge. The standard Tx for suspected gonococcal urethritis (ID)
1895
presumes infection by both organisms. Therefore, ceftriaxone is given for
N gonorrhoeae, and doxycycline or azithromycin is given for C
trachomatis.
Urethritis Neisseria can be isolated by culture on selective media such as the Thayer- Infectious Microbiolog 4 ID
Martin VCN (vancomycin/colistin/nystatin) medium, which inhibs growth Diseases y (Micr)
1912
of contaminants such as gram (+) organisms, gram (-) organisms other than (ID)
Neisseria, and fungi.
Urethritis Gonorrhoea can cause urethritis (dysuria and purulent urethral d/c). The Infectious Microbiolog 4 ID
NAAT is the Dx tool of choice. Gram stain showing gram (-), intracellular Diseases y (Micr)
1949 diplococci is also Dx. Dual therapywith ceftriaxone and azithromycin is the (ID)
1st-line Tx due to concerns about resistance and chlamydia coinfection.

Urinary tract S. saprophyticus is responsible for almost half of all UTIs in sexually active Infectious Microbiolog 12 ID
infection young women. S. saprophyticus belongs to coag (-) staphylococci (CoNS) Diseases y (Micr)
678
and is unique among these b/c it's resistant to novobiocin. (ID)

Urinary tract E coli is one of the dominant components of the normal flora in the Infectious Microbiolog 12 ID
infection intestinal tract of humans and animals. It causes approximately 80% of all Diseases y (Micr)
UTIs. P fimbriae are the most important VF that UPEC express.witho P (ID)
1139 fimbriae, E coli would not be able to bind to uroepithelial cells and infect
the bladder, ureters, and kidneys. Instead, the bacteria would simply be
washed away during urination.

Urinary tract Escherichia coli is the most common cause of UTI in both healthy adults Infectious Microbiolog 12 ID
infection and elderly pts. E coli is a part of the normal GI flora, and special adhesive Diseases y (Micr)
proteins (fimbriae) allow some strains to colonize and ascend the urinary (ID)
1142
tract. This can result in UTI, pyelonephritis, or bacteremia and sepsis
following access to the bloodstream. UTIs are the most common cause of E
coli bacteremia.
Urinary tract Escherichia coli are lactose-fermenting, indole-positive gram-negative rods Infectious Microbiolog 12 ID
infection that are an important cause of urinary tract infection in women. Diseases y (Micr)
####
(ID)

Vibrio V. vulnificus is a curved, gram (-), free-living bacterium that grows in Infectious Microbiolog 1 ID
vulnificus marine environments. Transmission 1arily occurs due to the consumption Diseases y (Micr)
of raw seafood (e.g. oysters) or wound contamination. MFxs are often (ID)
####
mild, but individualswith liver disease or Fe overload are at very high risk
of severe, fulminant infection (e.g. sepsis, necrotising fasciitis).

Viral genetics Recombination refers to gene exchange that occurs through the crossing Infectious Microbiolog 4 ID
over of 2 ds DNA molecules. Reassortment describes the mixing of Diseases y (Micr)
1461
genome segments in segmented viruses that infect the same host cell. (ID)
 Viral genetics Phenotypically mixing refers to coinfection of a host cell by 2 viral strains, Infectious Microbiolog 4 ID
resulting in progeny virions that contain nucleocapsid proteins from 1 Diseases y (Micr)
strain and the unchanged parental genome of the other strain. B/c there's no (ID)
1462
change in underlying viral genomes (no genetic exchange), the next gen of
virions revert to their original, unmixed phenotypes.

Viral genetics Influenza epidemics and pandemics are typically caused by reassortment of Infectious Microbiolog 4 ID
the RNA segments coding for HA or NA proteins (major antigenic shifts). Diseases y (Micr)
####
This process can occur b/w human and animal strains of influenza A virus (ID)
in avian or swine hosts.
Zika virus Zika virus is an ssRNA that infects foetal neural progenitor cells, causing Infectious Microbiolog 1 ID
severe congenital malformations (e.g. microcephaly, arthrogryposis), Diseases y (Micr)
####
cerebral cortical thinning, and possible foetal demise. (ID)

Bacterial Bacterial vaginosis is a vaginal infection diagnosed by the presence of clue Infectious Pathology 3 ID
vaginosis cells and a positive amine "whiff" test with potassium hydroxide (KOH). Diseases (Path)
1958 The pathogenesis involves a loss of lactobacilli in the normal vaginal flora (ID)
and overgrowth of Gardnerella vaginalis. It is treated with clindamycin or
metronidazole.
Community Acute phase reactants (APRs) are proteins whose serum concentrations Infectious Pathology 21 ID
acquired change by 225% during periods of inflammation. Procalcitonin is a unique Diseases (Path)
#### pneumonia APR that can rise or fall depending on the etiology of the infection; (ID)
elevated levels correlate with a bacterial source, whereas low levels
indicate a viral source.
Hepatocellular Universal vaccination of children against HBV would likely cause a steep Infectious Pathology 5 ID
cancer decline in the worldwide incidence of hepatocellular carcinoma. Diseases (Path)
60
(ID)

Kaposi Kaposi's sarcoma usually involves the skin and GI tract and is common in Infectious Pathology 2 ID
sarcoma HIV patients not on antiretroviral therapy. Endoscopy reveals characteristic Diseases (Path)
lesions, which range from reddish/violet flat maculopapular lesions to (ID)
8290
raised hemorrhagic nodules or polypoid masses. Biopsy can show spindle
cells, neovascularization, and extravasated red blood cells.

Lyme disease The characteristic cutaneous lesion in Borrelia burgdorferi infection (Lyme Infectious Pathology 3 ID
disease) is erythema migrans, which begins as an erythematous macule at Diseases (Path)
1676 the site of an Ixodes tick bite. The erythema spreads outward, often leaving (ID)
a zone of central clearing ("bull's-eye" rash).

Schistosomiasis Schistosomiasis is a parasitic blood fluke infection that is associated with Infectious Pathology 2 ID
bathing in freshwater contaminated with cercariae from infected snails. Diseases (Path)
Patients often are asymptomatic for months or years but may eventually (ID)
develop eosinophilic granulomatous inflammation in the liver, spleen,
####
gastrointestinal tract, or genitourinary system. One common manifestation
of genitourinary schistosomiasis is painless terminal hematuria; eggs can
often be identified in the urine or on biopsy.

Syphilis Tertiary syphilis can result in thoracic aortic aneurysm. If the aneurysm Infectious Pathology 9 ID
compresses adjacent structures and dilates the aortic valve ring, a murmur Diseases (Path)
and mediastinal widening might be present. The pathogenesis begins with (ID)
472 vasa vasorum endarteritis and obliteration, resulting in inflammation,
ischemia, and weakening of the aortic adventitia. Fluorescent treponemal
antibody absorption testing is specific for syphilis.

Syphilis Histopathologic examination of syphilitic lesions classically demonstrates a Infectious Pathology 9 ID

proliferative endarteritis with a surrounding plasma cell infiltrate. Most of Diseases (Path)
####
the manifestations of syphilis are due to localized tissue ischemia resulting (ID)
from endarteritis.
Echinococcosis Echinococcus granulosus is the most common cause of hydatid cysts. Infectious Pathophysiol 1 ID
Spilling of cyst contents can cause anaphylactic shock. Surgical Diseases ogy (Patp)
61
manipulation should be performed with caution. (ID)

Pneumocystis Pneumocystis pneumonia is an atypical fungal infection seen primarily in Infectious Pathophysiol 2 ID
pneumonia those with impaired cell mediated immunity (eg, advanced AIDS). Diseases ogy (Patp)
Manifestations often include slowly worsening pulmonary symptoms, (ID)
####
hypoxia, and bilateral interstitial infiltrates on chest x-ray. The cystic
organism can be Visualized using silver stain of respiratory secretions.

Rheumatic Acute rheumatic fever is an autoimmune reaction following an untreated Infectious Pathophysiol 5 ID
fever group A streptococcal pharyngitis. Anti-group A Streptococcus antibodies Diseases ogy (Patp)
724 (eg, anti-M protein, anti-N-acetyl-β-D glucosamine) cross-react and attack (ID)
cardiac and central nervous system antigens.
 Septic shock Tumor necrosis factor-α is released from activated macrophages and is one Infectious Pathophysiol 6 ID
of the most important mediators of the systemic inflammatory response in Diseases ogy (Patp)
1799
sepsis. Other cytokines responsible for inducing the systemic inflammatory (ID)
response include IL-1 and IL-6.
Acyclovir Antiviral drugs currently recommended for the Tx of 1° genital herpes incl Infectious Pharmacolog 4 ID
the nucleoside analogues (e.g. acyclovir). These are incorporated into Diseases y (Phar)
1551
newly replicating viral DNA and ultimately terminate viral DNA chain (ID)
synthesis.
Acyclovir IV acyclovir can cause crystalline nephropathy if adequate hydration isn't Infectious Pharmacolog 4 ID
also provided. Diseases y (Phar)
1642
(ID)

Acyclovir Monophosphorylation of acyclovir by a viral thymidine kinase is the 1st Infectious Pharmacolog 4 ID
(and RLS) step in conversion of acyclovir to its active triphosphate form. Diseases y (Phar)
1645 Acyclovir and related drugs (e.g. famciclovir, valaciclovir) are more (ID)
effective against HSV and VZV than CMV and EBV.

Adverse drug Hypokalaemia and hypomagnesaemia are common electrolyte disturbances Infectious Pharmacolog 2 ID
reaction in patients undergoing Txwith amphotericin B and reflect an ↑ in DCT Diseases y (Phar)
275
membrane permeability. (ID)

Aminoglycosid Aminoglycoside (e.g. gentamicin) resistance is most commonly due to Abx- Infectious Pharmacolog 3 ID
e modding enzymes. These enzymes add chem groups to the Abx, which Diseases y (Phar)
1000
diminishes its ability to bind to the 16S rRNAwithi the 30S ribosomal (ID)
subunit.
Aminoglycosid Aminoglycosides inhibit genetic code reading and protein synthesis by Infectious Pharmacolog 3 ID
e binding to the prokaryotic 30S ribosomal subunit. Diseases y (Phar)
1488
(ID)

Antibiotic The mech of vancomycin resistance in organisms such as VRE is a Infectious Pharmacolog 8 ID
resistance substitution of D-lactate in the place of D-alanine during the process of Diseases y (Phar)
643
PGCW synthesis. This prevents the binding of vancomycin to its usual D- (ID)
ala-D-ala binding site in the cell wall.
Antibiotic ESBLs can be produced by gram (-) bacteria, rendering cephalosporins and Infectious Pharmacolog 8 ID
resistance other β-lactam Abx inactive. These genes can be transmitted b/w Diseases y (Phar)
####
organisms thru plasmid conjugation. (ID)

Antibiotic MRSA is resistant to most β-lactam Rx (e.g. oxacillin, methicillin, Infectious Pharmacolog 8 ID
resistance cephalosporins) due to the acquisition of a mobile genetic element that Diseases y (Phar)
contains the mecA gene. This gene encodes for a specialised PBP that has (ID)
####
low affinity for β-lactam Abx. Tx of MRSA therefore req a non-β-lactam
Rx such as TMP-SMX, clindamycin, doxycycline, or vancomycin.

Antiretroviral PIs are HIV ARV Rx that inhib cleavage of the polypeptide precursor into Infectious Pharmacolog 7 ID
therapy mature viral proteins. Their AEs as a class incl. hyperglycaemia, Diseases y (Phar)
819
lipodystrophy, and drug-drug interactions due to inhib of CYP450. (ID)

Antiretroviral NNRTIs are ARV drugs that don't req activation via intracellular Infectious Pharmacolog 7 ID
therapy phosphorylation. The more common NNRTIs incl nevirapine and Diseases y (Phar)
1674
efavirenz. (ID)

Antiretroviral Fusion inhibs (e.g. enfuvirtide) bind the HIV transmembrane glycoprotein Infectious Pharmacolog 7 ID
therapy gp41 and prevent it from approx. the viral and host cellular membranes, Diseases y (Phar)
1675
which prevents HIV penetration into new host cells. (ID)

Antiretroviral ZDT is an NRTI used to prevent maternal to foetal transmission of HIV Infectious Pharmacolog 7 ID
therapy during labour (when the mother isn't virally suppressed). It's a thymidine Diseases y (Phar)
analogue that doesn't have the normal 3'-OH group found on thymidine. (ID)
2019
B/c new nucleotides are added to growing DNA chains only at the 3'-OH
group, the addn of ZDT into DNA results in chain termination.

Antiretroviral Integration of HIV dsDNA into the host cell's chrom is necessary to induce Infectious Pharmacolog 7 ID
therapy viral gene expression and prevent degradation of the viral genome. Diseases y (Phar)
8371
Raltegravir is an integrase inhib that disrupatients HIV genome integration, (ID)
preventing synthesis of viral mRNA.
Antiretroviral Abacavir HSR occurs in 2-8% of patients and is strongly a/w the HLA- Infectious Pharmacolog 7 ID
therapy B*57:01 allele. Diseases y (Phar)
####
(ID)

Aspergillosis Amphotericin B binds the ergosterol of fungal cell membranes to exert its Infectious Pharmacolog 5 ID
antifungal effects. However, it also binds chol to some degree, causing tox Diseases y (Phar)
273 to human tissues. The most important AEs of amphotericin B are (ID)
nephrotox, hypokalaemia, and hypomagnesaemia.
 Azoles Azoles inhibit the synthesis of ergosterol by the fungal cytochrome P450 Infectious Pharmacolog 1 ID
enzymes. They also suppress the human P450 system, resulting in many Diseases y (Phar)
276
drug-drug interactions. (ID)

Cephalosporins Penicillins, cephalosporins, and vancomycin are able to disrupt the PGCW Infectious Pharmacolog 2 ID
of gram (+) and gram (-) organisms. The PGCW of these organisms gives Diseases y (Phar)
959
them the ability to survive osmotic stress; this ability is lost after Txwith (ID)
these Abx agents.
Cytomegalovir Of all the antiviral agents that bind and inhib DNA polymerase in Infectious Pharmacolog 9 ID
us herpesvirus and reverse transcriptase in HIV, the PPi analogue foscarnet is Diseases y (Phar)
1644
1 of few that don't req intracellular activation by viral or cellular kinases. (ID)

Cytomegalovir 1st-line therapy for CMV colitis and retinitis is ganciclovir. This Rx inhibs Infectious Pharmacolog 9 ID
us viral synthesis by blocking CMV DNA polymerase. However, ganciclovir Diseases y (Phar)
1647 also blocks host DNA polymerase to a lesser degree, which can lead to (ID)
heme AEs such as neutropaenia, anaemia, and thrombocytopaenia.

Daptomycin Daptomycin is a lipopeptide Abxwith activity limited to gram (+) Infectious Pharmacolog 1 ID
organisms, incl MRSA. It causes depol of bacterial cellular membrane and Diseases y (Phar)
8288
inhib of DNA, RNA, and protein synthesis. Daptomycin is a/w ↑ CPK lvls (ID)
and an ↑ incidence of myopathy.
Diabetic foot Piperacillin-tazobactam is a combo of extended-spectrum penicillinwith β- Infectious Pharmacolog 2 ID
lactamase inhib. It's effective against most gram (-) enteric rods (incl P. Diseases y (Phar)
1198
aeruginosa) and against B. fragilis. (ID)

Folate TMP, MTX, and pyrimethamine inhib DHFR. TMP restricts bacterial Infectious Pharmacolog 1 ID
antimetabolites growth thru this process, and works particularly well in conjunctionwith Diseases y (Phar)
1104
sulphonamide, which inhibs an earlier step in the bacterial vitB9 pathway. (ID)

Foscarnet Foscarnet is an analogue of PPi that can chelate Ca2+ and promote Infectious Pharmacolog 1 ID
nephrotox renal Mg wasting. These tox can result in hypocalcaemia and Diseases y (Phar)
1643
hypomagnesaemia, which can cause seizures. (ID)

HIV R5 strains (macrophage-tropic) of HIV attach to the host CD4 receptor and Infectious Pharmacolog 11 ID
CCR5 chemokine coreceptor; CCR5 inhibs such as maraviroc can be used Diseases y (Phar)
#### in the Tx of R5 virus. X4 strains (T lymphotropic) of HIV bind to the CD4 (ID)
receptor and CXCR4 chemokine receptor; X4 virus can't be Txwith CCR5
inhibs.
Infection Alcohols fxn by disorganising the lipid structure in membranes, causing Infectious Pharmacolog 3 ID
control them to be leaky, and by denaturing cellular proteins. They're bactericidal, Diseases y (Phar)
8593
tuberculocidal, fungicidal, and virucidal, but don't destroy bacterial spores. (ID)

Influenza Oseltamivir is a neuraminidase inhib useful in the Tx and prevention of Infectious Pharmacolog 5 ID
both influenza A and B virus infections. This Rx impairs the release of Diseases y (Phar)
1648 newly formed virions from infected host cells and impairs viral penetration (ID)
of mucous secretions that overlie the resp epithelium.

Intestinal E. vermicularis infection (enterobiasis) occurs most freq in school-age Infectious Pharmacolog 3 ID
helminth children and presentswith perianal pruritus. Dx is made by the Scotch tape Diseases y (Phar)
8538
parasites test. Albendazole is the 1st-line Tx,with pyrantel pamoate as an alt agent (ID)
preferred in preg pts.
Malaria Chloroquine is the TOC for uncomplicated malaria contracted in a Infectious Pharmacolog 5 ID
chloroquine-sen geographic region. It eliminates susceptible erythrocytic Diseases y (Phar)
forms of all Plasmodium species. Primaquine is added in the Tx of (ID)
1965
infectionswith P. vivax and P. ovale to eradicate the intrahepatic stages
(hypnozoites) of these malarial species, which are responsible for relapses.

Mucormycosis Amphotericin B is a polyene antifungal drug notorious for its renal tox. Infectious Pharmacolog 3 ID
Severe hypokalaemia and hypomagnesaemia are commonly seen during Diseases y (Phar)
274
therapy and often req daily supplementation. (ID)

Mycobacterium MAC infections are common in ptswith advanced AIDS. The bacterium Infectious Pharmacolog 1 ID
avium often spreads thru the bloodstream and RES and causes nonspecific SSx Diseases y (Phar)
1312 intracellulare (e.g. fever, fatigue, weight loss, diarrhoea), LAD, and HSM. Dx is often (ID)
complex made on blood culture or bone marrow aspirate (intracellular acid-fast
bacteria that aren't M. tuberculosis).
Penicillin β-lactamase inhibs (e.g. clavulanic acid, sulbactam, tazobactam) prevent β- Infectious Pharmacolog 2 ID
lactamase from inactivating penicillin class drugs, which extends the Diseases y (Phar)
1091
spectrum of their activity. (ID)

Penicillin Clavulanic acid, sulbactam, and tazobactam are β-lactamase inhibs. Infectious Pharmacolog 2 ID
Concurrent admin of clavulanatewith amoxicillin expands amoxicillin's Diseases y (Phar)
1959
spectrum of activity to incl strains of β-lactamase synthesising bacteria (ID)
that're resistant to amoxicillin alone.
 Tinea Tinea pedis is a superficial infection of the epidermis caused by Infectious Pharmacolog 4 ID
dermatophytes (e.g. T. rubrum). It most often presents as a pruritic, Diseases y (Phar)
erythematous rash b/w the toes that freq extends along the sole. KOH (ID)
####
micro of skin scrapings shows branching hyphae. Tx options incl a variety
of topical antifungals (e.g. clotrimazole), but not nystatin.

Tuberculosis The rifamycins block the action of the bacterial DNA-dependent RNA Infectious Pharmacolog 18 ID
polymerase, thereby inhib transcription. Resistance is acq by mod of the Diseases y (Phar)
1226 rifampin binding site on the bacterial DNA-dependent RNA polymerase. (ID)
Common AEs incl hepatotox, blood dyscrasias, and harmless red-orange
discolouration of body fluids.
Tuberculosis Ethambutol can cause optic neuropathy that results in colour blindness, Infectious Pharmacolog 18 ID
central scotoma, and ↓ visual acuity. This AE may be reversedwith Diseases y (Phar)
1228
discontinuation of the drug. (ID)

Tuberculosis Isoniazid is an antimycobacterial agent that specifically inhibits the Infectious Pharmacolog 18 ID
synthesis of mycolic acids, which are essential components of the unique Diseases y (Phar)
1309 mycobacterial peptidoglycan cell wall. Without mycolic acids, the (ID)
mycobacteria lose their acid-fastness and become unable to synthesize new
cell walls or multiply.
Tuberculosis INH can be directly hepatotox, causing acute, mild hepatic dysfxn in 10- Infectious Pharmacolog 18 ID
20% of patients and frank hepatitis (fever, anorexia, and nausea, Diseases y (Phar)
1774
sometimes progressing to hepatic failure) in a small % of pts. (ID)

Benign The prostate is located between the pubic symphysis and the anal canal Male Anatomy 6 MR
prostatic and is visible on inferior sections of the pelvis on CT scan. Benign Reproduct (Anat)
hyperplasia prostatic hyperplasia is a common, age-related condition that causes ive (MR)
1737
urinary symptoms (eg, hesitancy, straining, incomplete voiding). It can be
medically treated with a-adrenergic blockers and 5-a reductase
inhibitors
#### Erectile The prostatic plexus (inferior hypogastric nerves plus pelvic and Male Anatomy 3 MR
Hydrocele Male Anatomy 2 MR
A communicating hydrocele results when serous fluid accumulates within
Reproduct (Anat)
1827 the tunica vaginalis in the setting of a patent processus (tunica) vaginalis.
ive (MR)
It presents as a painless swelling that transilluminates on examination
Prostate cancer The skeletal system is a common site of metastasis due to Male Anatomy 10 MR
hematogenous seeding. Cancers of the pelvis, including the prostate, Reproduct (Anat)
#### spread to the lumbosacral spine via the vertebral venous plexus, which in ive (MR)
turn communicates with a number of venous networks, including the
prostatic venous plexus.
Scrotum Male Anatomy 1 MR
Due to its intra-abdominal origin, lymphatic drainage of the testis is to
Reproduct (Anat)
8326 the para-aortic lymph nodes. In contrast, lymph drainage from the
ive (MR)
scrotum goes into the superficial inguinal lymph nodes
#### Superficial The superficial and deep inguinal rings are physiologic openings in the Male Anatomy 1 MR
Testicular Lymph from the testes drains through lymph channels directly back to Male Anatomy 4 MR
2021 cancer the para-aortic lymph nodes In contrast, lymph from the scrotum drains Reproduct (Anat)
to the superficial inguinal lymph nodes. ive (MR)
Prostate cancer Male Anatomy MR
Most prostate cancer arises in the peripheral zone of the gland which Reproduct (Anat)
abuts the rectum. Therefore, prostate biopsies are primarily obtained ive (MR)
#### via the transrectal approach: multiple random core samples of the
prostate are typically taken. Because only a small part of the
peripheral zone encases the distal urethra, patients with prostate
cancer do not typically present with urinary symptoms.
Testicular Male Anatomy 1 MR
torsion Testicular torsion is due to twisting of the testis around the spermatic Reproduct (Anat)
####
cord (containing the gonadal artery), which can eventually lead to ive (MR)
ischemia. The gonadal arteries arise from the abdominal aorta.
Urethral injury Injury to the posterior urethra is associated with pelvic fractures, and Male Anatomy 1 MR
the anterior urethra is most commonly damaged in straddle injures. Reproduct (Anat)
Inability to void with a full bladder sensation, a high-riding boggy prostate, ive (MR)
839 and blood at the urethral meatus are suggestive of urethral injury
(membranous segment), particularly in the presence of a pelvic fracture.
If urethral injury is suspected placement of a Foley catheter is
contraindicated.
Hydrocele Male Embryology 2 MR
419 • Communicating Hydroceles and Indirect Inguinal Hernias are caused Reproduct (Embr)
by an incomplete obliteration of the processes vaginalis. ive (MR)
Hypospadia In males, incomplete fusion of the urethral (urogenital) folds results in Male Embryology 1 MR
1870 and epispadia hypospadias, an abnormal opening of the urethra proximal to the glans Reproduct (Embr)
penis along the ventral shaft of the penis. ive (MR)
 Mullerian The embryonic testis secretes testosterone and mullerian inhibiting factor Male Embryology 1 MR
inhibitory (MIF). MIF is responsible for regression of the paramesonephric Reproduct (Embr)
1427
factor (mullerian) ducts that normally give rise to the internal genitalia in the ive (MR)
female fetus.
Sexual Male Embryology 2 MR
The SRY gene on the Y chromosome codes for the testes-determining
differentiation Reproduct (Embr)
factor, which differentiates the primitive gonads into testes. Sertoli cells
ive (MR)
produce anti-Mullerian hormone, which causes regression of the
1449 Mullerian ducts and suppresses female internal reproductive organ
development. Leydig cells produce testosterone, differentiating Wolffian
ducts into internal male reproductive organs. Dihydrotestosterone is
required for differentiation of the external male genitalia.
Cystic fibrosis Congenital Bilateral Absence of Vas Deferens (CBAVD) Male Genetics 11 MR
• CFTR gene mutations – MCC of CBAVD Reproduct (Gene)
• Patients with CBAVD: ✓ Have azoospermia and infertility ✓ But ive (MR)
807
normal levels of FSH, LH, Testosterone
• ↑ Sweat Chloride Levels are diagnostic of cystic fibrosis.

Klinefelter Male Genetics 3 MR

47.XXY is the most common genotype causing Klinefelter syndrome.
syndrome Reproduct (Gene)
Patients present with tall stature; small, firm testes; azoospermia; and
343 ive (MR)
gynecomastia. Mild intellectual disability is seen in some patients, and the
severity generally increases with each additional X chromosome.
Bronchiectasis Male Pathology 2 MR
Primary ciliary dyskinesia results from an autosomal recessive mutation
Reproduct (Path)
in the proteins responsible for normal flagellar and ciliary structure and
664 ive (MR)
function (eg, dynein, assembly proteins). Clinical manifestations include
situs inversus, chronic sinusitis, bronchiectasis, and infertility.
Cryptorchidism In undescended testes, the seminiferous tubules atrophy if uncorrected Male Pathology 2 MR
due to higher body temperatures, resulting in decreased fertility and Reproduct (Path)
580 increased risk for malignancy. Orchiopexy (surgical placement of the ive (MR)
testes in the scrotal sac) can minimize damage and decrease risk for
testicular cancer.
Epididymitis Male Pathology 1 MR
Epididymitis presents with acute testicular pain, tenderness, and pyuria
Reproduct (Path)
(leukocytes but no bacteria). It is caused by retrograde passage of
ive (MR)
organisms from the urethra into the ejaculatory duct and vas deferens via
#### unprotected sex. The microbiology is largely influenced by patient age:
epididymitis in young men is usually due to sexually acquired infections
(eg, Chlamydia trachomatis, Neissena gonorrhoeae), whereas in older men
(age >35) it is usually due to gram-negative colonic flora
Erectile Male Pathology 3 MR
Psychogenic distress causes of erectile dysfunction include performance
dysfunction Reproduct (Path)
8351 anxiety, depression, sexual trauma, relationship problems, and stress.
ive (MR)
Important clues include sudden-onset and normal nocturnal erections.
Hemochromato Hereditary hemochromatosis can cause secondary hypogonadism due to
sis deposition of iron in the pituitary gland, resulting in decreased
gonadotropin secretion. Patients who develop secondary hypogonadism are
####
also at risk for deficiencies in other pituitary hormones (eg, central
hypothyroidism. hyperpigmentation of the skin, elevated
glucose/diabetes mellitus, and hepatomegaly
Prostate Prostate adenocarcinoma is generally diagnosed with transrectal prostate Male Pathology MR
adenocarcinom biopsy, which usually reveals atypical glandular cells with enlarged nuclei Reproduct (Path)
#### a and prominent nucleoli. In contrast, normal prostate cells are small and ive (MR)
glandular with scant cytoplasm, small nuclei, and normal nucleoli.
Neoplastic proliferation of prostate gland cells
Prostate cancer Prostate cancer is common in older men and metastasizes primarily to bone Male Pathology MR
due to bone-specific tumor adhesion molecules and receptor ligands on the Reproduct (Path)
cellular surface. Prostate cancer causes osteoblastic lesions that result in ive (MR)
####
new bone growth. Biopsy would show disordered trabeculae and signs of
prostate cancer such as irregular glands with enlarged nuclei and
prominent nucleoli.
1055 Klinefelter Patients with Klinefelter syndrome (47.ХХУ) have primary Male Pathology 3 MR
Testicular Male Pathology 4 MR
Human chorionic gonadotropin (hCG) has a structure similar to TSH
cancer Reproduct (Path)
Patients with testicular germ cell tumors or gestational trophoblastic
624 ive (MR)
disease may develop very high serum hCG concentrations, which can
stimulate TSH receptors and cause paraneoplastic hyperthyroidism
Testicular Male Pathology 4 MR
A painless, solid scrotal mass should be considered testicular cancer
cancer Reproduct (Path)
until proven otherwise. Examination generally reveals a solid, firm, or
#### ive (MR)
fixed nodule in the tunica albuginea that is ovoid in shape and painless to
palpation. Testicular tumors do not transilluminate
 Testicular Male Pathology 4 MR
Most cases of testicular cancer are either seminomatous or
cancer Reproduct (Path)
nonseminomatous germ cell tumors. Nonseminomatous germ cell tumors
ive (MR)
are composed of partially differentiated germ cells, which often retain the
####
ability to secrete human chorionic growth hormone and alpha-
fetoprotein (serum tumor markers). Serum lactate dehydrogenase, a
marker of tissue injury and cell turnover, is also frequently increased.
Because prostate cancer is an androgen-dependent tumor, patients with MR
#### Prostate cancer Male Pharmacolog
advanced disease
Management are generally
of male treated(bilateral
hypogonadism with surgical or medical sparse
gynecomastia, MR
#### Hypogonadism Male Pharmacolog
facial hair, and small, firm testes) includes testosterone therapy, which MR
Prostate cancer Male Pharmacolog
Patients with advanced or castration-resistant prostate cancer are often
Reproduct y (Phar)
treated with an 17-alpha-hydroxylase inhibitors (eg. abiraterone),
ive (MR)
#### which block the generation of androgens in the adrenal glands, testes, and
tumor cells. This reduces systemic androgen levels, which limit
metastatic prostate adenocarcinoma.
Benign 5-alpha reductase inhibitors (eg. finasteride, dutasteride) block the Male Pharmacolog 6 MR
prostatic conversion of testosterone to dihydrotestosterone in the prostate. These Reproduct y (Phar)
8930 hyperplasia drugs reduce prostate volume in patients with benign prostatic ive (MR)
hyperplasia and relieve the fixed component of bladder outlet
obstruction.
Prostate cancer Male Pharmacolog 10 MR
Flutamide is a nonsteroid anti-androgen that acts as a competitive
Reproduct y (Phar)
inhibitor of testosterone receptors (Impaired androgen-receptor
657 ive (MR)
interaction). It is used in combination with long-acting gonadotropin-
releasing hormone agonists for the treatment of prostate cancer
Contraception After vasectomy, viable sperm remain in the portion of the vas deferens Male Physiology 3 MR
8468 distal to the ligation. Patients can still have viable sperm in the Reproduct (Phys)
ejaculate for 3 months and at least 20 ejaculations. ive (MR)
Inhibin Sertoli cells produce inhibin in response to FSH from the anterior pituitary. Male Physiology 1 MR
Inhibin suppresses FSH production in the pituitary. Sertoli cells also Reproduct (Phys)
facilitate spermatogenesiswithi the seminiferous tubules. Impaired Sertoli ive (MR)
1902
cell function would lead to ↓ production of inhibin, ↑ FSH lvls, and
impaired fertility. Normal LH and testesteron

Compartment Acute compartment syndrome (ACS) is caused by increased pressure Miscellan Anatomy 2 MS
syndrome within fascial compartments of the limbs, leading to impaired perfusion. eous (Anat)
#### ACS can cause severe pain, myonecrosis, and nerve injury. The anterior (Multisyst
compartment of the leg, which contains the deep peroneal (fibular) nerve, em) (MS)
is the most common site of ACS.
Antihistamines Review of Rx to determine if any are unnecessary or causing AEx is Miscellan Behavioral 3 MS
essential in providing high-quality pt care. The cumulative anticholinergic eous Science
#### burden of multiple Rx is especially problematic in the elderly. (Multisyst (Beha)
em) (MS)

Health Medicare is a federal socialized medical insurance program that covers Miscellan Behavioral 3 MS
insurance individuals age 65 and older who have a work Hx and younger eous Science
#### individualswith disabilities. (Multisyst (Beha)
em) (MS)

Medical errors Physicians must be able to identify ptswith limited English proficiency and Miscellan Behavioral 8 MS
ensure that professional interpreters are made available in high-risk clinical eous Science
#### situations. (Multisyst (Beha)
em) (MS)

Medical errors Sleep deprivation in physicians often causes cognitive impairment, Miscellan Behavioral 8 MS
resulting in medical errors. Although mandated resident work-hr eous Science
#### limitations are in place, it is the responsibility of all physicians to self- (Multisyst (Beha)
regulate their workloads to promote pt safety. em) (MS)

Medical errors Avoiding the use of unsafe abbreviations and trailing zeros in Rx orders Miscellan Behavioral 8 MS
can help ↓ the incidence of Rx errors. eous Science
#### (Multisyst (Beha)
em) (MS)

Polypharmacy Falls are a common problem in elderly nursing home patients. Optimal Miscellan Behavioral 1 MS
management includes a careful medication review with the goal of limiting eous Science
#### the use of agents associated with increased fall risk. (Multisyst (Beha)
em) (MS)

Treatment Effective d/c planning requires collaboration of multiple disciplines Miscellan Behavioral 5 MS
adherence (physician, nurse, social worker). A social worker can be instrumental in eous Science
#### Ax whether the pt has adequate family or caregiver support at home. (Multisyst (Beha)
em) (MS)
 Treatment Pts' misunderstanding of Rx use can result in Rx errors, including potential Miscellan Behavioral 5 MS
adherence overdose, toxicity, and withdrawal. Physicians must Ax the pt's eous Science
#### understanding and provide targeted education to address misconceptions. (Multisyst (Beha)
em) (MS)

Treatment A d/c checklist detailing Rx changes and f/u appointments can significantly Miscellan Behavioral 5 MS
adherence facilitate a pt's transition from the hospital and improve adherence to outPt eous Science
#### Tx. Individuals who experience a smooth transition from the inPt to the (Multisyst (Beha)
outPt setting are at ↓ risk for early rehospitalization. em) (MS)

AlkaptonuriaAlkaptonuria is an autosomal recessive disorder in which the lack of Miscellan Biochemistr 2 MS

homogentisic acid dioxygenase blocks the metabolism of tyrosine (to eous y (Bioc)
1502 fumarate), leading to an accumulation of homogentisic acid. Clinical (Multisyst
features include a black urine color when exposed to air, a blue-black em) (MS)
pigmentation on the face, and ochronotic arthropathy.
Homocystinuri Homocystinuria is most commonly caused by cystathionine synthase Miscellan Biochemistr 1 MS
a deficiency. Affected individuals have marfanoid habitus, ectopia lentis, and eous y (Bioc)
1504 developmental delay. Significant morbidity and mortality are due primarily (Multisyst
to TE. Many ptswith homocystinuria respond dramatically to pyridoxine em) (MS)
(vitamin B6) supplementation.
Signal The phosphoinositol 2nd messenger system beginswith ligand-receptor Miscellan Biochemistr 1 MS
transduction binding and Gq-protein activation leading to activation of PLC. PLC then eous y (Bioc)
1122 hydrolyzes PIP2 and forms DAG and IP3. Finally, IP3 activates PKC via an (Multisyst
↑ in intracellular Ca2+. em) (MS)

Vitamin C Vitamin C is necessary for the hydroxylation of proline and lysine residues Miscellan Biochemistr 3 MS
deficiency in pro-collagen. Vitamin C deficiency (scurvy) is most often seen in eous y (Bioc)
severely malnourished individuals and leads to capillary bleeding, poor (Multisyst
311
wound healing, and periodontal disease. In children, bony deformities and em) (MS)
subperiosteal hemorrhages are also Chx.

Holoprosencep A developmental field defect describes multiple malformations that occur Miscellan Embryology 1 MS
haly 2° to an embryonic disturbance in an adjoining group of cells. HPE is a eous (Embr)
252 developmental field defect Chx by a spectrum of fetal anomalies due to (Multisyst
incomplete division of the forebrain (prosencephalon). em) (MS)

Autosomal AR disorders affect 25% of offspring of aSSx heterozygous carrier parents. Miscellan Genetics 5 MS
recessive Classical galactosemia is the most common and severe galactosemic eous (Gene)
1728 inheritance disorder and Pxwithi days of birthwith jaundice, vomiting, and (Multisyst
hepatomegaly. em) (MS)

DiGeorge Chromosome 22q11.2 microdeletion results in DGS (cardiac anomalies, Miscellan Genetics 2 MS
syndrome hypoplastic or absent thymus, and hypocalcemia) and VCFS (cleft palate, eous (Gene)
34 cardiac anomalies, dysmorphic facies). FISH is the "gold standard" for (Multisyst
detecting a microdeletion. em) (MS)

Down Down syndrome (trisomy 21) is associated with decreased maternal serum Miscellan Genetics 6 MS
syndrome alpha-fetoprotein and increased nuchal translucency Duodenal atresia is eous (Gene)
1824 the most common gastrointestinal complication in these patients (Multisyst
em) (MS)

Genetic code Translation of the mRNA template proceeds in the 5' to 3' direction. B/c Miscellan Genetics 1 MS
complementary sequences align in antiparallel fashion, during translation eous (Gene)
tRNA anticodons will be oriented in the opposite 3' to 5' direction. Stop (Multisyst
1420
codons (UAA, UAG, and UGA) halt protein synthesis by binding a RF; em) (MS)
they do not add AAs to the polypeptide chain.

Linkage Two allele loci are said to be in linkage disequilibrium when a pair of Miscellan Genetics 1 MS
disequilibrium alleles are inherited together in the same gamete (haplotype) more often or eous (Gene)
8283 less often than would be expected given random pairing. This most often (Multisyst
occurs when the genes are in close physical proximity on the same em) (MS)
chromosome.
Trisomy 13 Patau syndrome (trisomy 13) usually occurs secondary to meiotic Miscellan Genetics 1 MS
nondisjunction in mothers of advanced maternal age. Key physical findings eous (Gene)
1822 reflect defective prechordal mesoderm fusion resulting in midline defects (Multisyst
(eg, holoprosencephaly, microphthalmia, cleft lip/palate, omphalocele) as em) (MS)
well as polydactyly and cutis aplasia.
Trisomy 18 Trisomy 18, or ES, is most commonly the result of meiotic nondisjxn due Miscellan Genetics 1 MS
to advanced maternal age. Key findings include fetal growth retardation, eous (Gene)
1823 hypertonia (clenched handswith overlapping fingers), rocker bottom feet, (Multisyst
and cardiac/GI/renal defects. em) (MS)
 Aging Presbyopia and skin wrinkles are age-related changes. Presbyopia occurs Miscellan Pathology 8 MS
due to denaturation of structural proteins within the lens, leading to loss of eous (Path)
lens elasticity which can result in improved vision in patients with mild (Multisyst
862
myopia. Decreased synthesis and increased breakdown of collagen and em) (MS)
elastin contribute to the development of skin wrinkles.

Cervical cancer Dysplasia is characterized by disruption of organized epithelial cell Miscellan Pathology 3 MS
differentiation with marked cellular pleomorphism. Although high-grade eous (Path)
dysplasia (involving most or the entire epithelial layer) often progresses to (Multisyst
1753 invasive cancer, low-grade dysplasia (involving a small portion of em) (MS)
epithelium) typically spontaneously regresses (reversible). Invasive
cancer occurs when the abnormal cells penetrate the basement membrane.

Gastroesophag Metaplasia is the substitution of one differentiated cell type for another Miscellan Pathology 7 MS
eal reflux due to the presence of an adverse environmental stimulus. It is often seen eous (Path)
disease in the bronchi of chronic cigarette smokers (substitution of columnar for (Multisyst
285 stratified squamous cells) and the distal esophagus of patients with em) (MS)
chronic gastroesophageal reflux (substitution of stratified squamous with
columnar cells). Metaplasia can lead to dysplasia and malignant
transformation.
Nuclear factor Nuclear factor-kappa В (NF-кВ) is a transcription factor with a critical Miscellan Pathology 1 MS
kappa B role in the immune response to infection NF-кВ is normally present in eous (Path)
the cytoplasm in a latent, inactive state bound to its inhibitor protein (Multisyst
####
IkB. Extracellular substances such as lipopolysaccharide can initiate a em) (MS)
signal cascade that results in the destruction of IkB and translocation of
free NF-кВ to the nucleus
Tuberous Renal angiomyolipoma is a benign tumor composed of blood vessels, Miscellan Pathology 1 MS
sclerosis smooth muscle, and fat. Bilateral renal angiomyolipomas are associated eous (Path)
6 with tuberous sclerosis, an autosomal dominant condition. Additional (Multisyst
finding brain hamartomas and ash-leaf skin patches em) (MS)

Acute The locus ceruleus is a paired brainstem nucleus located in the posterior Nervous Anatomy 1 NS
intracerebral rostral pons near the lateral floor of the fourth ventricle and functions (NS) (Anat)
hemorrhage as the principal site for norepinephrine synthesis in the brain. It projects
####
to virtually all parts of the central nervous system and helps control mood,
arousal (reticular activating system), sleep-wake states, cognition, and
autonomic function.
Anesthesia A femoral nerve block below the inguinal ligament (ie, in the inguinal Nervous Anatomy 9 NS
crease) will anesthetize the skin and muscles of the anterior thigh, femur, (NS) (Anat)
#### and knee. This type of block can be used in patients requiring tendon
repair after a knee injury (eg, quadriceps rupture).

Anoxic brain The upper midbrain contains neural structures (e.g. CNII, pretectal nuclei, Nervous Anatomy 1 NS
#### injury EWN, CNIII) that mediate the direct and consensual pupillary light reflex. (NS) (Anat)

Aphasia A lesion in Wernicke's area can cause receptive aphasia, which is Nervous Anatomy 2 NS
characterised by well-articulated, nonsensical speech pairedwith a lack of (NS) (Anat)
language comprehension (Wernicke-Word salad). Wernicke's area is
1846 located in the auditory assoc cortexwithi the posterior portion of the
superior temporal gyrus in the dom temporal lobe. The MCA supplies
Broca's area (superior division) and Wernicke's area (inferior division).

Aphasia Broca (motor, nonfluent) aphasia results from damage to the inferior Nervous Anatomy 2 NS
frontal gyrus of the dominant hemisphere. Patients are often frustrated as (NS) (Anat)
they understand language but cannot properly formulate the motor
1955 commands to write or form words (eg, slow, fragmented speech). Aphasia
may be associated with right upper limb and face weakness due to
extension of the lesion into the primary motor cortex.

Appendicitis Nervous Anatomy 5 NS

The iliohypogastric nerve provides sensation to the suprapubic and gluteal
(NS) (Anat)
regions and motor function to the anterolateral abdominal wall muscles.
####
Abdominal surgery (eg, appendectomy) can damage the nerve and cause
decreased sensation and/or burning pain at the suprapubic region.
Axillary nerve Injury to the axillary nerve most commonly occurs in the setting of Nervous Anatomy 1 NS
injury shoulder trauma (eg, anterior dislocation, humeral fracture) and presents (NS) (Anat)
####
with sensory loss over the lateral shoulder and weakness on shoulder
abduction ( due to denervation of the deltoid muscle).
Bell's palsy In addition to unilateral facial paralysis, patients with Bell's palsy may Nervous Anatomy 1 NS
8329 experience decreased tearing, hyperacusis, and/or loss of taste sensation (NS) (Anat)
over the anterior two-thirds of the tongue.
 Bladder cancer Nervous Anatomy 4 NS
The obturator nerve is the only major nerve that exits the pelvis through the
(NS) (Anat)
obturator foramen Nerve injury typically results from compression (eg, due
1802
to pelvic trauma, surgery, or tumor) and presents with weakness on thigh
adduction and sensory loss over the distal medial thigh.
Brachial plexus The musculocutaneous nerve innervates the major forearm flexors (eg, Nervous Anatomy 7 NS
biceps brachii, brachialis) and coracobrachialis (flexes and adducts the (NS) (Anat)
arm) and provides sensory innervation to the lateral forearm. It is derived
1636
from the upper trunk of the brachial plexus (C5-C7) and can be
injured by trauma or strenuous upper extremity exercise.

Brachial plexus The lower trunk of the brachial plexus carries nerve fibers from the C8 and Nervous Anatomy 7 NS
T1 spinal levels that are responsible for innervating all of the intrinsic (NS) (Anat)
muscles of the hand (via the median and ulnar nerves). Sudden upward
1829
stretching on the arm at the shoulder can damage the lower trunk, resulting
in finger clumsinesswith total claw hand deformity.

Brachial plexus The radial nerve provides sensory innervation to the skin of the posterior Nervous Anatomy 7 NS
arm; forearm, and dorsal lateral hand and provides motor innervation to all (NS) (Anat)
of the extensor muscles of the upper limb below the shoulder. Damage to
1930
the proximal radial nerve (eg, at the axilla or midshaft humerus) may
result in wrist drop (Extension of the wrist).

Brachial plexus An interscalene nerve block is used to provide anaesthesia for the shoulder Nervous Anatomy 7 NS
and upper arm by anaesthetising the upper brachial plexus (C5-C7) as it (NS) (Anat)
passes b/w the anterior and middle scalene muscles. Anaesthetic also
####
transverses along the interscalene sheath, freq resulting in transient
ipsilateral diaphragmatic paralysis due to involvement of the phrenic nerve
roots (C3-C5).
Brain abscess A single brain abscess is usually caused by direct spread of a contiguous Nervous Anatomy 1 NS
infection. Temporal lobe abscess is usually a result of OM that has spread (NS) (Anat)
to the mastoid air cells, while frontal lobe abscess is usually due to ethmoid
####
or frontal sinusitis. Multiple brain abscesses typically indicate
hematogenous dissemination of a distant infection (eg, endocarditis,
empyema).
Brain Nervous Anatomy 2 NS
Expanding space-occupying lesions can increase intracranial pressure,
herniation (NS) (Anat)
causing transtentorial herniation of the uncus. Uncal herniation often
#### compresses the ipsilateral oculomotor nerve (CN Ill) as it exits the
midbrain, resulting in oculomotor nerve palsy with a fixed dilated pupil
(due to preganglionic parasympathetic nerve fiber damage).
Brain tumors Germinomas are the most common pineal gland tumor and Pxwith Nervous Anatomy 10 NS
obstructive hydrocephalus and dorsal midbrain (Parinaud) syndrome. (NS) (Anat)
1261
Germinomas in the suprasellar region cause endocrinopathies due to
pituitary/hypothalamic dysfxn.
Brain tumors The hypothalamus is a key region responsible for homeostasis. The Nervous Anatomy 10 NS
2020 ventromedial nucleus mediates satiety; lesions of this area of the (NS) (Anat)
hypothalamus can result in hyperphagia and obesity.
Brain tumors The cerebellar hemispheres are responsible for motor planning and Nervous Anatomy 10 NS
coordination of the ipsilateral extremities via their connections with the (NS) (Anat)
#### lateral descending motor systems. Consequently, cerebellar hemisphere
lesions typically result in ipsilateral dysdiadochokinesia, limb dysmetria,
and/or intention tremor
Carpal tunnel CTS occurs due to compression a/o inflammation of the median nerve in Nervous Anatomy 3 NS
syndrome the carpel tunnel and typically results in sensory loss over the palm and (NS) (Anat)
anterior aspect of the 1st 3.5 digitswith thenar atrophy and impairment of
1749
thumb flexion/opposition. In the forearm, the median nerve courses b/w the
humeral and ulnar heads of the pronator teres muscle and b/w the FDS and
FDP muscles.
Cauda equina Saddle anesthesia and loss of the anocutaneous reflex are SSx of CES, Nervous Anatomy 1 NS
1693
syndrome which is a/w damage to the S2 through S4 nerve roots. (NS) (Anat)
Cavernous Nervous Anatomy 1 NS
Infection of the medial face, sinuses (ethmoidal or sphenoidal), or teeth
sinus (NS) (Anat)
may spread through the valveless facial venous system into the cavernous
thrombosis
#### sinus, resulting in cavernous sinus thrombosis. Patients typically present
with headache, fever, proptosis, and ipsilateral deficits in cranial nerves III,
IV, VI, and V (ophthalmic and maxillary branches).
Cerebral An expanding aneurysm in the cavernous portion of the internal Nervous Anatomy 1 NS
aneurysm carotid artery (ICA) is most likely to initially cause headache and diplopia (NS) (Anat)
(ipsilateral lateral rectus weakness) due to compressing or stretching of
#### the abducens nerve (CN VI) as it runs next to the ICA in the cavernous
sinus. Other commonly affected nerves include the oculomotor nerve (CN
III), trochlear nerve (CN IV), and the V1 and V2 branches of the trigeminal
nerve (CN V)
 Cranial nerve Nervous Anatomy 9 NS
The oculomotor nerve (CN III), ophthalmic nerve (CN Vt) branches,
palsy (NS) (Anat)
1703 trochlear nerve (CN IV), abducens nerve (CN VI), and superior ophthalmic
vein enter the orbit via the superior orbital fissure.
Cranial nerve Lesions of the glossopharyngeal nerve result in loss of the gag reflex Nervous Anatomy 9 NS
palsy (afferent limb); loss of sensation in the upper pharynx, posterior tongue, (NS) (Anat)
1815
tonsils, and middle ear cavity; and loss of taste sensation on the
posterior third of the tongue.
Cranial nerve The trochlear nerve CN IV innervates the superior oblique muscle, which Nervous Anatomy 9 NS
palsy causes the eye to intort (internally rotate) and depress while adducted (NS) (Anat)
Trochlear nerve palsy is typically traumatic or idiopathic and presents with
1933 vertical diplopia that worsens when the affected eye looks down and
toward the nose (eg, walking downstairs, up-close reading). Patients may
compensate by tucking the chin and tilting the head away from the affected
eye.
Cranial nerve Nervous Anatomy 9 NS
The oculomotor nerve (CN III) is most susceptible to injury from ipsilateral
palsy (NS) (Anat)
posterior communicating artery aneurysms. Aneurysmal compression of
2126 CN III produces mydriasis (due to superficial parasympathetic fiber
damage) with diplopia, ptosis, and down and out deviation of the ipsilateral
eye (due to somatic efferent fiber injury).
Cranial nerve Nervous Anatomy 9 NS
Lesions of the jugular foramen can result in jugular foramen (Vernet)
palsy (NS) (Anat)
syndrome, which is characterized by the dysfunction of cranial nerves IX,
8522
X, and XI. Symptoms include dysphagia, hoarseness, loss of gag reflex on
the ipsilateral side, and deviation of the uvula toward the normal side.
Cranial nerve Lesions involving CNIII cause ptosis, a downward and laterally deviated Nervous Anatomy 9 NS
palsy eye, impaired pupillary constriction and accommodation, and diagonal (NS) (Anat)
8701
diplopia. The most dreaded cause of CNIII palsy is an enlarging
intracranial aneurysm.
Cranial nerve Nervous Anatomy 9 NS
The spinal accessory nerve is vulnerable to injury in the posterior triangle
palsy (NS) (Anat)
of the neck. Injury results in weakness of the trapezius muscle, which
####
presents with drooping of the shoulder, impaired abduction of the arm
above 100 degrees, and lateral displacement of the scapula
Epidural Nervous Anatomy 2 NS
The middle meningeal artery is a branch of the maxillary artery, which
hematoma (NS) (Anat)
enters the skull at the foramen spinosum and courses intracranially deep to
1813 the pterion (where the frontal, parietal, temporal, and sphenoid bones
meet). Skull fractures at this site may cause laceration of this vessel,
leading to an epidural hematoma.
Facial nerve The stapedius muscle is innervated by the stapedius nerve (a branch of the Nervous Anatomy 3 NS
1452 facial nerve). Paralysis of the stapedius muscle results in hyperacusis (eg, (NS) (Anat)
increasedsensitivity to sound).
Facial nerve Nervous Anatomy 3 NS
The facial nerve (CN VII) exits the stylomastoid foramen and courses
(NS) (Anat)
through the substance of the parotid gland, where it divides into its 5
#### terminal branches that innervate the muscles of facial expression.
Malignant tumors of the parotid gland often compress and disrupt the facial
nerve and its branches, causing ipsilateral facial droop.
Falls Superior gluteal nerve injury results in weakness and paralysis of the Nervous Anatomy 1 NS
gluteus medius, gluteus minimus, and tensor fasciae latae muscles. This (NS) (Anat)
causes the pelvis to tilt downward toward the contralateral side ((+)
1639
Trendelenburg SSx). patients will also lean toward the ipsilateral side
when walking to help stabilise the pelvis (gluteus medius gait).

Fecal Stretch injury of the pudenda! nerve may occur due to stress placed on the Nervous Anatomy 1 NS
incontinence pelvic floor during labor. Pudenda! nerve injury leads to weakness of the (NS) (Anat)
####
perinea! musculature causing fecal and urinary incontinence, perinea! pain,
and sexual dysfunction.
Generalized Nervous Anatomy 4 NS
Serotonin-releasing neurons in the central nervous system (CNS) are
anxiety (NS) (Anat)
located in the raphe nuclei. These neurons disseminate widely to synapse
disorder
1834 on numerous structures in the CNS. Antidepressants such as selective
serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors,
and tricyclic antidepressants inhibit serotonin reuptake at these synapses.
Hemiballismus The subthalamic nucleus plays an important role in the modulation of basal Nervous Anatomy 1 NS
ganglia output. Damage to this structure (eg. due to lacunar stroke) may (NS) (Anat)
635 result in contralateral hemiballism, characterized by wild, involuntary,
large-amplitude, flinging movements of the proximal limbs (eg, arm and/or
leg) on one side of the body.
 Hemorrhagic Spontaneous deep intracerebral hemorrhage is typically caused by Nervous Anatomy 3 NS
stroke hypertensive vasculopathy involving the small, penetrating branches of the (NS) (Anat)
major cerebral arteries. The most frequently affected locations include the
####
BG (putamen), cerebellar nuclei, thalamus, and pons. The putamen is
supplied by the lenticulostriate arteries, which are deep, small vessel
branches off the MCAs.
Huntington The head of the caudate lies in the inferolateral wall of the frontal horn of Nervous Anatomy 5 NS
disease the lateral ventricle. It is separated from the GP and putamen by the IC. (NS) (Anat)
1690 Atrophy of the caudate nucleiwith enlargement of the lateral ventricles is
Chx of HD and can be observed on neuroimaging.

Hydrocephalus Nervous Anatomy 4 NS

CSF flows from the third ventricle to the fourth ventricle via the cerebral
(NS) (Anat)
aqueduct of Sylvius. Obstruction at this level can cause dilated lateral and
third ventricles with a normal-sized fourth ventricle. Obstruction at the
1635
foramen of Monro would cause enlargement of only the affected lateral
ventricle, while obstruction at the foramen of Magendie and Luschka
causes enlargement of all 4 ventricles.
Internuclear INO is a disorder of impaired horizontal gaze caused by a lesion in the Nervous Anatomy 1 NS
ophthalmoplegi MLF. The affected eye (ipsilateral to the lesion) is unable to adduct while (NS) (Anat)
#### a the contralateral eye is able to abduct (oftenwith assoc nystagmus).
Convergence and the pupillary light reflex are preserved b/c these
pathways bypass the MLF.
Intraventricular Neonatal intraventricular hemorrhage usually originates from the Nervous Anatomy 1 NS
hemorrhage fragile germinal matrix in infants born before 32 weeks gestation and/or (NS) (Anat)
8564 with birth weight <1,500 g (3 lb 5 oz). It is a common complication of
prematurity that can lead to long-term neurodevelopmental impairment.

Ischemic stroke Nervous Anatomy 19 NS

Occlusion of the middle cerebral artery (MCA) typically results in
(NS) (Anat)
contralateral hemiparesis and hemisensory loss of the face and upper limb
21
with relative preservation of lower limb function. If the occluded MCA is
in the dominant (usually left) hemisphere, aphasia may also occur.
Ischemic stroke Upper motor neuron lesions (ie, internal capsule stroke) cause Nervous Anatomy 19 NS
contralateral weakness with clasp-knife spastic rigidity, hyperreflexia, (NS) (Anat)
and a positive Babinski sign. These lesions damage the pyramidal motor
1687
system (eg, corticospinal tracts), which runs from the precentral gyrus
(primary motor cortex) through the internal capsule to the brainstem and
spinal cord.
Ischemic stroke The anterior cerebral arteries supply the medial portions of the 2 Nervous Anatomy 19 NS
hemispheres (frontal and parietal lobes). Occlusion can cause contralateral (NS) (Anat)
1696
motor and sensory deficits of the lower extremities, behavioral changes,
and urinary incontinence.
Ischemic stroke Nervous Anatomy 19 NS
The ventral posterior lateral nucleus (receives input from the spinothalamic
(NS) (Anat)
tract and dorsal columns) and ventral posterior medial nucleus (receives
2076 input from the trigeminal pathway) of the thalamus send somatosensory
projections to the cortex via thalamocortical fibers. Damage to these nuclei
results in complete contralateral sensory loss.
Ischemic stroke Lacunar infarctions are the result of small vessel occlusion (eg, due to Nervous Anatomy 19 NS
lipohyalinosis and microatheroma formation) in the penetrating vessels (NS) (Anat)
2077 supplying the deep brain structures. Uncontrolled hypertension and
diabetes mellitus are major risk factors for this condition.

Ischemic stroke The posterior cerebral artery branches off the basilar artery and supplies Nervous Anatomy 19 NS
cranial nerves III and IV and other structures in the midbrain. It also (NS) (Anat)
supplies the thalamus, medial temporal lobe, splenium of the corpus
2127
callosum, and occipital lobe. The most common finding with posterior
cerebral artery stroke is contralateral homonymous hemianopia, often with
macular spanng
Ischemic stroke Gerstmann syndrome results from damage to the angular gyrus of the Nervous Anatomy 19 NS
dominant parietal lobe and is characterized by agraphia (inability to write), (NS) (Anat)
#### acalculia (inability to carry out mathematical calculations), finger agnosia
(inability to identify individual fingers on the hand), and left-right
disorientation.
Ischemic stroke Cervical spine trauma can cause dissection of the vertebral artery, resulting Nervous Anatomy 19 NS
in ischemic manifestations due to occlusion of the vertebral artery (NS) (Anat)
and/or its branches. Posterior inferior cerebellar artery occlusion causes
lateral medullary (Wallenberg) syndrome, characterized by
####
vertigo/nystagmus. ipsilateral cerebellar signs, loss of pain/temperature
sensation in the ipsilateral face and contralateral body, bulbar
weakness, and ipsilateral Horner Syndrome
 Ischemic stroke The ACA supplies the medial aspects of the frontal and parietal lobes, Nervous Anatomy 19 NS
which contain the UMNs responsible for contralateral lower extremity (NS) (Anat)
####
motor control. TE occlusion of the ACA Chx results in contralateral lower
extremity weaknesswith hyperreflexia.
Lung cancer Pancoast tumours are NSCLCs (e.g. SCC, AC) that arise near the superior Nervous Anatomy 9 NS
sulcus. patients may develop ipsilateral shoulder pain, upper limb (NS) (Anat)
paraesthesias, and areflexic arm weakness due to involvement of the
566
brachial plexus. Horner's syndrome (e.g. ipsilateral partial ptosis, miosis,
anhidrosis) can also occur due to involvement of the cervical sympathetic
ganglia.
Median nerve The median nerve is most commonly injured within the carpal tunnel, Nervous Anatomy 1 NS
injury leading to pain and numbness in the first 3 digits and lateral half of the (NS) (Anat)
fourth, as well as weakness of thumb ffexion and opposition. More
####
proximal injury (in the forearm) additionally causes decreased sensation
over the thenar eminence and weakness of flexion in the wrist and second
and third digits.
Meningiomas Meningiomas are common adult intracranial tumours that typically arise in Nervous Anatomy 2 NS
regions of dural reflection (e.g. falx cerebri, tentorium cerebelli). (NS) (Anat)
Parasagittal lesions compressing the medial portion of the 1°
1150 somatosensory cortex in the parietal lobe can result in contralateral lower
limb sensory loss alongwith contralateral hemineglect if there's also
damage to the parietal assoc cortex (non-dom hemisphere).

Nausea and The vomiting reflex is initiated by the chemoreceptor trigger zone (ie. Nervous Anatomy 2 NS
vomiting area postrema) and nucleus tractus solitarius within the dorsal medulla at (NS) (Anat)
the caudal end of the fourth ventricle. The area postrema does not have a
1741 well-developed blood brain barrier, allowing it to be activated directly by
emetogenic substances (eg, drugs, toxins) or indirectly by ascending
afferents from the bowel wall (eg, chemotherapy-induced release of
serotonin).
Orbital fracture Fractures to the orbital floor commonly result from direct frontal trauma Nervous Anatomy 2 NS
to the orbit. The infraorbital nerve runs along the orbital floor in a groove (NS) (Anat)
in the maxilla before exiting the skull just inferior to the orbit. Damage can
####
result in paresthesia of the upper cheek, upper lip. and upper gingiva.
In addition, the inferior rectus muscle can also become entrapped, limiting
vertical gaze.
Peroneal The common peroneal nerve is susceptible to injury at the lateral neck of Nervous Anatomy 3 NS
neuropathy the fibula caused by compression or fracture. patients often have weakness (NS) (Anat)
1149 on foot dorsiflexion ('foot drop') and eversion, as well as toe extension.
Sensory loss typically occurs over the lateral leg and dorsolateral foot.

Peroneal Trauma/sustained pressure to the neck of the fibula can injure the common Nervous Anatomy 3 NS
neuropathy peroneal nerve, causing weakness on foot dorsiflexion and eversion and (NS) (Anat)
1748
impaired sensation over the lateral shin and dorsal foot, and b/w the 1st
and 2nd toes.
Phrenic nerve Nervous Anatomy 1 NS
The right phrenic nerve courses along the pericardium overlying the right
injury (NS) (Anat)
side of the heart and is at risk for injury during procedures in or near the
####
right atrium (eg, radiofrequency ablation). Right phrenic nerve injury is
typically recognized by elevation of the right hemidiaphragm.
Radial Nervous Anatomy 3 NS
Radial nerve injury can occur with repetitive pressure/trauma at the axilla
neuropathy (NS) (Anat)
(eg, improperly fitted crutches). Findings include weakness of the forearm,
1685 hand, and fingers extensors (eg, wrist drop, absent triceps reflex) and
sensory loss over the posterior arm and forearm, dorsolateral hand, and
dorsal thumb. More distal lesions spare the triceps brachii.
Radial Injury to the radial nerve at the supinator muscle may occur due to Nervous Anatomy 3 NS
neuropathy repetitive pronation/supination of the forearm, direct trauma, or (NS) (Anat)
1694 subluxation of the radius. Patients typically have weakness during finger
and thumb extension (ie, finger-drop) without wrist drop or sensory
deficits.
Radiculopathy Sciatica is a nonspecific term for low back pain that radiates down the Nervous Anatomy 3 NS
leg due to compression of the lumbosacral nerve roots (eg, from (NS) (Anat)
vertebral disc herniation). The S1 nerve root is commonly involved,
1692 resulting in pain/sensory loss down the posterior thigh and calf to the
lateral aspect of the foot. Patients may also have weakness on thigh
extension, knee flexion, and foot plantarflexion with an absent ankle
jerk reflex.
Radiculopathy The C5-C6 spinal nerves mediate the biceps and brachioradialis Nervous Anatomy 3 NS
####
reflexes. (NS) (Anat)
 Sciatic Sciatic neuropathy is a common complication of hip fracture and/or Nervous Anatomy 3 NS
neuropathy arthroplasty because of the proximity of the sciatic nerve to the hip joint. (NS) (Anat)
Injury to the sciatic nerve in the pelvis causes neurological deficits across
####
the sciatic nerve (knee flexion), common peroneal nerve (dorsiflexion,
numbness of the calf and dorsal foot), and tibial nerve (plantar flexion,
ankle reflex).
Seizures The primary somatosensory cortex (postcentral gyrus) is responsible for Nervous Anatomy 8 NS
processing all somatic sensory input from the contralateral side of the body. (NS) (Anat)
#### A focal onset seizure originating in this region of the cerebral cortex often
results in contralateral sensory disturbance (eg, numbness,
paresthesia).
Spinal anatomy The optimal location for needle insertion during a lumbar puncture is the Nervous Anatomy 1 NS
L3/L4 or L4/L5 space as this is well below the spinal cord termination site (NS) (Anat)
####
(L 1 in adults). The L 4 vertebral body lies on a line drawn between the
highest points of the iliac crests.
Spinal cord Nervous Anatomy 1 NS
Brown-Sequard syndrome results from hemisection of the spinal cord It is
injury (NS) (Anat)
characterized by ipsilateral paralysis due to corticospinal tract injury;
#### ipsilateral loss of vibratory, proprioceptive, and light touch sensation
(dorsal columns); and contralateral loss of pain, temperature, and crude
touch sensation (spinothalamic tract) below the level of the injury.
Syphilis Nervous Anatomy 9 NS
The Romberg test is a test of proprioception in which patients are observed
(NS) (Anat)
for unsteadiness as they stand with their feet close together, arms to the
#### sides, and eyes closed. Failure to maintain this posture indicates sensory
ataxia, which may be caused by defects in the posterior column or
peripheral nerves (eg, tabes dorsalis, vitamin B,2 deficiency).
Temporomandi Temporomandibular disorder is associated with dysfunction of the Nervous Anatomy 1 NS
bular disorders temporomandibular joint and hypersensitivity of the mandibular nerve (CN (NS) (Anat)
#### V3). This can result in pathologic contraction of the pterygoid muscles (eg.
jaw pain/dysfunction) and the tensor tympani in the middle ear (eg. ear
pain, muffled hearing).
Traumatic Smell occurs when odorants bind to nasal chemoreceptors that relay signals Nervous Anatomy 5 NS
brain injury via the olfactory nerve through the cribriform plate to the olfactory bulb, (NS) (Anat)
which then projects to the primary olfactory cortex in the medial temporal
####
lobe. Head trauma can tear olfactory nerve rootlets as they cross the
cribriform plate, causing anosmia. Anosmia is often associated with
ageusia (loss of taste).
Trigeminal General sensation from the anterior 2/3 of the tongue is carried by the Nervous Anatomy 3 NS
nerve mandibular division of the trigeminal nerve. Gustatory innervation of the (NS) (Anat)
1453
anterior 2/3 of the tongue is provided by the chorda tympani branch of the
facial nerve.
Trigeminal The third (mandibular) branch of the trigeminal nerve exits the skull Nervous Anatomy 3 NS
nerve through the foramen ovale and innervates the muscles of mastication, (NS) (Anat)
2024
including the masseter, the medial and lateral pterygoids, and the
temporalis muscles.
Trigeminal Infarcts involving the anterior portion of the medial pons can produce Nervous Anatomy 3 NS
nerve dysarthria and contralateral hemiparesis/lower facial palsy due to (NS) (Anat)
2125 disruption of the ipsilateral corticospinal and corticobulbar tracts. The
trigeminal nerve arises at the level of the middle cerebellar peduncle at the
lateral aspect of the mid-pons.
Ulnar nerve Nervous Anatomy 2 NS
Ulnar nerve injury most commonly occurs at the elbow (eg, compression
neuropathy (NS) (Anat)
due to resting arm on a hard surface while using a computer) and usually
presents with discomfort and sensory loss/paresthesia in the fifth digit,
1743
medial half of the fourth digit, and the hypothenar eminence. In severe
cases, patients can also have weakness on wrist flexion and adduction (ie,
ulnar deviation) along with finger weakness/clumsiness.
Vestibular Nervous Anatomy 3 NS
Vestibular schwannomas arise from the vestibulocochlear nerve (CN VIII)
schwannoma (NS) (Anat)
and are usually located at the cerebellopontine angle. These tumors can
cause a range of symptoms by damaging the vestibulocochlear nerve
1306 (unsteadiness and ipsilateral sensorineural hearing loss with tinnitus),
trigeminal nerve (ipsilateral facial paresthesia and diminished corneal
reflex), and facial nerve (ipsilateral facial paresis). Bilateral acoustic
neuromas are assocciated with nf2
Vestibular Acoustic neuromas are Schwann cell-derived tumors that typically arise Nervous Anatomy 3 NS
schwannoma from the vestibular portion of the vestibulocochlear nerve CN VIII and are (NS) (Anat)
#### commonly located at the cerebellopontine angle (between the cerebellum
and lateral pons). Patients usually present with unilateral sensorineural
hearing loss and tinnitus.
 Visual pathway CNII carries the afferent limb of the pupillary light reflex pathway, which Nervous Anatomy 5 NS
activates the efferent limb bilaterally and causes both direct and consensual (NS) (Anat)
pupillary constriction. Unilateral CNII lesions (e.g. demyelination due to
1735 optic neuritis) can result in impaired pupillary constriction bilaterally when
light enters the eye ipsilateral to the lesion. When light enters the
contralateral eye, pupillary constriction occurs normally in both eyes.

Visual pathway Lesions of the occipital cortex (e.g. PCA occlusion) can produce Nervous Anatomy 5 NS
8592
contralateral homonymous hemianopiawith macular sparing. (NS) (Anat)
Visual pathway Injury to Meyer's loop in the temporal lobe results in contralateral superior Nervous Anatomy 5 NS
8594
quadrantanopia. (NS) (Anat)
Visual pathway An aneurysm of the ICA can laterally impinge on the optic chiasm. This Nervous Anatomy 5 NS
8636 can cause ipsilateral nasal hemianopia by dmging uncrossed CNII fibres (NS) (Anat)
from the temporal portion of the retina.
Visual pathway Damage to the left temporal hemiretina will disrupt the transmission of Nervous Anatomy 5 NS
visual information along the ipsilateral optic nerve, lateral optic chiasm, (NS) (Anat)
####
optic tract, lateral geniculate body, optic radiations, and 1° visual cortex.

Vitamin B12 Neuro damage a/w vitamin B12 deficiency classically includes SCD of the Nervous Anatomy 9 NS
#### deficiency dorsal columns (loss of position and vibration sensation, (+) Romberg sign) (NS) (Anat)
and lateral corticospinal tracts (spastic paresis).
Wernicke- Wernicke encephalopathy is a complication of thiamine deficiency and is Nervous Anatomy 5 NS
Korsakoff characterized by oculomotor dysfunction, encephalopathy, and ataxia. (NS) (Anat)
syndrome Chronic deficiency results in Korsakoff syndrome (eg. anterograde and
2129 retrograde amnesia, confabulation, apathy). Thiamine is involved in
glucose metabolism, and areas of the brain with high metabolic demands
are particularly susceptible: the mammillary bodies are most commonly
affected
Wilson disease WD can cause cystic degen of the putamen as well as damage to other BG Nervous Anatomy 5 NS
1689 structures. The putamen is located medial to the insula and lateral to the (NS) (Anat)
GP on coronal sections.
Torticollis Acute EPS (e.g. dystonia, akathisia, parkinsonism) are due to D2 blockade Nervous Behavioral 2 NS
in the nigrostriatal pathway. High-potency FGAs (e.g. haloperidol, (NS) Science
8323
fluphenazine) strongly block D2 receptors and are most likely to cause (Beha)
EPS.
Lesch-Nyhan LNS is an XLR disorder caused by a defect in HGPRT. This results in Nervous Biochemistr 1 NS
syndrome failure of the purine salvage pathway, leading to ↑ degradation of (NS) y (Bioc)
2067 hypoxanthine and guanine to uric acid. De novo purine synthesis must ↑ to
replace the lost bases, necessitating an ↑ in PRPP amidotransferase activity.

Metabolic Methylmalonic acidemia is an organic acidemia due to complete or partial Nervous Biochemistr 4 NS
acidosis defx of methylmalonyl-CoA mutase. Complete defx classically Pxwith (NS) y (Bioc)
lethargy, vomiting, and tachypnea in a newborn. LTx shows
1341
hyperammonemia, ketotic hypoglycemia, and metabolic acidosis. The Dx is
confirmed by ↑ urine methylmalonic acid and propionic acid.

Organic Propionyl-CoA is derived from the metabolism of valine, isoleucine, Nervous Biochemistr 1 NS
acidemias methionine, threonine, and odd-chain FAs. Congenital defx of propionyl- (NS) y (Bioc)
CoA carboxylase, the enzyme responsible for the conversion of propionyl-
1340
CoA to methylmalonyl-CoA, leads to the development of propionic
acidemia. The condition Pxwith lethargy, poor feeding, vomiting, and
hypotonia 1-2 wks after birth.
Organophospha OPs are AChEIs that are widely used as pesticides in agriculture. They Nervous Biochemistr 2 NS
te poisoning inhib the breakdown of ACh, leading to a state of cholinergic excess. SSx (NS) y (Bioc)
1998
of OP poisoning include salivation, lacrimation, diaphoresis, bradycardia,
and bronchospasm.
Peroxisomal The buildup of very long chain and branched-chain (e.g. phytanic) FAs due Nervous Biochemistr 1 NS
disorders to impaired oxidation is the hallmark of peroxisomal disorders (e.g. (NS) y (Bioc)
1120 Zellweger syndrome, adrenoleukodystrophy). Accumulation of these FAs
in the brain results in permanent neuro dysfxn.

Phenylketonuri Deficiency of the enzyme phenylalanine hydroxylase or its cofactor BH4 Nervous Biochemistr 5 NS
a causes accumulation of phenylalanine in body fluids and the CNS. (NS) y (Bioc)
Homozygous infants are normal at birth but gradually develop severe
1483
intellectual disability and seizures if left unTx. Hypopigmentation of the
skin, hair, eyes, and catecholaminergic brain nuclei is also frequently seen.

Phenylketonuri BH4 is a cofactor used by hydroxylase enzymes in the synthesis of tyrosine, Nervous Biochemistr 5 NS
a DA, and 5-HT. PKU can result from BH4 defx due to dihydropteridine (NS) y (Bioc)
reductase defx. Intellectual disability is the hallmark of this condition and
1500
results in NT (e.g. 5-HT) defx and hyperphenylalaninemia. Tx involves a
low phenylalanine diet and BH4 supplementation.
 Spinal snRNPs are important components of the spliceosome, a molecule which Nervous Biochemistr 1 NS
muscular removes introns from pre-mRNA during processingwithi the nucleus. SMA (NS) y (Bioc)
dystrophy is a disorder caused by muts in the SMN1 gene, resulting in impaired
2036
assembly of snRNPs in LMNS. Infants often have flaccid paralysis due to
degen of ant horn cells in the spinal cord.

Tay-Sachs Tay-Sachs disease is an autosomal recessive disorder caused by B- Nervous Biochemistr 1 NS

hexosaminidase A deficiency, which results in GM2 ganglioside (NS) y (Bioc)
accumulation. Key clinical features include progressive neurodegeneration
8524
and a cherry-red macular spot. In contrast to patients with Niemann-Pick
disease, those with Tay Sachs disease have no hepatosplenomegaly.

TCA cycle Alanine is the major AA responsible for transferring N to the liver for Nervous Biochemistr 2 NS
disposal. During the catabolism of proteins, amino groups are transferred to (NS) y (Bioc)
α-KG to form glutamate. Glutamate is then processed in the liver to form
1369
urea, the 1° disposal form of N in humans. Free NH3 is also excreted into
the urine by the kidney for regulation of acid-base status.

Ubiquitin Ubiquitin is a protein that undergoes ATP-dependent attachment to other Nervous Biochemistr 2 NS
proteasome proteins, labeling them for degradation. These modified proteins enter the (NS) y (Bioc)
8385 pathway proteasome and are degraded into small peptides. Impairment of the
ubiquitin-proteasome system can contribute to the development of
neurodegen disorders, including PD and AD.
Urea cycle Ornithine transport into mitochondria is necessary for proper fxn of the Nervous Biochemistr 3 NS
urea cycle, which is the major disposal pathway for waste N generated by (NS) y (Bioc)
1372 catabolism of AAs. Urea cycle defects typically cause neuro damage due to
the accumulation of NH3. Protein restriction improves this condition by ↓
the amount of AA turnover.
Urea cycle Arginase is a urea cycle enzyme that produces urea and ornithine from Nervous Biochemistr 3 NS
arginine. Arginase deficiency results in progressive spastic diplegia, (NS) y (Bioc)
1480
growth delay, and abnormal movements. Treatment includes an arginine-
free, low-protein diet.
Vitamin A Vit A overuse can result in intracranial HTN, skin changes, and HSM. Nervous Biochemistr 1 NS
1048
toxicity (NS) y (Bioc)
Vitamin B12 Vit B12 defx often Pxwith megaloblastic anemia (impaired DNA Nervous Biochemistr 9 NS
deficiency synthesis) and neuro deficits (impaired myelin synthesis). Chx neuro (NS) y (Bioc)
64 findings include SCD of the dorsal columns and lateral corticospinal tract.
↑ in methylmalonic acid and homocysteine lvls occur due to ↓ metabolism
of these molecules.
Wernicke- Chronic vit B1 defx impairs Glc utilization in the CNS. This occurs due to Nervous Biochemistr 5 NS
Korsakoff ↓ activity of the enzymes that use B1 as a cofactor (e.g. PDH, α-KG (NS) y (Bioc)
598 syndrome dehydrogenase, transketolase). B1 defx can be Dx if baseline erythrocyte
transketolase activity is low but ↑ after addition of B1-PPi.

Neural tube Failure of neural tube closure at 4 wks gestation results in NTDs. 1st Nervous Embryology 4 NS
496 defects trimester use of valproate is a significant RF for NTDs, but (NS) (Embr)
periconceptional vit B9 supplementation ↓ this risk.
Neural tube NTDs most often occur when the neural folds fail to fuse in the region of Nervous Embryology 4 NS
defects the ant or post neuropores. Persistent communication b/w the spinal canal (NS) (Embr)
502 and the amniotic cavity allows leakage of AFP and AChE into the
amnionic fluid, leading to ↑ lvls of AFP and AChE that can be detected on
amniocentesis.
Neural tube MTX and other vit B9 antagonists adversely affect rapidly dividing cells Nervous Embryology 4 NS
defects (e.g. epithelial cells, stem cells, neural tube cells) by limiting the production (NS) (Embr)
#### of precursors essential to DNA synthesis and repair. If used in the 1st
trimester of pregnancy, these drugs can cause major congenital
abnormalities (e.g. CV abnormalities, NTDs).
Neurofibromat NF-I (vRD) is an AD disorder caused by muts in the NF1 TSG. patients Nervous Embryology 3 NS
osis Chx develop numerous cutaneous neurofibromas comprised mostly of (NS) (Embr)
1534
Schwann cells, which are embryologically derived from the neural crest.

Pharyngeal The development of derivatives of the 1st (e.g. CN V, mandible, maxilla, Nervous Embryology 1 NS
arches zygoma, incus, malleus) and 2nd (e.g. CN VII, stapes, styloid process, (NS) (Embr)
1691 lesser horn of hyoid) pharyngeal arches can be disrupted in genetic
disorders (e.g. TCS), resulting in hypoplasia of the mandibular and
zygomatic bones.
Pituitary All adult cells and tissues can be traced back to the 3 primary germ layers: Nervous Embryology 8 NS
8702 adenoma ectoderm, mesoderm, and endoderm. The ectoderm gives rise to the (NS) (Embr)
surface ectoderm, neural tube, and neural crest.
Alzheimer Early-onset familial AD is a/w 3 gene muts: APP (chrom 21), presenilin 1, Nervous Genetics 7 NS
591 disease and presenilin 2. Late-onset familial AD is a/w apoE4 genotype. (NS) (Gene)
 Down Ptswith trisomy 21 (DS) have 3 copies of the amyloid precursor protein Nervous Genetics 6 NS
syndrome gene located on chrom 21. This ↑ amyloid-β accumulation in the brain, (NS) (Gene)
590
placing these patients at high risk for developing early-onset AD.

Fragile X FXS, an XL disorder, is the most common cause of inherited intellectual Nervous Genetics 3 NS
syndrome disability. The pathogenesis involves an unstable expansion of TNRs (NS) (Gene)
344 (CGG) in the FMR1 gene. Key physical findings include dysmorphic facial
features (e.g. large jaw, protruding ears, long face) and macroorchidism.

Fragile X FXS is caused by an ↑ # of CGG TNRs on the FMR1 gene on the long arm Nervous Genetics 3 NS
1421 syndrome of the X chrom. This leads to hypermethylation and inactivation of FMR1. (NS) (Gene)

Fragile X FXS is an XL disorder that Pxwith a long, narrow face, a prominent chin Nervous Genetics 3 NS
syndrome and forehead, and large testes. patients often have developmental delay and (NS) (Gene)
1808
neuropsych findings that overlapwith anxiety disorders, autism, and
ADHD.
Huntington Hypo-acetylated histones bind tightly to DNA and prevent transcription of Nervous Genetics 5 NS
disease genes in their associated regions. Alteration of gene expression in HD (NS) (Gene)
840 occurs in part due to deacetylation of histones. This prevents the
transcription of certain genes that code for neurotrophic factors,
contributing to neuronal cell death.
Mitochondrial Red ragged muscle fibers are seen in mitochondrial diseases. Muscle fibers Nervous Genetics 1 NS
diseases, have this appearance b/c abnormal mitochondria accumulate under the (NS) (Gene)
357
inheritance sarcolemma. Mitochondrial diseases show maternal inheritance.

Mitochondrial Mitochondrial diseases are Chx by exclusively-maternal inheritance. The Nervous Genetics 4 NS
disorders variable severity of these diseases is explained by the random distribution (NS) (Gene)
of normal and mutated mitochondria b/w daughter cells during mitosis; as
596 a result, some cells may have completely healthy mitochondria, while other
cells contain mitochondria affected by genetic mutation (heteroplasmy).
MELAS is a mitochondrial syndrome.

Neurofibromat NF-I is a single-gene AD disorder. It occurs due to mut of the NF1 gene Nervous Genetics 3 NS
1307 osis located on chrom 17. Café-au-lait spots, multiple neurofibromas, and Lisch (NS) (Gene)
nodules are the most common SSx.
Neuronal Kinesin is a microtubule-associated motor protein that fxns in the Nervous Histology 3 NS
physiology anterograde transport of materials and organelleswithi cells. Reactivation (NS) (Hist)
1922 of latent HSV requires anterograde transport of viral particles from
neuronal cell bodies in the sensory ganglia to the skin and oral mucosa.

Neuronal Kinesin is a microtubule-associated, ATP-powered motor protein that Nervous Histology 3 NS

1936 physiology facilitates the anterograde transport of neurotransmitter-containing (NS) (Hist)
secretory vesicles down axons to synaptic terminals.
Parkinson The BBB is formed by tight jxns b/w nonfenestrated capillary endothelial Nervous Histology 7 NS
disease cells that prevent the paracellular passage of fluid and solutes. This barrier (NS) (Hist)
only permits the passage of substances from the blood to the brain via
1536
transcellular movement across the endothelial plasma membrane, which is
limited by diffusion or carrier-mediated transport.

Botulism Botulinum neurotoxin produced by Clostridium botulinum prevents the Nervous Microbiolog 4 NS
release of acetylcholine from presynaptic nerve terminals. The toxin (NS) y (Micr)
impairs peripheral muscarinic and nicotinic neurotransmission, causing
both autonomic symptoms (eg, fixed pupillary dilation, dry mouth) and
1399
skeletal muscle weakness (eg, diplopia, dysphagia, respiratory depression).
Its effects at the neuromuscular junction can be seen on electromyography
as a decrease in muscle response following stimulation of a motor nerve.

Botulism C. botulinum is a spore-forming, Gram (+), anaerobic bacillus that synth Nervous Microbiolog 4 NS
bot tox, which prevents the presynaptic release of ACh from the nerve (NS) y (Micr)
1401
terminal at the NMJ. Bot tox can be used to Tx focal dystonia and other
disorders of abn muscle contraction.
Botulism Bot tox blocks the presynaptic exocytosis of ACh vesicles, causing Nervous Microbiolog 4 NS
impaired musc and nico NT; it char Px as a symmetric, desc paralysis that (NS) y (Micr)
1997
1st MFxwith CN abns, often following consumption of home-canned
foods.
CNS Primary central nervous system lymphoma is typically composed of B- Nervous Microbiolog 2 NS
2083
lymphoma lymphocytes. (NS) y (Micr)
Cryptococcal Cryptococcus neoformans is a round/oval yeastwith a thick PSC. It is a Nervous Microbiolog 3 NS
infections common cause of meningoencephalitis (eg, h/a, vomiting, confusion, (NS) y (Micr)
####
seizure) in ptswith unTx AIDS. The yeast can frequently be visualized in
the CSF by India ink or silver stain.
 Guillain-Barre GBS represents a group of imm-med polyneuropathies that're thought to be Nervous Microbiolog 3 NS
syndrome caused by molecular mimicry, leading to demyelination of the peri nerves. (NS) y (Micr)
1601 Up to 1/3 of GBS cases are preceded by a Campylobacter jejuni
infection, which is a common cause of acute diarrheal illness.

Herpes zoster 1ary VZV infection (chickenpox) occurs most commonly in childhood. Nervous Microbiolog 4 NS
Subseq, the virus migrates to the sensory ganglia, where it lies dormant for (NS) y (Micr)
decaded. Over time, waning cell-mediated immunity allows reactivation of
1552
the virus, which spreads down a single nerve to cause a painful,
erythematous, vesicular rash in a derm distribution.

HSV infection HSV-1 encephalitis is a potentially fatal complication from 1ary infection Nervous Microbiolog 9 NS
or reactivation of latent disease. NS invasion leads to necrosis of the temp (NS) y (Micr)
907 lobe, which can result in aphasia and personality changes in addn to classic
features of encephalitis (e.g. h/a, fever, AMS, seizure).

Meningitis C. neoformans is a yeastwith a thick PSC that's found 1arily in soil Nervous Microbiolog 17 NS
contaminated by bird droppings. Inhalation of the pathogen into the lungs (NS) y (Micr)
113 leads to (a usually aSSx) 1ary infection. In patients who're immsup (e.g.
adv AIDS), the pathogen can spread thru the bloodstream to other organs,
particularly the CNS.
Meningitis Ptswith suspected cryptococcal meningitis can be Dx using India ink Nervous Microbiolog 17 NS
116 staining of the CSF. Txwith amphotericin B and flucytosine is req at 1st, (NS) y (Micr)
f/b long-term fluconazole maint therapy.
Meningitis C. neoformans causes ME in ptswith unTx AIDS. Dx can be made by Nervous Microbiolog 17 NS
detecting the PSC in CSF using the latex agglutination test. India ink (NS) y (Micr)
118
staining of CSF is also used for Dx and can demo round or oval budding
yeast.
Meningitis Bacterial meningitis causes an incr in CSF neutrophil count and protein Nervous Microbiolog 17 NS
conc as well as decr in CSF Glc. S. pneumoniae is a leading cause of CAP, (NS) y (Micr)
735
OM, and meningitis in adults. S. pneumoniae appears on Gram stain as
lancet-shaped, Gram (+) cocci in pairs.
Meningitis N. meningitidis is transmitted 1arily by aerosolized droplets and subseq Nervous Microbiolog 17 NS
colonizes the nasopharyngeal epithelium. Penetration of the epithelium can (NS) y (Micr)
737 lead to bloodstream infection. Spread to the meninges occurs via
transcellular penetration of the cerebral cap endothelium or entry at the
choroid plexus.
Meningitis N. meningitidis can cause sepsis and circulatory collapse in previously Nervous Microbiolog 17 NS
738 healthy young individuals. LOS, a VF in the pathogens outer membrane, is (NS) y (Micr)
the major underlying cause of disease severity.
Meningitis Pili are the 1ary VF that allow N. meningitidis to initially attach to and Nervous Microbiolog 17 NS
1005 colonize the nasopharyngeal epithelial surface. Pili undergo significant Ag (NS) y (Micr)
variation, which makes them a difficult vax target.
Meningitis Listeriosis is most commonly transmitted thru food ingestions and can Nervous Microbiolog 17 NS
cause meningitis in immsup adults. Listeria is a Gram (+) rodwith tumbling (NS) y (Micr)
1392
motility. It grows well in cold temps and can therefore contaminate
refrigerated food.
Meningitis Abs against the PSC of N. meningitidis provide immunity against this Nervous Microbiolog 17 NS
pathogen. Quadrivalent MCVs contain capsular PSs from major serotypes (NS) y (Micr)
1853
(A, C, Y, and W) of N. meningitidis. Serotype B vax use recomb proteins.

Meningitis Fever; meningeal SSx (e.g. h/a, neck stiffness); and CSF that shows Nervous Microbiolog 17 NS
lymphocytic pleocytosis, a modestly incr protein lvl, and normal Glc are (NS) y (Micr)
1966
suggestive of aseptic meningitis. Enteroviruses are the most common cause
of aseptic meningitis.
Meningitis The classic triad of fever, stiff neck, and AMS should raise suspicion for Nervous Microbiolog 17 NS
#### acute bacterial meningitis. Eval req prompt blood cultures, empiric Abx, (NS) y (Micr)
and LPwith CSF analysis.
Neonatal sepsis E. coli is a freq cause of neonatal meningitis, 2nd only to GBS. E. coli Nervous Microbiolog 1 NS
strains that cause neonatal meningitis possess the K1 capsular Ag. The K1 (NS) y (Micr)
1140
capsule is a VF that allows the bacteria to survive in the bloodstream and
establish meningeal infection.
Rabies Rabies virus has a bullet-shaped envelopewith knob-like GP that bind to Nervous Microbiolog 2 NS
nAChRs. Once transmission occurs (usually due to a bite wound from an (NS) y (Micr)
8324 infected animal), the virus replicates locally in muscle tissue for several dys
or wks before spreading in a retrograde fashion thru the peri nerve axons to
the CNS.
Tetanus Tet is caused by infectionwith toxigenic strains of the anaerobic bacterium Nervous Microbiolog 5 NS
C. tetani. Transmission typically occurs when spores are inoculated into the (NS) y (Micr)
skin via a puncture wound. The bacteria germinate, replicate locally, and
1402 elaborate tetanospasmin (TT). The tox spreads in a retrograde fashion thru
the LMNs to the spinal cord, where it blocks inhib interneurons and causes
spasmodic muscle contraction (e.g. trismus, risus sardonicus).
 Toxoplasmosis Congenital toxoplasmosis is a transplacental infection (acq in utero). Its Nervous Microbiolog 5 NS
classic triad includes hydrocephalus, intracranial calcifications, and (NS) y (Micr)
1038
chorioretinitis. Expecting mothers should avoid cat feces to help prevent
exposure to Toxoplasma.
Toxoplasmosis The finding of multi ring-enhancing lesions in an HIV pt is most likely due Nervous Microbiolog 5 NS
1573
to toxoplasmosis. (NS) y (Micr)
Toxoplasmosis In patients with HIV, the presence of multiple ring-enhancing lesions with Nervous Microbiolog 5 NS
2082 mass effect is most often indicative of toxoplasmosis, followed by primary (NS) y (Micr)
central nervous system lymphoma.
Toxoplasmosis T. gondii is an intracellular parasite that's typically transmitted to humans Nervous Microbiolog 5 NS
after accidental ingestion of contaminated cat feces (e.g. cat handling, litter (NS) y (Micr)
box). Most initial cases are aSSx. However, the organism establishes a
####
latent infection that can reactivate in the setting of severe immsup,
particularly adv AIDS. patients usually develop encephalitiswith multi ring-
enhancing lesions.
West Nile virus West Nile virus is a single-strand flavivirus transmitted by mosquitoes, Nervous Microbiolog 2 NS
infection most commonly in the summer. Most infections are asymptomatic or may (NS) y (Micr)
present with a flu-like illness (West Nile fever), often with a maculopapular
1906 or morbilliform rash. Neuroinvasive disease manifests as meningitis,
encephalitis, or asymmetric flaccid paralysis; patients may have
parkinsonian features.

West Nile virus WNV is harbored in birds and transmitted to humans by mosquitos. Most Nervous Microbiolog 2 NS
infection patients are aSSx, but the virus can cause an influenza-like illness or (NS) y (Micr)
####
neuroinvasive diseasewith meningitis, encephalitis, and flaccid paralysis.

Alzheimer Amyloid is an abnormally folded (insoluble) extracellular protein that has Nervous Pathology 7 NS
disease apple-green birefringence when stainedwith Congo red and viewed under (NS) (Path)
592 polarized light. AD is a/w β-amyloid deposits in the brain parenchyma
(neuritic plaques) and walls of cerebral vessels (amyloid angiopathy).

Alzheimer AD is characterised by ↓ lvls of ACh in the nucleus basalis of Meynert and Nervous Pathology 7 NS
593 disease the hippocampus, caused by ↓ activity of choline acetyltransferase. (NS) (Path)

Alzheimer The hippocampus is the area of the brain demonstrating the greatest degree Nervous Pathology 7 NS
794 disease of atrophy in AD. Hippocampal atrophy on MRI is highly suggestive of the (NS) (Path)
Dx.
Alzheimer Alzheimer dementia typically presents insidiously with memory loss Nervous Pathology 7 NS
disease (especially of recent events), executive dysfunction, and visuospatial (NS) (Path)
impairment. Classic histopathologic findings include amyloid plaques
7490
(central amyloid beta core surrounded by dystrophic neurites) and
neurofibrillary tangles (aggregates of hyperphosphorylated tau protein).

Alzheimer Inappropriate processing of amyloid precursor protein down the beta- and Nervous Pathology 7 NS
disease gamma-secretase pathway results in the production of beta-amyloid. (NS) (Path)
Insufficient clearance of beta-amyloid can result in formation of
####
extracellular amyloid plaques, which are neurotoxic and thought to play a
key role in the pathogenesis of Alzheimer dementia.

Amyotrophic UMN damage leads to spastic paralysis, hyperreflexia, and an upgoing Nervous Pathology 2 NS
lateral sclerosis plantar reflex (Babinski sign) due to loss of descending inhib over LMNs (NS) (Path)
674 in the anterior horn. Conversely, LMN lesions cause flaccid paralysis,
hypotonia, hyporeflexia, muscle atrophy, and fasciculations.

Amyotrophic ALS causes both UMN and LMN lesions. Loss of neurons of the anterior Nervous Pathology 2 NS
lateral sclerosis horns of the spinal cord (LMN lesion) causes muscle weakness and (NS) (Path)
675
atrophy. Demyelination of the lateral corticospinal tract (UMN lesion)
leads to spasticity and hyperreflexia.
Ataxia AT is an AR disorder resulting from a defect in DNA-repair genes. The Nervous Pathology 2 NS
telangiectasia DNA of these patients is hypersensitive to ionizing radiation. MFx include (NS) (Path)
673
cerebellar ataxia, oculocutaneous telangiectasias, repeated sinopulm
infections, and an ↑ incidence of malignancy.
Brain Transtentorial (ie, uncal) herniation is a complication of an ipsilateral mass Nervous Pathology 2 NS
herniation lesion, such as a hemorrhage or brain tumor. The 1st sign of uncal (NS) (Path)
herniation is a fixed and dilated pupil on the side of the lesion. Ipsilateral
495
paralysis of oculomotor muscles, contralateral or ipsilateral hemiparesis,
and contralateral homonymous hemianopsiawith macular sparing may also
occur.
Brain tumors GBM is the most common 1° cerebral neoplasm of adults that's typically Nervous Pathology 10 NS
locatedwithi the cerebral hemispheres and may cross the midline ('butterfly (NS) (Path)
613
glioma'). These tumours are highly malignant and grossly contain areas of
necrosis and hemorrhage.
 Brain tumors Synaptophysin is a protein found in presynaptic vesicles of neurons, Nervous Pathology 10 NS
neuroendocrine, neuroectodermal cells. CNS tumours of neuronal origin (NS) (Path)
880 freq stain (+) for synaptophysin on IHC. Neoplasms of glial origin
(astrocytomas, ependymomas, and oligodendrogliomas) stain for GFAP.

Brain tumors A cystic tumor in the cerebellum of a child is most likely a pilocytic Nervous Pathology 10 NS
astrocytoma. Biopsy will show a well-differentiated neoplasm comprised of (NS) (Path)
1153 spindle cells with hair-like glial processes that are associated with
microcysts. These cells are mixed with Rosenthal fibers and granular
eosinophilic bodies.
Brain tumors Medulloblastoma is the 2nd most common brain neoplasm of childhood. It Nervous Pathology 10 NS
is located in the cerebellum, often at the vermis, and consists of sheets of (NS) (Path)
1259 small, blue cells. Like other "PNET" tumors, medulloblastomas are poorly
differentiated and have a bad prognosis.

Brain tumors Ependymomas originate from the ependymal cells that line the ventricular Nervous Pathology 10 NS
system and the central canal of the spinal cord. Ventricular ependymomas (NS) (Path)
#### can block the flow of CSF thru the interventricular foramina, causing SSx
of ↑ ICP (e.g. h/a, papilloedema) due to obstr (noncommunicating)
hydrocephalus.
Brain tumors GBM is an aggressive 1° brain neoplasm that generally Pxwith slowly Nervous Pathology 10 NS
worsening h/a, seizure, a/o focal neuro issues. Most cases are a/w (NS) (Path)
#### oncogenic mutations that increase EGFR expression on the tumor cells,
leading to ↑ transduction of growth signals that promote cellular survival
and proliferation.
Carpal tunnel CTS is a peri neuropathy characterised by pain/paraesthesias in a median Nervous Pathology 3 NS
syndrome nerve distribution (palmar surface of the 1st 3 digits and radial half of the (NS) (Path)
4th digit), weakness on thumb abduction/opposition, thenar atrophy, and a
1264
(+) Tinel a/o Phalen test. It's caused by median nerve compression at the
transverse carpal ligament.

Central pontine Rapid correction of chronic hyponatraemia may led to osmotic Nervous Pathology 2 NS
myelinolysis demyelination syndrome (i.e. central pontine myelinolysis). It typically (NS) (Path)
915
MFx 2-6days after the osmotic insultwith spastic quadriplegia,
pseudobulbar palsy, and locked-in syndrome.
Cerebellar PNP syndromes can occur due to the production of hormone-like Nervous Pathology 1 NS
degeneration substances from tumour cells. They can also result from immune rxns (NS) (Path)
against tumour cells that cross-reactwith normal cells, causing dysfxn a/o
595
damage to healthy organs and tissues. Neuro PNP syndromes (e.g. PNP
cerebellar degen) are an autoimmune phenomenon.

Chiari Chiari malformations are congenital disorders that result from Nervous Pathology 1 NS
malformation underdevelopment of the posterior fossa, causing parts of the cerebellum (NS) (Path)
and medulla to herniate through the foramen magnum. Chiari-I is relatively
504 benign and Px during adulthoodwith occipital h/a and cerebellar dysfxn.
Chiari-II is a more severe form that affects neonates and is often a/w
lumbar myelomeningocele and hydrocephalus.

Child abuse Abusive head trauma can be caused by vigorous shaking of an infant and Nervous Pathology 2 NS
results in SDH (due to tearing of bridging veins) and retinal hemorrhages. (NS) (Path)
347
Additional red flags are injuries inconsistentwith Hx or developmental age.

Cluster CHs cause severe, episodic, unilateral periorbital and temporal pain a/w Nervous Pathology 1 NS
headache ipsilateral autonomic SSx (e.g. lacrimation, nasal congestion, miosis, (NS) (Path)
1962 conjunctival injection). The h/a typically last 15-180min and tend to occur
in clusters (often at the same time each day). Males are affected more
commonly than females.
CNS 1° CNS lymphomas occur in immunosuppressed pts, such as those Nervous Pathology 2 NS
lymphoma suffering from AIDS. These tumors arise from B cells and are universally (NS) (Path)
1260
a/w EBV. They are high-grade tumorswith a poor prognosis.

Cranial nerveDiabetic mononeuropathy often involves CNIII. It's caused by Nervous Pathology 9 NS
palsy predominantly central ischemia, which affects the somatic nerve fibres but (NS) (Path)
1060
spares peri parasympathetic fibres. SSx incl ptosis, a 'down and out' gaze,
and normal light and accommodation reflexes.
Craniopharyngi Craniopharyngiomas are suprasellar tumours found in children and Nervous Pathology 2 NS
omas composed of calcified cysts containing chol crystals. They arise from (NS) (Path)
1152
remnants of Rathke's pouch, an embryonic precursor of the anterior
pituitary.
Dandy-Walker DWM is a developmental anomaly Chx by hypoplasia/absence of the Nervous Pathology 1 NS
syndrome cerebellar vermis and cystic dilation of the 4th ventriclewith posterior fossa (NS) (Path)
#### enlargement. patients often Px during infancywith developmental delay and
progressive skull enlargement. Other features may include cerebellar
dysfxn and NCH.
 Delirium Delirium is characterised by the acute onset of fluctuating disturbance in Nervous Pathology 4 NS
attn and gen cognition (e.g. altered lvl of consciousness, disorientation, (NS) (Path)
#### hallucinations). Common Rx that may precipitate delirium in high-risk
pops (e.g. elderly pts) incl sedative-hypnotics, benzos, opioids, and
anticholinergic Rx.
Diabetic DM is the most common cause of peri polyneuropathy in adults. Common Nervous Pathology 1 NS
neuropathy findings incl numbness and paraesthesias in a stocking-glove distribution (NS) (Path)
####
and ↓ proprioception due to degen of large-fibre sensory axons.

Dystonia Dystonia is a syndrome of prolonged, repetitive muscle contractions. This Nervous Pathology 1 NS
condition may be the result of impaired fxn of the basal ganglia. Cervical (NS) (Path)
634 dystonia (spasmodic torticollis), blepharospasm, and writer's cramp are the
most common types of focal dystonia.

Epidural EDH is an accumulation of blood b/w the bone and dura mater. It typically Nervous Pathology 2 NS
hematoma occurs due to a tear of the MMA a/w fracture of the pterion region of the (NS) (Path)
505 skull (often involving the temporal bone). patients char have transient LOC
f/b a lucid interval before ↑ ICP leads to neuro deterioration.

Facial nerve Hyperacusis (↑ sensitivity to sound) is an indication of damage to the facial Nervous Pathology 3 NS
####
nerve (CN VII) close to its origin from the brainstem. (NS) (Path)
Friedreich FA is an AR condition that presents during childhood/adolescencewith Nervous Pathology 2 NS
ataxia progr gait ataxia (due to degen of the spinocerebellar tracts) and impaired (NS) (Path)
joint and vibration sense (due to degen of the posterior columns and DRG).
636
Other features incl HCM (most common cause of death), skeletal abns (e.g.
kyphoscoliosis, pes cavus), and DM.

Friedreich FA is Chx by cerebellar ataxia (spinocerebellar tract degeneration) and loss Nervous Pathology 2 NS
ataxia of position/vibration sensation (dorsal column/DRG degeneration), (NS) (Path)
672
kyphoscoliosis, and HCM. Foot abnormalities and DM are also common.

Frontotemporal FTD is a/w pronounced atrophy of the prefrontal cortexwith later degen of Nervous Pathology 2 NS
dementia the anterior temporal cortex. It MFx initiallywith changes in personality, (NS) (Path)
594
social behaviour, and language that progress over time to a more global
dementiawith obvi neurocognitive deficits.
Giant cell Polymyalgia rheumatica occurs in more than 1/2 of ptswith temporal Nervous Pathology 5 NS
arteritis arteritis. It's characterised by neck, torso, shoulder, and pelvic girdle pain (NS) (Path)
913 and morning stiffness. Fatigue, fever, and weight loss may also occur.
Monocular vision loss is a common complication of temporal arteritis.

Glioblastoma GBM is the most common 1° brain tumour in adults. Areas of necrosis and Nervous Pathology 1 NS
614 (Multiforme) hemorrhage are seen on gross Ex. LM showing pseudopalisading tumour (NS) (Path)
cells around areas of necrosis is Dx.
Guillain-Barre GBS is an acute, demyelinating polyneuropathy thought to be caused by Nervous Pathology 3 NS
syndrome molecular mimicry. Abs formed against infectious agents cross-reactwith (NS) (Path)
myelin and Schwann cells, leading to immune-mediated demyelination.
66
LM shows segmental demyelination and an endoneurial inflammatory
infiltrate composed of lymphocytes and macrophages.

Guillain-Barre GBS is an acute demyelinating polyneuropathy. It's thought to be due to Nervous Pathology 3 NS
syndrome molecular mimicry and is commonly preceded by a viral URI or (NS) (Path)
1058
gastroenteritis. Segmental demyelination of the peri nerves and an
endoneurial inflammatory infiltrate are seen on LM.
Hemangioma Cavernous hemangiomas are vascular malformations that occur most Nervous Pathology 6 NS
#### commonlywithi the brain parenchyma; they carry an ↑ risk of intracerebral (NS) (Path)
hemorrhage and seizure.
Hemangioma Cavernous hemangiomas are vascular malformations composed of abnly Nervous Pathology 6 NS
dilated capillaries separated by thin connective tissue septa. The lack of (NS) (Path)
#### structural support gives them a tendency to bleed, and those that occur in
the brain can presentwith neurologic deficits and seizures.

Hemorrhage Cerebral amyloid angiopathy is the most common cause of spontaneous Nervous Pathology 1 NS
stroke lobar hemorrhage, particularly in the elderly. The most common sites of (NS) (Path)
499
hemorrhage include the occipital and parietal lobes.

Hemorrhagic Deep intraparenchymal hemorrhage is most commonly caused by HTN Nervous Pathology 3 NS
stroke vasculopathy of the small penetrating branches of the cerebral arteries (NS) (Path)
498 (Charcot-Bouchard aneurysm rupture). This is in contrast to rupture of
saccular aneurysms, which tyrupture of saccular aneurysms, which
typically cause SAH.
 Hemorrhagic Acute lesions to the cerebellar vermis typically cause truncal and gait Nervous Pathology 3 NS
stroke ataxia due to impaired modulation of the medial-descending motor (NS) (Path)
#### systems. Involvement of the lower vermis and the flocculonodular lobe also
causes vertigo/nystagmus due to dysregulation of the vestibular nuclear
complex.
HIV HIV-assoc dementia should be suspected in ptswith AIDS who have progr Nervous Pathology 11 NS
cognitive decline. The char histopath finding is microglial nodules (groups (NS) (Path)
####
of activated microglia/macrophages around small areas of necrosis) and
multinucleated giant cells.
HSV infection Viral infections of the CNS are usually characterised by ↑ protein, normal Nervous Pathology 9 NS
Glc, and an ↑ WBC countwith a lymphocytic predominance. Ptswith (NS) (Path)
908
herpes encephalitis also usually have ↑ erythrocytes in the CSF due to
hemorrhagic inflammation of the temporal lobes.
Huntington HD is an AD neurodegen disorder that MFxwith chorea (e.g. involuntary, Nervous Pathology 5 NS
disease jerky, fidgety movements) and behavioural abns (e.g. aggressiveness, (NS) (Path)
632 depression). Char neuroimaging findings incl atrophy of the caudate nuclei
which results in enlargement of the frontal horns of the lateral ventricles.

Huntington HD is an AD neurodegen disease that leads to the accumulation of abn, Nervous Pathology 5 NS
disease toxic huntingtin protein in neural cells. Inhib GABAergic neurons in the (NS) (Path)
902
caudate nuclei are most susceptible, and their loss is responsible for the
ChFx of HD (e.g. chorea, behavioural abns).
Hydrocephalus Hydrocephalus is an enlargement of the ventricles (+/- ↑ pressure) caused Nervous Pathology 4 NS
by either neuronal volume loss (eg, hydrocephalus ex-vacuo) or excessive (NS) (Path)
CSF accumulation (due to flow obstruction or impaired absorption).
14 Neurodegenerative diseases (eg, AIDS dementia) can be a/w
hydrocephalus ex-vacuo due to significant cortical atrophy, which allows
the ventricles to expand while maintaining normal pressure.

Hydrocephalus Symmetrical enlargement of the ventriculi is Chx of communicating Nervous Pathology 4 NS

hydrocephalus. Communicating hydrocephalus usually occurs 2° to dysfxn (NS) (Path)
15 or obliteration of subarachnoid villi. This dysfxn is usually a sequelae of
meningeal infection (including tuberculosis meningitis) or SAH/IVH.

Ischemic stroke Global cerebral ischemia is typically precipitated by systemic hypotension Nervous Pathology 19 NS
(e.g. cardiac arrest). The cells most susceptible to ischemia are the CA1 (NS) (Path)
pyramidal neurons of the hippocampus. Other areas of the brain that are
18
damaged early in the course of global cerebral ischemia incl the cerebellar
Purkinje cells and the pyramidal neurons of the neocortex.

Ischemic stroke Inadequate blood supply to the brain (e.g. arterial thrombosis or embolism) Nervous Pathology 19 NS
leads to ischemic stroke. The 1st microscopic changes are typically seen 12- (NS) (Path)
19 24hrs after irreversible ischemic injury and incl intense eosinophilic
staining of the neuronal cytoplasm (red neurons) and nuclear
fragmentation.
Ischemic stroke Microglia are the predominant cell in the necrotic area 3-7 days after the Nervous Pathology 19 NS
20 onset of ischemia and phagocytize the fragments of neurons, myelin, and (NS) (Path)
necrotic debris.
Ischemic stroke Lacunar infarcts are small ischemic infarcts (<15mm in diameter) Nervous Pathology 19 NS
involving the deep brain structures (e.g. basal ganglia, pons) and (NS) (Path)
subcortical white matter (e.g. internal capsule, corona radiata). They're
22
most often due to lipohyalinosis, microatheroma formation, and
hardening/thickening of the vessel wall (HTN arteriolar sclerosis), which
predisposes to thrombotic vessel occlusion.
Ischemic stroke Sustained cerebral hypoperfusion (eg, hypotension, shock) may cause Nervous Pathology 19 NS
global cerebral ischemia and watershed infarction. These watershed zones (NS) (Path)
are located at the borders b/w areas perfused by the ACAs, MCAs, and
23
PCAs and typically appear as symmetric, bilateral wedge-shaped strips of
necrosis over the cerebral convexity, parallel and adjacent to the
interhemispheric fissure.
Ischemic stroke Neurons that sustain irreversible ischemic injury begin to develop char Nervous Pathology 19 NS
histopath changes 12-24hrs after the inciting event. These changes incl (NS) (Path)
492
shrinkage of the cell body, pyknosis of the nucleus, loss of Nissl bodies,
and cytoplasmic eosinophilia (red neurons).
Ischemic stroke CNS injury is a/w astrocyte hypertrophy and proliferation (gliosis). This Nervous Pathology 19 NS
493 process leads to the formation of a glial scar, which compensates for the (NS) (Path)
volume loss that occurs after neuronal death.
Ischemic stroke Several mos to yrs after ischemic brain infarction, the necrotic area appears Nervous Pathology 19 NS
501 as a cystic cavity surrounded by a wall composed of dense fibers formed by (NS) (Path)
astrocytic processes (glial scar).
 Ischemic stroke WD refers to the process of axonal degeneration and breakdown of the Nervous Pathology 19 NS
myelin sheath that occurs distal to a site of injury. Axonal regeneration (NS) (Path)
#### does not occur in the CNS due to the persistence of myelin debris,
secretion of neuronal inhibitory factors, and development of dense glial
scarring.
Lambert-Eaton LEMS is characterised by Abs against presynaptic v-gated Ca2+ channels. Nervous Pathology 2 NS
myasthenic patients develop progr proximal muscle weaknesswith ↓/absent reflexes (NS) (Path)
1267
syndrome that predominantly involves the lower extremities. The syndrome is often
a/w malignancy, particularly SCLC.
Lung cancer The phrenic nerve arises from the C3-C5 segments of the spinal cord and Nervous Pathology 9 NS
innervates the ipsilateral hemidiaphragm. Intrathoracic spread of lung ca (NS) (Path)
may affect the phrenic nerve, causing hiccups and diaphragmatic
647
paralysiswith dyspnoea. Brachial plexus involvement can cause pain in the
distribution of the C8, T1, and T2 nerve roots. Involvement of the recurrent
laryngeal nerve may cause hoarseness.
Measles SSPE is a rare complication of measles infection that occurs several yrs Nervous Pathology 3 NS
910 after apparent recovery from initial infection. Oligoclonal bands of measles (NS) (Path)
virus Abs are found in the CSF of these pts.
Meningiomas Meningiomas are slow-growing, well-circumscribed, benign intracranial Nervous Pathology 2 NS
tumors typically found at the cerebral convexities in adults. Chx (NS) (Path)
1151 histopathologic features include a whorled pattern of cellular growth that
forms nests, which may calcify into round, eosinophilic laminar structures
called psammoma bodies.
Migraine Migraines are an episodic neurological disorder that results in severe, Nervous Pathology 3 NS
unilateral, throbbing headaches often associated with photophobia, (NS) (Path)
phonophobia, and nausea/vomiting. Migraines typically last 4-72 hours,
####
and up to 25% of patients also develop an aura (focal, reversible neurologic
symptoms that precede or accompany the headache).

Multiple MS is Chx by episodic, progressive neuro deficits involving multiple Nervous Pathology 6 NS
sclerosis anatomic regionswithi the CNS. Demyelinating plaques are commonly seen (NS) (Path)
916 as hyperintense lesions on T2-weighted MRI of the brain and spinal cord.
Common MFx include optic neuritis, INO, sensory deficits, and fatigue,
which may worsenwith heat exposure.
Multiple MS is an AI disorder of the CNS Chx by recurrent episodes of Nervous Pathology 6 NS
917 sclerosis demyelination, leading to ↓ saltatory conduction. INO and optic neuritis are (NS) (Path)
common MFx.
Multiple MS is an autoimmune demyelinating disease that results from Nervous Pathology 6 NS
sclerosis oligodendrocyte depletion.withi the lesions, inflammatory infiltrates of (NS) (Path)
918 lymphocytes and macrophages are seen surrounding oligodendrocytes and
myelin sheaths. Oligoclonal bands are highly sensitive but nonspecific in
ptswith MS.
Multiple MS is an immune-mediated disorder of the CNS characterised by focal Nervous Pathology 6 NS
sclerosis demyelination (plaques). Histo, plaques contain foci of perivenular (NS) (Path)
919 inflammatory infiltrates made up 1arily of autoreactive T lymphocytes and
macrophages. Patchy demyelination occurs f/b astrocyte hyperplasia (glial
scarring).
Multiple The pathogenesis of MS involves an AI response (T cell and Ab mediated) Nervous Pathology 6 NS
#### sclerosis targeting oligodendrocytes and myelin in the CNS, leading to slowed nerve (NS) (Path)
conductionwith neuro deficits.
Myasthenia MG is caused by circulating Abs directed against AChR of the NMJ. Auto- Nervous Pathology 10 NS
gravis Ab binding leads to receptor degradation, producing fluctuating weakness (NS) (Path)
749 that worsens over the course of the day and most commonly affects the
extraocular muscles (e.g. ptosis, diplopia). Most patients also have thymic
abns (e.g. thymoma).
Myasthenia MG is an AI disorder caused by an autoAb-mediated atk on the ACh Nervous Pathology 10 NS
gravis receptors of the postsynaptic NMJ, leading to a ↓ number of ACh receptors. (NS) (Path)
6554
It is Chx by fatigable weakness of the skeletal muscles; resp failure can
occur due to diaphragmatic weakness.
Myotonic MMD is an AD disorder. It is caused by an ↑ number of TNRs on MPK Nervous Pathology 1 NS
dystrophy gene. Sustained muscle contraction (myotonia), alongwith weakness and (NS) (Path)
1268 atrophy, is common. Cataracts are seen in almost all pts. Frontal balding
and gonadal atrophy are other common features.

Necrosis Irreversible ischemic injury to brain tissue causes tissue digestion by Nervous Pathology 3 NS
hydrolytic enzymes (liquefactive necrosis). The infarcted CNS tissue is (NS) (Path)
177
eventually replaced with a cystic astroglial scar. In other organs, lethal
ischemic injury results in coagulative necrosis.
Necrosis Liquefactive necrosis is characterised by complete digestion and removal Nervous Pathology 3 NS
of necrotic tissuewith formation of a cystic cavity. Irreversible ischemic (NS) (Path)
871 CNS injury is typically f/b liquefactive necrosis due to the release of
lysosomal enzymes from inflammatory cells and dmgd neurons.
 Neuroblastoma Opsoclonus-myoclonus is a paraneoplastic syndrome associated with Nervous Pathology 1 NS
neuroblastoma, the most common extracranial solid neoplasm in children. (NS) (Path)
The tumor typically arises from the neural crest cells of the adrenal medulla
1263 and presents with an abdominal mass and elevated catecholamine
breakdown products.

Neurofibromat Bilateral acoustic neuromas are a/w NF-2, an AD condition caused by mut Nervous Pathology 3 NS
1305
osis of the NF-2 gene on chrom 22. (NS) (Path)
Neuronal The changes in the body of a neuron after the axon has been severed are Nervous Pathology 3 NS
physiology called axonal rxn. This process reflects an ↑ protein synthesis that (NS) (Path)
494 facilitates axon repair. Enlarged, rounded cellswith perily located nuclei
and dispersed finely granular Nissl substance are seen.

Normal NPH presentswith progr gait difficulties, cognitive disturbances, and Nervous Pathology 2 NS
pressure urinary incontinence. It's a form of communicating hydrocephalus (NS) (Path)
16 hydrocephalus characterised by ventriculomegalywitho persistent ↑ in ICP. Brain imaging
reveals ventricular enlargement out of proportion to sulci enlargement.

Normal NPH occurs due to ↓ CSF absorption, resulting in ventriculomegalywith Nervous Pathology 2 NS
pressure normal ICP. This causes stretching of the descending cortical fibers (NS) (Path)
hydrocephalus (corona radiata) from the frontal lobe and contributes to the classic triad of
17
SSx (ie, dementia, gait abnormalities, urinary incontinence). Loss of
cortical inhibition of the sacral micturition center leads to urge
incontinence.
Parkinson Nigrostriatal degen in Parkinson disease ↓ activity of the thalamus and its Nervous Pathology 7 NS
disease projections to the cortex, resulting in bradykinesia and rigidity. Ptswith (NS) (Path)
medically intractable SSx of Parkinson disease may benefit from high-freq
####
deep brain stimulation of the globus pallidus internus (GPi) or subthalamic
nucleus (STN) as it promotes thalamo-cortical disinhibwith improved
mobility.
Peripheral Diabetic peri neuropathy is characterised by numbness and paraesthesia in Nervous Pathology 3 NS
neuropathy a stocking-and-glove distribution. It results from nonenzymatic (NS) (Path)
glycosylation of proteins, leading to hyalinisation of endoneurial arteries
1059
and ischemic nerve dmg. In addn, accumulation of toxic substanceswithi
neurons results in deranged meta and ↑ oxidative stress.

Prion disease CJD is a prion disease characterised by rapidly progr dementia, myoclonus, Nervous Pathology 3 NS
and deathwithi a yr of SSx onset. Histopath shows widespread neuronal (NS) (Path)
911
losswith small, uniform vacuoles in the grey matter of the brain (e.g.
spongiform encephalopathy).
Prion disease Prion diseases are rapidly progr neurodegen disorders caused by the Nervous Pathology 3 NS
accumulation an abnly folded proteinwithi the brain. Prion proteins are (NS) (Path)
normally found in an α helix form; a conformation change into a β-sheet
912 form confers resistance to proteases and can trigger similar conformational
changes in other normally folded proteins. Char micro findings incl
spongiform degen of the grey matterwith vacuolisation of neurons, gliosis,
and cyst formation.
Seizures Seizures can be classified as focal (partial) if they originate from a Nervous Pathology 8 NS
localized region of one cerebral hemisphere or generalized if they involve (NS) (Path)
both hemispheres at onset. The MFx of focal seizure depend on the brain
####
region in which seizure activity is occurring. Focal seizure can be
subclassified as simple if consciousness is preserved or complex if there is
LOC.
Subarachnoid Intracranial BAs of the COW are often seen in ptswith ADPKD; when Nervous Pathology 4 NS
4 hemorrhage ruptured, they cause SAH that presentswith sudden onset of 'thunderclap (NS) (Path)
h/a'.
Subarachnoid SAH Pxwith a generalized, excruciating h/a. It is classically described by Nervous Pathology 4 NS
hemorrhage patients as "the worst h/a of my life." SAH usually occurs due to rupture of (NS) (Path)
497
saccular (berry) aneurysms or AVMs. Berry aneurysms of the COW are
a/w AD PKD.
Subarachnoid The most common complication of aneurysmal SAH is vasospasm, which Nervous Pathology 4 NS
hemorrhage typically occurs 3-12days after the initial insult and can cause delayed (NS) (Path)
500 cerebral ischemia (e.g. sudden change in mental status, new focal neuro
deficits). The CT scan usually remains unchanged, unlikewith rebleeding.

Syphilis Tabes dorsalis, a later form of neurosyphilis, causes progr degen of the Nervous Pathology 9 NS
dorsal columns and dorsal roots of the spinal cord. MFxs incl loss of (NS) (Path)
906 proprioception and vibratory sensation, severe lancinating pains, and
sensory ataxia (e.g. wide-based gait, (+) Romberg sign). Many patients also
have Argyll Robertson pupils.
 Syringomyelia Syringomyelia is characterised by the formation of a cavity (syrinx) in the Nervous Pathology 2 NS
cervical region of the spinal cord. The syrinx dmgs the ventral white (NS) (Path)
commissure, leading to bilateral loss of pain and temp sensation that's
503 limited to the affected lvls (typically the arms and hands); distal sensation
is preserved. Destruction of the motor neurons in the ventral horns (due to
extension of the syrinx) results in flaccid paralysis and atrophy of the
intrinsic muscles of the hand.
Syringomyelia The combo of fixed segmental loss of upper extremity pain and temp Nervous Pathology 2 NS
1904 sensations, upper extremity LMN SSx, a/o lower extremity UMN SSx in (NS) (Path)
the setting of scoliosis suggests syringomyelia.
Tension THs are the most common form of h/a. They are Chx by an achy or Nervous Pathology 1 NS
headache pressure-like pain that is often bilateral and a/w pericranial muscle (NS) (Path)
7492
tenderness. THs are not a/w other neuro SSx and do not typically limit a
pt's ability to perform daily fxns.
Traumatic Damage to the brainstem at/below the level of the red nucleus (eg, Nervous Pathology 5 NS
brain injury midbrain tegmentum, pons) typically results in decerebrate (extensor) (NS) (Path)
#### posturing. In contrast, damage to neural structures above the red nucleus
(eg, cerebral hemispheres, IC) typically results in decorticate (flexor)
posturing.
Traumatic DAI is a type of TBI that results from disruption of the white matter tracts. Nervous Pathology 5 NS
brain injury Microscopically, DAI is visible as widespread axonal swelling, most (NS) (Path)
#### pronounced at the gray-white matter jxn,with accumulation of transport
proteins (eg, amyloid precursor, α synuclein) at the site of injury.

Vertigo Vertigo is a sensation of excessive motion compared to physical reality. It Nervous Pathology 1 NS
8859 is most commonly due to dysfxnwithi the vestibular system. (NS) (Path)

Vestibular Schwannomas Px histologicallywith a biphasic pattern of cellularity Nervous Pathology 3 NS

schwannoma (Antoni A and B areas) and S-100 (+) (indicating neural crest origin). (NS) (Path)
Schwannomas can arise from the peripheral nerves, nerve roots, and CNs
1304
(except CN II). Acoustic neuromas are the most common type of
intracranial schwannoma and are located at the CPA at CN VIII.

Vitamin B12 Myelopathy a/w vitB12 defic is called SCD. 'combo' refers to myelin degen Nervous Pathology 9 NS
deficiency of both the ascending (dorsal columns) and descending (corticospinal tract) (NS) (Path)
65 pathways. Loss of position and vibration sensation, sensory ataxia, and
spastic paresis are common MFxs.

Vitamin E VitE is a lipid-soluble vit that has antioxidative properties. Neuro SSx of Nervous Pathology 2 NS
deficiency vitE defic closely mimic FA and incl ataxia (due to degen of (NS) (Path)
671 spinocerebellar tracts), loss of position and vibration sense (due to degen of
the dorsal columns), and loss of DTR (due to peri nerve degen).

von Hippel- A cerebellar hemangioblastoma in a/w congenital cysts of the kidneys, Nervous Pathology 2 NS
468 Lindau disease liver, a/o pancreas is highly suggestive of vHL disease, a rare AD (NS) (Path)
condition.
Wernicke- Oculomotor dysfxn, ataxia, and confusion form the triad of WE. Most of Nervous Pathology 5 NS
Korsakoff these SSx usually resolve after vitB1 administration. Korsakoff syndrome (NS) (Path)
63
syndrome is a complication of WE, the hallmarks of which are permanent memory
loss and confabulation.
Wernicke- WE is a complication of thiamine deficiency Chx by encephalopathy, Nervous Pathology 5 NS
Korsakoff ataxia, and oculomotor dysfxn. It occurs most commonly in ptswith chronic (NS) (Path)
597 syndrome Alc abuse and may be precipitated by infusion of Glc-containing fluids.
Neuroimaging reveals focal hemorrhage or atrophy of the mammillary
bodies.
Wilson disease WD is an AR condition Chx by excessive Cu deposition into tissues (eg, Nervous Pathology 5 NS
liver, basal ganglia, cornea). It typically Px in young adultswith liver (NS) (Path)
397 disease, neuropsych SSx (eg, gait disturbance, dysarthria, depression,
personality changes), and Kayser-Fleischer rings on slit lamp Ex.

Ataxia Cerebellar ataxia, telangiectasias, and ↑ risk of sinopulm infections Nervous Pathophysiol 2 NS
telangiectasia constitute a Chx triad of AT. This illness exhibits AR inheritance, and the (NS) ogy (Patp)
defect is in a gene that codes for the ATM gene which plays a role in DNA
587
break repair. The immune defx primarily MFx as an IgA defx and
predisposes to infections of the upper and lower airways.

Central pontine Osmotic demyelination syndrome results from overly rapid correction of Nervous Pathophysiol 2 NS
myelinolysis chronic hyponatremia. Clinical features include quadriplegia, pseudobulbar (NS) ogy (Patp)
####
palsy, and reduced level of consciousness. MRI demonstrates focal
demyelination of the pons.
Frontotemporal The frontal lobes are involved in personality, language, motor fxns, and Nervous Pathophysiol 2 NS
dementia executive fxns (e.g. abstraction). Frontal lobe fxn may be Dx by testing (NS) ogy (Patp)
####
abstraction ability (e.g. asking about the similarities b/w 2 related objects)
on the MSE.
 Hydrocephalus Hydrocephalus in infants presents with macrocephaly and poor feeding. Nervous Pathophysiol 4 NS
Imaging studies showing enlarged ventricles are characteristic. Untreated (NS) ogy (Patp)
1854 hydrocephalus leads to spasticity due to stretching of the periventricular
pyramidal tracts, developmental delays, and seizures.

Ischemic stroke UMN SSx include abnormal plantar flexion (Babinski sign), spastic Nervous Pathophysiol 19 NS
paralysis, ↑ muscle tone, clasp-knife rigidity, hyperreflexia, pronator drift, (NS) ogy (Patp)
and pyramidal weakness (weakness more pronounced in lower extremity
1920
flexors and upper extremity extensors). LMN SSx include flaccid paralysis,
weaknesswith hypotonia and muscle atrophy, fasciculations, and
suppressed or absent reflexes.
Meningitis Pneumococcal meningitis is associated with massive cerebrospinal fluid Nervous Pathophysiol 17 NS
inflammatory cytokine release in response to bacterial cell wall (NS) ogy (Patp)
components. Treatment with dexamethasone prior to antibiotic therapy has
#### been shown to reduce inflammation and decrease the risk of adverse
outcomes (eg, seizures, focal neurologic deficits) and death. Other forms of
bacterial meningitis do not seem to benefit from glucocorticoid treatment.

Myasthenia Progressively weakening diaphragmatic contractions during max voluntary Nervous Pathophysiol 10 NS
gravis ventilationwith intact phrenic nerve stim indicate NMJ pathology (e.g. (NS) ogy (Patp)
1657
MG) a/o abnormally rapid diaphragmatic muscle fatigue (e.g. restrictive
lung or chest wall disease).
Myasthenia MG is an AI disease that causes a ↓ in the # of fxnal AChRswithi the NMJ. Nervous Pathophysiol 10 NS
gravis This ↓ the # of postsynaptic cation channels that can open in response to (NS) ogy (Patp)
2061
ACh, which ↓ the amplitude of motor end plate potential and prevents
muscle fiber depol.
Myasthenia The Tx of MG involves the use of an AChEI, immsups, and possible Nervous Pathophysiol 10 NS
gravis thymectomy. AChEIs may cause AEs related to muscarinic overstim, (NS) ogy (Patp)
2062
which can be ameliorated by the use of an antimusc agent such as
glycopyrrolate, hyoscyamine, or propantheline.
Neuromuscular ACh release from presynaptic terminal vesicles at the NMJ depends upon Nervous Pathophysiol 1 NS
junction the influx of extracellular Ca into the presynaptic terminal. Ca influx into (NS) ogy (Patp)
1934
the nerve terminal occurs following neuronal depol and opening of v-gated
Ca channels.
Peripheral Ulnar neuropathy is Chx by numbness of the 4th and 5th digits, pain, and Nervous Pathophysiol 3 NS
neuropathy weakness. It is most commonly caused by compressive injury, leading to (NS) ogy (Patp)
tissue ischemia and demyelination (Schwann cell injury). A nerve
#### conduction study can help differentiate demyelinating vs axonal
neuropathies; demyelination causes slowed or blocked nerve conduction
velocity whereas axonal injury leads to a ↓ in signal strength.

Rheumatoid Long-standing RA can affect the cervical spine, causing vertebral Nervous Pathophysiol 10 NS
arthritis misalignment (subluxation) that can affect the atlantoaxial joint. Extension (NS) ogy (Patp)
#### of the neck during endotracheal intubation can worsen the subluxation,
leading to acute compression of the spinal cord a/o vertebral arteries.

Seafood Pufferfish poisoning is caused by tetrodotoxin, a neurotoxin produced by Nervous Pathophysiol 1 NS

poisoning microorganisms a/w the fish. Tetrodotoxin binds to v-gated Na channels in (NS) ogy (Patp)
8352
nerve and cardiac tissue, preventing Na influx and depol.

Tetanus Tetanospasmin is a neuro-exotoxin released by C. tetani. The toxin blocks Nervous Pathophysiol 5 NS
the release of glycine and GABA from the spinal inhib interneurons that (NS) ogy (Patp)
966
regulate the LMNs. These disinhib motor neurons cause ↑ activation of
muscles, leading to spasms and hyperreflexia.
Tetanus Tet is a CDx that should be suspected in patients who have Chx SSx (e.g. Nervous Pathophysiol 5 NS
lockjaw, muscle pain/spasms, difficulty swallowing), particularly if they are (NS) ogy (Patp)
969
unlikely to be adequately vax or have an antecedent cutaneous injury.

Wilson disease WD (hepatolenticular degen) is an AR condition of excess Cu leading to Nervous Pathophysiol 5 NS

toxic accumulation in the liver, basal ganglia, and cornea. Chelation (NS) ogy (Patp)
1167
Thxwith D-penicillamine is indicated to remove excess loosely bound
serum Cu.
Alzheimer A chronically progressive pre-senile dementia with cortical atrophy but no Nervous Pharmacolog 7 NS
disease other radiological or laboratory abnormalities permits a clinical diagnosis (NS) y (Phar)
of Alzheimer's disease (AD), which is a diagnosis of exclusion. Current
1442
AD-specific therapies include cholinesterase inhibitors (Donepezil),
antioxidants (vitamin E), and NMDA receptor antagonists (e.g.
memantine).
Anesthesia The onset of action of a gas anaesthetic depends on its solubility in the Nervous Pharmacolog 9 NS
blood (blood/gas partition coefficient). Drugswith high blood/gas partition (NS) y (Phar)
659 coefficients are more soluble in the blood, demonstrate slower
equilibriumwith the brain, and have longer onset times.
 Anesthesia The arteriovenous concentration gradient reflects the overall tissue Nervous Pharmacolog 9 NS
solubility of an anesthetic. Anesthetics with high tissue solubility are (NS) y (Phar)
660
characterized by large arteriovenous concentration gradients and slower
onsets of action.
Anesthesia The MAC is a measure of potency of an inhaled anaesthetic. It's the conc of Nervous Pharmacolog 9 NS
the anaesthetic in the alveoli that renders 50% of patients unresponsive to (NS) y (Phar)
851 painful stimuli (ED50). Potency is inversely proportional to the MAC: the
lower the MAC, the more potent the anaesthetic.

Anesthesia Almost all volatile anaesthetics ↑ cerebral blood flow. It's an undesirable Nervous Pharmacolog 9 NS
effect as it results in ↑ ICP. Other important effects of inhalation (NS) y (Phar)
854
anaesthetics are myocardial depression, hypotension, resp depression, and
↓ renal fxn.
Anesthesia Propofol and other highly lipophilic drugs readily diffuse across Nervous Pharmacolog 9 NS
membranes, quickly accumulating in tissues receiving high blood flow; this (NS) y (Phar)
856 accounts for their rapid onset of action. These compounds are subseq
redistributed to organs receiving less blood flow, which explains their short
duration of action.
Anesthesia SCh can cause significant K+ release and life-threatening arrhythmias in Nervous Pharmacolog 9 NS
patients at high risk for hyperkalaemia, incl thosewith burns, myopathies, (NS) y (Phar)
8481
crush injuries, and denervating injuries or disease.

Anticholinergic Anticholinergic agents (e.g. atropine, scopolamine) competitively inhib Nervous Pharmacolog 3 NS
s ACh at the mAChR. The effects can be memorisedwith the mnemonic, (NS) y (Phar)
1321 'blind as a bat, mad as a hatter, red as a beat, hot as a hare, dry as a bone,
full as a flask, and fast as a fiddle,' and can be reversed by AChEIs
(physostigmine).
Anticholinergic Physostigmine is a AChEIwith a 3° NH4+ structure that can reverse both Nervous Pharmacolog 3 NS
s the CNS and PNS SSx of anticholinergic tox. Neostigmine, edrophonium, (NS) y (Phar)
1564
and pyridostigmine have a 4° NH4+ structure that limits CNS penetration.

Antiepileptics
Phenytoin meta depends on the fxn of hepatic P450 oxidases and is dose- Nervous Pharmacolog 3 NS
dependent. Drugs that induce hepatic microsomal enzymes (phenobarbital, (NS) y (Phar)
carbamazepine, and rifampin) enhance phenytoin meta and ↓ its serum
351
conc. You should know all of the commonly-prescribed Rx that're meta by
the P450 system, and you should know which drugs induce or inhib the fxn
of these enzymes.
Antiepileptics Lamotrigine can be used to Tx partial and gen seizures and works by Nervous Pharmacolog 3 NS
blocking v-gated Na+ channels. SJS and TEN are rare, life-threatening (NS) y (Phar)
356
AEs characterised by flu-like SSx f/b widespread mucocutaneous
epidermal necrosis.
Antiepileptics Gingival hyperplasia is a common side effect of phenytoin and is Nervous Pharmacolog 3 NS
sometimes reversible when phenytoin is withdrawn. Phenytoin causes (NS) y (Phar)
increased expression of platelet-derived growth factor (PDGF). When
1197 gingival macrophages are exposed to increased amounts of PDGF, they
stimulate proliferation of gingival cells and alveolar bone. Phenytoin
toxicity mainly affects the cerebellum and vestibular system, causing ataxia
and nystagmus.
Antihistamines In addn to blocking H receptors, 1st-gen antihistamines (e.g. Nervous Pharmacolog 3 NS
chlorpheniramine, diphenhydramine) have antimuscarinic, anti-α (NS) y (Phar)
173 adrenergic, and anti-5-HT-ergic properties. Anticholinergic effects on the
ocular ciliary muscles impair accommodation and cause blurring of vision
for close objects.
Autonomic The SNS typically regulates visceral fxn via 2-neuron signal transmission Nervous Pharmacolog 3 NS
nervous system involving cholinergic preganglionic neurons and adrenergic postganglionic (NS) y (Phar)
neurons. Eccrine sweat glands and the AMs are exceptions to this rule as
1359
they're both innervated by cholinergic neurons. The PSNS uses both
preganglionic and postganglionic cholinergic neurons.

Autonomic The ANS utilises 3 types of signal pathways: cAMP, IP3, and ion channels. Nervous Pharmacolog 3 NS
nervous system nAChRs are ligand-gated ion channels that open after binding ACh. This (NS) y (Phar)
1360
results in an immediate influx of Na+ and Ca2+ into the cell and an outflux
of K+ from the cell.
Autonomic Inhib of uterine contractions (tocolysis) is a result of β2 adrenergic receptor Nervous Pharmacolog 3 NS
1368 nervous system stim. α1 receptor stim causes contraction of the ocular pupillary dilator (NS) y (Phar)
muscle, resulting in mydriasis (pupillary dilation).
Benzodiazepin 1st-gen H1 receptor antagonists, incl diphenhydramine and Nervous Pharmacolog 6 NS
352 es chlorpheniramine, can cause significant sedation, esp. when usedwith other (NS) y (Phar)
Rx that caused CNS depression (such as benzos).
 Beta blockers β blockers are used in the Tx of essential tremor. Propranolol, a Nervous Pharmacolog 3 NS
nonselective β blocker, is the most commonly used therapy and prevents (NS) y (Phar)
the interaction of EPI and NEwith β1 and β2 receptors to relieve tremor
2000
SSx. However, inhib of pulm β2 receptors in ptswith underlying reactive
airway disease can cause bronchoconstriction, leading to cough, wheeze,
and dyspnoea.
Capsaicin Topical capsaicin causes defxnalisation of afferent pain fibres and Nervous Pharmacolog 1 NS
depletion of substance P. Initial application results in a burning and (NS) y (Phar)
####
stinging sensation, but chronic exposure leads to ↓ pain transmission.

DRESS DRESS syndrome typically occurs 2-8wks after exposure to high-risk Nervous Pharmacolog 1 NS
syndrome drugs such as anticonvulsants (e.g. phenytoin, carbamazepine), allopurinol, (NS) y (Phar)
sulphonamides (e.g. sulfasalazine), and Abx (e.g. minocycline,
508
vancomycin). patients typically develop fever, gen LAD, facial oedema,
diffuse skin rash, eosinophilia, and internal organ dysfxn.

Drug induced Halogenated inhaled anaesthetics (e.g. halothane, enflurane, isoflurane, Nervous Pharmacolog 2 NS
liver injury sevoflurane, desflurane) are meta by the hepatic CYP450 system by which (NS) y (Phar)
they're converted to reactive intermediates that can cause hepatocellular
853
damage (halothane hepatitis). patients often presentwith acute hepatitis
days after Rx exposure, and liver Bx may show centrilobular hepatic
necrosis.
Essential Essential tremor is the most common movement disorder. patients Nervous Pharmacolog 1 NS
tremor experience a slowly progr, symmetric postural a/o kinetic tremor that most (NS) y (Phar)
1946 commonly affects the upper extremities. Essential tremor is often inherited
in an AD fashion (referred to as familial tremor). 1st-line Tx is the
nonspecific β-adrenergic antagonist propranolol.
Febrile seizure Febrile seizures are the most common neuro disorder affecting children Nervous Pharmacolog 1 NS
and are benign sequelae of fever. Children who experience a febrile seizure (NS) y (Phar)
866 are at risk for recurrence but have a low risk of developing epilepsy.
Supportive care (eg, antipyretics) can improve pt comfort during fever but
does not prevent future seizures.
Glaucoma Atropine is indicated for the Tx of bradycardia as it ↓ vagal influence on Nervous Pharmacolog 3 NS
1322 the SA and AV nodes. A common AE is ↑ IOP. It may precipitate acute (NS) y (Phar)
CAG in susceptible individuals.
Malignant Malignant hyperthermia occurs after admin of inhalation anaesthetics a/o Nervous Pharmacolog 1 NS
hyperthermia SCh to genetically susceptible individuals. It's Txwith dantrolene that (NS) y (Phar)
855
blocks RyR and prevents release of Ca2+ into the cytoplasm of skeletal
muscle fibres.
Migraine Migraine h/a are unilateral, have a pulsating or throbbing quality, and are Nervous Pharmacolog 3 NS
a/w photophobia, phonophobia, and nausea. Triptans are 5-HT1B/5-HT1D (NS) y (Phar)
agonists used as abortive therapy during an acute migraine. β blockers,
8476
antidepressants (e.g. amitriptyline and venlafaxine), and anticonvulsants
(e.g. valproate and topiramate) are commonly used for migraine
prophylaxis.
Migraine Migraine is an episodic disorder characterised by severe, often unilateral Nervous Pharmacolog 3 NS
h/a, commonly a/w nausea and sensitivity to light and sound. Tx is divided (NS) y (Phar)
into abortive therapy (e.g. mild analgesics, triptans, antiemetics,
####
ergotamines) for acute SSx and preventive therapy (e.g. β blockers, TCAs,
anticonvulsants [topiramate, valproate]) to ↓ the freq of h/a.

Myasthenia Exacerbation of MG in a pt Txwith long-acting AChEIs (e.g. Nervous Pharmacolog 10 NS

gravis pyridostigmine) occurs due to myasthenic or cholinergic crisis. The (NS) y (Phar)
1320 edrophonium (Tensilon) test helps to diffiate these 2 conditions. Clinical
improvement after edrophonium admin indicates that the pt is under-Tx
(myasthenic crisis).
Myasthenia MG is caused by auto-Abs against postsynaptic nAChRs, leading to fewer Nervous Pharmacolog 10 NS
gravis fxnal AChRs and fatigable muscle weakness. Non-depolarising (NS) y (Phar)
neuromuscular blocking agents (e.g. vecuronium) are competitive
####
antagonists of AChRs; due to the depletion of receptors, ptswith MG are
extremely sensitive to these agents and very small doses can induce
paralysis and impair airway protection.
Neuroleptic NMS is a life-threatening rxn to antipsychotic Rx characterised by diffuse Nervous Pharmacolog 2 NS
malignant muscle rigidity, hyperthermia, autonomic instability, and altered sensorium. (NS) y (Phar)
#### syndrome The antipsychotic should be stopped and supportive care provided;
dantrolene, a RyR blocker that inhibs Ca2+ release from the SR, is an
effective antidote.
Opioids Opiate analgesics ↓ pain by binding to μ receptors and inhib synaptic Nervous Pharmacolog 14 NS
activity in the CNS. Activation of presynaptic μ receptors on the 1° afferent (NS) y (Phar)
neuron leads to closure of v-gated Ca2+ channels and ↓ excitatory NT
776
release. Binding to μ receptors on the postsynaptic membrane causes
opening of K+ channels and membrane hyperpol.
 Opioids Opioid intox presentswith miosis, depressed mental status, ↓ RR, ↓ bowel Nervous Pharmacolog 14 NS
#### sounds, and hypotension. Of these, ↓ RR is the best predictor of intox and (NS) y (Phar)
is also a freq cause of mortality.
Organophospha OPs inhibit AChE in both muscarinic and nicotinic cholinergic synapses, Nervous Pharmacolog 2 NS
te poisoning leading to ↓ ACh degradation and over-stim of the corresponding (NS) y (Phar)
receptors. Atropine reverses muscarinic effects but doesn't prevent the
1323 devel of nicotinic effects such as muscle paralysis. Pralidoxime is a AChE-
reactivating agent that allows for degradation of excess ACh and Tx both
the muscarinic and nicotinic effects of OPs.

Parkinson Selegiline is an inhib of MAO-B and can prevent MPTP-induced damage Nervous Pharmacolog 7 NS
disease of DA-ergic neurons. Selegiline is used clinically to delay the progr of (NS) y (Phar)
Parkinson disease. Many neurologists favour the use of combos of
259
selegiline, anticholinergics, and amantadine until they no longer provide
control of SSx. Only then is L-DOPA/carbidopa introduced.

Parkinson Adding carbidopa can ↓ most of the peri AEs of L-DOPA. However, Nervous Pharmacolog 7 NS
262 disease behavioural changes from L-DOPA can actually worsenwith addn of (NS) y (Phar)
carbidopa b/c more DA becomes available to the brain.
Parkinson Long-term Tx of PDwith levodopa can be complicated by periodic and Nervous Pharmacolog 7 NS
disease sometimes unpredictable fluctuations in motor fxn. This "on-off" (NS) y (Phar)
264 phenomenon is thought to be a consequence of progressive nigrostriatal
neurodegeneration leading to a ↓ therapeutic window for levodopa.

Parkinson PD is typically Txwith L-DOPA (immediate precursor of DA), which Nervous Pharmacolog 7 NS
disease crosses the BBB. L-DOPA is adminwith DDCIs (e.g. carbidopa) and (NS) y (Phar)
265
sometimes COMTIs (e.g. entacapone) to ↓ the peri meta of L-DOPA,
resulting in ↑ L-DOPA bioavailability to the brain.
Parkinson DA agonists have a chem structure similar to the NT DA and directly stim Nervous Pharmacolog 7 NS
disease DA receptors. The 2 classes of DA agonists are ergot compounds (e.g. (NS) y (Phar)
703
bromocriptine) and non-ergot compounds (e.g. pramipexole, ropinirole).

Restless leg RLS is characterised by an uncomfortable sensation in the legs Nervous Pharmacolog 1 NS
#### syndrome accompanied by an urge to move them. It's worse at rest and when falling (NS) y (Phar)
asleep. DA agonists are the preferred Rx for Tx.
Seizures Older childrenwith absence seizures may also develop gen onset tonic- Nervous Pharmacolog 8 NS
clonic or myoclonic seizures. Although ethosuximide is effective against (NS) y (Phar)
249 isolated absence seizures, it isn't effective for tonic-clonic seizures.
Valproic acid is a broad-spectrum antiepileptic that Tx both types of
seizures.
Seizures Absence seizures are a type of gen epilepsy characterised by brief staring Nervous Pharmacolog 8 NS
spellswith momentary loss of awareness f/b an abrupt return to full (NS) y (Phar)
250
consciousness. A classic 3-Hz spike-wave is seen on EEG; the Tx is
ethosuximide.
Seizures SE is a single seizure lasting >5min or the occurrence of multi discrete Nervous Pharmacolog 8 NS
seizureswith incomplete recovery of consciousness b/w episodes. The (NS) y (Phar)
initial Tx incls IV lorazepam and phenytoin given concurrently. Phenytoin
353
is a long-acting anticonvulsant that inhibs neuronal high-freq firing by ↓
the ability of Na+ channels to recover from inactivation.

Seizures Broad-spectrum anticonvulsants (e.g. levetiracetam, valproic acid) Tx both Nervous Pharmacolog 8 NS
focal and gen onset seizures, whereas narrow-spectrum anticonvulsants (NS) y (Phar)
(e.g. carbamazepine, phenytoin) are 1arily used only for focal onset
355
seizures. B/c the seizures in JME are usually gen onset (i.e. affect both
cerebral hemispheres at onset), Tx iswith a broad-spectrum agent such as
valproic acid.
Seizures Ethosuximide, the 1st-line Tx for absence seizures, prevents neuronal burst Nervous Pharmacolog 8 NS
firing by blocking thalamic T-type Ca2+ channels. Phenytoin, (NS) y (Phar)
509 carbamazepine, and valproic acid inhib neuronal high-freq firing by ↓ the
ability of Na+ channels to recover from inactivation.

Seizures IV benzos (e.g. lorazepam) are the initial DOC for SE. They work by Nervous Pharmacolog 8 NS
#### enhancing the effect of GABA at the GABA-A receptor, leading to ↑ Cl- (NS) y (Phar)
influx and suppression of AP firing.
Spasticity Baclofen, an agonist at the GABA-B receptor, is effective as monoThx for Nervous Pharmacolog 1 NS
the Tx of spasticity 2° to both brain and spinal cord disease, including MS. (NS) y (Phar)
####
Tizanidine, an α-2 adrenergic agonist, is also effective and commonly used.

Subarachnoid Delayed cerebral ischemia due to cerebral vasospasm usually presents 3- Nervous Pharmacolog 4 NS
hemorrhage 12days after the initial SAHwith an acute change in mental status a/o new (NS) y (Phar)
146 focal neuro deficits. Nimodipine, a selective CCB, improves outcomes in
ptswith cerebral vasospasm by inducing cerebral vasodilation and ↓ Ca2+-
dependent excitotoxicity.
 Transient TIAs are transient episodes of focal neuro impairment that occur due to Nervous Pharmacolog 1 NS
ischemic attack local brain ischemia; tissue infarction doesn't occur, and brain imaging is (NS) y (Phar)
#### normal. Ptswith TIA are at ↑ risk of future stroke; 2° prevention incls
antiplatelet agents (e.g. aspirin, clopidogrel), statins, and LSMs (e.g.
tobacco cessation, exercise) to ↓ future risk.
Trigeminal CNV neuralgia presentswith brief episodes of sudden and severe 'electric Nervous Pharmacolog 2 NS
354 neuralgia shock-like' or 'stabbing' pain in the distribution of CNV (particularly V2 (NS) y (Phar)
and V3). Carbamazepine is the DOC.
Trigeminal The first-line treatment for trigeminal neuralgia is carbamazepine, a Nervous Pharmacolog 2 NS
neuralgia neuroleptic medication that inhibits neuronal high-frequency firing by (NS) y (Phar)
reducing the ability of sodium channels to recover from inactivation.
1199
Carbamazepine can cause bone marrow suppression; therefore, complete
blood cell counts should be monitored periodically.

Tuberculosis Isoniazid is structurally similar to vitB6. As a result, this Abx ↑ the urinary Nervous Pharmacolog 18 NS
excretion of vitB6 — often causing a frank defic of vitB6 — and competes (NS) y (Phar)
1308 for vitB6-binding sites, leading to the defective synthesis of NTs like
GABA. Isoniazid-induce neuropathy can usually be preventedwith vitB6
supplementation.
Urinary Cholinomimetics are indicated in non-obstr urinary retention, paralytic Nervous Pharmacolog 4 NS
retention ileus, and glaucoma. Their AEs incl nausea, vomiting, abdo cramps, (NS) y (Phar)
1362
diarrhoea, dyspnoea, and ↑ secretions (sweating, lacrimation, and
salivation).
Warfarin St John's wort induces CYP450 hepatic microsomal enzymes. As a result, a Nervous Pharmacolog 2 NS
1777 wide variety of drugs that're meta by these enzymes, such as warfarin, will (NS) y (Phar)
have lower plasma concs and ↓ efficacy.
Circadian The suprachiasmatic nucleus regulates circadian rhythms by processing Nervous Physiology 1 NS
rhythm light info from the retina and modulating body temp and the production of (NS) (Phys)
hormones (e.g. cortisol, melatonin). Dyssynchrony b/w the local
8573 environment (e.g. daylight hrs, sleep schedules) and internal circadian
rhythms can cause insomnia and daytime sleepiness (i.e. jet lag). Melatonin
supplementation is recommended for the Tx of insomnia associatedwith jet
lag.
Multiple The speed of conduction down an axon depends on 2 constants: the length Nervous Physiology 6 NS
sclerosis constant and the time constant (i.e. velocity = length / time). Myelination ↑ (NS) (Phys)
1318 the length constant and ↓ the time constant, both of which improve axonal
conduction speed. Demyelination thus impairs stim transmission.

Mushroom Activation of mAChRs by ACh or cholinergic agonists results in peripheral Nervous Physiology 2 NS
poisoning vasodilation due to synthesis of NO in endothelial cells, which leads to (NS) (Phys)
1361 vascular smooth muscle relaxation (e.g. hypotension). mAChR activation
in other sites causes smooth muscle contraction.

Opioids β-endorphin is 1 endogenous opioid peptide that is derived from POMC. Nervous Physiology 14 NS
POMC is a polypeptide precursor that goes thru enzymatic cleavage and (NS) (Phys)
modification to produce not only β-endorphins, but also ACTH and MSH.
775
The fact that β-endorphin and ACTH are derived from the same precursor
suggests that there may be a close physiological relationship b/w the stress
axis and the opioid system.
Resting The AP results from changes in the membrane permeability to K and Na Nervous Physiology 5 NS
membrane ions. Depol results from massive influx of Na thru v-gated Na channels. (NS) (Phys)
1380 potential and Repol occurs due to closure of v-gated Na channels and opening of v-gated
action potential K channels. K ion permeance is highest during the repol phase of the AP.

Resting Changes in membrane potential occur in response to changes in neuronal Nervous Physiology 5 NS
membrane membrane permeability to various cellular ions. The more permeable the (NS) (Phys)
2007 potential and membrane becomes for a cellular ion, the more that ion’s equilibrium
action potential potential contributes to the total membrane potential.

Resting A Rx that binds to and activates GABA-A receptors (or enhances their Nervous Physiology 5 NS
membrane activity) will ↑ the conductance of Cl ions, leading to ↑ passive transport of (NS) (Phys)
#### potential and Cl into the cell interior. This causes the membrane potential to become
action potential hyperpolarized (more (-) than the RMP) by approaching or reaching the
equilibrium potential for Cl.
Synapse V-gated Na channels are important for the generation and propagation of Nervous Physiology 1 NS
APs. When the AP reaches the axon terminal, v-gated Ca channels open (NS) (Phys)
#### and allow the influx of Ca, which is essential for the fusion and release of
NT vesicles into the synaptic cleft.

Traumatic Carbon dioxide is a potent vasodilator of cerebral vasculature. Tachypnea Nervous Physiology 5 NS
1493 brain injury causes hypocapnia and cerebral vasoconstriction, thereby decreasing (NS) (Phys)
cerebral blood volume and intracranial pressure.
 Cranial nerve
The pupillary light reflex is assessed by shining light in an eye and Ophthalm Anatomy 9 OP
palsy observing the response in that eye (direct) and the opposite eye ology (Anat)
8557 (consensual). The optic nerve (CN II) is responsible for the afferent limb of (OP)
the pupillary reflex, and the oculomotor nerve (CN III) is responsible for
the efferent limb.
Cytomegalovir The most common eye-related complication of congenital CMV infection Ophthalm Microbiolog 9 OP
#### us is chorioretinitis. ology y (Micr)
(OP)
Diabetic Chronic hyperglycemia in patients with diabetes can lead to increased Ophthalm Pathology 1 OP
retinopathy permeability and arteriolar obstruction in retinal vessels. The resulting ology (Path)
ischemia stimulates production of vascular endothelial growth factor and (OP)
#### other angiogenic factors, leading to neovascularization (proliferative
diabetic retinopathy). Complications include retinal hemorrhage, retinal
detachment, and vision loss.

Hypertensive Severe hypertension in retinal precapillary arterioles causes endothelial Ophthalm Pathology 1 OP
retinopathy disruption, leakage of plasma into the arteriolar wall, and fibrinous ology (Path)
#### necrosis. The necrotic vessels can then bleed into the nerve fiber layer, (OP)
which can be seen on examination as dot- or flame-shaped hemorrhages.

Retinoblastoma Familial retinoblastoma occurs as a result of mutations of each of the two Ophthalm Pathology 1 OP
863 Rb genes ("two hits"). These patients have an increased risk of secondary ology (Path)
tumors, especially osteosarcomas, later in life. (OP)
Wilson disease The Kayser-Fleischer ring is an ophthalmologic finding most strongly Ophthalm Pathology 5 OP
associated with Wilson's disease. It is seen most frequently in patients with ology (Path)
398
neuropsychiatric complications. Basal ganglia atrophy is typically present (OP)
in these patients.
Idiopathic Idiopathic intracranial HTN (pseudotumor cerebri) Px in young obese Ophthalm Pathophysiol 1 OP
intracranial womenwith daily h/a (which worsens during Valsalva), bilaterally ology ogy (Patp)
#### hypertension symmetric papilledema, and transient visual disturbances. ↑ ICP (OP)
compresses the optic nerves, resulting in impaired axoplasmic flow and
optic disc edema.
Macular A scotoma is a visual field defect that occurs due to a pathologic process Ophthalm Pathophysiol 2 OP
degeneration that involves parts of the retina or the optic nerve resulting in a discrete ology ogy (Patp)
1356
area of altered vision surrounded by zones of normal vision. Lesions of the (OP)
macula cause central scotomas.
Renal artery Central RAO Pxwith sudden, painless, and permanent monocular Ophthalm Pathophysiol 1 OP
360 occlusion blindness. Funduscopic Ex reveals a pale retina and a "cherry-red" macula.
ology ogy (Patp)
(OP)
Cytomegalovir CMV retinitis is the most common cause of ocular disease in ptswith unTx Ophthalm Pharmacolog 9 OP
us AIDS who have CD4 counts <50/mm3. Dx is made by funduscopy, which ology y (Phar)
1646 typically reveals yellow-white, fluffy retinal lesions near the retinal (OP)
vesselswith associated hemorrhage. Txwith ganciclovir is required to
prevent blindness.
Glaucoma OAG is Chx by progressive loss of peripheral vision from ↑ IOP. Timolol Ophthalm Pharmacolog 3 OP
and other nonselective β blockers work by diminishing the secretion of ology y (Phar)
aqueous humor by the ciliary epithelium. Acetazolamide, a CAI, also ↓ (OP)
1363 aqueous humor secretion by the ciliary epithelium. PGF2α (eg, latanoprost,
travoprost) and cholinomimetics (eg, pilocarpine, carbachol) ↓ IOP by ↑ the
outflow of aqueous humor.

Glaucoma Glaucoma is a form of optic neuropathy characterized by increased Ophthalm Pharmacolog 3 OP

intraocular pressure associated with increased production or decreased ology y (Phar)
#### outflow of aqueous humor. Topical prostaglandins (eg, latanoprost) (OP)
increase outflow of aqueous via the uveoscleral pathway and are the
preferred treatment for open-angle glaucoma.
Macular Wet age-related macular degeneration is characterized by retinal Ophthalm Pharmacolog 2 OP
degeneration neovascularization due to increased vascular endothelial growth factor ology y (Phar)
(VEGF) levels. Patients typically have acute vision loss and (OP)
7721 metamorphopsia with funduscopy showing a grayish-green subretinal
membrane and/or subretinal hemorrhage. Treatment includes smoking
cessation and VEGF inhibitor therapy (eg, ranibizumab, bevacizumab).

Lead poisoning Young children who reside in homes built before 1978 are at significant Poisoning Biochemistr 4 PO
risk for Pb toxicity. Pb directly inhibits ferrochelatase and δ-ALA & y (Bioc)
dehydratase, resulting in anemia, ALA accumulation, and ↑ Zn Environm
1454
protoporphyrin levels. Neurotoxicity is also a significant long-term ental
complication. Exposure
(PO)
 Mushroom Amatoxins are found in a variety of poisonous mushrooms (eg, Amanita Poisoning Biochemistr 2 PO
poisoning phalloides, known as death cap) and are potent inhibitors of RNA & y (Bioc)
polymerase II (halting mRNA synthesis). Environm
8482
ental
Exposure
(PO)
Lead poisoning Lead poisoning can cause neurologic (cognitive impairment Poisoning Pathology 4 PO
irritability), gastrointestinal (constipation, abdominal pain, decrease & (Path)
vit D metabolism), renal (interstitial nephritis), and hematologic (anemia) Environm
#### complications. Although symptoms can be vague, lead poisoning should be ental
suspected if these symptoms arise while residing in a home built before Exposure
1978. Diagnosis is made by measuring the patient's blood lead level. (PO)

Aspirin Aspirin intoxication should be suspected in a ptwith the triad of fever, Poisoning Pathophysiol 2 PO
poisoning tinnitus, and tachypnea. Adultswith aspirin toxicity initially develop a 1° & ogy (Patp)
resp alkalosis f/b a mixed resp alkalosis and AGMA. When the PaCO2 and Environm
1544
HCO3 are outside the normal range, a normal pH suggests a mixed ental
acidosis/alkalosis disorder, as compensatory responses do not correct the Exposure
pH completely. (PO)
Antidepressant TCA overdose can Pxwith mental status changes, seizures, prolonged QRS Poisoning Pharmacolog 4 PO
s duration, ventricular arrhythmias, and anticholinergic findings. NaHCO3 is & y (Phar)
used to Tx associated cardiac toxicity and works by ↑ serum pH and Environm
708
extracellular Na (alleviating fast Na channel blockade). ental
Exposure
(PO)
Arsenic Acute arsenic poisoning impairs cellular respiration and presents with Poisoning Pharmacolog 1 PO
poisoning abdominal pain, vomiting, diarrhea, hypotension, and a garlic odor on & y (Phar)
the breath. Insecticides and contaminated water are common sources of Environm
841
arsenic. Dimercaprol is the chelating agent of choice ental
Exposure
(PO)
Aspirin Salicylate toxicity typically presents with mixed primary respiratory Poisoning Pharmacolog
poisoning alkalosis and anion gap metabolic acidosis. Sodium bicarbonate & y (Phar)
facilitates conversion to the lipophobic ionized form of salicylate (Sal"), Environm
####
which traps much of the compound in the bloodstream and increases ental
its urinary excretion. Exposure
(PO)
Cyanide Cyanide toxicity can occur in patients Txwith nitroprusside. Cyanide Poisoning Pharmacolog 2 PO
poisoning toxicity Pxwith altered mental status, seizures, CV collapse, lactic acidosis, & y (Phar)
and bright red venous blood. Antidotal Tx of cyanide toxicity can be Environm
1254 achieved by 3 different strategies: direct binding of cyanide ions ental
(hydroxocobalamin), induction of methemoglobinemia (Na nitrite), and use Exposure
of detoxifying sulfur donors (Na thiosulfate). (PO)

Theophylline Seizures are the major cause of morbidity and mortality from theophylline Poisoning Pharmacolog 2 PO
intoxication. Tachyarrhythmias are the other major concern. & y (Phar)
Environm
172
ental
Exposure
(PO)
Toxic alcohols Ethylene glycol and methanol are toxic alcohols that cause AGMA and an Poisoning Pharmacolog 1 PO
↑ osmolar gap. Toxicity occurs after metabolization by alcohol & y (Phar)
dehydrogenase; fomepizole is a competitive inhibitor of alcohol Environm
####
dehydrogenase and is used for the Tx of acute poisoning. ental
Exposure
(PO)
Warfarin Most available rodenticides contain brodifacoum, a long-acting 4- Poisoning Pharmacolog 2 PO
hydroxycoumarin derivative. A pt who has ingested a quantity of & y (Phar)
rodenticide sufficient to cause coagulopathy and abnormal bleeding Environm
1448
(similar to warfarin toxicity) requires immediate Txwith FFP in addition to ental
vitamin K. Exposure
(PO)
Organophosphates inhibit acetylcholinesterase, leading to symptoms of Poisoning
muscarinic (mnemonic: DUMBELS) and nicotinic (neuromuscular &
dysfunction) cholinergic hyperstimulation. Management includes atropine, Environm
#### a competitive inhibitor of acetylcholine at the muscarinic receptor (reverses ental
muscarinic symptoms), followed by pralidoxime, a cholinesterase- Exposure
reactivating agent that treats both nicotinic and muscarinic symptoms. (PO)
 Antipsychotics Antipsychotic Rx work by blocking DA-2 receptors in the mesolimbic DA Pregnancy Anatomy 9 PR
pathway. DA-2 receptor blockade in the tuberoinfundibular pathway can , (Anat)
result in galactorrhea and amenorrhea. Childbirth
513
&
Puerperiu
m (PR)
Adjustment Evaluation of depressive symptoms occurring in response to psychosocial Pregnancy Behavioral 2 PR
disorders stressors must take into account the severity, duration, and degree of , Science
functional impairment. Mild or brief sadness without significant Childbirth (Beha)
####
interference in psychosocial functioning is consistent with normal &
sadness. Puerperiu
m (PR)
Adjustment Adjustment disorder involves emotional or behavioral symptoms Pregnancy Behavioral 2 PR
disorders occurring within 3 months of an identifiable stressor. The diagnosis is , Science
indicated when the patient has significant distress and impairment but does Childbirth (Beha)
####
not meet full criteria for another mental disorder. &
Puerperiu
m (PR)
Adolescent Adolescents have low treatment adherence rates due to issues with Pregnancy Behavioral 1 PR
adherence autonomy, rebellion against authority, increased self-consciousness, and a , Science
lack of understanding of potential risks. Peer behavior has a strong Childbirth (Beha)
####
influence on adherence due to adolescents' desire to fit in with their social &
groups. (Seeing peers use asthma inhalers at school) Puerperiu
m (PR)
Alcohol use Behavioural change often happens in 5 distinct stages: precontemplation Pregnancy Behavioral 3 PR
disorder (denial of the problem), contemplation (acceptance of the problem and , Science
thinking about change), preparation (planning to make a change in the Childbirth (Beha)
####
near future), action (putting active changes into place), and maintenance &
(maintaining change over the long term). Puerperiu
m (PR)
Alcohol Tremulousness is typically one of the earliest symptoms of alcohol Pregnancy Behavioral 2 PR
withdrawal withdrawal. Other common symptoms include gastrointestinal distress, , Science
agitation, anxiety, and autonomic disturbance. Delirium tremens is the Childbirth (Beha)
870
most severe manifestation of alcohol withdrawal and typically begins 48-96 &
hours after the last drink. Puerperiu
m (PR)
Anorexia Anorexia nervosa is an eating disorder characterized by low body weight, Pregnancy Behavioral 3 PR
nervosa intense fear of becoming fat, and distorted body image. Medical , Science
complications due to starvation in anorexia include bradycardia, Childbirth (Beha)
1046
hypotension, osteoporosis, and amenorrhea. &
Puerperiu
m (PR)
Anorexia Anorexia nervosa is characterized by a distorted body image and fear of Pregnancy Behavioral 3 PR
nervosa weight gain despite significantly low body weight. Patients may restrict , Science
their food intake and/or binge and purge. The key in distinguishing Childbirth (Beha)
####
anorexia nervosa from bulimia nervosa is abnormally low body weight. &
Puerperiu
m (PR)
Antidepressant Antidepressants (eg, selective serotonin reuptake inhibitors) take 4-6 Pregnancy Behavioral 4 PR
s weeks to achieve maximal clinical effect. (Inadequate duration of , Science
treatment) Childbirth (Beha)
####
&
Puerperiu
m (PR)
Antipsychotics Tardive dyskinesia consists of abnormal involuntary movements of the Pregnancy Behavioral 9 PR
mouth, tongue, face, extremities, or trunk associated with prolonged , Science
exposure to antipsychotics. Characteristic movements include lip Childbirth (Beha)
511
smacking, facial grimacing, tongue protrusions, and choreoathetoid &
movements of the head, limbs, and trunk. Puerperiu
m (PR)
Antipsychotics As a class, second-generation antipsychotics are associated with metabolic Pregnancy Behavioral 9 PR
adverse effects (eg, weight gain, dyslipidemia, hyperglycemia, increased , Science
risk of diabetes). Within the class, olanzapine and clozapine carry the Childbirth (Beha)
####
greatest risk. (Checkup Fasting glucose and lipid panel) &
Puerperiu
m (PR)
Anxiety The differential diagnosis of anxiety includes medical conditions and Pregnancy Behavioral 1 PR
substance-induced etiologies (eg, intoxication, withdrawal). Primary , Science
anxiety disorders are not diagnosed when anxiety is caused by the Childbirth (Beha)
####
physiological effects of a medical condition (eg, hyperthyroidism) or drug. &
Puerperiu
m (PR)
 Attention Attention-deficit hyperactivity disorder is characterized by a pattern of Pregnancy Behavioral 5 PR
deficit inattention and/or hyperactivity/impulsivity that interferes with functioning , Science
hyperactivity in >2 settings. Childbirth (Beha)
####
disorder &
Puerperiu
m (PR)
Attention Stimulant medications are a first-line treatment for attention-deficit Pregnancy Behavioral 5 PR
deficit hyperactivity disorder. They work by increasing the availability of , Science
hyperactivity norepinephrine and dopamine in the prefrontal cortex. Childbirth (Beha)
####
disorder &
Puerperiu
m (PR)
Attention Decreased appetite and insomnia are the most common adverse effects Pregnancy Behavioral 5 PR
deficit of psychostimulant medications used to treat attention-deficit hyperactivity , Science
hyperactivity disorder. They are usually mild and can be managed without stopping the Childbirth (Beha)
####
disorder medication. &
Puerperiu
m (PR)
Attention Attention-deficit hyperactivity disorder (ADHD) often persists into Pregnancy Behavioral 5 PR
deficit adulthood. Adults with ADHD are less overtly hyperactive but experience , Science
hyperactivity chronic problems with distractibility, disorganization, and impulsivity that Childbirth (Beha)
####
disorder cause significant social and occupational impairment. &
Puerperiu
m (PR)
Attention Diagnosis of b requires evidence of inattentive and/or Pregnancy Behavioral 5 PR
deficit hyperactive/impulsive symptoms for >6 months in >2 settings (eg, home, , Science
hyperactivity school, after-school program). Teacher evaluations can assist in Childbirth (Beha)
####
disorder diagnosis. &
Puerperiu
m (PR)
Autism Autism spectrum disorder is characterized by impaired social Pregnancy Behavioral 2 PR
spectrum communication/interactions and restricted, repetitive interests or behaviors. , Science
disorders It can occur with or without language and intellectual impairment. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Autism Patients with milder forms of autism spectrum disorder frequently have Pregnancy Behavioral 2 PR
spectrum normal language and cognitive development. Characteristic features , Science
disorders include deficits in social communication and reciprocal social Childbirth (Beha)
####
interactions, restricted interests, and behavioral rigidity that become &
more apparent as social and academic demands increase. Puerperiu
m (PR)
Behavioural Classical conditioning involves a neutral stimulus being repeatedly paired Pregnancy Behavioral 1 PR
responses with a non-neutral stimulus that elicits a reflexive, unconditioned response. , Science
Over time, the formerly neutral stimulus is able to evoke a conditioned Childbirth (Beha)
1729
response by itself in absence of the non-neutral stimulus. &
Puerperiu
m (PR)
Benzodiazepin When benzodiazepines are used in the treatment of anxiety, drug selection Pregnancy Behavioral 6 PR
es should consider the medication’s duration of action. Short- to intermediate- , Science
acting benzodiazepines (eg, lorazepam) are preferred in situations in Childbirth (Beha)
1352
which prolonged side effects of sedation and cognitive impairment must be &
minimized. periods of increased anxiety before bedtime Puerperiu
m (PR)
Bipolar diagnosis of attention-deficit hyperactivity disorder requires evidence of Pregnancy Behavioral 7 PR
disorder inattentive and/or hyperactive/impulsive symptoms for >6 months in >2 , Science
settings (eg, home, school, after-school program). Teacher evaluations can Childbirth (Beha)
518
assist in diagnosis. &
Puerperiu
m (PR)
Bipolar The anticonvulsant valproate has mood-stabilizing properties and is an Pregnancy Behavioral 7 PR
disorder effective maintenance treatment for bipolar disorder. Other maintenance , Science
options for bipolar disorder include lithium, lamotrigine, and quetiapine. Childbirth (Beha)
1348
&
Puerperiu
m (PR)
Bipolar Patients who experience major depressive and hypomanic episodes are Pregnancy Behavioral 7 PR
disorder diagnosed with bipolar II disorder. In contrast to manic episodes, , Science
hypomanic episodes are less severe, do not involve psychosis, and cause a Childbirth (Beha)
####
lesser degree of functional impairment. &
Puerperiu
m (PR)
 Bipolar Patients experiencing a major depressive episode should be carefully Pregnancy Behavioral 7 PR
disorder screened for past manic episodes to rule out bipolar disorder. , Science
Antidepressant monotherapy should be avoided in patients with bipolar Childbirth (Beha)
####
disorder due to the risk of precipitating mania. &
Puerperiu
m (PR)
Bipolar Bipolar I disorder is diagnosed in patients with >1 episodes of mania. Pregnancy Behavioral 7 PR
disorder Manic episodes are characterized by elevated/irritable mood, impulsivity, , Science
hyperactivity, decreased need for sleep, pressured speech, and grandiosity Childbirth (Beha)
####
and may occur with psychotic features. &
Puerperiu
m (PR)
Bipolar Manic episodes are characterized by euphoric/irritable mood, impulsivity, Pregnancy Behavioral 7 PR
disorder hyperactivity, decreased need for sleep, pressured speech, racing , Science
thoughts, and grandiosity. They may occur with or without psychotic Childbirth (Beha)
####
features. &
Puerperiu
m (PR)
Body BDD involves fixation on a perceived defect in appearance and repetitive Pregnancy Behavioral 1 PR
dysmorphic behaviours in response to the fixation. It can presentwith absent , Science
disorder insight/delusional beliefs and result in significant psychosocial dysfxn. Childbirth (Beha)
1346
&
Puerperiu
m (PR)
Bulimia BN is characterised by episodes of binge eating and compensatory weight- Pregnancy Behavioral 4 PR
nervosa ↓ behaviours. SSx of self-induced vomiting incl hypokalaemia, meta , Science
alkalosis, parotid gland enlargement, dorsal hand calluses, and dental Childbirth (Beha)
1843
erosion. &
Puerperiu
m (PR)
Bulimia BN is characterised by recurrent episodes of binge eating f/b compensatory Pregnancy Behavioral 4 PR
nervosa behaviours to prevent weight gain (e.g. fasting, exercising, vomiting, using , Science
laxatives). In contrast to ptswith AN, BN patients are normal weight to Childbirth (Beha)
2050
overweight. &
Puerperiu
m (PR)
Bulimia Tx options for bulimia nervosa incl nutritional rehab, CBT, and Rxwith Pregnancy Behavioral 4 PR
nervosa SSRIs. Fluoxetine is the DOC. , Science
Childbirth (Beha)
####
&
Puerperiu
m (PR)
Bulimia Hypokalaemia in an otherwise healthy young adultwith a normal BMI and Pregnancy Behavioral 4 PR
nervosa preoccupwith body size is concerning for self-induced vomiting a/w BN. , Science
Common PEx findings in BN incl tachycardia, hypotension, painless Childbirth (Beha)
####
parotid gland swelling, calluses or scarring on the dorsum of the hand, and &
erosion of dental enamel. Puerperiu
m (PR)
Cannabis Marijuana contains tetrahydrocannabinol, which stims cannabinoid Pregnancy Behavioral 1 PR
receptors to produce a mild euphoriawith inappropriate laughter, ↑ , Science
appetite, slowed rxn time/motor speed, and cognitive impairment. Childbirth (Beha)
1289
Tachycardia and conjunctival injection are the 2 most immediate physical &
SSx of marijuana use. Puerperiu
m (PR)
Child and Adolescence often involves some degree of moodiness, intense self- Pregnancy Behavioral 1 PR
adolescent consciousness and transient emotional outbursts. Assessment of severity, , Science
mental health persistence, and degree of social and academic impairment can help Childbirth (Beha)
####
differentiate normal adolescent behavior from behavioral changes &
requinng further evaluation. Puerperiu
m (PR)
Cocaine Cocaine withdrawal is characterised by the devel of acute depression Pregnancy Behavioral 3 PR
accompanied by fatigue, hypersomnia, hyperphagia, and vivid dreams. , Science
Childbirth (Beha)
####
&
Puerperiu
m (PR)
Cocaine Cocaine intox can produce psychotic SSx (e.g. paranoid delusions), Pregnancy Behavioral 3 PR
euphoria, and agitation. Physical SSx indicating sympathetic stim (e.g. , Science
tachycardia, diaphoresis, mydriasis) can assist in diffiating cocaine intox Childbirth (Beha)
####
from 1° psychiatric disorders. &
Puerperiu
m (PR)
 Complementary Physicians should routinely ask their patients about the use of herbal preps Pregnancy Behavioral 1 PR
and alternative and nutritional supplements and advise them on the quality, safety, and , Science
medicine efficacy of these products. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Conduct Conduct disorder involves a persistent pattern of violating major societal Pregnancy Behavioral 1 PR
disorder norms or the rights of others. Behaviors include aggression toward people , Science
and animals, deceitfulness or theft, destruction of property, and serious Childbirth (Beha)
####
violation of rules. &
Puerperiu
m (PR)
Conversion Conversion disorder is characterized by neurologic symptoms and Pregnancy Behavioral 1 PR
disorder examination findings that are incompatible with a known neurological , Science
disease. Patients do not consciously produce the symptoms like in Childbirth (Beha)
1433
factitious disorder or malingering, and the condition may cause significant &
distress/impairment. Puerperiu
m (PR)
Defense In displacement, emotions are transferred from the person causing the (-) Pregnancy Behavioral 8 PR
mechanisms emotions to a more neutral, less threatening person or object. , Science
Childbirth (Beha)
1234
&
Puerperiu
m (PR)
Defense Splitting is a defence mech that involves organising experiences of the self Pregnancy Behavioral 8 PR
mechanisms or others into extremes to keep (+) and (-) aspects separated. It's commonly , Science
seen in ptswith BPD. Childbirth (Beha)
1350
&
Puerperiu
m (PR)
Defense Suppression is a mature defence mech involving a conscious choice not to Pregnancy Behavioral 8 PR
mechanisms dwell on a particular thought or feeling. , Science
Childbirth (Beha)
1351
&
Puerperiu
m (PR)
Defense Projection is an immature defence mech involving the misattribution of 1's Pregnancy Behavioral 8 PR
mechanisms unacceptable feelings or thoughts to another person who doesn't actually , Science
have them. Childbirth (Beha)
1429
&
Puerperiu
m (PR)
Defense Rxn formation is a defence mech that involves replacing unacceptable Pregnancy Behavioral 8 PR
mechanisms feelings and impulseswith their extreme opposites. , Science
Childbirth (Beha)
1459
&
Puerperiu
m (PR)
Defense Passive aggression is the expression of angry feelings in a non- Pregnancy Behavioral 8 PR
mechanisms confrontational manner. , Science
Childbirth (Beha)
2051
&
Puerperiu
m (PR)
Defense Transference is the unconscious shifting of emotions a/w a significant Pregnancy Behavioral 8 PR
mechanisms person from 1's past to a person in the present. , Science
Childbirth (Beha)
2053
&
Puerperiu
m (PR)
Defense Countertransference consists of a provider's response (e.g. attitudes, Pregnancy Behavioral 8 PR
mechanisms thoughts, feelings, behaviours) toward a pt based on past personal , Science
relationships. Countertransference can be (+) or (-), conscious or Childbirth (Beha)
####
unconscious; if unrecognised, it may have detrimental effects on pt care. &
Puerperiu
m (PR)
Delirium Delirium is a reversible, acute-onset confusional state characterised by a Pregnancy Behavioral 4 PR
fluctuating lvl of consciousnesswith deficits in attn, memory, and executive , Science
fxn. In contrast, dementia has a gradual onset, is irreversible, and doesn't Childbirth (Beha)
2122
involve fluctuations in consciousness. &
Puerperiu
m (PR)
 Delirium Delirium may MFx as acute changes in cognition and behaviour. When Pregnancy Behavioral 4 PR
non-Rx interventions are ineffective, low-dose antipsychotics (e.g. , Science
haloperidol) are the Rx of choice to Tx the behavioural (e.g. severe Childbirth (Beha)
####
agitation) and psychotic MFxs of delirium. &
Puerperiu
m (PR)
Delirium Delirium is frequently associated with psychotic symptoms. It is Pregnancy Behavioral 4 PR
differentiated from primary psychotic disorders by fluctuating levels of , Science
consciousness, impaired attention and disorientation. Delirium can occur Childbirth (Beha)
####
postoperatively and/or in association with underlying medical illnesses &
or the introduction of certain medications. Puerperiu
m (PR)
Depersonalizati D/DD is a dissociative disorder involving recurrent episodes of feeling Pregnancy Behavioral 1 PR
on disorder detached from 1's body or surroundings a/o feelings of unreality. , Science
Childbirth (Beha)
####
&
Puerperiu
m (PR)
Depression MAOIs are particularly useful in ptswith Tx-resistant MDDwith atypical Pregnancy Behavioral 8 PR
features. ↑ appetite and sleep, leaden paralysis, rejection sensitivity, and , Science
mood reactivity are hallmarks of the atypical subtype. Childbirth (Beha)
573
&
Puerperiu
m (PR)
Depression Postpartum mood disturbances incl postpartum blues, postpartum Pregnancy Behavioral 8 PR
depression, and, rarely, postpartum psychosis. The most common , Science
disturbance, postpartum blues, is a benign self-limited condition that begins Childbirth (Beha)
1430
several days postpartum and resolveswithi 14dayswitho intervention. &
Puerperiu
m (PR)
Depression Major depressive disorder (MDD) with psychotic features is a severe Pregnancy Behavioral 8 PR
subtype of unipolar major depression characterized by symptoms meeting , Science
the criteria for MDD and the presence of delusions and/or hallucinations. Childbirth (Beha)
####
require combined treatment with an antidepressant and anti psychotic &
or electroconvulsive therapy. Puerperiu
m (PR)
Depression Suicide risk Ax incls consideration of both RFs and protective factors. A Pregnancy Behavioral 8 PR
Hx of a previous suicide attempt is the strongest single RF for further , Science
attempatients and completed suicide. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Depression Ptswith sufficient depressive SSx are Dxwith MDD even if there's a clear Pregnancy Behavioral 8 PR
psychosocial stressor that precipitated the depression. , Science
Childbirth (Beha)
####
&
Puerperiu
m (PR)
Depression Most available antidepressants target the neurotransmission of serotonin or Pregnancy Behavioral 8 PR
norepinephrine, or both. Inhibition of serotonin reuptake by blocking the , Science
serotonin transporter is the primary mechanism of action of selective Childbirth (Beha)
####
serotonin reuptake inhibitors. &
Puerperiu
m (PR)
Depression Somatic SSx of depression (weight loss, low energy, sleep disturbance) are Pregnancy Behavioral 8 PR
less reliable indicators of MDD in ptswith advanced medical illness. , Science
Focusing on non-somatic SSx, such as loss of interest, anhedonia, Childbirth (Beha)
####
worthlessness, excessive guilt, and suicidality, can assist in Dx comorbid &
depression in these pts. Puerperiu
m (PR)
Depression Depression-related cognitive impairment refers to cognitive impairment Pregnancy Behavioral 8 PR
that occurs in the context of MDD, which may be mistaken for mild , Science
cognitive impairment or dementia. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Developmental By age 3, a child is expected to play imaginatively in parallelwith others, Pregnancy Behavioral 1 PR
milestones speak in simple sentences, copy a circle, use utensils, and ride a tricycle. , Science
Childbirth (Beha)
1781
&
Puerperiu
m (PR)
 Dysthymia The DSM-5 Dx of dysthymia is characterised by chronic depressed mood Pregnancy Behavioral 1 PR
and at least 2 other depressive SSx lasting for at least 2yrs. , Science
Childbirth (Beha)
1347
&
Puerperiu
m (PR)
Erectile Premature ejaculation is characterised by recurrent episodes of early Pregnancy Behavioral 3 PR
dysfunction ejaculation accompanied by a sense of lack of control. Eval of any sexual , Science
disorder req taking careful med and substance use Hx and Ax psychosocial Childbirth (Beha)
####
stressors and comorbid psych conditions. &
Puerperiu
m (PR)
Ethical patients have the right to make decisions about their healthcare. However, Pregnancy Behavioral 3 PR
principles in based on the principle of non-maleficence, the prescription of Rx likely to , Science
healthcare do more harm than good should be avoided, even if requested by pts. Childbirth (Beha)
1182
&
Puerperiu
m (PR)
Factitious Factitious disorder involves the conscious and deceptive feigning or self- Pregnancy Behavioral 1 PR
disorder production of physical or psychological SSx to obtain attn and medical care , Science
from health care personnel. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Generalized SSRIs and SNRIs are 1st-line Rx for GAD. BZDs should be limited to Pregnancy Behavioral 4 PR
anxiety short-term use while antidepressants take effect and avoided in ptswith a , Science
disorder Hx of substance abuse. Childbirth (Beha)
248
&
Puerperiu
m (PR)
Generalized GAD involves excessive uncontrollable worry about multi issueswith a SSx Pregnancy Behavioral 4 PR
anxiety duration of >6mos. assoc SSx incl restlessness, muscle tension, fatigue, , Science
disorder sleep disturbance, irritability, and difficulty concentrating. Childbirth (Beha)
2048
&
Puerperiu
m (PR)
Grief Transient behavioral disturbances are common in children after the Pregnancy Behavioral 3 PR
death of a loved one. Hallucinations of recently deceased relatives are part , Science
of a normal grief reaction and may not be indicative of major psychiatric Childbirth (Beha)
####
illness. &
Puerperiu
m (PR)
Grief Normal grief presentswith SSx similar to those of a major depressive Pregnancy Behavioral 3 PR
episode. However, in normal grief, pervasive anhedonia, worthlessness, , Science
and suicidality aren't present. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Grief Preschool children haven't developed an understanding of the finality of Pregnancy Behavioral 3 PR
death, which typically occurs around age 7. They may have magical , Science
thoughts that death is temporary or reversible and believe that other Childbirth (Beha)
####
people's grief is their fault. &
Puerperiu
m (PR)
Illness anxiety Illness anxiety disorder is characterized by excessive concern about Pregnancy Behavioral 1 PR
disorder having a serious, undiagnosed disease, despite few or no symptoms and , Science
negative medical workup. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Impulse control IED is characterised by recurrent episodes of explosive verbal or physical Pregnancy Behavioral 1 PR
disorders aggression. The aggressive behaviours are impulsive and grossly out of , Science
proportion to the provocation. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Inhalants Inhalant intox is characterised by immediate onset of euphoria, lethargy, Pregnancy Behavioral 1 PR
ataxia, a/o LOC f/b rapid recoverywithi 45mins. Perioral and perinasal , Science
dermatitis (i.e. 'glue sniffer's rash') may be seen in chronic users. Childbirth (Beha)
####
&
Puerperiu
m (PR)
 Insomnia Age-related sleep changes may be reported as insomnia and must be Pregnancy Behavioral 3 PR
diffiated from 1° sleep disorders and other disorders. Normal changes incl , Science
↓ total sleep time, ↑ night-time awakenings, sleepiness earlier in the Childbirth (Beha)
####
eveningwith earlier morning awakening, and ↑ daytime napping. &
Puerperiu
m (PR)
Iron deficiency Pica is the compulsive consumption of a non-nutritive a/o non-staple food. Pregnancy Behavioral 7 PR
anemia It's common in preg and is often a/w IDA and other forms of nutritional , Science
defic. Childbirth (Beha)
8893
&
Puerperiu
m (PR)
Language At age 2, children should have a vocab of 50-200 words and be using 2- Pregnancy Behavioral 1 PR
disorder word phrases. Parents' concerns about delayed milestones should be , Science
validated; they should be reassured that children often catch up but may Childbirth (Beha)
####
need help. Further eval and regular monitoring are req. &
Puerperiu
m (PR)
Learning Learning disorders are characterised by difficultieswith key academic skills Pregnancy Behavioral 1 PR
disorders (reading, writing, or math), resulting in performance well below , Science
expectations for age. Providers should consider a possible learning disorder Childbirth (Beha)
####
in any school-aged childwith behavioural, academic, or social difficulties at &
school. Puerperiu
m (PR)
Mental status Quick clinical tests to Ax attn and conc incl counting down from 100 by Pregnancy Behavioral 1 PR
examination intervals of 3 or 7, reciting the mos of the yr in reverse order, and spelling , Science
'world' backwards. Childbirth (Beha)
8295
&
Puerperiu
m (PR)
Narcolepsy Narcolepsy is a chronic sleep disorder characterised by excessive daytime Pregnancy Behavioral 3 PR
sleepiness, cataplexy, and REM sleep-related phenomena (i.e. , Science
hypnagogic/hypnopompic hallucinations, sleep paralysis). Childbirth (Beha)
1458
&
Puerperiu
m (PR)
Narcolepsy Hypocretin-1 (orexin-A) and hypocretin-2 (orexin-B) are neuropeptides Pregnancy Behavioral 3 PR
produced in the lateral hypothalamus that promote wakefulness and , Science
inhibit REM sleep-related phenomena. Most patients who have narcolepsy Childbirth (Beha)
8878
with cataplexy have undetectable levels of hypocretin-1 in their &
cerebrospinal fluid. Puerperiu
m (PR)
Normal child Although children understand the concept of gender by age 3-4 and have a Pregnancy Behavioral 2 PR
development sense of the permanence of gender around age 5-6, it is normal for them , Science
to explore activities culturally associated with the opposite gender. In Childbirth (Beha)
#### contrast gender dysphoria is diagnosed when there is marked distress &
associated with a prolonged and intense feeling that one is a different Puerperiu
gender from one's birth sex. m (PR)
gender by age.
Normal child Short attn span and varying degrees of hyperactivity and impulsivity are Pregnancy Behavioral 2 PR
development commonly seen in children under age 4. ADHD shouldn't be Dx until age 4- , Science
5. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Obsessive OCD is characterised by persistent, intrusive thoughts leading to repetitive, Pregnancy Behavioral 2 PR
compulsive ritualistic behaviours. SSRIs are considered 1st-line Tx for OCD and exert , Science
disorder their effects by inhib 5-HT reuptake. Childbirth (Beha)
2049
&
Puerperiu
m (PR)
Obsessive OCD is characterised by persistent, unwanted thoughts (obsessions) and Pregnancy Behavioral 2 PR
compulsive repetitive, time-consuming rituals (compulsions) that the individual feels , Science
disorder driven to perform to alleviate anxiety. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Opioids Methadone and buprenorphine are a potent, long-acting opioid agonist Pregnancy Behavioral 14 PR
used in the maintenance treatment of opioid use disorder. Its prolonged , Science
effects suppress withdrawal symptoms and cravings . Childbirth (Beha)
1287
&
Puerperiu
m (PR)
 Opioids Opioid withdrawal is marked by mydriasis, abdominal pain, diarrhea, Pregnancy Behavioral 14 PR
piloerection, lacrimation, and yawning. It is generally nonlife- , Science
threatening. unlike withdrawal from alcohol and benzodiazepines. Childbirth (Beha)
1353
&
Puerperiu
m (PR)
Opioids When abuse of prescription opioids is suspected, physicians should 1st Pregnancy Behavioral 14 PR
engage patients in a non-judgemental, collaborative discussion to , Science
understand the reasons for the misuse. Childbirth (Beha)
8943
&
Puerperiu
m (PR)
Opioids In the US, the majority of overdose deaths are caused by opioids, incl Pregnancy Behavioral 14 PR
prescription analgesics and heroin. , Science
Childbirth (Beha)
8954
&
Puerperiu
m (PR)
Oppositional ODD is a behavioural disorder of childhood characterised by Pregnancy Behavioral 1 PR
defiant disorder argumentative and defiant behaviour toward authority figures. It doesn't , Science
involve the more severe violations of the basic rights of others seen in CD. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Panic disorder PD involves recurrent, unexpected panic atks characterised by an abrupt Pregnancy Behavioral 4 PR
surge of fear accompanied by physical and cognitive SSx. Individuals , Science
experience persistent worry about future atks and typically restrict their Childbirth (Beha)
####
activities as a result. &
Puerperiu
m (PR)
Panic disorder PD is characterised by recurrent, unexpected panic atks and should be Pregnancy Behavioral 4 PR
considered in young, healthy adults who come to the EDwith unexplained , Science
chest pain. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Panic disorder Rx of PD incls SSRIs and benzos. SSRIs are often preferred to benzos due Pregnancy Behavioral 4 PR
to the lack of phys dependence and abuse potential. , Science
Childbirth (Beha)
####
&
Puerperiu
m (PR)
Panic disorder PD consists of recurrent and unexpected panic atks characterised by an Pregnancy Behavioral 4 PR
abrupt surge of anxiety and distressing cardiopulm/neuro SSx. , Science
Agoraphobia, a common comorbid disorder, results in anxiety about and Childbirth (Beha)
####
avoidance of situations where patients may feel trapped and helpless in the &
event of a panic atk (e.g. crowds, enclosed spaces, public transportation. Puerperiu
m (PR)
Personality APD is a maladaptive pattern of behaviour characterised by social inhib, Pregnancy Behavioral 6 PR
disorders feelings of inadequacy, and fear of embarrassment and rejection. , Science
Childbirth (Beha)
1431
&
Puerperiu
m (PR)
Personality BPD is characterised by a persistent pattern of unstable relationships, mood Pregnancy Behavioral 6 PR
disorders lability, and impulsivity. Individualswith this disorder may exhibit suicidal , Science
ideation or behaviour in the context of an interpersonal crisis in which they Childbirth (Beha)
####
feel rejected or abandoned. &
Puerperiu
m (PR)
Personality Individualswith PPD exhibit a lifelong pattern of pervasive suspicion and Pregnancy Behavioral 6 PR
disorders distrust. Unlike ptswith psychotic disorders, they don't have fixed delusions , Science
and other psychotic SSx. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Personality Schizotypal personality disorder is characterized by a long-standing Pregnancy Behavioral 6 PR
disorders pattern of eccentric behavior, odd beliefs, perceptual distortions, and social , Science
anxiety despite familiarity Childbirth (Beha)
####
&
Puerperiu
m (PR)
 Personality ASPD involves a pattern of violating the rights of others, engaging in Pregnancy Behavioral 6 PR
disorders unlawful behaviours (e.g. physical aggression, illegal occups), and lacking , Science
remorse for transgressions. Individuals must be age >18 for Dx and have a Childbirth (Beha)
####
Hx of CD prior to age 15. &
Puerperiu
m (PR)
Personality Schizoid personality disorder consists of a persistent pattern of social Pregnancy Behavioral 6 PR
disorders detachment, preference for solitary activities, and constricted range of , Science
affect in social interactions. says "I 've always liked being on my own" Childbirth (Beha)
####
&
Puerperiu
m (PR)
Phencyclidine PCP is 1arily an NMDA receptor antagonist,with lesser effects on the Pregnancy Behavioral 2 PR
reuptake inhib of biogenic amines and other receptors. It can have , Science
dissociative and anaesthetic effects but may also cause psychosis and Childbirth (Beha)
1165
severe agitation, leading to violent trauma. Ataxia, horizontal and vertical &
nystagmus, and memory loss can also be present. Puerperiu
m (PR)
Phencyclidine PCP is a hallucinogen that causes dissociative SSx, agitation, Pregnancy Behavioral 2 PR
hallucinations, and violent behaviour. Ataxia, nystagmus, and memory loss , Science
are other distinguishing SSx of PCP abuse. Childbirth (Beha)
1288
&
Puerperiu
m (PR)
Physician When confronting an angry patient, the physician should use a non- Pregnancy Behavioral 11 PR
patient defensive, empathic approach that acknowledges the patient's anger and , Science
communication attempatients to build a collaborative physician-patient relationship. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Physician Physicians may become frustratedwith a pt who's hopeless about Tx, often Pregnancy Behavioral 11 PR
patient compelling them to refer the pt to a specialist. Empathisingwith the pt's , Science
communication frustration over past Tx failures can help build the physician-pt Childbirth (Beha)
####
relationship. &
Puerperiu
m (PR)
Physician Empiric Abx therapy for ptswith uncomplicated URIs is c/i. patients Pregnancy Behavioral 11 PR
patient requesting Abx prescriptions should be educated in a non-judgemental , Science
communication manner about the lack of efficacy and AEs of Abx therapy. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Post-traumatic Post-traumatic stress disorder is characterized by intrusive thoughts, Pregnancy Behavioral 3 PR
stress disorder nightmares, flashbacks, avoidance of trauma reminders, hypervigilance, , Science
and sleep disturbance lasting >1 month. Childbirth (Beha)
2123
&
Puerperiu
m (PR)
Post-traumatic First-line treatment for post-traumatic stress disorder includes trauma- Pregnancy Behavioral 3 PR
stress disorder focused cognitive-behavioral therapy and antidepressant medication. , Science
Selective serotonin reuptake inhibitors have the best evidence for efficacy. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Post-traumatic Acute stress disorder is characterised by intrusive experiences (flashbacks, Pregnancy Behavioral 3 PR
stress disorder nightmares), arousal (poor conc, restless sleep), dissociative SSx, and , Science
avoidance of traumatic reminders, as well as mood disturbances in Childbirth (Beha)
####
response to a life-threatening trauma. SSx last b/w 3days and 1mos. &
Puerperiu
m (PR)
Priapism Trazodone is a highly sedating antidepressant commonly used to treat Pregnancy Behavioral 1 PR
insomnia. Priapism is a rare but serious adverse effect. , Science
Childbirth (Beha)
707
&
Puerperiu
m (PR)
Professional Physicians are ethically obligated to question orders that raise concern Pregnancy Behavioral 4 PR
conduct about potential harm to pts. Issues should initially be discussed directlywith , Science
the physician who made the order and not involve ancillary staff. Childbirth (Beha)
970
&
Puerperiu
m (PR)
 Psychosis DD is characterised by >1 delusions for >1mos in the absence of other Pregnancy Behavioral 6 PR
psychotic SSx. Behaviour isn't obvi bizarre, and fxning isn't significantly , Science
impaired apart from the direct impact of the delusions. Childbirth (Beha)
2046
&
Puerperiu
m (PR)
Psychosis Schizophreniform disorder is characterised by psychotic SSx (delusions, Pregnancy Behavioral 6 PR
hallucinations, disorganised speech and behaviour, (-) SSx) lasting >1mos , Science
and <6mos. Childbirth (Beha)
2063
&
Puerperiu
m (PR)
Psychosis In addition to positive psychotic symptoms (eg delusions, hallucinations, Pregnancy Behavioral 6 PR
disorganization), patients with schizophrenia frequently exhibit negative , Science
symptoms such as fiat affect (ie lack of facial expression). Negative Childbirth (Beha)
####
symptoms typically persist between acute psychotic episodes and are more &
resistant to treatment. Puerperiu
m (PR)
Psychosis Brief psychotic disorder is characterised by >1 psychotic SSx lasting >1day Pregnancy Behavioral 6 PR
and <1moswith full return to previous lvls of fxning. Onset is typically , Science
sudden and a/w a stressor. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Psychosis Huntington Disease is an autosomal dominant, progressive Pregnancy Behavioral 6 PR
neurodegenerative disorder characterized by chorea, psychiatric symptoms, , Science
and dementia. Psychiatric symptoms may occur early in the disease course Childbirth (Beha)
####
and include irritability, anxiety, apathy, depression, and psychosis. &
Puerperiu
m (PR)
Rett syndrome Rett syndrome is characterised by loss of speech and motor skill, Pregnancy Behavioral 1 PR
deceleration of head growth, and stereotypically purposeless hand , Science
movements after a period of normal devel. It affects mainly girls and is a/w Childbirth (Beha)
####
muts in the MECP2 gene. &
Puerperiu
m (PR)
Schizoaffective For diagnosis of schizoaffective disorder, psychosis must occur in the Pregnancy Behavioral 1 PR
disorder absence of major mood episodes, but mood episodes must be present for a , Science
majority of this lifelong illness. In bipolar disorder and major depression Childbirth (Beha)
2047
with psychotic features, psychotic symptoms occur exclusively during &
mood episodes. Puerperiu
m (PR)
Schizophrenia The Dx of schizophrenia req >2 of the following 5 SSx: delusions, Pregnancy Behavioral 4 PR
hallucinations, disorganised speech, grossly disorganised behaviour, and (- , Science
) SSx. The total impairment duration must be >6mos. Childbirth (Beha)
2045
&
Puerperiu
m (PR)
Schizophrenia The antipsychotic clozapine is the DOC for Tx-resistance schizophrenia. Pregnancy Behavioral 4 PR
Tx req monitoring of the absolute neutrophil count due to the risks of , Science
neutropaenia and agranulocytosis. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Schizophrenia (+) SSx of schizophrenia (e.g. delusions, hallucinations) are a/w ↑ activity Pregnancy Behavioral 4 PR
of DA in the mesolimbic pathway. Antipsychotics work by antagonising , Science
DA receptors in this pathway. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Schizophrenia 2nd-gen antipsychotics are a/w a lower risk of EPS AEs comparedwith 1st- Pregnancy Behavioral 4 PR
gen antipsychotics but may cause metabolic AEs. , Science
Childbirth (Beha)
####
&
Puerperiu
m (PR)
Selective Selective serotonin reuptake inhibitors (SSRIs) (sertraline) have improved Pregnancy Behavioral 3 PR
serotonin tolerability and a better side-effect profile compared with tncyclic , Science
reuptake antidepressants and monoamine oxidase inhibitors but are associated with Childbirth (Beha)
576
inhibitors sexual dysfunction. Physicians should routinely inquire about sexual &
dysfunction because it is a relatively common side effect of SSRIs that may Puerperiu
lead to nonadherence m (PR)
 Separation SAD consists of excessive and distressing anxiety (>4wks in children, Pregnancy Behavioral 1 PR
anxiety >6mos in adults) due to separation from attachment figures. Childrenwith , Science
disorder this disorder often experience physical SSx and nightmares. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Social anxiety SAD involves excessive fear of scrutiny or embarrassment in social or Pregnancy Behavioral 2 PR
disorder performance situations, resulting in significant distress and fxnal , Science
impairment. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Social anxiety SAD is characterised by anxiety and fear of scrutiny in social situations Pregnancy Behavioral 2 PR
disorder and can result in marked social-occup impairment. Preferred , Science
pharmacotherapy is Rx that inhibs 5-HT reuptake (e.g. SSRIs or SNRIs). Childbirth (Beha)
####
&
Puerperiu
m (PR)
Somatic SSD is best Mxwith regularly scheduled medical visits that aren't Pregnancy Behavioral 1 PR
symptom contingent on having active SSx. Unnecessary Dx testing and specialist , Science
disorder referrals should be avoided. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Specific phobia Exposure-based cognitive-behavioral therapy, in which patients are Pregnancy Behavioral 1 PR
systematically confronted with their feared objects or situations, is the most , Science
effective long-term treatment for specific phobia. Childbirth (Beha)
####
&
Puerperiu
m (PR)
Substance use Physicians have a responsibility to ID SSx of potential drug-seeking Pregnancy Behavioral 1 PR
disorders behaviour and prescription drug misuse. This involves being alert to red , Science
flags (e.g. lost or stolen Rx, pain inconsistentwith PEx) and attempting to Childbirth (Beha)
####
clarify Rx Hx by using prescription drug-monitoring programs or other info &
sources. Puerperiu
m (PR)
Substance- Stimulant intoxication can present with paranoid ideation and must be Pregnancy Behavioral 1 PR
induced differentiated from primary psychiatric disorders. Physical signs of , Science
psychotic stimulant intoxication include mydriasis, tachycardia, hypertension, and Childbirth (Beha)
####
disorder diaphoresis. Substance-induced psychotic disorder &
Puerperiu
m (PR)
Suicide Access to firearms greatly ↑ the risk of completed suicide. Eval of a pt's Pregnancy Behavioral 1 PR
access to guns is a key part of suicide risk Ax. Other interventions to ↓ , Science
suicide risk incl ↓ stress, ↑ psychosocial support, Tx psych illness and Childbirth (Beha)
9814
substance use, and Mx pain. &
Puerperiu
m (PR)
Tourette Tourette syndrome is a common childhood neuropsych disorder Pregnancy Behavioral 1 PR
syndrome characterised by both vocal and multi motor tics. These tics char wax and , Science
wane, can be suppressed temporarily, and are preceded by a premonitory Childbirth (Beha)
####
urge. &
Puerperiu
m (PR)
Traumatic Ptswith OFC injury often experience personality changes, disinhib, and Pregnancy Behavioral 5 PR
brain injury irritability 2° to impairment of the behavioural and emotional mod systems. , Science
Childbirth (Beha)
7752
&
Puerperiu
m (PR)
Treatment IDing and Mx non-adherence is critical to improving outcomes for many Pregnancy Behavioral 5 PR
adherence chronic conditions, incl HTN. Creating an alliance by validating the pt's , Science
perspective and using an open-ended, non-judgemental question is the Childbirth (Beha)
####
most effective way to initiate a discussion. &
Puerperiu
m (PR)
Wilson disease WD is a/w Cu accumulation in the liver, brain, and cornea. It commonly Pregnancy Behavioral 5 PR
presents in childhood or adolescencewith abn LFTs a/o neuropsych SSx. , Science
Psych SSx may predate other MFxs and incl personality changes, Childbirth (Beha)
####
depression, mania, a/o psychosis. &
Puerperiu
m (PR)
 Wernicke- Pyruvate dehydrogenase and a-ketoglutarate dehydrogenase require Pregnancy Biochemistr 5 PR
Korsakoff thiamine as a cofactor. Administration of glucose to thiamine-deficient , y (Bioc)
syndrome patients (eg, alcoholics) can result in Wernicke encephalopathy (eg, acute Childbirth
1021
confusion, ophthalmoplegia, and ataxia) due to increased thiamine &
demand. Puerperiu
m (PR)
Multiple Dizygotic-Dichorionic Pregnancy Embryology 1 PR
gestation diamniotic- the sex of twins may differ. , (Embr)
chorions and placenta may be fused depending on the proximity of the Childbirth
8406
implantation. &
Puerperiu
m (PR)
Normal B-hCG is produced by the syncytiotrophoblast after implantation, which Pregnancy Embryology 2 PR
pregnancy generally occurs 6-7 days after fertilization at the earliest. B-hCG , (Embr)
typically is detectable in the maternal serum approximately 8 days Childbirth
1772
after fertilization, whereas it is detectable in the urine 14 days after &
fertilization. Therefore, a serum pregnancy test will be positive before a Puerperiu
urine pregnancy test. m (PR)
Polyhydramnio Polyhydramnios (excessive accumulation of amniotic fluid) presents Pregnancy Embryology 1 PR
s with increased abdominal circumference out of proportion to gestational , (Embr)
age. The etiology is decreased fetal swallowing or increased fetal urination. Childbirth
337
Fetal anomalies associated with impaired swallowing include &
gastrointestinal obstruction (eg duodenal, esophageal, or intestinal Puerperiu
atresia) and anencephaly. m (PR)
Down Down syndrome is the most common chromosomal anomaly trisomy 21. Pregnancy Genetics 6 PR
syndrome It is associated with low levels of maternal serum a-fetoprotein and estriol , (Gene)
and increased levels of B-hCG and inhibin A. Elevated a-fetoprotein levels Childbirth
312
are seen in multiple gestation, open neural tube defects, and abdominal &
wall defects. Puerperiu
m (PR)
Down Unbalanced Robertsonian translocations account for a minority of Down Pregnancy Genetics 6 PR
syndrome syndrome cases. Karyotyping shows 46 chromosomes with a translocation , (Gene)
between 2 acrocentric nonhomologous chromosomes [eg, 46, XX, Childbirth
1825
t(14;21)]. &
Puerperiu
m (PR)
Oogenesis Primary oocytes are completely developed in female embryos by the fifth Pregnancy Genetics 1 PR
month of gestation, at which point they are arrested in prophase of meiosis , (Gene)
I. Normal menstrual cycle hormones stimulate the primary oocyte to Childbirth
1688
resume differentiation. Prior to fertilization, secondary oocytes are &
arrested in metaphase of meiosis II. Puerperiu
m (PR)
Ectopic An ectopic pregnancy is characterized by implantation outside of the Pregnancy Histology 1 PR
pregnancy uterus. Uterine curettage would reveal decidual changes in the , (Hist)
endometrium due to progesterone secretion but no embryonic or Childbirth
334
trophoblastic tissue (eg, no villi). &
Puerperiu
m (PR)
Rubella The congenital rubella syndrome is predominantly characterized by Pregnancy Microbiolog 3 PR
neonatal defects of the head (microcephaly, mental retardation), eyes , y (Micr)
(cataracts), ears (deafness), and heart/cardiovascular system (patent ductus Childbirth
1464 arteriosus, peripheral pulmonic stenosis). To decrease the incidence of this &
syndrome, the CDC currently recommends the vaccination of children and Puerperiu
non-pregnant females of childbearing age with live, attenuated rubella m (PR)
virus vaccine.
Rubella Maternal rubella infection produces a low-grade fever, a maculopapular Pregnancy Microbiolog 3 PR
rash with cephalocaudal progression, and posterior auricular and , y (Micr)
suboccipital lymphadenopathy. Most adult women patients develop Childbirth
1575
polyarthritis and polyarthralgia as sequelae. Congenital rubella syndrome is &
associated with sensorineural deafness, cataracts, and cardiac Puerperiu
malformations (PDA). m (PR)
1440 Diabetes Neonates born to mothers with poorly controlled diabetes during Pregnancy Pathology 31 PR
#### Placenta Postpartum hemorrhage is an obstetric emergency and can result from Pregnancy Pathology 1 PR
Preeclampsia Preeclampsia is defined as hypertension onset after 20 weeks gestation Pregnancy Pathology 1 PR
plus proteinuria or signs of end-organ damage. End-organ damage is , (Path)
due to endothelial damage seconday to the release of inflammatory factors Childbirth
1914
from abnormal placentation. &
Puerperiu
m (PR)
 Torticollis Congenital torticollis is typically noted by 2 to 4 weeks of age, after Pregnancy Pathology 2 PR
which the child prefers to hold the head tilted to one side, firm mass on , (Path)
his neck that does not move when the child swallows.. It is most Childbirth
8325 commonly the result of Intrauterine malposition of the head in utero (eg; &
due to fetal macrosomia or oligohydramnios) or birth trauma. Most cases Puerperiu
resolve with conservative therapy and stretching exercises. m (PR)

Amniotic fluid Amniotic fluid embolism (AFE) is a rare and catastrophic pregnancy Pregnancy Pathophysiol 1 PR
embolism complication that results from amniotic fluid entering the maternal , ogy (Patp)
circulation. Common signs of AFE include hypoxia hypotensive shock, and Childbirth
####
disseminated intravascular coagulation Fetal squamous cells are seen in &
the pulmonary vasculature during histologic evaluation. Puerperiu
m (PR)
Aromatase Aromatase converts androgens into estrogens in the ovaries, testes, Pregnancy Pathophysiol 1 PR
deficiency placenta, and other peripheral tissues. Placental aromatase deficiency , ogy (Patp)
causes accumulation of androgens during pregnancy, resulting in Childbirth
955
ambiguous external genitalia in female infants and maternal virilization. &
Puerperiu
m (PR)
Fetal alcohol Typical features of fetal alcohol syndrome include facial dysmorphism Pregnancy Pathophysiol 1 PR
syndrome (short palpebral fissures, thin upper lip, smooth philtrum), growth , ogy (Patp)
retardation, neurological abnormalities, and behavioral difficulties. Childbirth
####
&
Puerperiu
m (PR)
Gallstones and Estrogen-induced cholesterol hypersecretion and progesterone- Pregnancy Pathophysiol 1 PR
pregnancy induced gallbladder hypomotility are responsible for the increased , ogy (Patp)
incidence of cholelithiasis in women who are pregnant or using oral Childbirth
68
contraceptives. &
Puerperiu
m (PR)
Gestational Choriocarcinoma is a malignant form of gestational trophoblastic disease Pregnancy Pathophysiol 3 PR
trophoblastic composed of anaplastic (Proliferation) cytotrophoblasts and , ogy (Patp)
disease syncytiotrophoblasts without villi. It often presents as Childbirth
335
dyspnea/hemoptysis due to pulmonary metastasis from hematogenous &
spread, increased BhCG Puerperiu
m (PR)
Gestational A partial mole will have a triploid karyotype (eg, 69,XXX or XXY) and Pregnancy Pathophysiol 3 PR
trophoblastic contain fetal tissue with some edematous villi with focal trophoblastic , ogy (Patp)
disease proliferation, and normal-appearing villi. Patients present with vaginal Childbirth
792
bleeding, and prior miscarriage (required a dilation and curettage) is a &
risk factor. Puerperiu
m (PR)
Gestational A complete mole is composed of multiple cystic edematous hydropic Pregnancy Pathophysiol 1 PR
trophoblastic villi as a result of trophoblast proliferation. Serial measurements of B- , ogy (Patp)
disease - hCG should be performed following evacuation of a hydatidiform mole. Childbirth
791
complete mole Persistently elevated or rising levels may signify the development of an &
invasive mole or choriocarcinoma. Puerperiu
m (PR)
Parasomnias REM sleep is characterized by dreaming and voluntary muscle paralysis, Pregnancy Pathophysiol 2 PR
and occurs more often during the final third of the night. Nightmares occur , ogy (Patp)
during REM sleep and can be differentiated from sleep terrors, a non-REM Childbirth
####
parasomnia characterized by incomplete arousals and lack of recall of &
dream content. Puerperiu
m (PR)
Parasomnias Sleepwalking, a common non-REM parasomnia of childhood, occurs Pregnancy Pathophysiol 2 PR
during slow-wave sleep (stage N3), which is characterized by delta Waves , ogy (Patp)
on EEG. Sleepwalking typically occurs during the first half of the night, Childbirth
####
when slow-wave sleep is most prominent. &
Puerperiu
m (PR)
Prenatal care The maternal serum quadruple screen is performed to assess risk of Pregnancy Pathophysiol 1 PR
congenital defects in fetuses. Accurate dating is important for determining , ogy (Patp)
whether levels of alpha-fetoprotein and other analytes are abnormal for Childbirth
342
gestational age Patients with a history of irregular menses are at risk for &
inaccurate pregnancy dating. Puerperiu
m (PR)
ACE inhibitors Fetopathy due to angiotensin-converting enzyme inhibitors or Pregnancy Pharmacolog 7 PR
angiotensin II receptor blockers results from blockade of angiotensin II. , y (Phar)
which is necessary for normal renal development. Use of these anti Childbirth
#### hypertensive drugs during pregnancy can result in fetal anuria, &
oligohydramnios, pulmonary hypoplasia, limb contractures, and Puerperiu
calvarium defects, impaired metabolism angiotensin I m (PR)
 Alcohol use The opioid antagonist naltrexone is a 1st-line Rx for mod-to-severe alcohol Pregnancy Pharmacolog 3 PR
disorder use disorder, and works by preventing the reinforcing effects of alcohol , y (Phar)
use. Childbirth
####
&
Puerperiu
m (PR)
Alcohol AWS should be considered in hospitalised patients who develop Pregnancy Pharmacolog 2 PR
withdrawal tremulousness, agitation, and ↑ HR and BPwithi 48hrs following , y (Phar)
admission. Benzos act as a substitute for the effects of alcohol on GABA Childbirth
350
receptors, preventing AWS from occurring. &
Puerperiu
m (PR)
Anticholinergic Anticholtox is characterised by fever; confusion; cutaneous flushing; dry Pregnancy Pharmacolog 3 PR
s oral mucosa; and dilated, poorly reactive pupils. TCAs, particularly , y (Phar)
amitriptyline, have strong anticholinergic effects. Childbirth
1868
&
Puerperiu
m (PR)
Antidepressant Bupropion is a 1st-lineantidep that isn't a/w sexual AEs or weight gain. Pregnancy Pharmacolog 4 PR
s However, it's a/w an ↑ seizure risk at high doses and is c/i in ptswith , y (Phar)
seizure disorders, AN, and BN. Childbirth
704
&
Puerperiu
m (PR)
Antidepressant Sexual dysfxn is seen in up to 50% of patients Txwith SSRIs. Bupropion, Pregnancy Pharmacolog 4 PR
s an NDRI, is a 1st-line Tx for MDD and doesn't cause sexual dysfxn. , y (Phar)
Childbirth
706
&
Puerperiu
m (PR)
Antipsychotics The secretion of PRL is controlled by the inhib effect of hypothalamusDA. Pregnancy Pharmacolog 9 PR
Risperidone and other antipsychs cause hyperprolactinaemia by blocking , y (Phar)
D2 receptors on lactotrophs. ↑ PRL leads to amenorrhoea (inhib of GnRH Childbirth
222
release), galactorrhoea, and breast soreness. &
Puerperiu
m (PR)
Antipsychotics DIP is an EPS caused by Rx that block D2 receptors (e.g. antipsychs). Mx Pregnancy Pharmacolog 9 PR
strategies incl ↓ or discontinuing the offending Rx and Txwith an antichol , y (Phar)
Rx. Childbirth
261
&
Puerperiu
m (PR)
Antipsychotics Akathisia is an EPS of antipsychRx characterised by inner restlessness and Pregnancy Pharmacolog 9 PR
an inability to sit or stand in 1 position. Tx involves a ↓ in the , y (Phar)
antipsychdose, if possible, or the addn of a β blocker or benzo. Childbirth
510
&
Puerperiu
m (PR)
Antipsychotics FGAs can be classified according to high or low potency and have char AE Pregnancy Pharmacolog 9 PR
profiles. Low-potency antipsychs are more likely to cause sedation, , y (Phar)
antichol AEs, and orthostatic hypotension. High-potency antipsychs are Childbirth
515
more likely to cause EPS (e.g. dystonia, akathisia, parkinsonism). &
Puerperiu
m (PR)
Antipsychotics patients Txwith clozapine are req to have regular monitoring of the Pregnancy Pharmacolog 9 PR
absolute neutrophil count due to the risk of life-threatening , y (Phar)
agranulocytosis. Childbirth
516
&
Puerperiu
m (PR)
Antipsychotics SGAs block 5-HT2A receptors and have lower binding affinity at DA D2 Pregnancy Pharmacolog 9 PR
receptor sites, which is a/w a lower risk of EPS. , y (Phar)
Childbirth
####
&
Puerperiu
m (PR)
Benzodiazepin Benzos act by binding to the benzo binding site, which allosterically mods Pregnancy Pharmacolog 6 PR
es the binding of GABA, resulting in an ↑ freq of Cl- ion channel opening. , y (Phar)
The influx of Cl- ions into the neurons causes neuronal hyperpol and inhib Childbirth
937
of the AP. &
Puerperiu
m (PR)
 Benzodiazepin Benzos bind GABAA receptors, resulting in an ↑ freq of Cl- channel Pregnancy Pharmacolog 6 PR
es opening in the presence of GABA. Indications for prescribing incl short- , y (Phar)
term Tx of anxiety disorders and AWS. Childbirth
1443
&
Puerperiu
m (PR)
Benzodiazepin Benzo withdrawal is characterised by anxiety, tremor, insomnia, and Pregnancy Pharmacolog 6 PR
es sympathetic hyperactivity (e.g. diaphoresis, palpitations). Severe benzo , y (Phar)
withdrawal may also be accompanied by psychosis, seizures, or death. Childbirth
####
&
Puerperiu
m (PR)
Benzodiazepin Flumazenil is a benzo receptor antagonist. It can reverse the sedative Pregnancy Pharmacolog 6 PR
es effects of benzos related to overdose and procedural sedation. , y (Phar)
Childbirth
####
&
Puerperiu
m (PR)
Bipolar Lithium and the anticons valproate, carbamazepine, and lamotrigine are Pregnancy Pharmacolog 7 PR
disorder mood-stabilising agents used in BD. Valproate is commonly used in the Tx , y (Phar)
of gen as well as myoclonic seizures. Childbirth
1193
&
Puerperiu
m (PR)
Cocaine Cocaine is a stim that inhibs the presynaptic reuptake of NE, DA, and 5- Pregnancy Pharmacolog 3 PR
HT. Intox patients develop agitation, tachycardia, HTN, and light- , y (Phar)
responsive mydriasis due to ↑ sympathetic activity. Cocaine is also a potent Childbirth
2001
vasoconstrictor that can cause myocardial ischemia and atrophy of the &
nasal mucosa and septum. Puerperiu
m (PR)
Congenital Lithium is commonly used to treat bipolar disorder. Its use during Pregnancy Pharmacolog 2 PR
cardiac defects pregnancy is associated with Ebstein's anomaly, which is , y (Phar)
characterized by apical displacement of the tricuspid valve leaflets, Childbirth
1490
decreased right ventricular volume, and atrialization of the right &
ventricle Puerperiu
m (PR)
Generalized Buspirone is an NBA used to Tx GAD. It has a slow onset of action, lacks Pregnancy Pharmacolog 4 PR
anxiety muscle relaxant or anticon properties, and carries no risk of dependence. , y (Phar)
disorder Childbirth
247
&
Puerperiu
m (PR)
Hypothyroidis Hypothyroidism and NDI are the most common AEs of long-term lithium Pregnancy Pharmacolog 14 PR
m therapy. Serum TSH and renal fxn (BUN and creatinine) should be , y (Phar)
monitored routinely. Childbirth
520
&
Puerperiu
m (PR)
Insomnia Benzos, antihists, and sedating antideps should be avoided in the Tx of Pregnancy Pharmacolog 3 PR
insomnia in elderly patients due to their AEs. Ramelteon, a melatonin , y (Phar)
agonist, has a lower AE burden than other sedative-hypnotic agents and is Childbirth
348
effective in ↓ time to sleep onset in the elderly. &
Puerperiu
m (PR)
Insomnia NonBZD Rx (eg, zolpidem, zaleplon, eszopiclone) stimulate specific Pregnancy Pharmacolog 3 PR
subtypes of GABA-A receptors. As a result, nonBZDs are primarily , y (Phar)
hypnotics and do not produce the anxiolytic, muscle relaxant, or Childbirth
349
anticonvulsant effects a/w BZDs. &
Puerperiu
m (PR)
Lithium Chronic lithium tox (e.g. confusion, ataxia, NM excitability) can be Pregnancy Pharmacolog 2 PR
precipitated by volume depletion and drug interactionswith TZDs, ACEIs, , y (Phar)
and NSAIDs. Childbirth
519
&
Puerperiu
m (PR)
Monoamine MAO is a mitochondrial enzyme that breaks down MA NTs (e.g. DA, NE, Pregnancy Pharmacolog 1 PR
oxidase 5-HT). Tyramine-induced HTC can occur in patients taking MAOIs who , y (Phar)
inhibitors consume foods containing high amounts of tyramine (e.g. aged cheeses, Childbirth
572
cured meats, draft beer). &
Puerperiu
m (PR)
 Narcolepsy Tx for narcolepsy incls psychostims (e.g. modafinil) for daytime sleepiness. Pregnancy Pharmacolog 3 PR
, y (Phar)
Childbirth
8259
&
Puerperiu
m (PR)
Neural tube Valproate decreases levels of folic acid and increases the risk of neural Pregnancy Pharmacolog 4 PR
defects tube defects (eg, meningocele, myelomeningocele). , y (Phar)
Childbirth
507
&
Puerperiu
m (PR)
Neuroleptic NMS is an AE to antipsych Rx characterised by severe 'lead-pipe' rigidity, Pregnancy Pharmacolog 2 PR
malignant hyperthermia, sympathetic hyperactivity, and mental status changes. NMS , y (Phar)
syndrome is characterised by severe rigidity rather than the NM irritability (e.g. Childbirth
512
hyperreflexia, myoclonus) seen in SS. &
Puerperiu
m (PR)
Opioids Buprenorphine is a partial opioid receptor agonist that bindswith high Pregnancy Pharmacolog 14 PR
affinity but has low intrinsic activity. In patients on long-term opioid , y (Phar)
therapy, buprenorphine can displace other opioids and precipitate Childbirth
774
withdrawal. &
Puerperiu
m (PR)
1255 Opioids Neonatal abstinence syndrome presents with neurologic, Pregnancy Pharmacolog 14 PR
Opioids Naloxone is a pure opioid receptor antagonist used to Tx opioid intox or Pregnancy Pharmacolog 14 PR
OD. Although it binds to μ, κ, and δ opioid receptors, it has the greatest , y (Phar)
affinity for μ receptors (which mediate opioid-induced bradycardia and Childbirth
1256
resp depression), making it an ideal agent for Tx opioid intox. &
Puerperiu
m (PR)
Psychosis Antipsych Rx are 1st-line Rx for schizophrenia. Their 1° MOA is D2 Pregnancy Pharmacolog 6 PR
receptor antagonism. , y (Phar)
Childbirth
####
&
Puerperiu
m (PR)
Selective SS is characterised by AMS, autonomic hyperactivity, and NM excitation Pregnancy Pharmacolog 3 PR
serotonin (e.g. hyperreflexia, clonus). Causes incl high doses a/o combos of 5-HT- , y (Phar)
reuptake ergic drugs (e.g. SSRI and MAOI). Tryptophan is a precursor for 5-HT. Childbirth
2088
inhibitors &
Puerperiu
m (PR)
Selective Cyproheptadine is an antihistwith anti-5HT-ergic properties that can be Pregnancy Pharmacolog 3 PR
serotonin used as an antidote in severe cases of SS that don't respond to supportive , y (Phar)
reuptake measures. Childbirth
2089
inhibitors &
Puerperiu
m (PR)
Serotonin Co-admin of SSRIs and MAOIs can produce excessive synaptic 5-HT lvls Pregnancy Pharmacolog 2 PR
syndrome 2° to ↓ reuptake and ↓ degradation of 5-HT, potentially causing SS. To , y (Phar)
avoid this risk, a 2-wk washout period after discontinuing a MAOI and Childbirth
773
before initiating SSRI therapy is req to allow sufficient time for MAO &
regen. Puerperiu
m (PR)
Serotonin SS is characterised by a triad of autonomic instability, AMS, and NM Pregnancy Pharmacolog 2 PR
syndrome irritability. It may develop when a MAOI antidep or a non-antidepwith , y (Phar)
MAOI activity (e.g. linezolid) is combowith a 5-HT-ergic Rx such as a Childbirth
8327
SSRI, SNRI, or TCA. &
Puerperiu
m (PR)
1568 Teratogens Isotretinoin is used to treat severe acne with significant scarring. Pregnancy Pharmacolog 2 PR
Teratogens Although tetracyclines are the 1st-line Tx for Lyme disease, they are c/i in Pregnancy Pharmacolog 2 PR
pregnancy due to the potential for fetal tooth discoloration. Amoxicillin , y (Phar)
should be given instead for Tx of Lyme disease in pregnant women. Childbirth
1775
&
Puerperiu
m (PR)
Tricyclic TCA OD can cause fatal cardiac arrhythmias and refractory hypotension Pregnancy Pharmacolog 1 PR
antidepressants due to inhib of fast Na+ channels in cardiac myocytes. , y (Phar)
Childbirth
574
&
Puerperiu
m (PR)
 Urinary TCAs have strong antichol properties. Potential AEs incl confusion, Pregnancy Pharmacolog 4 PR
retention constipation, and urinary retention. These Rx should be usedwith caution , y (Phar)
in elderly pts. Childbirth
575
&
Puerperiu
m (PR)
Gestational Human placental lactogen increases maternal insulin resistance during Pregnancy Physiology 2 PR
diabetes the second and third trimesters, leading to a rise in serum glucose that , (Phys)
helps provide adequate nutrition to the growing fetus. Gestational Childbirth
8330
diabetes occurs when the compensatory rise in maternal insulin secretion &
is inadequate to prevent serum glucose levels from reaching excessively Puerperiu
high levels. m (PR)
Normal In pregnancy, progesterone is secreted by the corpus luteum and later by Pregnancy Physiology 2 PR
pregnancy the placenta. Although prolactin secretion increases as pregnancy , (Phys)
progresses, high progesterone levels inhibit lactation by preventing Childbirth
1987
binding of prolactin to receptors on alveolar cells in the breast. &
Puerperiu
m (PR)
Aspiration Due to gravity, supine patients typically aspirate into the posterior Pulmonary Anatomy 2 PU
pneumonia segments of the upper lobes and superior segments of the lower lobes. & Critical (Anat)
1745 Patients who are upright tend to aspirate into the basilar segments of the Care (PU)
lower lobes. Aspirated material is more likely to travel down the right main
bronchus.
Community Irritation of the parietal pleura will cause sharp pain, which is worse on Pulmonary Anatomy 21 PU
acquired inspiration. Pain arising from the mediastinal or diaphragmatic pleura will & Critical (Anat)
1535 pneumonia be carried by the phrenic nerve and referred to the C3-C5 distribution. Care (PU)

Obstructive Neuromuscular weakness of the oropharynx is involved in the Pulmonary Anatomy 4 PU

sleep apnea pathophysiology of obstructive sleep apnea. Electrical stimulation of the & Critical (Anat)
#### hypoglossal nerve increases the diameter of the oropharyngeal airway and Care (PU)
decreases the frequency of apneic events.

Pneumothorax The lung apices extend above the level of the clavicle and first rib through Pulmonary Anatomy 2 PU
the superior thoracic aperture. Penetrating injury in this area (Lung & Critical (Anat)
1695 pleura) may lead to pneumothorax, tension pneumothorax, or hemothorax. Care (PU)

Thoracentesis Thoracentesis should be performed below the 6th rib in the midclavicular Pulmonary Anatomy 2 PU
line, the 8th rib along the midaxillary line, or the 10th rib along the & Critical (Anat)
paravertebral line in order to minimize the risk of lung injury. Insertion of a Care (PU)
844 needle lower than 9th rib increases the risk of penetrating abdominal
structures (Right hepatic lobe). The needle should also be inserted along
the upper border of the rib to prevent injury to the intercostal vessels.

Thoracentesis A chest tube for drainage of pleural effusion is placed through the skin and Pulmonary Anatomy 2 PU
subcutaneous fat into the 4th or 5th intercostal space in the anterior axillary & Critical (Anat)
#### or midaxillary line. The tube traverses through the serratus anterior Care (PU)
muscle, intercostal muscles, and parietal pleura.

Alpha1 The rubber-like properties of elastin are due to high content of nonpolar Pulmonary Biochemistr 8 PU
antitrypsin (hydrophobic) amino acids and extensive (lnterchain cross-links & Critical y (Bioc)
deficiency involving lysine) between elastin monomers facilitated by lysyl oxidase. Care (PU)
1249
Patients with α-1 antitrypsin deficiency can develop early-onset, lower lobe-
predominant emphysema due to excessive alveolar elastin degradation.

Respiratory The binding of O2 to hemoglobin increases the affinity for binding of Pulmonary Biochemistr 8 PU
physiology subsequent O2 molecules (cooperative binding). In the lungs, the binding & Critical y (Bioc)
of O2 to hemoglobin drives the release of (protons) H+ and CO2 from Care (PU)
1386
hemoglobin (Haldane effect). In the peripheral tissues, high concentrations
of CO2 and H+ facilitate O2 unloading from hemoglobin (Bohr effect).

Fetal The most highly oxygenated blood in the fetus is carried by the umbilical Pulmonary Embryology 1 PU
circulation vein, which empties directly into the inferior vena cava via the ductus & Critical (Embr)
1833 venosus. Care (PU)

Neonatal Phospholipids, including dipalmitoyl phosphatidylcholine, are a major Pulmonary Embryology 5 PU

respiratory component of pulmonary surfactant. The amniotic fluid lecithin & Critical (Embr)
distress (phosphatidylcholine) to sphingomyelin ratio (L/S ratio) is measured in Care (PU)
482
syndrome order to assess fetal lung maturity. The fetal lungs are considered mature
when they are producing adequate surfactant to yield an L/S ratio greater
than 2.
 Neonatal Both maternal and fetal cortisol help to accelerate fetal lung maturation by Pulmonary Embryology 5 PU
respiratory stimulating surfactant production. Betamethasone or dexamethasone is & Critical (Embr)
550 distress administered to pregnant women at risk of premature delivery to prevent Care (PU)
syndrome neonatal respiratory distress syndrome.

Neonatal Dipalmitoyl phosphatidylcholine (lecithin, L) and phosphatidylglycerol are Pulmonary Embryology 5 PU

respiratory major constituents of surfactant. Fetal lung lecithin production increases & Critical (Embr)
distress sharply after 30 weeks gestation, and phosphatidylglycerol production Care (PU)
syndrome increases at 36 weeks gestation. The amniotic fluid sphingomyelin (S) level
800
should remain approximately constant during the third trimester. An L/S
ratio > 2.0 indicates adequate surfactant production to avoid neonatal
hyaline membrane disease.

Autosomal The probability that a child of parents from 2 populations with different Pulmonary Genetics 5 PU
recessive mutant allele carrier frequencies will inherit an autosomal recessive disease & Critical (Gene)
1791 inheritance is 25% multiplied by the carrier frequencies. Care (PU)

Cystic fibrosis Cystic fibrosis (CF) is most commonly due to a 3-base pair deletion in the Pulmonary Genetics 11 PU
CF transmembrane conductance regulator (CFTR) gene at amino acid & Critical (Gene)
position 508 (ΔF508). This mutation impairs post translational Care (PU)
802 processing of CFTR, resulting in shunting of CFTR toward the
proteasome, with complete absence of the protein on the cell surface.
Elevated sweat chloride concentrations are found in most patients with CF.

Cystic fibrosis AF508 is the most common mutation in the cystic fibrosis transmembrane Pulmonary Genetics 11 PU
regulator (CFTR) protein in patients with cystic fibrosis. This mutation & Critical (Gene)
805 leads to protein misfolding and failure of glycosylation, followed by Care (PU)
proteasome-mediated degradation and significantly decreased number of
transmembrane CFTR proteins.
COPD Thickened bronchial walls, lymphocytic infiltration, mucous gland Pulmonary Histology 16 PU
enlargement, and patchy squamous metaplasia of the bronchial mucosa are & Critical (Hist)
524 features of chronic bronchitis. Tobacco smoking (Behavioral factors) is Care (PU)
the leading cause of chronic bronchitis.

Respiratory Type II pneumocytes have 2 important functions: regeneration of the Pulmonary Histology 4 PU
mucosa alveolar lining following injury and surfactant production. & Critical (Hist)
478 Care (PU)

Respiratory Bronchi have a ciliated pseudostratified columnar epithelium with mucin- Pulmonary Histology 4 PU
mucosa secreting goblet cells and submucosal mucoserous glands. The airway & Critical (Hist)
epithelium gradually changes to ciliated simple cuboidal by the level of the Care (PU)
terminal bronchioles. Bronchioles lack glands and cartilage, and the
480
number of goblet cells decreases distally, ending before the terminal
bronchioles. Ciliated epithelium persists up to the respiratory bronchioles.
(Which features is last to disappear - Cilia)

Asthma An excess of Th2 cell activity relative to Th1 cell activity may underlie the Pulmonary Immunology 12 PU
pathogenesis of asthma. In the asthma sensitization phase, inhaled & Critical (Immu)
antigens stimulate Th2 cells to secrete IL-4 and IL-13, which together Care (PU)
526
promote B-lymphocyte class switching for IgE synthesis, leading to mast
cell priming. Th2 cells also secrete IL-5, which activates eosinophils.

Epiglottitis Rapidly progressing fever, severe sore throat, drooling and progressive Pulmonary Immunology 2 PU
airway obstruction potentially accompanied by stridor are the presenting & Critical (Immu)
symptoms of acute epiglottitis. This illness is most commonly caused by H. Care (PU)
influenzae type b, but the Hib vaccine has dropped the incidence of this
967
disease considerably. H. influenzae type b can still cause disease in
unimmunized or improperly (lncomplete) immunized patients as well
as fully immunized patients in some cases.

Hypersensitivit Type IV (delayed) hypersensitivity reactions (eg, Candida extract skin test, Pulmonary Immunology 4 PU
y reactions contact dermatitis) are characterized by erythema and induration that & Critical (Immu)
develops 24-48 hours after repeat exposure to an antigen. T lymphocytes Care (PU)
544
mediate the inflammation in these reactions through cytokine release,
CD8+ cytotoxicity, and macrophage recruitment.
 Hypersensitivit Type 1 hypersensitivity reactions are mediated by the interaction of Pulmonary Immunology 4 PU
y reactions allergen with preexisting IgE bound to basophils and mast cells (Trigger- & Critical (Immu)
Cell surface-bound antibody bridging by antigen). This facilitates cross- Care (PU)
linking of the surface IgE molecules that signals the cell to degranulate
1131
releasing chemical mediators (eg, histamine, heparin). These agents are
responsible for the immediate signs and symptoms of allergy, from a local
wheal and flare to life threatening anaphylaxis.

Immotile cilia Kartagener syndrome (denin arm defect) is a form of primary ciliary Pulmonary Immunology 1 PU
syndrome dyskinesia characterized by the triad of situs inversus, chronic sinusitis, & Critical (Immu)
and bronchiectasis. It occurs due to mutations that impair the structure or Care (PU)
1611
function of cilia. Cystic fibrosis also causes chronic respiratory infections,
but it is not associated with situs inversus.

Inflammation Leukotriene B4 stimulates neutrophil migration to sites of inflammation. Pulmonary Immunology 3 PU

Other important chemotactic agents include 5-HETE (leukotriene & Critical (Immu)
1800 precursor), complement component C5a, and IL-8. Parapneumonic Care (PU)
effusions occur in bacterial pneumonia as a result of exudative fluid
accumulation within the pleural space.
Lung Chronic lung transplant rejection is due primarily to progressive scarring of Pulmonary Immunology 2 PU
transplantation the small airways, leading to bronchiolitis obliterans. Manifestations & Critical (Immu)
534 occur months or years after transplantation and include obstructive lung Care (PU)
disease (eg, reduced FEV1) with dyspnea and dry cough.

Primary Chronic granulomatous disease (CGD) results from a genetic defect in Pulmonary Immunology 7 PU
immunodeficie NADPH oxidase. Normally, NADPH oxidase participates in the killing of & Critical (Immu)
ncy disorder microbes within neutrophil and macrophage phagolysosomes. Patients Care (PU)
1441 with CGD develop recurrent bacterial and fungal infections that are
predominantly caused by 5 catalasepositive organisms: Staphylococcus
aureus, Burkholderia cepacia, Serratia marcescens, Nocardia, and
Aspergillus.
Sarcoidosis Sarcoidosis is characterized by noncaseating granulomas due to Pulmonary Immunology 7 PU
dysregulated cell-mediated immunity. Activated antigen-presenting cells & Critical (Immu)
produce IL-12, which stimulates the differentiation of Th1-type CD4+ Care (PU)
797
cells. Th1 cells produce IL-2 and interferon-y, which stimulate Th1 cell
proliferation and macrophage activation, respectively.

Selective IgA Selective IgA deficiency is the most common primary immune deficiency Pulmonary Immunology 1 PU
deficiency and can present with recurrent sinopulmonary and gastrointestinal & Critical (Immu)
1130 infections as well as autoimmune disease. Patients with severe IgA Care (PU)
deficiency can have anaphylaxis during transfusion of blood products that
contain small amounts of IgA.
Tuberculosis T-helper subtype 1 cells release interferon-gamma leading to the Pulmonary Immunology 18 PU
activation of macrophages, a process critical for control of & Critical (Immu)
Mycobacterium tuberculosis infection. Activated macrophages form Care (PU)
mature phagolysosomes that destroy phagocytosed mycobacteria and can
301
differentiate into epithelioid and Langhans giant cells to wall off
extracellular mycobacteria within caseating granulomas. Interferon-γ, IL-
12, and TNF-α are critical cytokines for the formation and maintenance of
granulomas.
Tuberculosis Mycobacteria tuberculosis primarily replicateswithi the phagosome, Pulmonary Immunology 18 PU
leading to display of mycobacterial Ags on MHC-II molecules. This results & Critical (Immu)
1218 in the activation of CD4 cells and subsequent control of the infectionwith Care (PU)
macrophages.

TuberculosisMycobacterium tuberculosis triggers CD4 T lymphocytes to release Pulmonary Immunology 18 PU

interferon-gamma, which leads to macrophage activation (improves & Critical (Immu)
intracellular killing ability) and differentiation into epithelioid histiocytes. Care (PU)
1220
These cells, along with horseshoe-shaped, multinucleated Langhans giant
cells (fused, activated macrophages) are a key component of granuloma
formation.
X-linked X-linked agammaglobulinemia is characterized by low or absent Pulmonary Immunology 2 PU
agammaglobuli circulating mature В cells (ie, CD19+, CD20+ CD21+ cells) and & Critical (Immu)
nemia panhypogammaglobulinemia. Affected patients have increased Care (PU)
1763
susceptibility to pyogenic bacteria, enteroviruses, and Giardia lamblia
due to the absence of opsonizing and neutralizing antibodies.

Actinomycosis Pulmonary actinomycosis develops most commonly following aspiration Pulmonary Microbiolog 2 PU
and can be confused with lung abscess, malignancy, or tuberculosis. & Critical y (Micr)
#### Microscopic findings include filamentous, branching, gram-positive Care (PU)
bacteria and sulfur granules.
 Aspergillosis A. fumigatus causes a wide spectrum of disease. It can be an opportunistic Pulmonary Microbiolog 5 PU
infection in immsup and neutropaenic patients (invasive pulm & Critical y (Micr)
aspergillosis). Aspergillosis can be colonising (aspergilloma) when it forms Care (PU)
108
a fungus ballwithi a pre-existing lung cavity. It can also cause a lung HSR
in allergic bronchopulm aspergillosis in individualswith asthma.

Aspergillosis Allergic bronchopulmonary aspergillosis (ABPA) due to Aspergillus Pulmonary Microbiolog 5 PU

fumigatus may complicate asthma. ABPA can result in transient recurrent & Critical y (Micr)
665 pulmonary infiltrates (eosinophilia) and eventual proximal bronchiectasis. Care (PU)

Blastomycosis Dimorphic fungi grow as molds at 25-30°C and as yeast at body Pulmonary Microbiolog 3 PU
temperature (35-37°C). Medically important dimorphic fungi include & Critical y (Micr)
103 Sporothrix, Coccidioides, Histoplasma, Blastomyces dermatitidis and Care (PU)
Paracoccidioides species.

Blastomycosis Blastomyces dermatitidis is a dimorphic fungus seen in tissue as round or Pulmonary Microbiolog 3 PU
oval yeasts with thick walls and broad-based budding. It is endemic in the & Critical y (Micr)
120 southeastern United States (states east of the Mississippi River). The lungs Care (PU)
are the primary site of involvement, and the skin and bone are the major
sites of dissemination.
Blastomycosis Blastomyces dermatitides can cause pulmonary disease in the Pulmonary Microbiolog 3 PU
immunocompetent host. Dissemination (most commonly to skin and bones) & Critical y (Micr)
121 occurs in immunocompromised individuals. Care (PU)

Coccidioidomy Coccidioides immitis infection can be asymptomatic or it can cause Pulmonary Microbiolog 2 PU
cosis pulmonary disease ranging from a flulike illness to chronic pneumonia. It & Critical y (Micr)
268 causes disseminated disease in immunocompromised patients. Spherules Care (PU)
containing endospores are found in tissue samples.

Coccidioidomy Coccidioides immitis is a dimorphic fungus endemic to the southwestern Pulmonary Microbiolog 2 PU
cosis United States (Arizona). It exists in the environment as a mold (with & Critical y (Micr)
269 hyphae) that forms spores. These spores are inhaled and turn into spherules Care (PU)
in the lungs.

Community The primary virulence factor of Streptococcus pneumoniae is a Pulmonary Microbiolog 21 PU

acquired polysaccharide capsule that inhibits opsonization and phagocytosis. The & Critical y (Micr)
730 pneumonia polysaccharide capsule of the most virulent strains is targeted by the Care (PU)
pneumococcal vaccine, which confers resistance to phagocytosis

Community Streptococcus pneumoniae are gram-positive, a-hemolytic, optochin- Pulmonary Microbiolog 21 PU

acquired sensitive, bile-soluble diplococci, cough and green sputum. Viridans & Critical y (Micr)
pneumonia group streptococci are also a-hemolytic, but they are optochin-resistant and Care (PU)
731
bile insoluble. Streptococcus pyogenes (Group A Streptococcus) appear as
gram-positive cocci in chains with bacitracin susceptibility.

Community Streptococcus pneumoniae vaccination reduces the risk of invasive disease Pulmonary Microbiolog 21 PU
acquired and is recommended for young patients and the elderly. The pneumococcal & Critical y (Micr)
pneumonia polysaccharide vaccine is an unconjugated vaccine that induces a T-cell- Care (PU)
734 independent humoral immune response. In contrast, the pneumococcal
conjugate vaccine contains polysaccharide material attached to a protein
antigen, which creates a robust T-cell-mediated humoral immune response.

Community Infection with Mycoplasma pneumoniae can result in the formation of Pulmonary Microbiolog 21 PU
acquired cold agglutinins, which are IgM antibodies (primarily) that bind red blood & Critical y (Micr)
pneumonia cells and cause clumping/agglutinations at low body temperatures. Other Care (PU)
958
illnesses resulting in cold agglutinin formation include infectious
mononucleosis and certain hematologic malignancies.

Community Legionella pneumophila has a propensity to affect older adults with Pulmonary Microbiolog 21 PU
acquired chronic lung disease who smoke. It causes Legionnaires' disease which is & Critical y (Micr)
pneumonia characterized by high fever, diarrhea, headache, and confusion. L Care (PU)
960 pneumophila is a gram-negative rod that is typically not detected on Gram
stain but can be diagnosed by PCR of a lower respiratory tract sample or
detection of Legionella antigen in the urine.

Community Legionella pneumophila commonly contaminates natural bodies of water, Pulmonary Microbiolog 21 PU
acquired municipal water supplies, and water-based cooling systems. The organism & Critical y (Micr)
pneumonia is inhaled in aerosolized water and establishes infection via the pulmonary Care (PU)
961
route. Diagnosis is generally made by urine antigen testing, silver stain, or
culture on buffered charcoal yeast extract agar supplemented with L-
cysteine and iron.
 Community Influenza infection alters the respiratory epithelium and can increase the Pulmonary Microbiolog 21 PU
acquired risk of secondary bacterial pneumonia. The leading pathogens are & Critical y (Micr)
pneumonia Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus Care (PU)
1666
influenzae. The elderly are affected most commonly, but S aureus can
cause secondary pneumonia in young, previously healthy patients.

Community All organisms in the Mycoplasma genus, including Ureaplasma Pulmonary Microbiolog 21 PU
acquired urealyticum, lack peptidoglycan cell walls and are therefore resistant to & Critical y (Micr)
pneumonia agents that target the cell wall such as penicillins, cephalosporins, Care (PU)
1677
carbapenems, and vancomycin. Mycoplasma infections can be treated
with antiribosomal agents (eg, tetracyclines, macrolides).

Community Mycoplasma pneumoniae is the causative agent of "walking pneumonia," Pulmonary Microbiolog 21 PU
acquired an infection typically characterized by a nagging nonproductive cough, low- & Critical y (Micr)
pneumonia grade fever, and malaise. Often, the chest x-ray suggests a severe Care (PU)
1679
pneumonia even though the patient appears relatively well. Mycoplasma
species require cholesterol supplementation to grow on artificial media.

Community The most common cause of community-acquired pneumonia in both HIV- Pulmonary Microbiolog 21 PU
acquired infected and HIV-uninfected individuals is Streptococcus pneumoniae. & Critical y (Micr)
1767 pneumonia Risk of invasive pneumococcal disease is significantly increased in patients Care (PU)
with HIV regardless of CD4 count.

Community Legionella pneumophila is a facultative intracellular gram-negative bacillus Pulmonary Microbiolog 21 PU

acquired that can cause a systemic infection. Symptoms frequently include high & Critical y (Micr)
pneumonia fever, cough, confusion, and diarrhea. The most common laboratory Care (PU)
8257
abnormality seen with Legionella pneumonia is hyponatremia, and
sputum Gram stain often shows many neutrophils but few or no organisms.

Community Klebsiella is an encapsulated, lactose-fermenting, gram-negative bacillus Pulmonary Microbiolog 21 PU

acquired that appears mucoid in culture. It causes pneumonia in individuals with & Critical y (Micr)
pneumonia impaired host defenses, especially patients with alcohol use disorder. Care (PU)
9989
Klebsiella pneumonia is characterized by tissue necrosis and early
abscess formation with production of thick, mucoid, blood-tinged sputum
(currant jelly sputum).
COPD Most chronic obstructive pulmonary disease exacerbations are triggered by Pulmonary Microbiolog 16 PU
viral or bacterial upper respiratory infections, with rhinovirus, influenza & Critical y (Micr)
#### virus, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus Care (PU)
pneumoniae being among the most common causes.

Cryptococcal Meningoencephalitis is the most common presentation of Cryptococcus Pulmonary Microbiolog 3 PU

infections neoformans infection. It occurs in immunosuppressed patients and can be & Critical y (Micr)
114 diagnosed by India ink staining of the cerebrospinal fluid. Cryptococcal Care (PU)
pneumonia is diagnosed by mucicarmine staining of lung tissue and
bronchoalveolar washings.
Cryptococcal Cryptococcus neoformans is the only pathogenic fungus that has a Pulmonary Microbiolog 3 PU
infections polysaccharide capsule. The capsule appears red on mucicarmine stain and & Critical y (Micr)
117 as a clear unstained zone with India ink. Care (PU)

Cytomegalovir In a transplant patient, pneumonia with intranuclear and cytoplasmic Pulmonary Microbiolog 9 PU
us inclusion bodies histologically points to opportunistic infection with & Critical y (Micr)
1576 cytomegalovirus, an enveloped double-stranded DNA virus Care (PU)

Epiglottitis Polyribosylribitol phosphate is a capsule component and major virulence Pulmonary Microbiolog 2 PU
factor for Haemophilus influenzae type b (Hib). Hib is the most common & Critical y (Micr)
962 cause of epiglottitis, which presents with fever, stridor, and dyspnea. Care (PU)

Group B Universal prenatal screening for group В strep colonization by vaginal- Pulmonary Microbiolog 2 PU
streptococcal rectal culture at 35-37 weeks gestation is recommended to identify & Critical y (Micr)
999 infection colonized women who require INTRAPARTUM antibiotics, most Care (PU)
frequently with penicillin or ampicillin, to prevent neonatal GBS sepsis,
pneumonia and meningitis.
Haemophilus Most chronic obstructive pulmonary disease exacerbations are caused by Pulmonary Microbiolog 2 PU
influenzae infection with an upper respiratory pathogen. The leading bacterial cause is & Critical y (Micr)
#### Haemophilus influenza and the leading viral cause is rhinovirus. Care (PU)
 Histoplasmosis Histoplasma capsulatum is endemic to the Ohio and Mississippi River Pulmonary Microbiolog 4 PU
valleys and is found primarily in soil contaminated with bird or bat & Critical y (Micr)
droppings. It exists in tissues as macrophages with intracellular small Care (PU)
266
ovoid/round yeasts. Immunocompetent patients are often asymptomatic
but can infrequently develop subacute pneumonia with hilar and
mediastinal lymphadenopathy.
Histoplasmosis Histoplasma capsulatum is a dimorphic fungus that exists as a small, Pulmonary Microbiolog 4 PU
ovoid yeast at tissue temperatures. It replicates within macrophages and & Critical y (Micr)
spreads through the lymphatic and reticuloendothelial system. Care (PU)
267 Immunocompetent patients usually have an asymptomatic pulmonary
infection, but those who are immunocompromised (eg, advanced AIDS)
can develop disseminated disease to the liver, spleen, and bone marrow.

Influenza Major adaptive immune mechanisms that prevent reinfection with the Pulmonary Microbiolog 5 PU
influenza virus include antihemagglutinin antibodies. & Critical y (Micr)
1649 Care (PU)

Laryngotracheo Brassy, barking cough; dyspnea; stridor, fever, and recent history of upper Pulmonary Microbiolog 1 PU
bronchitis respiratory infection (Paramyxovirus) in a child are suggestive of viral & Critical y (Micr)
1667 laryngotracheitis (croup). The most common cause of croup is Care (PU)
parainfluenza virus.

Nocardiosis Nocardia is a filamentous, branching, gram-positive bacteria that is Pulmonary Microbiolog 1 PU

partially acid-fast. It most commonly causes pneumonia and brain & Critical y (Micr)
#### abscesses in immunocompromised patients. Care (PU)

Normal flora Expectorated sputum cultures are often contaminated by normal oral Pulmonary Microbiolog 1 PU
flora. The growth of Candida albicans, a normal commensal of the & Critical y (Micr)
119 gastrointestinal tract and skin, almost always indicates oral contamination Care (PU)
rather than true pulmonary infection.

Pertussis Pertussis Gram-negative coccobacillus should be considered in any adult Pulmonary Microbiolog 3 PU
who has not had updated vaccination boosters. The clinical presentation is & Critical y (Micr)
#### a paroxysmal cough lasting >2 weeks that is associated with post-tussive Care (PU)
emesis or inspiratory whoop after a severe coughing episode.

Pneumocystis Pneumocystis pneumonia is common in patients with advanced HIV and Pulmonary Microbiolog 2 PU
pneumonia usually presents with slowly worsening cough and dyspnea, hypoxia, and & Critical y (Micr)
bilateral interstitial infiltrates. Diagnosis requires visualizing the organism Care (PU)
####
in respiratory secretions using special stains (eg, silver stain). First-line
treatment is trimethoprim-sulfamethoxazole.

Septic arthritis Haemophilus influenzae is a gram-negative coccobacillus that requires Pulmonary Microbiolog 4 PU
both X factor (hematin) and V factor (NAD-) to grow. H influenzae type b & Critical y (Micr)
964 has an antiphagocytic polysaccharide capsule, which allows it to spread Care (PU)
hematogenously and cause invasive disease such as septic arthritis and
meningitis.
Tuberculosis The acid-fast stain identifies organisms that have mycolic acid present in Pulmonary Microbiolog 18 PU
their cell walls, including Mycobacterium and some Nocardia species. Acid- & Critical y (Micr)
fast staining is carried out by applying an aniline dye (eg, carbolfuchsin) to Care (PU)
1215
a smear and then decolorizing with acid alcohol to reveal whether the
organisms present are "acid fast."

Tuberculosis Mycobacterium tuberculosis grows in long, serpentine cords due to the Pulmonary Microbiolog 18 PU
presence of cord factor, a surface glycolipid, on the cell wall. Cord factor is & Critical y (Micr)
a primary virulence factor of M tuberculosis; it prevents macrophages Care (PU)
1216
from being bactericidal due to the inhibition of phagolysosome
acidification and also leads to the formation of caseating granulomas.

Tuberculosis Primary tuberculosis infection is marked by initial unchecked Pulmonary Microbiolog 18 PU

Mycobacterium tuberculosis replication within the alveolar space and & Critical y (Micr)
alveolar macrophages (Intracellular bacterial proliferation). After a few Care (PU)
1217
weeks, CD4 lymphocytes are stimulated to release interferon-gamma,
which activates macrophages and leads to control of the infection.

Hypersensitivit Hypersensitivity pneumonitis involves an exaggerated immunologic Pulmonary Pathology PU

y pneumonitis response to an inhaled antigen and can have an acute or chronic & Critical (Path)
presentation. Chronic disease presents with gradually progressive cough, Care (PU)
####
dyspnea, fatigue, and weight loss and lung biopsy reveals lymphocytic
infiltrate, poorly formed noncaseating granulomas, and septal fibrosis.
 Acute heart Acute pulmonary edema is a common consequence of acute myocardial Pulmonary Pathology 7 PU
failure infarction affecting the left ventricle. Elevated hydrostatic pressure in the & Critical (Path)
pulmonary venous system leads to engorged alveolar capillaries with Care (PU)
1881 transudation of fluid engorged capillaries and alveoli filled with
acellular pink material on histology. Hemosiderin-laden macrophages are
indicative of chronic lung congestion and are not present acutely.

Alpha1 Alveolar fluid contains neutral proteases (eg, elastases) that are derived Pulmonary Pathology 8 PU
antitrypsin from alveolar macrophages and infiltrating neutrophils. These proteases & Critical (Path)
484 deficiency can cause destruction of terminal lung parenchyma (eg, emphysema) when Care (PU)
secreted in excess or if left unchecked by deficient antiprotease activity.

Alpha1 Alpha-1 antitrypsin is the major serum inhibitor of neutrophil elastase. Pulmonary Pathology 8 PU
antitrypsin Alpha-1 antitrypsin deficiency typically causes early-onset panacinar & Critical (Path)
491 deficiency emphysema, predominantly affecting the lower lung lobes. Care (PU)

ARDS Pancreatitis is a major risk factor for acute respiratory distress syndrome as Pulmonary Pathology 3 PU
it results in the release of large amounts of inflammatory cytokines and & Critical (Path)
pancreatic enzymes, which leads to activation of neutrophils in the alveolar Care (PU)
485
tissues. During the initial phase, interstitial and intraalveolar edema,
inflammation, and fibrin deposition cause the alveoli waxy hyaline
membranes.
ARDS Acute respiratory distress syndrome is characterized by hypoxia and Pulmonary Pathology 3 PU
bilateral pulmonary infiltrates and is associated with pneumonia, sepsis, & Critical (Path)
486 trauma, and pancreatitis. The associated pulmonary edema is Care (PU)
noncardiogenic in nature, so the pulmonary capillary wedge pressure
will be within the normal range (6-12 mm Hg).
ARDS Acute respiratory distress syndrome is caused by injury of the pulmonary Pulmonary Pathology 3 PU
epithelium and/or endothelium, and occurs most often due to sepsis or & Critical (Path)
pneumonia. Cytokines recruit neutrophils to the lung tissue, which cause Care (PU)
1579 capillary damage and leakage of protein-rich fluid accumulationin the
alveoli. Later, cellular proliferation and collagen deposition occurs, and in
some patients, this leads to irreversible pulmonary fibrosis.

Asbestos Patients with a long history of asbestos exposure are at risk for developing Pulmonary Pathology 5 PU
asbestosis, pleural disease, and malignancies such as bronchogenic & Critical (Path)
carcinoma and mesothelioma arising from bronchial epithelium. Care (PU)
553
Bronchogenic carcinoma is the most common malignancy in this
population, although mesothelioma is more specific for asbestos exposure.

Asbestos Malignant mesothelioma is a rare neoplasm typically arising from the Pulmonary Pathology 5 PU
pleura. It is strongly associated with asbestos exposure and presents with & Critical (Path)
progressive dyspnea, cough, and chest pain. Unilateral pleural thickening Care (PU)
649 or plaque formation is seen on imaging; pleural effusions are also common
and may be hemorrhagic. Histopathology reveals tumor cells with
numerous long, slender microvilli and abundant tonofilaments.

Asbestos Asbestos-related pleural disease is characterized by pleural plaques (focal Pulmonary Pathology 5 PU
pleural thickening, typically with calcifications). Common occupational & Critical (Path)
exposures include shipbuilding, insulation manufacturing and Care (PU)
669
application, and drywall application. Most affected patients remain
asymptomatic for 20-30 years following initial exposure.

Aspiration Elderly patients with dementia or hemiparesis may have dysphagia, which Pulmonary Pathology 2 PU
pneumonia is a risk factor for aspiration pneumonia. Dependent lung consolidation is & Critical (Path)
2102 commonly seen in aspiration pneumonia. Etiology- Swallowing muscle Care (PU)
dysfunction

Asthma Intermittent respiratory symptoms in a patient with a normal chest x-ray, Pulmonary Pathology 12 PU
sputum eosinophils, and reduced FEV1 suggest asthma. Common asthma & Critical (Path)
1925 triggers include exercise, cold air, respiratory infection, and exposure to Care (PU)
inhaled allergens (eg, dust mites, cockroaches, pet dander, mold, pollen).

Atelectasis An obstructive lesion in a mainstem bronchus can prevent ventilation of Pulmonary Pathology 1 PU
an entire lung, leading to obstructive atelectasis and complete lung & Critical (Path)
2116 collapse. Characteristic findings on chest x-ray include unilateral Care (PU)
pulmonary opacification and deviation of the mediastinum toward the
opacified lung.
 Barrett Squamous metaplasia is a reversible, adaptive response to chronic Pulmonary Pathology 2 PU
esophagus irritation, such as smoking. The normal columnar epithelium is & Critical (Path)
replaced by squamous epithelium, which is more resistant to irritation Care (PU)
1041 but has reduced mucociliary clearance. Metaplasia also occurs with
Barrett esophagus, in which esophageal squamous epithelium is replaced
by columnar epithelium in response to chronic acid exposure.

Bronchiectasis Digital clubbing is often associated with prolonged hypoxia. It can be Pulmonary Pathology 2 PU
found in patients with large-cell lung cancer, tuberculosis, cystic fibrosis, & Critical (Path)
820 and suppurative lung diseases such as empyema, bronchiectasis, and Care (PU)
chronic lung abscesses.

Community Lobar pneumonia is marked by the cytokine-mediated accumulation of Pulmonary Pathology 21 PU

acquired neutrophils and proteinaceous material in the alveoli. Over several days, & Critical (Path)
pneumonia the proteinaceous material becomes fibrinous, neutrophils are replaced by Care (PU)
531
macrophages, and macrophages digest the fibrinous exudate, thereby
restoring normal lung histology. Leakage of protein-rich fluid in the
alveolar airspaces
COPD Hyperplasia of the submucosal bronchial glands is the major contributor to Pulmonary Pathology 16 PU
bronchial wall thickening in chronic bronchitis. The Reid index is the ratio & Critical (Path)
of the thickness of the submucosal bronchial glands to the thickness of the Care (PU)
525
bronchial wall between the epithelial basement membrane and the
bronchial cartilage. Higher values correlate with increased duration and
severity of chronic bronchitis.
COPD Emphysema consists of alveolar destruction and enlargement that results Pulmonary Pathology 16 PU
from a combination of inflammation and leukocyte infiltration, increased & Critical (Path)
protease activity, and oxidative stress, usually in response to exposure to Care (PU)
#### cigarette smoke. In severe disease, large air spaces known as subpleural
blebs can form in the lung apices. lnteralveolar septal destruction with
bronchial wall inflammation

Cystic fibrosis Meconium ileus is a distal small bowel obstruction due to abnormally Pulmonary Pathology 11 PU
dehydrated meconium in a patient with cystic fibrosis (CF). Persistent, & Critical (Path)
803 treatment-resistant infectious pneumonias, bronchiectasis, and cor Care (PU)
pulmonale account for most deaths due to CF.

Cystic fibrosis Recurrent sinopulm infections and exocrine gland atrophy in a young Pulmonary Pathology 11 PU
Caucasian are suggestive of CF. CF can lead to pancreatic insufficiency, & Critical (Path)
fat malabsorption, and a defic of vits A, D, E, and K. VitA maintains Care (PU)
orderly diff of specialised epithelia, incl the mucus-secreting columnar
806
epithelia of the ocular conjunctiva, resp and urinary tracts, and pancreatic
and other exocrine ducts. Avitaminosis A can cause squamous metaplasia
of such epithelia to a keratinising epithelium.

Fat embolism Fat embolism syndrome most commonly results from the release of fat Pulmonary Pathology 2 PU
globules from bone marrow following a long-bone or pelvic fracture. The & Critical (Path)
fat globules form inflammatory aggregates that cause microvessel Care (PU)
197
obstruction and systemic inflammation leading to the triad of respiratory
distress, neurologic dysfunction, and petechial rash that characterizes the
condition.
Fat embolism Fat embolism syndrome should be strongly suspected in a patient with Pulmonary Pathology 2 PU
severe long-bone and/or pelvic fractures who develops acute-onset & Critical (Path)
1876 neurologic abnormalities, hypoxemia, and a petechial rash. Occlusion of Care (PU)
the fat microglobules in pulmonary arterioles (microvessels) is an early
histologic finding of this syndrome.
Histoplasmosis Histoplasma capsulatum replicates within macrophages and often spreads Pulmonary Pathology 4 PU
from the lungs through the pulmonary lymphatics to the reticuloendothelial & Critical (Path)
system (eg, spleen, liver). Most healthy individuals quickly contain fungal Care (PU)
#### infection within granulomas and do not become ill; a minority develop self-
limited pneumonia. Over time, the granulomas at the initial sites of
infection calcify and may be seen incidentally on radiographic imaging.

Interstitial lung Pulmonary fibrosis presents with gradual-onset progressive dyspnea, Pulmonary Pathology 8 PU
disease nonproductive cough, fatigue, eventual weight loss, and bilateral & Critical (Path)
reticulonodular opacities on chest x-ray. Pulmonary function tests ijeveal a Care (PU)
653 restrictive pattern. Patients with rheumatoid arthritis can develop
interstitial lung diseases, both from the pulmonary manifestations of the
disease itself and from certain therapies (eg, methotrexate,
cyclophosphamide, sulfasalazine).
 Interstitial lung Idiopathic pulmonary fibrosis is an interstitial lung disease characterized by Pulmonary Pathology 8 PU
disease chronic progressive dyspnea, nonproductive cough, inspiratory crackles, & Critical (Path)
and subpleural (peripheral) lung honeycombing. In IPF, repetitive Care (PU)
microinjury to the alveolar epithelium (eg, smoking, acid reflux) is focally
666
repaired by fibroblast proliferation/collagen deposition instead of normal
restoration via type 2 pneumocyte differentiation. Loss of type 1
pneumocytes and hyperplasia of type 2 pneumocytes

Interstitial lung Histologic findings of idiopathic pulmonary fibrosis are most prominent Pulmonary Pathology 8 PU
disease in the lung periphery and include a heterogeneous mixture of chronic & Critical (Path)
7648 inflammation and patchy interstitial fibrosis, focal fibroblast proliferation, Care (PU)
and formation of fibrotic cystic spaces in a honeycomb pattern.

Lung abscess Lung abscess is most often due to aspiration of anaerobic oral bacteria such Pulmonary Pathology 4 PU
as Peptostreptococcus, Prevotella, Bacteroides, and Fusobacterium species. & Critical (Path)
533 Risk factors for lung abscess include conditions that increase aspiration Care (PU)
risk, such as alcoholism, drug abuse, seizure disorders, previous stroke,
and dementia.
Lung cancer Adenocarcinoma is the most common primary lung cancer in the general Pulmonary Pathology 9 PU
population, women, and nonsmokers. Epidermal growth factor receptor & Critical (Path)
(EGFR) mutations and ALK gene rearrangements are seen more commonly Care (PU)
554 in nonsmokers and thought to contribute to disease formation in this
subgroup. Adenocarcinoma is typically located peripherally and may be
associated with clubbing or hypertrophic osteoarthropathy.

Lung cancer Small cell lung cancer is strongly associated with smoking and is usually Pulmonary Pathology 9 PU
centrally located. Histopathology shows small round/oval cells with scant & Critical (Path)
cytoplasm, hyperchromatic (blue) nuclei, and granular chromatin; abundant Care (PU)
555 mitoses are also usually seen. Immunohistochemical stains are frequently
positive for neuroendocrine markers (eg, chromogranin, synaptophysin,
neural cell adhesion molecule [CD56]).

Lung cancer Adenocarcinoma, the most common pulmonary malignancy, is Pulmonary Pathology 9 PU
characterized histopathologically by invasive glandular cells with abundant & Critical (Path)
564 cytoplasm and eccentrically placed nuclei; mucin production is common. Care (PU)
Imaging typically demonstrates a discrete mass or pneumonia-like
consolidation at the periphery of the lung.
Lung cancer Tumors located in the lung apex (superior sulcus tumor) are called Pulmonary Pathology 9 PU
Pancoast tumors. Invasion of surrounding structures can lead to ipsilateral & Critical (Path)
648 Horner syndrome, rib destruction, atrophy of hand muscles, and pain in the Care (PU)
distribution of C8, T1, and T2 nerve roots.

Lung cancer Small cell carcinoma of the lung is the most aggressive type of lung cancer Pulmonary Pathology 9 PU
and is commonly associated with paraneoplastic syndromes (eg, SIADH, & Critical (Path)
Cushing syndrome). It is thought to have a neuroendocrine origin; tumor Care (PU)
650
cells express neuroendocrine markers (eg, neural cell adhesion molecule,
chromogranin, synaptophysin) and contain neurosecretory granules in the
cytoplasm.
Lung nodule Hamartomas are the most common benign lung tumors. They present as Pulmonary Pathology 1 PU
asymptomatic peripherally located "coin lesion" in patients 50-60 years old. & Critical (Path)
552 These tumors are composed of disorganized cartilage, fibrous, and adipose Care (PU)
tissue.

Lung Chronic rejection of lung transplant recipients; it affects small airways, Pulmonary Pathology 2 PU
transplantation causing bronchiolitis obliterans. It is characterized by lymphocytic & Critical (Path)
535 inflammation, fibrosis, and, ultimately, destruction of the bronchioles. Care (PU)

Metabolic Lactic acidosis in septic shock results from tissue hypoxia, which Pulmonary Pathology 4 PU
acidosis decreased oxidative phosphorylation and causes shunting of pyruvate to & Critical (Path)
2101 lactate following glycolysis. Hepatic hypoperfusion also contributes to the Care (PU)
buildup of lactic acid as the liver is the primary site of lactate clearance.

Neonatal The lamellar bodies of type II pneumocytes store and release pulmonary Pulmonary Pathology 5 PU
respiratory surfactant into the fluid layer lining the inner surfaces of alveoli. The major & Critical (Path)
distress function of surfactant is to reduce surface tension in this fluid layer, and so Care (PU)
479
syndrome a surfactant deficiency can cause alveolar atelectasis, as seen in neonatal
respiratory distress syndrome. (Increased alveolar tendency to collapse)

Neonatal Use of concentrated O2 therapy for NRDS may be complicated by Pulmonary Pathology 5 PU
respiratory retinopathy of prematurity. This abn retinal neovascularisation is a major & Critical (Path)
799 distress cause of blindness in developed nations. Care (PU)
syndrome
 Pleural effusion A pleural effusion is a collection of fluid between the visceral pleura that Pulmonary Pathology 4 PU
lines the lungs and the parietal pleura that lines the thoracic cavity. The & Critical (Path)
fluid acts to insulate vibrations and sounds that originate in the airways of Care (PU)
####
the lung; therefore, decreased tactile fremitus and breath sounds are
decreased over a pleural effusion. Dullness to percussion is also present.

Pneumothorax Primary spontaneous pneumothorax occurs in patients without preexisting Pulmonary Pathology 2 PU
pulmonary disease when a large change in the alveolar or intrapleural & Critical (Path)
490 pressure results in a break in the visceral (eg, ruptured apical superficial Care (PU)
bleb) pleura and air trapping between the pleural spaces.

Pulmonary Ventilation-perfusion (V/Q) scans use radiotracers to compare the Pulmonary Pathology 13 PU
embolism ventilation and blood perfusion of each area of the lung. V/Q mismatch & Critical (Path)
with perfusion defects are often indicative of a pulmonary embolism, Care (PU)
476
which are most commonly caused by deep vein thrombosis in the lower
extremities that embolizes to the pulmonary vasculature.

Pulmonary The risk of venous thromboembolism (ie, pulmonary embolism or deep Pulmonary Pathology 13 PU
embolism vein thrombosis) in hospitalized patients can be greatly reduced with the & Critical (Path)
529 administration of prophylactic anticoagulation, usually with low- Care (PU)
molecular-weight heparin.

Pulmonary Pulmonary infarcts are typically hemorrhagic (red) and wedge-shaped in Pulmonary Pathology 13 PU
embolism the periphery of the lung. Intravenous drug users are at increased risk of & Critical (Path)
975 tricuspid valve endocarditis, which can cause multiple septic pulmonary Care (PU)
infarcts due to embolization of tricuspid valve vegetation fragments

Pulmonary Massive pulmonary embolism can lead to sudden cardiac death (SCD) due Pulmonary Pathology 13 PU
embolism to a sudden loss of cardiac output. Less commonly, SCD may result from & Critical (Path)
#### cardiac arrhythmia triggered by right ventricular strain and ischemia. Deep Care (PU)
femoral vein thrombus formation

Hypersensitivit Hypersensitivity pneumonitis results from an exaggerated immunologic Pulmonary Pathology 2 PU

y pneumonitis response to an inhaled antigen (eg, mold, animal protein), and presents & Critical (Path)
#### with cough and dyspnea of variable acuity. Bronchoalveolar lavage Care (PU)
typically shows high relative lymphocyte count (eg. >20%), which helps
support the diagnosis.
Sarcoidosis Sarcoidosis often presents in young women with the insidious onset of Pulmonary Pathology 7 PU
respiratory symptoms (eg, cough, dyspnea, chest pain) accompanied by & Critical (Path)
fatigue, fever, and weight loss. The characteristic histopathologic feature is Care (PU)
795
noncaseating granulomas, which consist of aggregates of epithelioid
macrophages, frequently with multinucleated giant cells.

Sarcoidosis Sarcoidosis is a CD4+ T-cell mediated disease, in which large numbers of Pulmonary Pathology 7 PU
CD4- lymphocytes release interferon-gamma and tumor necrosis factor- & Critical (Path)
alpha to drive macrophage activation and granuloma formation. Care (PU)
796
Bronchoalveolar lavage fluid in pulmonary sarcoidosis demonstrates a
lymphocytic predominance with a high CD4+/CD8* ratio.

Sarcoidosis Sarcoidosis is a systemic inflammatory disorder characterized by Pulmonary Pathology 7 PU

noncaseating granulomas in a variety of tissues. Most patients develop liver & Critical (Path)
involvement, which typically manifests as asymptomatic hepatomegaly Care (PU)
798
with mild liver function test abnormalities. Liver biopsy frequently
demonstrates scattered noncaseating granulomas.

Sarcoidosis Sarcoidosis commonly presents with hilar adenopathy, pulmonary Pulmonary Pathology 7 PU
infiltrates, and skin (eg, erythema nodosum) and ocular findings. Biopsy & Critical (Path)
shows noncaseating granulomas composed of epithelioid cells (activated Care (PU)
877
macrophages) and giant multinucleated cells. Oral glucocorticoids
(Prednisone) are the treatment of choice for significant disease.

Sarcoidosis Hypercalcemia in sarcoidosis is caused by parathyroid hormone- Pulmonary Pathology 7 PU

independent formation of 1,25-dihydroxyvitamin D by activated & Critical (Path)
984 macrophages. This leads to increased intestinal absorption of calcium. Care (PU)

Sarcoidosis Sarcoidosis is an inflammatory disorder characterized histologically by Pulmonary Pathology 7 PU

noncaseating granulomas consisting of aggregates of epithelioid & Critical (Path)
1147 macrophages and multinucleated giant cells. Common manifestations Care (PU)
include hilar adenopathy, pulmonary infiltrates, skin rash, ophthalmic
findings, and constitutional symptoms.
 SIADH Small cell lung cancer is a neuroendocrine malignancy associated with Pulmonary Pathology 3 PU
several paraneoplastic syndromes. It is the most common cause of & Critical (Path)
syndrome of inappropriate antidiuretic hormone (SIADH) due to ectopic Care (PU)
####
secretion of antidiuretic hormone. SIADH is characterized by
hyponatremia, decreased serum osmolality, and urine osmolality >100
mOsm/kg H20.
SIDS The AEs of 2nd-hand smoke exposure incl an ↑ risk of low birth weight, Pulmonary Pathology 1 PU
asthma, middle ear disease, and SIDS. Up to 1/2 of all SIDS cases are due & Critical (Path)
310 to tobacco exposure, likely from impaired arousal and abn CV responses to Care (PU)
stimuli.

Silicosis Silicosis is characterized by dyspnea and productive cough occurring years Pulmonary Pathology 2 PU
after inhalational exposure to crystalline silica. Histologically, it is & Critical (Path)
characterized by birefringent silicate particles within dense, whorled Care (PU)
collagenous nodules surrounded by dust-laden macrophages. Radiography
668
typically demonstrates numerous small, rounded nodules predominant in
the upper lobes; calcification of the rim of hilar nodes (eggshell
calcification) may also be seen.

Superior vena Extrinsic compression of the superior vena cava by a mediastinal mass Pulmonary Pathology 1 PU
cava syndrome (eg, malignancy) can cause superior vena cava syndrome, with impaired & Critical (Path)
565 venous return from the upper body. Signs and symptoms include facial Care (PU)
swelling, distended collateral veins, headache, and dyspnea.

Systemic Pulmonary arterial hypertension is a common complication of systemic Pulmonary Pathology 4 PU

sclerosis sclerosis, likely resulting from proliferation of T cells with release of & Critical (Path)
cytokines (eg, TGF-beta) and consequent progressive thickening and Care (PU)
825 occlusion of the pulmonary arteries/arterioles. Patients typically have
progressive dyspnea and a loud pulmonic component of S2 and may
develop signs of right-sided heart failure (eg, hepatomegaly, peripheral
edema).
Tuberculosis Primary tuberculosis causes the formation of Ghon foci in the lower lungs. Pulmonary Pathology 18 PU
Secondary (reactivation of an old infection) tuberculosis occurs in & Critical (Path)
patients with prior tuberculosis infection that never cleared completely. Care (PU)
1219
Reactivation tuberculosis occurs most often in immunosuppressed patients
and is characterized by apical cavitary lesions and hemoptysis.

Tuberculosis The Ghon complex describes the two initial sites (lower lobe of lung, Pulmonary Pathology 18 PU
ipsilateral hilar lymph node) of primary tuberculosis infection. Over & Critical (Path)
1221 time, these sites become calcified and fibrosed and can be visualized on Care (PU)
gross pathology and radiographic imaging (Ranke complex).

Tuberculosis Control of Mycobacterium tuberculosis infection is mediated primarily by Pulmonary Pathology 18 PU

aggregation of activated macrophages, which surround extracellular & Critical (Path)
mycobacteria and wall them off within granulomas. The release of Care (PU)
1222
digestive enzymes by these cells not only helps control the infection, but
also leads to damage of the surrounding tissue and the formation of
cavitary lung lesions.
Acute heart Left-sided heart failure is common following myocardial infarction Pulmonary Pathophysiol 7 PU
failure affecting the left ventricle. The resulting accumulation of edema in the & Critical ogy (Patp)
1585 pulmonary interstitium makes the lungs heavy and stiff, restricting Care (PU)
inspiratory expansion and decreasing lung compliance.

Allergic rhinitis Type I hypersensitivity reactions are an allergic response triggered by the Pulmonary Pathophysiol 2 PU
binding of previously recognized antigen to IgE antibodies on mast cells. In & Critical ogy (Patp)
the early phase of the response, histamine, already stored in preformed Care (PU)
661 granules in mast cells, is the first chemical mediator released. Once
released, histamine stimulates smooth muscle contraction
(bronchoconstriction), increases vascular permeability (edema), and
increases mucus secretion.
Alpha1 AAT is a serum protein that, thru the inhib of neutrophil elastase, ↓ tissue Pulmonary Pathophysiol 8 PU
antitrypsin damage caused by inflammation. Histo, AATD can demonstrate reddish- & Critical ogy (Patp)
399 deficiency pink globules on PAS stain; these globules represent un-secreted, Care (PU)
polymerised AAT in the periportal hepatocytes.

Alpha1 The major serum inhibitor of extracellular elastase is alpha-1 antitrypsin Pulmonary Pathophysiol 8 PU
antitrypsin (AAT); patients with AAT deficiency typically develop early-onset & Critical ogy (Patp)
deficiency panacinar emphysema due to unchecked elastase activity. Exposure to Care (PU)
489
tobacco smoke dramatically accelerates the development of emphysema in
patients with AAT deficiency and should be avoided.
 Alpha1 Emphysema most commonly results from chronic smoking but can also Pulmonary Pathophysiol 8 PU
antitrypsin occur in genetically predisposed individuals with alpha-1 antitrypsin & Critical ogy (Patp)
1919 deficiency deficiency. Patients with emphysema have a decreased forced expiratory Care (PU)
volume in 1 second/forced vital capacity ratio, increased total lung
capacity, and decreased diffusing capacity.
Alpha1 Patients with severe emphysema typically have chronic C02 retention Pulmonary Pathophysiol 8 PU
antitrypsin leading to chronic respiratory acidosis with metabolic compensation (high & Critical ogy (Patp)
#### deficiency PaC02, compensatory high bicarbonate, slightly acidic pH), often Care (PU)
accompanied by hypoxemia (Pa02 <75 mm Hg on room air).

Asbestos Asbestosis is a pneumoconiosis that occurs with inhalation of asbestos Pulmonary Pathophysiol 5 PU
fibers, most commonly in patients with occupational exposure (eg, & Critical ogy (Patp)
insulation installation, shipbuilding, pipe work). Histopathology Care (PU)
#### demonstrates diffuse interstitial fibrosis and ferruginous asbestos bodies
(translucent fibers coated with a golden iron-containing material). Pleural
disease (eg, plaques, benign effusions) is common.

Asbestos Mesothelioma is a neoplasm arising from mesothelial cells and is strongly Pulmonary Pathophysiol 5 PU
associated with asbestos exposure. In early mesothelioma, multiple nodules & Critical ogy (Patp)
form on the parietal pleura and gradually encase the lung parenchyma. Care (PU)
####
Immunohistochemistry is important for diagnosis; nearly all mesotheliomas
stain positive for cytokeratins and many also stain positive for calretinin.

Asthma Eosinophils have bilobed nuclei (Destruction of helminths) and numerous Pulmonary Pathophysiol 12 PU
eosinophilic granules in the cytoplasm and are important in allergic disease & Critical ogy (Patp)
and defense against parasitic infection. The eosinophilic granules Care (PU)
523 predominantly contain major basic protein, which acts as a potent
antihelminthic toxin. Major basic protein also damages epithelial and
endothelial cells and is a major cause of chronic lung damage in asthma.

Asthma Paroxysmal breathlessness and wheezing in a young patient that are Pulmonary Pathophysiol 12 PU
unrelated to ingestion of aspirin, pulmonary infection, inhalation of & Critical ogy (Patp)
irritants, and/or exercise should raise a strong suspicion for atopic Care (PU)
527
(extrinsic) asthma. Classic sputum findings include eosinophils and
Charcot-Leyden crystals. Eosinophils are recruited and activated by IL-5
secreted by TH2 type T cells.
Asthma Bronchial challenge testing is a highly sensitive but nonspecific measure Pulmonary Pathophysiol 12 PU
that can help exclude a diagnosis of asthma. A provocative stimulus & Critical ogy (Patp)
(typically aerosolized methacholine) is administered at increasing Care (PU)
663 concentrations to induce bronchoconstriction. Patients with asthma are
hyperresponsive to this stimulus and experience a decline in FEV1 at lower
doses than nonasthmatics. (Negative methacholine challenge)

Asthma Occupational asthma is characterized by airway inflammation, bronchial Pulmonary Pathophysiol 12 PU

hyperreactivity, and a variable airflow obstruction triggered by workplace & Critical ogy (Patp)
exposure. Exposure can be immunologic (atopic), due to exposure to a Care (PU)
####
inhaled aeroallergen causing a Th2-mediated IgE formation, or
nonimmunologic, due to exposure to workplace irritants that lead to
denudation of the bronchial mucosa.
Asthma Bronchodilators induce bronchial smooth muscle relaxation to relieve Pulmonary Pathophysiol 12 PU
airway spasm and bronchoconstriction in patients with asthma. & Critical ogy (Patp)
#### Bronchodilation is most commonly accomplished with beta-2 receptor Care (PU)
agonists (eg, albuterol), which function by increasing cyclic AMP levels in
bronchial smooth muscle tone.
Community The green discoloration of pus or sputum seen during common bacterial Pulmonary Pathophysiol 21 PU
acquired infections is due to the presence of myeloperoxidase, a blue-green heme- & Critical ogy (Patp)
1910 pneumonia based enzyme that is released from neutrophil azurophilic granules and Care (PU)
forms hypochlorous acid (bleach).

Community Alveolar consolidation occurs when the alveoli become filled with Pulmonary Pathophysiol 21 PU
acquired neutrophil fluid (eg, inflammatory exudate in bacterial pneumonia). The & Critical ogy (Patp)
pneumonia increased compactness of the alveolar fluid (compared to air) causes sound Care (PU)
#### to travel faster and more efficiently, resulting in bronchophony, increased
tactile fremitus (vibration), and increased intensity of breath sounds over
the affected area. Dullness to percussion is also present.

COPD The flow-volume loop for chronic obstructive pulmonary disease is Pulmonary Pathophysiol 16 PU
characterized by increased residual volume and total lung capacity, as well & Critical ogy (Patp)
as a "scooped-out" expiratory pattern due to reduced expiratory flow rates. Care (PU)
487 Both airway narrowing due to chronic bronchitis and decreased elasticity
due to emphysematous destruction of interalveolar walls are responsible
for the hyperinflation and airflow limitation.
 COPD The pathogenesis of centriacinar emphysema associated with chronic, Pulmonary Pathophysiol 16 PU
heavy smoking predominantly involves the release of proteases, especially & Critical ogy (Patp)
488 elastase, from infiltrating neutrophils and alveolar macrophages. Care (PU)

COPD Chronic obstructive pulmonary disease is a combination of emphysema and Pulmonary Pathophysiol 16 PU
chronic bronchitis and commonly presents with progressive dyspnea and & Critical ogy (Patp)
recurrent upper respiratory infections. Bronchial obstruction and alveolar Care (PU)
destruction cause air trapping that manifests on pulmonary function testing
521
as decreased forced expiratory volume in 1 second (FEV1), forced vital
capacity (FVC), and FEV1/FVC ratio. Residual volume and total lung
capacity are increased.

COPD Chronic obstructive pulmonary disease involves components of chronic Pulmonary Pathophysiol 16 PU
bronchitis and emphysema. Bronchial airway obstruction from chronic & Critical ogy (Patp)
bronchitis and decreased alveolar elasticity from emphysema result in air- Care (PU)
522
trapping and lung hyperinflation. The functional residual capacity is
increased, as are residual volume and total lung capacity.

COPD Smoking is the strongest risk factor for chronic obstructive pulmonary Pulmonary Pathophysiol 16 PU
disease (COPD) and is responsible for accelerated decline in forced & Critical ogy (Patp)
expiratory volume in 1 second (FEV1) in patients with COPD. Smoking Care (PU)
7558
cessation will slow the accelerated decline in FEV1, but FEV1 will not
return to the level it would have been had the patient never smoked.

COPD Neutrophils, macrophages, and CD8* T lymphocytes are the primary Pulmonary Pathophysiol 16 PU
mediators of disease in chronic obstructive pulmonary disease. They & Critical ogy (Patp)
#### secrete enzymes and proteases that cause and perpetuate both the alveolar Care (PU)
destruction of emphysema and the mucus hypersecretion found in chronic
bronchitis.
COPD Supplemental oxygen administration in patients with chronic obstructive Pulmonary Pathophysiol 16 PU
pulmonary disease can lead to increased C02 retention (oxygen-induced & Critical ogy (Patp)
hypercapnia), resulting in confusion and depressed consciousness. The Care (PU)
#### major cause is reversal of hypoxic pulmonary vasoconstriction, which
increases physiologic dead space as blood is shunted away from well-
ventilated alveoli. Ventilation-perfusion mismatch

COPD Chronic obstructive pulmonary disease causes air trapping and Pulmonary Pathophysiol 16 PU
hyperinflation; consequently, these patients breathe at higher baseline lung & Critical ogy (Patp)
volumes (higher functional residual capacity). The volume of air in the Care (PU)
#### lungs that is not respired (residual volume) increases substantially, as does
the fraction of air in the lungs that is not involved in respiration (residual
volume/total lung capacity ratio).

Cystic fibrosis In CF, impairment of the CFTR protein ↓ Cl- secretion and ↑ Na+ Pulmonary Pathophysiol 11 PU
absorption by the resp epithelia, resulting in dehydrated mucus. When & Critical ogy (Patp)
804 saline is applied to the nasal mucosa, the ↑ Na+ absorption in ptswith CF Care (PU)
causes a more (-) nasal transepithelial potential diff, which can be used to
Dx CF.
Cystic fibrosis Patients with cystic fibrosis (CF) produce eccrine sweat with higher-than- Pulmonary Pathophysiol 11 PU
normal concentrations of sodium and chloride. Exposure to high & Critical ogy (Patp)
1939 temperature or exercise can lead to hyponatremia and hypochloremia due Care (PU)
to excessive sodium chloride loss through sweat; therefore, salt
supplementation is recommended.
Interstitial lung The work of breathing is minimized in patients with increased elastic Pulmonary Pathophysiol 8 PU
disease resistance (eg, pulmonary fibrosis) when their respiratory rate is high and & Critical ogy (Patp)
tidal volume is low (fast, shallow breaths). In contrast, patients with Care (PU)
8260 diseases that increase airflow resistance (eg, asthma, chronic obstructive
pulmonary disease) breathe at a lower respiratory rate and higher tidal
volume (slow, deep breaths) to minimize the work of breathing.

Lung abscess Abscess formation is largely driven by lysosomal content release by Pulmonary Pathophysiol 4 PU
neutrophils recruitment and activation leading to the release of cytotoxic & Critical ogy (Patp)
302 granules that kill bacteria but also cause liquefying necrosis of surrounding Care (PU)
tissue.

Myasthenia Myasthenia gravis is characterized by autoantibodies against postsynaptic Pulmonary Pathophysiol 10 PU

gravis nicotinic acetylcholine receptors at the neuromuscular junction, which & Critical ogy (Patp)
result in receptor degradation. Patients typically have extraocular, bulbar, Care (PU)
####
and facial weakness that worsens with activity. In severe cases, the
respiratory muscles may be affected, leading to hypoventilation and
respiratoryfailure.
 Obesity Obesity, particularly morbid, central obesity, can cause a pattern of Pulmonary Pathophysiol 2 PU
extrinsic restrictive pulmonary function tests. The most common indicator & Critical ogy (Patp)
of obesity-related disease is a reduction in expiratory reserve volume and Care (PU)
####
functional residual capacity, but forced expiratory volume in 1 second,
forced vital capacity, and total lung capacity are also typically decreased.

Obstructive Obstructive sleep apnea is due to relaxation of oropharyngeal muscle tone Pulmonary Pathophysiol 4 PU
sleep apnea with occlusion of the upper airway. Symptoms include daytime sleepiness, & Critical ogy (Patp)
1460 headaches, and depression. Complications include systemic and pulmonary Care (PU)
hypertension, right heart failure, and an increased risk for cardiac events.

Obstructive Obstructive sleep apnea presents in obese individuals with excessive Pulmonary Pathophysiol 4 PU
sleep apnea daytime sleepiness and signs of nocturnal upper airway obstruction (eg, & Critical ogy (Patp)
1985 snoring, gasping). The condition is associated with systemic hypertension. Care (PU)
Prolonged, untreated obstructive sleep apnea can also cause pulmonary
hypertension and right heart failure.
Obstructive Obstructive sleep apnea, the most common sleep-related breathing Pulmonary Pathophysiol 4 PU
sleep apnea disorder, is characterized by recurrent obstruction of the upper airways. & Critical ogy (Patp)
Relaxation of the oropharyngeal and/or soft palate musculature during Care (PU)
8262
sleep results in a functional collapse of the airway, producing periods of
reduced (hypopnea) or absent (apnea) airflow despite continued breathing
efforts.
Opioids Acute opioid OD is characterised by altered lvl of consciousness, pinpoint Pulmonary Pathophysiol 14 PU
pupils, and central resp depression. patients are expected to have acute resp & Critical ogy (Patp)
#### acidosis (low pH, high PaCO2) due to hypoventilation. Serum HCO3- is Care (PU)
typically near normal as there isn't time for meta compensation in the acute
setting.
Pleural effusion Fluid in the pleural space acts to insulate sound vibrations that originate in Pulmonary Pathophysiol 4 PU
the airways; therefore, pleural effusion causes decreased tactile fremitus & Critical ogy (Patp)
7614 and decreased intensity of breath sounds. The high density of pleural fluid Care (PU)
compared to normal lung tissue also causes dullness to percussion.

Pleural effusion Transudative effusions are typically caused by alterations in hydrostatic or Pulmonary Pathophysiol 4 PU
oncotic pressure (eg, heart failure, cirrhosis, nephrotic syndrome), whereas & Critical ogy (Patp)
exudative effusions typically result from inflammation and consequent Care (PU)
increased pleural vascular membrane permeability (eg, infection,
#### malignancy, rheumatologic disease). Exudative effusions are characterized
by a high ratio of pleural fluid to serum total protein (>0.5) or lactate
dehydrogenase (>0.6), or high absolute levels of lactate dehydrogenase.

Pleural effusion Transudative pleural effusions result from increased intracapillary pressure Pulmonary Pathophysiol 4 PU
(eg, heart failure) and exudative effusions develop from inflammatory & Critical ogy (Patp)
disruption of the vascular membrane. Transudative pleural effusions have Care (PU)
####
low fluid/serum ratios of total protein and lactate dehydrogenase and low
absolute levels of lactate dehydrogenase compared to exudative effusions.

Polycythemia In response to tissue hypoxia, specialized interstitial cells in the renal Pulmonary Pathophysiol 5 PU
medulla and cortex release erythropoietin to stimulate the bone marrow to & Critical ogy (Patp)
increase red blood cell (erythropoietin) production and improve the Care (PU)
1942 oxygencarrying capacity of the blood. This response, known as secondary
polycythemia, is an expected finding in diseases or conditions that cause
significant chronic hypoxemia (eg, chronic obstructive pulmonary disease).

Pulmonary Hereditary pulmonary arterial hypertension develops in 2 steps. An Pulmonary Pathophysiol 8 PU

arterial abnormal BMPR2 gene predisposes affected individuals to excessive & Critical ogy (Patp)
hypertension endothelial and vascular smooth muscle cell proliferation. An insult (eg, Care (PU)
530 infection, drugs) is thought to then activate the disease process, resulting in
vascular remodeling, increased pulmonary vascular resistance, and
progressive pulmonary hypertension.

Pulmonary Pulmonary hypertension can occur due to a primary change in the Pulmonary Pathophysiol 8 PU
arterial pulmonary arteries (ie, pulmonary arterial hypertension) or it can be & Critical ogy (Patp)
hypertension secondary to a separate disease process such as left-sided heart failure Care (PU)
#### (ruled out by normal pulmonary capillary wedge pressure). Endothelin
receptor antagonists (eg, bosentan, ambrisentan) lower pulmonary arterial
pressure and improve dyspnea in patients with pulmonary arterial
hypertension.
Pulmonary The lungs are supplied by dual circulation from both the pulmonary and Pulmonary Pathophysiol 13 PU
embolism bronchial arteries. This collateral circulation can help protect against lung & Critical ogy (Patp)
#### infarction due to pulmonary artery occlusion (ie, pulmonary embolism), as Care (PU)
the bronchial circulation can continue to provide blood to the lung
parenchyma.
 Pulmonary Ventilation/perfusion scanning can be useful for diagnosing pulmonary Pulmonary Pathophysiol 13 PU
embolism embolism. A large perfusion defect without ventilation defect is the & Critical ogy (Patp)
#### characteristic positive test result. Care (PU)

Respiratory An acute ventilation/perfusion mismatch (eg, due to pulmonary embolism Pulmonary Pathophysiol 1 PU
alkalosis or pneumonia) causes hypoxemia and triggers hyperventilation. Because & Critical ogy (Patp)
the removal of C02 is directly dependent on ventilation but the absorption Care (PU)
528 of 02 is capped by the high baseline saturation of hemoglobin, the
hyperventilation response typically leads to respiratory alkalosis (low
arterial partial pressure of carbon dioxide) with persistent hypoxemia.

Silicosis In silicosis, internalized silica particles impair macrophage function by Pulmonary Pathophysiol 2 PU
disrupting phagocytosis and promoting apoptosis. This increases the risk of & Critical ogy (Patp)
670 mycobacteria infection (particularly M tuberculosis). Care (PU)

Asthma Improper administration of inhaled glucocorticoids for the treatment of Pulmonary Pharmacolog 12 PU
asthma can lead to adverse effects, including oropharyngeal candidiasis & Critical y (Phar)
168 and dysphonia. Using a spacer during administration and rinsing the Care (PU)
mouth after each use can help prevent these adverse effects.

Asthma Asthma is characterized by chronic airway inflammation, which leads to Pulmonary Pharmacolog 12 PU
airway remodeling, airway hyperresponsiveness, and bronchoconstriction. & Critical y (Phar)
Corticosteroids (Fluticasone) reduce airway inflammation and are used for Care (PU)
169
both chronic asthma management (inhaled administration) and acute
exacerbations (systemic administration).

Asthma Cromolyn and nedocromil are mast cell-stabilizing agents that inhibit Pulmonary Pharmacolog 12 PU
mast cell degranulation independent of the triggering stimulus. They are & Critical y (Phar)
171 less effective than inhaled glucocorticoids and are considered second-line Care (PU)
treatments for allergic rhinitis and bronchial asthma.

Asthma Asthma is characterized by reversible airway obstruction, and lung Pulmonary Pharmacolog 12 PU
function tests may be normal between exacerbations. Bronchoprovocation & Critical y (Phar)
can be used to aid diagnosis in patients with normal spirometry; Care (PU)
1523 methacholine is administered and followed by serial spirometry. Patients
with asthma demonstrate hyperresponsivity to the stimulus, leading to
FEV1 reductions at lower doses than in those without asthma.

Asthma IgE-binding monoclonal antibodies (eg, omalizumab) are effective in Pulmonary Pharmacolog 12 PU
treating asthma that remains uncontrolled despite optimal therapy with & Critical y (Phar)
bronchodilators and inhaled corticosteroids. IgE-binding monoclonal Care (PU)
2128 antibodies reduce airway inflammation by blocking the binding of IgE to
the IgE receptors on mast cells and preventing the release of
proinflammatory substances, including histamine and leukotrienes.

COPD Ipratropium, an anticholinergic agent and derivative of atropine, treats Pulmonary Pharmacolog 16 PU
obstructive lung disease by blocking acetylcholine at muscarinic receptors, & Critical y (Phar)
170 which prevents bronchoconstriction and reduces mucus secretion from Care (PU)
tracheobronchial submucosal glands.

Interstitial lung Histologic findings of idiopathic pulmonary fibrosis include patchy Pulmonary Pharmacolog 8 PU
disease lymphoplasmacytic infiltrates, focal fibroblastic proliferation with dense & Critical y (Phar)
fibrosis, honeycombing, and hyperplasia of type 2 pneumocytes. Therapies Care (PU)
#### are directed at slowing the progression of fibrosis by inhibiting
transforming growth factor-beta and other fibrogenic growth factors (eg,
PDGF, fibroblastic growth factor, and VEGF).

Lung abscess Patients with alcohol use disorder are at increased risk for lung abscess Pulmonary Pharmacolog 4 PU
due to the aspiration of oral flora during periods of unconsciousness. & Critical y (Phar)
Although many cases are polymicrobial, the main pathogens are strict and Care (PU)
facultative anaerobic oral flora (eg, Bacteroides, Prevotella,
1446 Fusobacterium, Peptostreptococcus). Manifestations include subacute
fever, cough, and foul-smelling sputum. Clindamycin provides coverage
against both anaerobic and aerobic organisms and has been traditionally
used in the treatment of lung abscess.
 The cysteinyl-containing leukotrienes (ie: leukotriene C4, D4, and E4) are Pulmonary Pharmacolog PU
inflammatory mediators that stimulate bronchoconstriction. bronchial & Critical y (Phar)
mucus secretion and bronchial edema to contribute to the pathogenesis of Care (PU)
#### asthma. Leukotriene receptor antagonists (eg. montelukast. zafirlukast)
treat asthma by reduces bronchoconstriction by inhibiting the
interaction of inflammatory mediators with cell surface receptors.

Neuromuscular Succinylcholine is a fast-acting, depolarizing neuromuscular blocking Pulmonary Pharmacolog 1 PU

blocker agent used for rapid-sequence intubation that causes equal reduction of all & Critical y (Phar)
4 twitches during train-of-four stimulation (phase I blockade). Prolonged Care (PU)
1212 administration of succinylcholine or use in patients with abnormal plasma
cholinesterase activity causes transition to a phase II (nondepolarizing)
block, seen as a progressive reduction in each of the 4 twitches.

Pulmonary Pulmonary arterial hypertension (PAH) typically affects young women and Pulmonary Pharmacolog 8 PU
arterial can be familial. It is characterized by luminal narrowing of the & Critical y (Phar)
hypertension pulmonary arteries and arterioles, with medial hypertrophy, intimal Care (PU)
903
fibrosis, and the eventual development of plexiform lesions. Bosentan is a
competitive antagonist of endothelin receptors used for the treatment of
PAH
Corticosteroids (eg, fluticasone, budesonide) have multiple beneficial Pulmonary Pharmacolog PU
effects in the treatment of asthma. In addition to their anti-inflammatory & Critical y (Phar)
#### effect, corticosteroids upregulate beta-2 receptors on bronchial smooth Care (PU)
muscle to increase cellular responsiveness to inhaled beta-2 agonists
(eg, albuterol).
Smoking Varenicline is a partial agonist of nicotinic acetylcholine receptors. It can Pulmonary Pharmacolog 1 PU
cessation assist patients with cessation of tobacco use by reducing withdrawal & Critical y (Phar)
8754 cravings and attenuating the rewarding effects of nicotine. Care (PU)

Theophylline Theophylline is an adenosine receptor antagonist and indirect adrenergic Pulmonary Pharmacolog 2 PU
agent with a narrow therapeutic index. It is predominantly metabolized by & Critical y (Phar)
the hepatic cytochrome oxidases. Inhibition of these enzymes by Care (PU)
#### concurrent illness (eg, infection with fever) or ingestion of certain drugs or
substances (eg, ciprofloxacin) can raise serum theophylline concentrations
and cause toxicity (eg, seizures, cardiac arrhythmias).

Venous Heparins are ideal anticoagulants for most patients with thromboembolic Pulmonary Pharmacolog 2 PU
thromboemboli disease in pregnancy as they do not cross the placenta and therefore the & Critical y (Phar)
sm risk of fetal bleeding or teratogenicity is low. Low molecular weight Care (PU)
1194
heparin (eg, enoxaparin) is the preferred therapy, with patients
transitioned to unfractionated heparin at term.

Acute There are 5 major causes of hypoxemia (low arterial partial pressure of Pulmonary Physiology 1 PU
respiratory oxygen [Pa02]): alveolar hypoventilation, low partial pressure of inspired & Critical (Phys)
failure oxygen, ventilation-perfusion mismatch, diffusion impairment, and right-to- Care (PU)
1582 left shunting. The A-а gradient is normal with alveolar hypoventilation and
low partial pressure of inspired oxygen, which helps distinguish these
causes from other causes of hypoxemia.

Aging Aging is associated with steady decreases in chest wall compliance but Pulmonary Physiology 8 PU
increases in lung compliance due to a loss of elastic recoil. This results in a & Critical (Phys)
#### marked increase in residual volume, a decrease in forced vital capacity, and Care (PU)
relatively unchanged total lung capacity.

COPD Chronic obstructive pulmonary disease causes air trapping and Pulmonary Physiology 16 PU
hyperinflation; consequently, these patients breathe at higher baseline lung & Critical (Phys)
volumes (higher functional residual capacity). The absolute volume of air Care (PU)
1521 in the lungs that is not respired (residual volume) increases substantially, as
does the fraction of air in the lungs that is not involved in respiration
(residual volume/total lung capacity ratio).

COPD Arterial partial pressure of carbon dioxide (PaC02) is the major stimulator Pulmonary Physiology 16 PU
of respiration in healthy individuals; even a slight increase in PaC02 & Critical (Phys)
stimulates central chemoreceptors and triggers increased ventilation. In Care (PU)
patients with chronic obstructive pulmonary disease, the response to PaC02
1583 is blunted and hypoxemia can contribute to respiratory drive. Peripheral
chemoreceptors are primarily responsible for sensing arterial partial
pressure of oxygen (Pa02) and can be suppressed with oxygen
administration. reduced respiratory rate is most likely caused by a sudden
decrease in stimulation of which of the following sensory receptors ----
Carotid bodies
 COPD In chronic obstructive pulmonary disease, air-trapping leads to an increase Pulmonary Physiology 16 PU
in residual volume (RV) and total lung capacity (TLC), as well as an & Critical (Phys)
7601 increase in the RV/TLC ratio. Airway obstruction causes a decrease in Care (PU)
forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1),
and the FEV1/FVC ratio.
Cystic fibrosis Cystic fibrosis is an autosomal recessive disease caused by mutations in the Pulmonary Physiology 11 PU
CF transmembrane conductance regulator (CFTR) gene. The CFTR protein & Critical (Phys)
1514 is a transmembrane ATP-gated chloride channel. Defects in CFTR result Care (PU)
in thick, plugging mucous and elevated sodium and chloride levels in
sweat.
High altitude At high altitude, the low partial pressure of inspired oxygen (Pi02) leads to Pulmonary Physiology 3 PU
illness hypoxemia that triggers hyperventilation with increased exhalation of C02 & Critical (Phys)
and resulting respiratory alkalosis. The kidneys compensate by increasing Care (PU)
1980
bicarbonate (HC03) excretion to decrease serum HC03- and help
normalize pH. Hypoxemia persists, but physiologic adjustments take place
to improve 02 use.
Interstitial lung Interstitial lung disease is associated with decreased lung volumes and Pulmonary Physiology 8 PU
disease increased lung elastic recoil caused by fibrotic interstitial tissue. The & Critical (Phys)
1543 increased elastic recoil results in increased radial traction (outward Care (PU)
pulling) on the airways, leading to increased expiratory flow rates when
corrected for the low lung volume.
Interstitial lung Reduction in the slope of the curve depicting lung volume versus Pulmonary Physiology 8 PU
disease distending pressure indicates decreased lung compliance (the hallmark of & Critical (Phys)
1650 pulmonary fibrosis). Care (PU)

Iron deficiency The 3 variables that affect the total oxygen content of blood are Pulmonary Physiology 7 PU
anemia hemoglobin concentration, oxygen saturation of hemoglobin (Sa02), and & Critical (Phys)
the partial pressure of oxygen dissolved in blood (Pa02). Anemia Care (PU)
1527
characterized by decreased hemoglobin concentration (Chronic blood
loss) in the setting of normal Sa02 and Pa02.

Obesity Obesity (Chronic) hypoventilation syndrome commonly presents with Pulmonary Physiology 1 PU
hypoventilation chronic fatigue, dyspnea, and difficulty concentrating. Patients will have & Critical (Phys)
syndrome BMI >30 kg/m2 and arterial blood gas while awake showing evidence of Care (PU)
1526 hypoventilation, including hypercapnia (PaC02 >45 mm Hg) and usually
hypoxemia (Pa02 <75 mm Hg). The expected alveolar to arterial oxygen
gradient is normal (4-15 mm Hg) with hypoventilation.

Polycythemia Polycythemia (erythrocytosis) is defined as a hematocrit level > 52% in Pulmonary Physiology 5 PU
men and > 48% in women. It may be the result of a true increase in the red & Critical (Phys)
1586 blood cell (RBC) mass (absolute erythrocytosis) or decrease in the plasma Care (PU)
volume (relative erythrocytosis).

Pulmonary The pulmonary vascular bed is unique in that tissue hypoxia results in a Pulmonary Physiology 8 PU
arterial vasoconstrictive response Such hypoxic vasoconstriction occurs in the & Critical (Phys)
hypertension small muscular pulmonary arteries to divert blood flow away from Care (PU)
1587
underventilated lung regions and toward well-ventilated lung areas to
minimize ventilation-perfusion mismatch, leading to more efficient overall
gas exchange.
Pulmonary Pulmonary embolism is common in hospitalized and postoperative patients, Pulmonary Physiology 13 PU
embolism and classically presents with sudden-onset shortness of breath and pleuritic & Critical (Phys)
1584 chest pain. It causes hypoxemia due to ventilation/perfusion mismatch; Care (PU)
arterial PC02 is usually normal or decreased.

Pulmonary The combination of calf swelling, history of prolonged immobility, and Pulmonary Physiology 13 PU
embolism sudden-onset dyspnea is strongly suggestive of acute pulmonary embolism & Critical (Phys)
1981 (PE). PE typically presents with hypoxemia due to ventilation/perfusion Care (PU)
mismatch and acute respiratory alkalosis (hypocapnia) due to
hyperventilation.
Pulmonary Pulmonary embolism causes dead space ventilation, which leads to Pulmonary Physiology 13 PU
embolism hypoxemia due to the consequent ventilation/perfusion mismatch. & Critical (Phys)
7660 Care (PU)

Pulmonary Patients being weaned from mechanical ventilation typically breathe at low Pulmonary Physiology 13 PU
embolism tidal volumes, with a compensatory increase in respiratory rate to & Critical (Phys)
maintain minute ventilation. Because at low tidal volumes a higher Care (PU)
7661
proportion of each breath is composed of dead space, this type of breathing
leads to an increase in wasted ventilation (inefficient breathing).
 Pulmonary gas Gas exchange between the alveoli and pulmonary capillary blood depends Pulmonary Physiology 1 PU
exchange on both perfusion and diffusion. The exchange of 02 and C02 in a normal & Critical (Phys)
individual at rest is perfusion-limited, so alveolar and capillary partial Care (PU)
1522 pressures are equal. Situations in which 02 exchange becomes diffusion-
limited (eg, emphysema, pulmonary fibrosis) cause a large gradient
between alveolar and capillary P02; PC02 is less affected due to the greater
diffusing capacity of C02.
Respiratory Respiratory acidosis presents with low pH and high PaC02. HC03- initially Pulmonary Physiology 1 PU
acidosis remains near normal but becomes elevated over several days as renal & Critical (Phys)
1357 compensation develops. Care (PU)

Respiratory The pneumoconioses are diseases resulting from the inhalation of fine dust Pulmonary Physiology 4 PU
mucosa particles that reach the respiratory bronchioles and alveoli. Particles that & Critical (Phys)
lodge in this region are normally cleared by alveolar macrophages. High Care (PU)
particulate burden can cause the excessive release of cytokines from
536
macrophages, resulting in progressive pulmonary fibrosis. The mechanisms
is most directly responsible for clearing the foreign particles from this
patient's respiratory tract-- Phagocytosis

Respiratory Most inhaled particles that lodge in the bronchial tree are removed via Pulmonary Physiology 4 PU
mucosa proximal transport by ciliated epithelial cells (mucociliary clearance). & Critical (Phys)
1548 Mucus-secreting cells are present to the level of the larger bronchioles, Care (PU)
after which club cells become the prominent secretory cell type.

Respiratory The airway resistance at each lvl of the LRT is inv related to the TCSA of Pulmonary Physiology 8 PU
physiology all the airways at that lvl. Airway resistance is high in the trachea and & Critical (Phys)
481 reaches a peak in the medium-sized bronchi, where TCSA is at a mini. Care (PU)
Airway resistance then progr decr as TCSA incr thru the smaller
bronchioles, term bronchioles, and alv.
Respiratory The majority of C02 produced in the tissues is transported to the lungs as Pulmonary Physiology 8 PU
physiology bicarbonate ion (HC03). Within red blood cells (RBCs), the enzyme & Critical (Phys)
carbonic anhydrase forms НСО,- from C02 and water. The excess HCOr Care (PU)
1414 is then transferred out of RBCs into the plasma via exchange with chloride
ions (CI-). This exchange is known as "chloride shift" and is the principal
cause of high RBC chloride content in venous blood.

Respiratory Panic attacks are typically accompanied by hyperventilation, leading to Pulmonary Physiology 8 PU
physiology hypocapnia. Cerebral blood flow is directly related to the arterial partial & Critical (Phys)
pressure of C02; therefore, hypocapnia (Decreased arterial partial Care (PU)
1494
pressure of CO2) can lead to reduced cerebral blood flow and symptoms
of cerebral hypoperfusion (eg, blurred vision, dizziness, lightheadedness).

Respiratory Both perfusion and ventilation are highest in the base of the lung and Pulmonary Physiology 8 PU
physiology lowest in the apex; however, the variability in perfusion is greater than that & Critical (Phys)
1541 in ventilation. This causes the ventilation/perfusion ratio to follow the Care (PU)
opposite gradient: it is lowest in the base and highest in the apex.

Respiratory The p02 in the left atrium and ventricle is lower than that in the pulmonary Pulmonary Physiology 8 PU
physiology capillaries due to mixing of oxygenated blood from the pulmonary veins & Critical (Phys)
1542 with deoxygenated blood from the bronchial circulation and thebesian Care (PU)
veins.

Respiratory Minute ventilation is equal to the product of tidal volume and respiratory Pulmonary Physiology 8 PU
physiology rate and includes dead space ventilation. Alveolar ventilation is equal to & Critical (Phys)
1563 the product of respiratory rate and the difference between tidal volume and Care (PU)
dead space volume.

Respiratory During physical exercise, there is increased skeletal muscle C02 Pulmonary Physiology 8 PU
physiology production that increases the C02 content of venous blood. Arterial 02 and & Critical (Phys)
C02 content remains constant via increases in alveolar ventilation and gas Care (PU)
1590 exchange efficiency. Venous 02 content remains constant or is decreased
due to increased 02 extraction by the tissues that matches or exceeds the
rate of oxygen delivery (ie, 02 consumption during exercise is limited by
cardiac output).
Septic shock The initial management of septic shock requires rapid fluid resuscitation to Pulmonary Physiology 6 PU
replace intravascular volume and restore adequate end-organ perfusion. & Critical (Phys)
This is best accomplished with intravenous boluses of isotonic crystalloid Care (PU)
####
in the form of 0.9% (normal) saline or lactated Ringer solution because
these solutions remain in the extracellular space.
 Congenital In horseshoe kidney, the kidneys are fused at the poles. The isthmus of the Renal, Anatomy 3 RE
anomalies of horseshoe kidney usually lies anterior to the aorta and posterior to the Urinary & (Anat)
2 kidney and inferior mesenteric artery (IMA). During fetal development, the IMA Electrolyte
urinary tract limits the ascent of the horseshoe kidney. s (RE)

Rib fracture The left kidney lies immediately deep to the tip of the 12th rib. Renal, Anatomy 1 RE
Urinary & (Anat)
1700 Electrolyte
s (RE)

Ureter injury The proximal ureter receives its blood supply from the renal artery Renal, Anatomy 3 RE
whereas the distal ureter is supplied by the superior vesical artery. Urinary & (Anat)
1680 Circulation to the middle portions of the ureter is variable and anastomotic. Electrolyte
s (RE)

Ureter injury The ureters pass posterior to the ovarian (gonadal) vessels within the Renal, Anatomy 3 RE
retroperitoneum and cross anterior to the common/external iliac arteries to Urinary & (Anat)
1804 reach the true pelvis. Within the true pelvis, the ureters lie anterior to the Electrolyte
internal iliac artery and posterior to the uterine artery. s (RE)

Urinary Stress incontinence is due to loss of pelvic floor support and incompetence Renal, Anatomy 7 RE
incontinence of the urethral sphincter. Increased abdominal pressure (eg, coughing, Urinary & (Anat)
#### sneezing, or vigorous effort) greater than the urethral sphincter pressure Electrolyte
can cause brief involuntary urine loss, which is virtually diagnostic of s (RE)
stress incontinence.
Urinary The bladder is extraperitoneal. In placement of a suprapubic cystostomy. Renal, Anatomy 4 RE
retention the trocar and cannula will pierce the layers (anterior aponeurosis) of the Urinary & (Anat)
#### abdominal wall, but will not enter the peritoneum, reducing the risk of Electrolyte
peritonitis and hemoperitoneum. s (RE)

Metabolic Acidosis stimulates renal ammoniagenesis, a process by which renal Renal, Biochemistr 4 RE
acidosis tubular epithelial cells metabolize glutamine to glutamate, generating Urinary & y (Bioc)
#### ammonium that is excreted in the urine and bicarbonate that is absorbed Electrolyte
into the blood. This process is responsible for the vast majority of renal s (RE)
acid excretion in chronic acidotic states.
Transcription Primase is a DNA-dependent RNA polymerase that incorporates short Renal, Biochemistr 7 RE
RNA primers into replicating DNA. Urinary & y (Bioc)
2017 Electrolyte
s (RE)

Congenital The urachus is a remnant of the allantois that connects the bladder with Renal, Embryology 3 RE
anomalies of the yolk sac during fetal development. Failure of the urachus to obliterate Urinary & (Embr)
652 kidney and at birth results in a patent urachus, which can facilitate discharge of urine Electrolyte
urinary tract from the umbilicus. s (RE)

Congenital The ureteric bud ultimately gives rise to the collecting system of the Renal, Embryology 3 RE
anomalies of kidney, including the collecting tubules and ducts, major and minor Urinary & (Embr)
1736 kidney and calyces, renal pelvis, and the ureters. The metanephric mesoderm Electrolyte
urinary tract (blastema) gives rise to the glomeruli. Bowman's space, proximal tubules, s (RE)
the loop of Henle, and distal convoluted tubules.
Polycystic In its most severe phenotype, autosomal recessive polycystic kidney Renal, Embryology 3 RE
kidney disease disease can be detected on prenatal sonogram along with Urinary & (Embr)
1915 oligohydramnios. Potter sequence (flattened facies, limb deformities, Electrolyte
pulmonary hypoplasia) is caused by oligohydramnios and is associated with s (RE)
high mortality.
Potter sequence Potter sequence results from a renal anomaly (agenesis) that causes Renal, Embryology 1 RE
decreased fetal urine output leading to oligohydramnios. The lack of Urinary & (Embr)
amniotic fluid causes compression of the fetus (characteristic facies and Electrolyte
1752
limb abnormalities) and pulmonary hypoplasia (Respiratory distress), s (RE)
which is the most common cause of death in affected infants.

Urinary tract Inadequate canalization of the ureteropelvic junction, the connection site Renal, Embryology 4 RE
obstruction between the kidney and the ureter, is the most common cause of unilateral Urinary & (Embr)
837 fetal hydronephrosis. Electrolyte
s (RE)

Renal cell Sporadic and hereditary (associated with von Hippel-Lindau disease) Renal, Genetics 8 RE
carcinoma renal cell carcinomas are associated with mutations involving the VHL Urinary & (Gene)
gene on chromosome 3p. The VHL gene is a tumor suppressor that inhibits Electrolyte
904 hypoxia-inducible factors; mutations lead to constitutive activation of these s (RE)
proteins, resulting in the activation of multiple angiogenic and tumorigenic
growth factors (eg, VEG-F, PDG-F).
 Anti GBM Anti-glomerular basement membrane (GBM) antibodies react with Renal, Histology 2 RE
disease collagen type IV, causing rapidly progressive glomerulonephritis with Urinary & (Hist)
9 glomerular crescent formation on light microscopy. Electrolyte
Immunofluorescence demonstrating linear deposits of IgG and C3 along s (RE)
the GBM is characteristic.
Poststreptococc Poststreptococcal glomerulonephritis is most common in children and Renal, Histology 8 RE
al presents with nephritic syndrome (eg, renal failure, hypertension, Urinary & (Hist)
glomerulonephr hematuria with red blood cell casts) 2-4 weeks after an infection with Electrolyte
8
itis group A β-hemolytic Streptococcus. Immunofluorescence microscopy s (RE)
shows granular deposits of IgG, IgM, and C3 in the mesangium and
basement membranes.
Poststreptococc The electron-dense deposits on the epithelial side of the glomerular Renal, Histology 8 RE
al basement membrane (subepithelial humps) seen in patients with Urinary & (Hist)
27 glomerulonephr poststreptococcal glomerulonephritis represent immune complexes Electrolyte
itis composed of IgG, IgM, and C3. s (RE)

Blood Acute hemolytic transfusion reaction is a antibody-mediated (type II) Renal, Immunology 2 RE
transfusion hypersensitivity reaction caused by pre-existing anti-ABO antibodies that Urinary & (Immu)
bind antigens on transfused donor erythrocytes. Subsequent complement Electrolyte
747
activation results in erythrocyte lysis, vasodilation, and symptoms of shock. s (RE)
Common findings include fever, hypotension, chest and back pain, and
hemoglobinuria.
Henoch- Henoch-Schonlein purpura is an IgA-mediated type III hypersensitivity Renal, Immunology 3 RE
Schonlein reaction in children that generally follows infection. Deposition of Urinary & (Immu)
purpura circulating IgA-containing immune complexes in small vessels results in Electrolyte
758
systemic vasculitis. Common manifestations include palpable lower- s (RE)
extremity purpura, abdominal pain, arthralgias, and hematuria.

Poststreptococc Poststreptococcal glomerulonephritis is the most common cause of Renal, Immunology 8 RE

al nephritic syndrome (eg, hematuria, edema, hypertension) in children, Urinary & (Immu)
glomerulonephr typically occuring 2-4 weeks after a streptococcal infection (eg, impetigo, Electrolyte
567 itis cellulitis, pharyngitis). It is caused by a type III (immune-complex-mediated s (RE)
(lgG immune complexes)) hypersensitivity reaction resulting from
nephritogenic strains of group A beta-hemolytic Streptococcus.

Transplant Organ rejection can be hyperacute, acute, or chronic. Acute rejection most Renal, Immunology 4 RE
rejection often occurs within weeks or up to 6 months after transplant and is Urinary & (Immu)
predominantly cell-mediated, involving sensitization of host T Electrolyte
546
lymphocytes against donor MHC antigens. There is typically graft s (RE)
dysfunction with histology showing a dense, mononuclear (ie,
lymphocytic) infiltrate.
Transplant Chronic renal allograft rejection manifests months to years after a Renal, Immunology 4 RE
rejection transplant and presents with worsening hypertension and a gradual decline Urinary & (Immu)
in renal function. It involves a chronic, antibody mediated response against Electrolyte
744
donor antigens and leads to obliterative vascular wall thickening, tubular s (RE)
atrophy, and interstitial fibrosis. The process is usually irreversible and
eventually leads to graft failure.
Transplant Sirolimus binds to the immunophilin FKBP in the cytoplasm, forming a Renal, Immunology 4 RE
rejection complex that binds and inhibits mTOR (mammalian target of rapamycin). Urinary & (Immu)
#### Inhibition of mTOR signaling blocks IL-2 signal transduction and prevents Electrolyte
cell cycle progression and lymphocyte proliferation. s (RE)

Schistosomiasis Humans acquire schistosomiasis via contactwith freshwater sources that Renal, Microbiolog 2 RE
contain snails infectedwith Schistosoma larvae. S japonicum and S Urinary & y (Micr)
8541 mansoni cause intestinal and hepatic schistosomiasis, and S haematobium Electrolyte
causes urinary schistosomiasis. s (RE)

Urinary tract Urinary tract infections are most common in women and are typically Renal, Microbiolog 12 RE
infection caused by enteric pathogens. Escherichia coli is the leading pathogen. Urinary & y (Micr)
1096 Electrolyte
s (RE)

Urinary tract Patients with multiple sclerosis often develop a spastic bladder a few weeks Renal, Microbiolog 12 RE
infection after developing an acute lesion of the spinal cord. These patients present Urinary & y (Micr)
1146 clinically with increased urinary frequency and urge incontinence. Electrolyte
Urodynamic studies show the presence of bladder hypertonia. s (RE)

Urinary tract Enterococcus is an important cause of urinary tract infections. These Renal, Microbiolog 12 RE
infection organisms are gram-positive cocci in pairs and chains and, when grown on Urinary & y (Micr)
#### blood agar, they do not cause hemolysis (gamma hemolytic). Electrolyte
s (RE)
 Acute Fever, maculopapular rash, and acute renal failure occurring 1-3 weeks Renal, Pathology 2 RE
interstitial after beginning a new medication (eg, antibiotics, proton pump Urinary & (Path)
nephritis inhibitors) is highly suggestive of acute interstitial nephritis. Peripheral Electrolyte
835
eosinophilia, sterile pyuria, eosinophiluria, and white blood cell casts s (RE)
may also be seen. Histology reveals leukocyte infiltration and edema of the
renal interstitium.
Acute Acute interstitial nephritis is a common cause of renal dysfunction; up to Renal, Pathology 2 RE
interstitial 75% of cases are due to medications including nonsteroidal anti- Urinary & (Path)
nephritis inflammatory drugs, antibiotics, diuretics, and proton pump inhibitors. Electrolyte
####
Presenting features include fever, rash, and eosinophilia. Urinalysis often s (RE)
demonstrates pyuria and white blood cell casts with elevated urine
eosinophils.
Acute kidney Acute tubular necrosis is caused by renal ischemia and is characterized by Renal, Pathology 5 RE
injury oliguria, increased serum creatinine, and muddy brown casts. Ischemic Urinary & (Path)
injury predominantly affects the renal medulla, which has a relatively low Electrolyte
blood supply. The terminal (straight) portion of the proximal tubules and s (RE)
885
the thick ascending limb of the loop of Henle are the most commonly
involved portions of the nephron due to their high metabolic rate and
location within the medulla.

Acute kidney Acute tubular necrosis is characterized by tubular injury due to renal Renal, Pathology 5 RE
injury ischemia or direct cytotoxicity. The course of the disease can be broken Urinary & (Path)
into 3 stages: initiation (initial insult), maintenance (oliguric renal failure), Electrolyte
886 and recovery. During the recover period, glomerular filtration rate s (RE)
improves prior to restoration of renal tubular resorptive capacity, so
transient polyuria and electrolyte wasting (eg. hypokalemia) can occur.

Acute kidney Ethylene glycol ingestion causes acute tubular necrosis with vacuolar Renal, Pathology 5 RE
injury degeneration and ballooning of the proximal tubular cells. Typical Urinary & (Path)
clinical findings include altered mentation, renal failure, high anion gap Electrolyte
887
metabolic acidosis, increased osmolar gap, and calcium oxalate crystals s (RE)
in the urine. (Direct tubular injury due to exogenous toxin ingestion)

Acute kidney Most patients with acute tubular necrosis (ATN) experience tubular re- Renal, Pathology 5 RE
injury epithelization and regain renal function. However, when ATN is associated Urinary & (Path)
1053 with multiorgan failure renal function may be permanently impaired; in Electrolyte
such patients, foci of interstitial scarring can be seen on light microscopy s (RE)

Acute kidney Surgeries complicated by significant blood loss or those requiring the use Renal, Pathology 5 RE
injury of cardiopulmonary bypass or clamping of the aorta can cause sustained Urinary & (Path)
renal hypoperfusion and result in acute tubular necrosis (ATN). ATN Electrolyte
#### presents with oliguria, increased serum creatinine, and blood urea s (RE)
nitrogen/creatinine ratio <20:1. Urinalysis is characterized by muddy
brown granular casts composed of sloughed renal tubular epithelial cells.

Aminoglycosid Aminoglycosides are filtered across the glomerulus and concentrate in the Renal, Pathology 3 RE
e renal tubules, leading to proximal tubular injury and acute tubular necrosis. Urinary & (Path)
#### This is visualized histologically as focal tubular epithelial necrosis, often Electrolyte
with extensive granular casts that obstruct the tubular lumen and lead to s (RE)
rupture of the basement membrane.
Anti GBM Goodpasture syndrome is caused by auto-Abs against the α 3 chain of type Renal, Pathology 2 RE
disease IV collagen in GBM and ABMs (anti-GBM Abs). patients typically Urinary & (Path)
7 presentwith RPGN (nephritic syndrome) and alveolar hemorrhage (SOB, Electrolyte
hemoptysis). s (RE)

810 Atheroembolis Invasive vascular procedures can be complicated by atheroembolic disease, Renal, Pathology 2 RE
m
Atheroembolis which may involve
Atheroembolic the kidneys,
disease typically gastrointestinal tract, CNS,
occurs after an invasive and the skin.
vascular Urinary
Renal, & (Path)
Pathology 2 RE
m procedure due to mechanical dislodgement of atherosclerotic plaque, Urinary & (Path)
resulting in the showering of cholesterol-rich microemboli into the Electrolyte
circulation. Needle-shaped cholesterol clefts in affected vessels are s (RE)
####
diagnostic Commonly involved organs include the kidneys (eg acute
kidney injury), skin (eg. blue toe syndrome, livedo reticularis),
gastrointestinal tract (eg. bleeding, infarction), and CNS (eg, stroke,
amaurosis fugax).
Benign Benign prostatic hyperplasia leads to progressive bladder outlet Renal, Pathology 6 RE
prostatic obstruction. Over time, increased urinary pressures can cause Urinary & (Path)
811 hyperplasia hydronephrosis and renal parenchymal atrophy with scarring. This can Electrolyte
progress to chronic kidney disease. s (RE)

Benign Benign prostatic hyperplasia (BPH) is associated with stromal and Renal, Pathology 6 RE
prostatic glandular growth in the periurethral and transitional zone of the prostate. Urinary & (Path)
#### hyperplasia The hyperplastic cells are supported by the formation of new blood Electrolyte
vessels, which may be friable. Therefore, BPH is often associated with s (RE)
microscopic or gross hematuria.
 Benign Benign prostatic hyperplasia can increase resistance to urine flow in the Renal, Pathology 6 RE
prostatic urethra and lead to incomplete bladder emptying during micturition. The Urinary & (Path)
#### hyperplasia residual urine can act as a growth medium for patiiogenic bacteria and Electrolyte
increase the risk for urinary tract infection. s (RE)

Amyloidosis AA amyloidosis results from excessive serum amyloid A produced in Renal, Pathology RE
rheumatoid arthritis and other chronic inflammatory conditions. Renal Urinary & (Path)
disease, the most common manifestation, presents as nephrotic syndrome. Electrolyte
7628
Light microscopy shows amorphous pink deposits with apple-green s (RE)
birefringence on Congo red stain under polarized light.

Amyloidosis Beta2-microglobulin is renally cleared and poorly dialyzed. It Renal, Pathology

accumulates as amyloid in dialysis patients, increasing in prevalence with Urinary & (Path)
7625 dialysis duration, and has a predilection for osteoarticular surfaces. Electrolyte
Shoulder pain and carpal tunnel syndrome are common. Bone cysts and s (RE)
pathologic fractures may also occur.
Bladder cancer Urothelial (transitional cell) bladder cancer typically affects the elderly Renal, Pathology 4 RE
and presents with gross hematuria, A history of smoking or occupational Urinary & (Path)
7623 exposure to rubber, plastics, aromatic aminecontaining dyes, textiles, or Electrolyte
leather increases the risk. s (RE)

#### Bladder cancer Major risk factors for urothelial cancer of the bladder include age >60, Renal, Pathology 4 RE
Chronic kidney Chronic kidney disease usually causes hyperphosphatemia (binds serum Renal, Pathology 8 RE
disease Ca2*) and low 1,25-dihydroxyvitamin D (decreases intestinal Ca2* Urinary & (Path)
979 absorption and Ca2- release from bone). The resulting hypocalcemia Electrolyte
stimulates release of parathyroid hormone, causing secondary s (RE)
hyperparathyroidism.
Chronic kidney Patients with chronic kidney disease may develop renal osteodystrophy Renal, Pathology 8 RE
disease from secondary hyperparathyroidism (caused by hyperphosphatemia and Urinary & (Path)
1663 hypocalcemia). Electrolyte
s (RE)

Chronic kidney Chronic kidney disease causes disordered mineralization and bone Renal, Pathology 8 RE
disease metabolism that usually presents with hyperphosphatemia, secondary Urinary & (Path)
#### hyperparathyroidism, and decreased calcitriol levels. Patients can be Electrolyte
asymptomatic or develop weakness, bone pain, and fractures. s (RE)

Cystinuria Cystinuria results from defective dibasic amino acid transport in intestinal Renal, Pathology 2 RE
and proximal renal tubular epithelial cells. It most often presents with Urinary & (Path)
recurrent stone formation at a young age due to decreased reabsorption of Electrolyte
814 cysteine from the urine. Urinalysis shows pathognomonic hexagonal s (RE)
cystine crystals, and the sodium cyanide-nitroprusside test can be used to
detect excess cystine in the urine. (Aminoaciduria)

Diabetes Vasopressin-2 gene mutations are a cause of congenital nephrogenic Renal, Pathology
insipidus diabetes insipidus, a condition in which renal resistance to antidiuretic Urinary & (Path)
hormone results in excessive urinary water losses. Expected findings Electrolyte
#### include high baseline serum osmolality (typically with hypernatremia), s (RE)
persistently dilute urine after water deprivation (low urine osmolality),
and lack of response to desmopressin

Diabetes Patients with diabetes insipidus (Dl) are unable to concentrate their urine Renal, Pathology 5 RE
insipidus in response to dehydration. Following desmopressin administration during Urinary & (Path)
211 the water deprivation test, urine osmolality increases to normal levels in Electrolyte
central Dl but does not change in complete nephrogenic Dl. s (RE)

Diabetic Metabolic acidosis is characterized by a decrease in serum pH and serum Renal, Pathology 6 RE
ketoacidosis bicarbonate. PaC.2 will also decrease as a result of respirator compensation Urinary & (Path)
2072 for primar metabolic acidosis. Electrolyte
s (RE)

Diabetic The treatment of choice for diabetic ketoacidosis is intravenous normal Renal, Pathology 6 RE
ketoacidosis saline and insulin. These therapies increase serum bicarbonate and Urinary & (Path)
2073 sodium levels, lower serum glucose and potassium levels, and decrease Electrolyte
overall serum osmolarity. s (RE)

Diabetic Nodular glomerulosclerosis is characterized by glomerular basement Renal, Pathology 4 RE

nephropathy membrane thickening, increased mesangial matrix deposition, and Urinary & (Path)
formation of Kimmelstiel-Wilson nodules. It is most commonly caused by Electrolyte
884
diabetic nephropathy and indicates irreversible glomerular damage with s (RE)
a rapid decline in kidney function.
 Diabetic Moderately increased albuminuria (urine albumin 30-300 mg/day) is the Renal, Pathology 4 RE
nephropathy earliest manifestation of diabetic nephropathy. Screening for diabetic Urinary & (Path)
1913 nephropathy is best achieved using an albumin-specific urine assay Electrolyte
(regular dipstick urinalysis has low sensitivity). s (RE)

Endocarditis The most likely cause of fever and fatigue with new-onset cardiac murmur Renal, Pathology 15 RE
is infective endocarditis (IE). Diffuse, proliferative glomerulonephritis Urinary & (Path)
229 secondary to circulating immune complex deposition may complicate IE Electrolyte
and can result in acute renal insufficiency. s (RE)

Glomerular IgA nephropathy (Berger disease) frequently presents as recurrent, self- Renal, Pathology 9 RE
disorders limited, painless hematuria; episodes often occur concurrently with an Urinary & (Path)
upper respiratory tract infection. Kidney biopsy will show mesangial Electrolyte
10
IgA deposits on immunofluorescence. In contrast, poststreptococcal s (RE)
glomerulonephritis is seen 1-3 weeks after streptococcal pharyngitis and is
usually not recurrent.
Glomerular Crescent formation on light microscopy is diagnostic tor rapidly Renal, Pathology 9 RE
disorders progressive glomerulonephritis. Crescents consist ot glomerular parietal Urinary & (Path)
24 cells, lymphocytes, and macrophages along with abundant fibrin Electrolyte
deposition Crescents eventually become fibrotic disrupting glomerular s (RE)
function and causing irreversible renal injury.
Glomerular Minimal change disease is the most common childhood nephrotic Renal, Pathology 9 RE
disorders syndrome. Increased glomerular capillary permeability causes massive Urinary & (Path)
protein (eg, albumin) loss in the urine. Hypoalbuminemia reduces plasma Electrolyte
28 oncotic pressure, which causes a fluid shift into the interstitial space, s (RE)
resulting in edema. Low oncotic pressure also triggers increased
lipoprotein production in the liver (ie, hyperlipidemia).

Glomerular Membranous glomerulopathy is a common cause of nephrotic syndrome Renal, Pathology 9 RE

disorders in adults and can occur in association with solid malignancy, viral Urinary & (Path)
hepatitis, and systemic lupus erythematosus. Immune-complex deposition Electrolyte
in the subepithelial portion of the glomerular capillary wall causes diffuse s (RE)
382
thickening of the glomerular basement membrane (without increased
cellularity); these deposits have a "spike and dome" appearance when
stained with silver stains.

Glomerular Minimal change disease is the most common cause of nephrotic syndrome Renal, Pathology 9 RE
disorders in children. Systemic T-cell dysfunction leads to the production of Urinary & (Path)
glomerular permeability factor, which causes podocyte foot process fusion Electrolyte
383 and decreases the anionic properties of the glomerular basement s (RE)
membrane. The loss of negative charge leads to selective albuminuria
(Increased filtration of plasma proteins).

Glomerular Minimal change disease is the most common cause of nephrotic syndrome Renal, Pathology 9 RE
disorders in children. Classic manifestations include proteinuria, hypoalbuminemia, Urinary & (Path)
and edema that are usually reversible with corticosteroids. The principal Electrolyte
384
lesion is a diffuse foot process effacement that can be seen on electron s (RE)
microscopy. Light and immunofluorescence microscopy are normal.

Glomerular Minimal change disease is caused by immune dysregulation and Renal, Pathology 9 RE
disorders overproduction of a glomerular permeability factor, which damages Urinary & (Path)
podocytes and decreases the anionic properties of the glomerular Electrolyte
385
basement membrane. This results in selective loss of albumin in the s (RE)
urine, in contrast to the nonselective proteinuria seen in other forms of
nephrotic syndrome.
Glomerular Minimal change disease is the most common cause of nephrotic syndrome Renal, Pathology 9 RE
disorders in children. It is often idiopathic but may be triggered by drugs( Urinary & (Path)
Ibuprofin), immunizations, or malignancy. Light microscopy shows Electrolyte
normal glomeruli, with no immunoglobulin or complement deposits on s (RE)
#### immunofluorescent staining. However, electron microscopy shows diffuse
podocyte foot process effacement and fusion. Treatment of hypertensive
emergency includes antihypertensive therapy with the goal of lowering
blood pressure to prevent end-organ damage.

Granulomatosis Pauci-immune rapidly progressive glomerulonephritis frequently occurs Renal, Pathology 2 RE

with as a manifestation of antineutrophil cytoplasmic antibodies (ANCA)- Urinary & (Path)
polyangiitis associated vasculitides (eg. granulomatosis with polyangiitis, microscopic Electrolyte
13
polyangiitis). It is characterized by glomerular crescent formation s (RE)
without immunoglobulin or complement deposits.
 Hemolytic Hemolytic uremic syndrome is a common cause of acute renal failure in Renal, Pathology 3 RE
uremic children. It is characterized by the triad of microangiopathic hemolytic Urinary & (Path)
syndrome anemia, thrombocytopenia, and acute kidney injury. (Microthrombi in Electrolyte
1849 small blood vessels). Most cases develop following a diarrheal illness s (RE)
caused by Shiga toxin-producing organisms (eg, Escherichia coli 0157:H7,
Shigella dysenteriae).

Henoch- Henoch-Schonlein purpura is an IgA-mediated leukocytoclastic vasculitis Renal, Pathology 3 RE

Schonlein that commonly causes lower extremity palpable purpura, abdominal pain (± Urinary & (Path)
1850 purpura gastrointestinal bleeding), renal disease (eg, hematuria), and joint pain. Electrolyte
s (RE)

Hyperparathyro Most kidney stones are made of calcium salts and are idiopathic, but Renal, Pathology 2 RE
idism conditions that increase renal calcium excretion can increase the risk of Urinary & (Path)
#### stones, (Ureterolithiasis). Hyperparathyroidism is a common cause of Electrolyte
recurrent kidney stones and is typically associated with mild hypercalcemia s (RE)
and hypophosphatemia.
Hypertensive Homogeneous deposition of eosinophilic hyaline material in the intima and Renal, Pathology 1 RE
nephropathy media of small arteries and arterioles characterizes hyaline Urinary & (Path)
455 arteriolosclerosis. This is typically produced by untreated or poorly Electrolyte
controlled hypertension and/or diabetes. s (RE)

IgA IgA nephropathy is characterized as recurrent hematuria that occurs Renal, Pathology 1 RE
nephropathy spontaneously or within 5-7 days of an upper respiratory or pharyngeal Urinary & (Path)
infection (synpharyngitic hematuria). Unlike other causes of immune Electrolyte
####
complex-mediated nephritic syndromes (eg. poststreptococcal s (RE)
glomerulonephritis), IgA nephropathy is associated with normal serum
complement levels.
Membranous Primary (idiopathic) membranous nephropathy is associated with lgG4 Renal, Pathology 2 RE
nephropathy antibodies to the phospholipase A2 receptor which might play a role in Urinary & (Path)
2131 development of the disease. Antibody titers are useful for diagnosis and Electrolyte
correlate with disease activity. s (RE)

Membranous Membranous nephropathy is a common cause of nephrotic syndrome in Renal, Pathology 2 RE

nephropathy adults. Electron microscopy of the glomerular capillary demonstrates Urinary & (Path)
irregular, subepithelial, electron-dense immune deposits on the glomerular Electrolyte
#### basement membrane with moderate effacement of the podocyte foot s (RE)
processes; immunofluorescence microscopy demonstrates a diffuse
granular pattern of IgG along the capillary loops.

Multiple Multiple myeloma should be suspected in elderly patients with any Renal, Pathology 9 RE
myeloma combination of hypercalcemia (causes constipation), normocytic anemia Urinary & (Path)
(causes fatigue), bone pain (often in the back and ribs due to lytic lesions), Electrolyte
elevated gamma gap (due to the presence of large amounts of monoclonal s (RE)
1054
proteins), or renal failure. Renal failure is commonly caused by ligtit chain
cast nephropathy, large, waxy, eosinophilic casts composed of Bence
dones proteins are seen in the tubular lumen.

Necrosis Lethal tissue ischemia causes coagulative necrosis in most tissues (eg, Renal, Pathology 3 RE
kidney, myocardium); cellular architecture is maintained but nuclei are Urinary & (Path)
178 absent. The exception is ischemic cell death in the CNS, which causes Electrolyte
liquefactive necrosis. s (RE)

NSAIDs Analgesic nephropathy is a form of chronic kidney disease caused by Renal, Pathology 4 RE
prolonged, heavy intake of nonsteroidal anti-inflammatory drugs and/or Urinary & (Path)
1049 acetaminophen. Pathologic characteristics include chronic interstitial Electrolyte
nephritis and papillary necrosis. s (RE)

NSAIDs Patients with intravascular volume depletion (eg, congestive heart failure, Renal, Pathology 4 RE
diarrhea, excessive diuresis) and chronic kidney disease depend on renal Urinary & (Path)
prostaglandin production to dilate the afferent glomerular arteriole and Electrolyte
####
maintain the glomerular filtration rate. Nonsteroidal anti-inflammatoty s (RE)
drugs inhibit prostaglandin synthesis, which can cause prerenal azotemia in
at-risk patients.
Polycystic Autosomal dominant (adult) polycystic kidney disease is caused by Renal, Pathology 3 RE
kidney disease mutations in the polycystin genes (PKD1, PKD2), which result in cystic Urinary & (Path)
enlargement of the kidneys and progressive renal dysfunction. Clinical Electrolyte
3
features include hypertension, abdominal/flank pain, and gross hematuria; s (RE)
extrarenal manifestations include liver cysts and intracranial aneurysms.
 Polycystic Autosomal dominant polycystic kidney disease manifests in patients 40- Renal, Pathology 3 RE
kidney disease 50 years old with enlarged kidneys, hypertension, and renal failure. In Urinary & (Path)
newborns, the kidneys are of normal size, and the cysts are too small to be Electrolyte
1052
detected on abdominal ultrasonography. As the cysts enlarge, they s (RE)
compress the renal parenchyma and cause symptoms.

Prostate cancer Fibrosis and strictures are late effects of radiation therapy. Radiotherapy Renal, Pathology
for prostate cancer may lead to urethral fibrosis and result in obstructive Urinary & (Path)
7631 uropathy. Electrolyte
s (RE)

Poststreptococc Poststreptococcal glomerulonephritis is an immune complex. position Renal, Pathology 8 RE

al disease that occurs 2-4 weeks after exposure to group A beta-hemotortic Urinary & (Path)
glomerulonephr Streptococcus species (eg, pharyngitis, skin infection), bight microscopy Electrolyte
itis shows enlarged, hypercellular glomeruli. Immunofluorescence s (RE)
11
demonstrates a "lumpy-bumpy" granular deposits of IgG and СЗ on the
glomerular basement membrane, and subepithelial, electron-dense deposits
are seen on electron microscopy.

Poststreptococc Poststreptococcal glomerulonephritis is the most common cause of Renal, Pathology 8 RE

al nephritic syndrome in children. Light microscopy demonstrates enlarged, Urinary & (Path)
glomerulonephr hypercellular glomeruli. Laboratoty bidings in poststreptococcal Electrolyte
12 itis glomerulonephritis include elevated antistreptococcal antibodies (eg, s (RE)
antistreptolysin 0. anti-DNase B) and decreased СЗ and total complement
levels. C4 levels are usually normal.

Poststreptococc Poststreptococcal glomerulonephritis presents with edema, Renal, Pathology 8 RE

al hypertension, and hematuria after a streptococcal infection. Most Urinary & (Path)
25 glomerulonephr children recover completely, but adult patients have a relatively poor Electrolyte
itis prognosis and higher risk of chronic hypertension and renal insufhciency. s (RE)

Prerenal Hypovolemia results in a reduced renal plasma flow (RPF) and Renal, Pathology 6 RE
azotemia glomerular filtration rate (GFR). This leads to compensatory efferent Urinary & (Path)
arteriolar vasoconstriction, which raises the filtration fraction and Electrolyte
1016 maintains GFR at near-normal levels. As RPF continues to decline, s (RE)
increasing glomerular oncotic pressure will eventually overwhelm the
compensatory increase in hydrostatic pressure leading to a precipitous drop
in GFR and renal failure.
Prerenal Blood volume loss can cause prerenal or intrinsic acute renal failure Renal, Pathology 6 RE
azotemia (ARF). Prerenal ARF is associated with normal nephron function (eg. low Urinary & (Path)
urine sodium level, low fractionated sodium excretion, high urine Electrolyte
7624 osmolarity, and a high BUN Creatinine ratio), whereas intrinsic ARF s (RE)
features diminished renal reabsorptive capacity (eg, lower urine osmolarity,
higher urinary sodium, normal serum BUNCreatinine ratio).

Primary Chronic hypertension can result in hypertensive nephrosclerosis, which is Renal, Pathology 14 RE
hypertension characterized by compensatory medial hypertrophy and fibrointimal Urinary & (Path)
proliferation; endothelial damage from elevated systemic pressure also Electrolyte
7570 leads to hyaline arteriolosclerosis. The narrowed arteriolar lumens cause a s (RE)
progressive decrease in renal blood flow, resulting in glomerular ischemia
and fibrosis (glomerulosclerosis).

Primary Hyperplastic arteriosclerosis ("onion-skinning") and fibrinoid necrosis Renal, Pathology 14 RE

hypertension of the renal arterioles are typical morphologic findings in hypertensive Urinary & (Path)
7571 (malignant) nephrosclerosis. End-organ damage can be prevented by Electrolyte
treatment of high blood pressure with antihypertensives. s (RE)

Renal artery Marked unilateral kidney atrophy is suggestive of renal artery stenosis. It Renal, Pathology 9 RE
stenosis occurs in elderly individuals due to atherosclerotic narrowing of the renal Urinary & (Path)
artery and is often seen in association with other atherosclerotic risk factors Electrolyte
832
or diseases (eg, chronic mesenteric ischemia, coronary artery disease, s (RE)
peripheral vascular disease). Hypertension and abdominal and flank bruits
are often present.
Renal artery Fibromuscular dysplasia is characterized by abnormal tissue growth within Renal, Pathology 9 RE
stenosis arterial walls, resulting in stenotic and tortuous arteries that can cause Urinary & (Path)
tissue ischemia and are prone to aneurysm formation. Pathology typically Electrolyte
demonstrates alternating fibromuscular webs and aneurysmal dilation with s (RE)
####
absent internal elastic lamina (string-of-beads appearance). Renovascular
hypertension occurs due to renal artery stenosis and activation of the
renin-angiotensin-aldosterone system.
 Renal calculi Urine supersaturation is the main mechanism underlying all types of renal Renal, Pathology 7 RE
stones. Low fluid intake increases the concentration of stone-forming Urinary & (Path)
816 agents, thereby promoting stone formation. All patients with nephrolithiasis Electrolyte
should be advised to maintain adequate fluid intake. s (RE)

Renal calculi Renal calculi occur due to an imbalance of the factors that facilitate or Renal, Pathology 7 RE
inhibit stone formation. Increased urinary concentrations of calcium, Urinary & (Path)
817 oxalate, and uric acid promote salt crystallization, whereas increased Electrolyte
urinary citrate concentration and high fluid intake prevent calculi s (RE)
formation.
Renal calculi Staghorn calculi are large renal stones that take on the shape of the renal Renal, Pathology 7 RE
calyces. They are composed primarily of struvite (magnesium Urinary & (Path)
ammonium phosphate) and are associated with recurrent upper Electrolyte
6739 urinary tract infections by urease-producing organisms (eg, Proteus, s (RE)
Klebsiella). Hydrolysis of urea yields ammonia, which alkalinizes the
urine and facilitates precipitation of struvite crystals.

Renal calculi Formation of uric acid kidney stones is promoted by low urine pH, Renal, Pathology 7 RE
which favors formation of insoluble uric acid over soluble urate ion. Urinary & (Path)
#### Gastrointestinal bicarbonate loss due to chronic diarrhea leads to chronic Electrolyte
metabolic acidosis and production of acidic urine, promoting formation s (RE)
of uric acid stones.
Renal calculi Struvite stones are typically seen in patients with recurrent upper Renal, Pathology 7 RE
urinary infection by urease-producing organisms (eg, Proteus, Urinary & (Path)
#### Klebsiella). Hydrolysis of urea yields ammonia, which alkalinizes the Electrolyte
urine and facilitates precipitation of magnesium ammonium phosphate. s (RE)
Urinalysis shows hematuria and elevated urine pH.
Renal calculi Urine sediment in acute ureterolithiasis typically shows free red blood Renal, Pathology 7 RE
cells (hematuria) and crystals consistent with the type of stone. Urinary & (Path)
#### Ultrasound can reveal ureteral and calyceal dilation (hydronephrosis), but Electrolyte
small stones themselves may not be visible. s (RE)

Renal cell Clear cell carcinoma (Kidney) is the most common subtype of renal cell Renal, Pathology 8 RE
carcinoma carcinoma and is composed of large, rounded, or polygonal cells with clear Urinary & (Path)
cytoplasm. These tumors are often detected incidentally at an advanced Electrolyte
818
stage; the lung is the most common site for metastasis, followed by s (RE)
osteolytic bone and liver.

Renal cell Clear Cell Carcinoma is the most common type of Renal Cell Carcinoma Renal, Pathology 8 RE
carcinoma and originates from the epithelial cells of the proximal renal tubules. Gross Urinary & (Path)
905 pathology typically demonstrates a sphere-like mass composed of golden- Electrolyte
yellow cells (due to high lipid content)with areas of necrotic cells and focal s (RE)
hemorrhage.
Renal cell The most common renal malignancy is clear cell carcinoma, which arises Renal, Pathology 8 RE
carcinoma from renal proximal tubular cells. Rounded or polygonal cells with Urinary & (Path)
1862 abundant clear cytoplasm are seen on light microscopy. "Clear cells" are Electrolyte
generally those with a high glycogen or lipid content that dissolves s (RE)
during routine tissue preparation.
Renal cell Renal cell carcinoma tends to invade the renal vein; inferior vena cava Renal, Pathology 8 RE
carcinoma obstruction can occur by intraluminal extension of the tumor. Obstruction Urinary & (Path)
7226 of the inferior vena cava produces symmetric bilateral lower extremity Electrolyte
edema, often associated with prominent development of venous collaterals s (RE)
in the abdominal wall.
Renal cell Renal cell carcinoma causes a vanety of paraneoplastic syndromes Renal, Pathology 8 RE
carcinoma including etythrocytosis (due to excessive erythropoietin production) Urinary & (Path)
7227 and hypercalcemia (due to parathyroid hormone-related peptide). Electrolyte
s (RE)

Renal cell Classic signs and symptoms of renal cell carcinoma (RCC) include Renal, Pathology 8 RE
carcinoma hematuria, an abdominal mass, flank pain, and weight loss. Hypercalcemia Urinary & (Path)
#### and erythrocytosis are common paraneoplastic syndromes associated with Electrolyte
RCC. s (RE)

Renal cell Renal cell carcinoma may present with a combination of hematuria, Renal, Pathology 8 RE
carcinoma abdominal mass, or flank pain; however, this triad occurs together in <10% Urinary & (Path)
#### of cases. Pathology demonstrates rounded, polygonal cells with clear Electrolyte
cytoplasm. Risk factors include smoking, toxin exposure, and certain s (RE)
hereditary disorders (eg, von Hippel-Lindau syndrome).
Renal Renal infarctions are most commonly caused by cardioembolic disease; Renal, Pathology 2 RE
infarction atrial fibrillation is the greatest risk factor. Clinical features include flank Urinary & (Path)
pain, nausea, vomiting, low-grade fever, and hypertension (due to renin Electrolyte
####
release from hypoxic tissue). Gross pathology demonstrates sharply s (RE)
demarcated, yellow-white, wedge-shaped areas with surrounding
hyperemia.
 Renal papillary Renal papillary necrosis classically presents with gross hematuria, acute Renal, Pathology 1 RE
necrosis flank pain, and passage of tissue fragments in urine. It is most commonly Urinary & (Path)
834 seen in patients with sickle cell disease or trait, diabetes mellitus, Electrolyte
analgesic nephropathy, or severe obstructive pyelonephritis. s (RE)

Rhabdomyolysi Rhabdomyolysis usually presents with myalgia, proximal muscle weakness, Renal, Pathology 2 RE
s and dark urine (myoglobinuria) in the setting of trauma, sepsis, or Urinary & (Path)
#### overexertion. Kidney injury occurs due to heme pigment-mediated tubular Electrolyte
injury, leading to acute tubular necrosis. Urine microscopy typically reveals s (RE)
granular, muddy brown casts.
Rhabdomyolysi Rhabdomyolysis is characterized by the release of intracellular muscle Renal, Pathology 2 RE
s contents (eg, myoglobin, electrolytes) due to myocyte injury; it is common Urinary & (Path)
with crush injuries, seizures, or drug use (eg, statins). Heme pigment Electrolyte
#### (released from myoglobin after degradation in the kidney) is toxic to s (RE)
tubular cells and can cause acute tubular necrosis. Positive blood on urine
dipstick in the absence of red blood cells on microscopic urinalysis
suggests myoglobinuria.
SLE Systemic lupus erythematosus is an autoimmune disease characterized by Renal, Pathology 7 RE
the formation of antinuclear antibodies (eg, anti-DNA antibodies). Lupus Urinary & (Path)
nephritis occurs primarily due to the formation of immune complexes Electrolyte
#### containing DNA and anti-DNA in the circulation. These are deposited s (RE)
in the glomerulus where they result in complement activation, recruitment
of inflammatory cells, and renal injury (type III hypersensitivity).

Thrombotic Primary thrombotic microangiopathy (TMA) syndromes share common Renal, Pathology 3 RE
thrombocytope clinical and pathologic features and result in platelet activation and Urinary & (Path)
nic purpura diffuse microthrombosis in arterioles and capillaries. TMA syndromes Electrolyte
####
present with hemolytic anemia with schistocytes, thrombocytopenia, and s (RE)
organ injury (eg, brain, kidneys, heart).

Urinary tract Pyuria and bacteriuria are found in both upper and lower UTIs. However, Renal, Pathology 12 RE
infection WBC casts only form in the renal tubules and are pathognomonic for acute Urinary & (Path)
888 pyelonephritis (APN) when accompanied by SSx of acute UTI. Electrolyte
s (RE)

Urinary tract The ureters run in close proximity to the pelvic lymph nodes and the Renal, Pathology 4 RE
obstruction uterine artery in the female pelvis, which predisposes them to injury Urinary & (Path)
1916 during pelvic surgery. (Hydronephrosis) Electrolyte
s (RE)

Urinary tractAcute urinary retention is characterized by anuria and bladder distension Renal, Pathology 4 RE
obstruction and can result in hydronephrosis and acute kidney injury. A palpable, Urinary & (Path)
distended bladder is present on examination, and abdominal and flank Electrolyte
####
pain may be present. The most common cause of urinary retention is s (RE)
bladder outlet obstruction (urethral compression) due to benign prostatic
hyperplasia.
Vesicoureteral Vesicoureteral reflux is caused by retrograde urine flow from the bladder Renal, Pathology 1 RE
reflux into the ureter. The hydrostatic pressure of refluxing urine along with Urinary & (Path)
infections due to ascending bacteria causes inflammation. The compound Electrolyte
833 papillae in the upper and lower poles of the kidney are most susceptible to s (RE)
reflux-induced damage (neuropathy), which appears as dilated calyces
with overlying renal cortical scarring.

ACE inhibitors In the kidney, angiotensin II preferentially constricts the efferent arteriole, Renal, Pathophysiol 7 RE
thereby maintaining the glomerular filtration rate (GFR) within normal Urinary & ogy (Patp)
1841 range. ACE-inhibitors (enalipril) promote efferent arteriolar dilation, Electrolyte
causing GFR reduction. s (RE)

Acute urate Tumor lysis syndrome occurs when tumors with a high cell turnover are Renal, Pathophysiol 1 RE
nephropathy treated with chemotherapy. The lysis of tumor cells catises intracellular Urinary & ogy (Patp)
ions, such as potassium and phosphorous, and uric acid (metabolite of Electrolyte
tumor nucleic acid) to be released into serum. Uric acid is soluble at s (RE)
1050 physiologic pH, but it can precipitate in the normally acidic environment of
distal tubules and collecting ducts. The prevention of tumor lysis syndrome
includes urine alkalinization and hydration, as high uhne flow and high pH
along the nephron prevents Ctystallization and precipitation of uric acid.

Chronic kidney In chronic kidney disease, reduced excretion of phosphate can cause Renal, Pathophysiol 8 RE
disease hyperphosphatemia. This induces hypocalcemia directly by binding free Urinary & ogy (Patp)
calcium and depositing in tissues, and indirectly by triggering fibroblast Electrolyte
#### growth factor 23 secretion (decreases calcitriol production and intestinal s (RE)
calcium absorption). The resulting hypocalcemia can manifest as
neuromuscular excitability (eg, carpal spasm).
 Cystinuria Cystinuria is an autosomal recessive disorder caused by defective Renal, Pathophysiol 2 RE
transportation of cystine, ornithine, arginine, and lysine across the Urinary & ogy (Patp)
815 intestinal and renal tubular epithelium. Recurrent nephrolithiasis (Kidney Electrolyte
stones) is the only clinical manifestation. Urinalysis shows pathognomonic s (RE)
hexagonal cystine crystals.
Diabetic In diabetic nephropathy early adaptive changes in the kidney cause a Renal, Pathophysiol 4 RE
nephropathy transient increase in glomerular filtration (hyperfiltration). As diabetic Urinary & ogy (Patp)
#### nephropathy progresses, glomerular filtration falls, with a concurrent Electrolyte
increase in urine albumin loss. s (RE)

Glomerular Frothy or foamy urine may be caused by proteinuria. Heavy proteinuria, Renal, Pathophysiol 9 RE
disorders as in nephrotic syndrome, can cause regional or generalized interstitial Urinary & ogy (Patp)
1577 edema because the decrease in serum albumin and total protein Electrolyte
concentrations lowers the plasma oncotic pressure and increases net s (RE)
plasma filtration in capillary beds.
Hypercalcemia Serum calcium >13 mg/dL is suggestive of an underlying malignancy. Renal, Pathophysiol 5 RE
Secretion of parathyroid hormone-related protein (PTHrP), which Urinary & ogy (Patp)
closely resembles parathyroid hormone at the bioactive amino-terminal Electrolyte
978
region, is a frequent cause of malignancy-related hypercalcemia and is s (RE)
commonly seen with squamous cell carcinomas (eg, lung, neck).

Hypercalcemia Multiple myeloma is associated with increased bone resorption due to the Renal, Pathophysiol 5 RE
production of tumor-related cytokines. This results in elevated serum Urinary & ogy (Patp)
calcium levels, which reduce parathyroid hormone (PTH) production. Electrolyte
####
Low PTH decreases renal calcium reabsorption (hypercalciuria), and, in s (RE)
combination with renal insufficiency, reduces 1,25-dihydroxyvitamin D
synthesis.
Kidney Acute renal allograft rejection can be an antibody- or cell-mediated Renal, Pathophysiol 1 RE
transplantation process. Acute cellular rejection is associated with diffuse lymphocytic Urinary & ogy (Patp)
#### infiltration of the renal vasculature (endotheliitis), tubules, and interstitium. Electrolyte
s (RE)

Fanconi Fanconi syndrome is an inherited disorder of proximal tubular Renal, Pathophysiol RE

syndrome transport. Glucose, bicarbonate, calcium, phosphate, and amino acids are Urinary & ogy (Patp)
7626 lost leading to a number of metabolic abnormalities. The classic clinical Electrolyte
presentation includes failure to thrive, polyuria, polydipsia, and rickets. s (RE)

Metabolic Metabolic alkalosis is characterized by a high arterial blood pH, HCO3, Renal, Pathophysiol 1 RE
alkalosis and pCO2. Vomiting/nasogastric suctioning and thiazide/loop diuretic use Urinary & ogy (Patp)
cause volume and Cl depletion, resulting in metabolic alkalosis that is Electrolyte
saline-responsive. In contrast, hyperaldosteronism leads to metabolic s (RE)
956
alkalosis that is saline-unresponsive. Determining the patient's volume
status and measuring the urinary chloride concentration can help to
identify the cause of metabolic alkalosis.

Prerenal Hypovolemia (eg, excessive diuresis) can cause acute kidney injury due to Renal, Pathophysiol 6 RE
azotemia reduced renal blood flow (prerenal azotemia). Urine sodium and fractional Urinary & ogy (Patp)
excretion of sodium levels are low and the BUN/creatinine ratio is Electrolyte
#### elevated. In severe cases, acute tubular necrosis can occur and cause an s (RE)
intrinsic renal injury pattern (ie, high urine sodium, normal BUN'creatinine
ratio) with muddy brown casts on urinalysis.

Prerenal Compensatory mechanisms for hypovolemia include activation of the Renal, Pathophysiol 6 RE
azotemia renin-angiotensin-aldosterone system and increased antidiuretic hormone Urinary & ogy (Patp)
#### release, fhis results in increased renal sodium, chloride, water, and urea Electrolyte
reabsorption with increased potassium excretion. s (RE)

Prerenal Hypovolemia triggers a variety of compensatory mechanisms to improve Renal, Pathophysiol 6 RE

azotemia tissue perfusion. These include activation of the renin-angiotensin- Urinary & ogy (Patp)
#### aldosterone system (resulting in increased aldosterone and endothelin Electrolyte
release), increased vasopressin release, and increased sympathetic s (RE)
tone.
Prerenal Cardiorenal syndrome is due to hemodynamic alterations related to a low Renal, Pathophysiol 6 RE
azotemia cardiac output state and maladaptive neurohormonal changes. Low cardiac Urinary & ogy (Patp)
output results in renal hypoperfusion, leading to activation of the renin- Electrolyte
angiotensin-aldosterone system, antidiuretic hormone release, and s (RE)
#### increased sympathetic nervous system activity. The resultant increase in
sodium and water reabsorption and systemic vasoconstriction have
detrimental effects on left ventricular systolic function, further worsening
cardiac output and renal perfusion.
 Renal artery Renal artery stenosis causing signifcant renal hypoperfusion will result in Renal, Pathophysiol 9 RE
stenosis a decreased glomerular filtration rate and activation of the renin- Urinary & ogy (Patp)
angiotensin-aldosterone system. This leads to increased renin release by Electrolyte
7569 modified smooth muscle juxtaglomerular cells in the walls of afferent s (RE)
glomerular arterioles. Chronic renal hypoperfusion can cause hyperplasia
of the juxtaglomerular apparatus.

Renal calculi Hypercalciuria is the most common risk factor for calcium (calcium Renal, Pathophysiol 7 RE
oxalate and calcium phosphate) kidney stones in adults; contributing Urinary & ogy (Patp)
factors may include increased gastrointestinal absorption, increased Electrolyte
813 mobilization of calcium from bone, or decreased renal tubular calcium s (RE)
reabsorption. However, most patients remain normocalcemic due to
regulation of plasma calcium levels by vitamin D and parathyroid hormone.

Urinary Patients with multiple sclerosis most commonly develop urge incontinence Renal, Pathophysiol 7 RE
incontinence due to loss of central nervous system inhibition of detrusor contraction Urinary & ogy (Patp)
#### in the bladder. As the disease progresses, the bladder can become atonic Electrolyte
and dilated, leading to overflow incontinence. s (RE)

Urinary Diabetic autonomic neuropathy is common in type 1 diabetics and can Renal, Pathophysiol 7 RE
incontinence cause overflow incontinence due to inability to sense a full bladder and Urinary & ogy (Patp)
#### incomplete emptying. PVR testingwith US or catheterization can confirm Electrolyte
inadequate bladder emptying. s (RE)

Urinary Patients with multiple sclerosis often develop a spastic bladder a few Renal, Pathophysiol 7 RE
incontinence weeks after developing an acute lesion of the spinal cord. These patients Urinary & ogy (Patp)
#### present clinically with increased urinary frequency and urge Electrolyte
incontinence. Urodynamic studies show the presence of bladder s (RE)
hypertonia.
Urinary tract Suppression of endogenous flora, colonization of the distal urethra by Renal, Pathophysiol 12 RE
infection pathogenic gram-negative rods, and attachment of these pathogens to the Urinary & ogy (Patp)
bladder mucosa are the stages of pathogenesis in lower urinary tract Electrolyte
831
infections. Anatomic or functional vesicoureteral reflux is almost always s (RE)
necessary for the development of acute pyelonephritis.

Urinary tract Urinary tract infections (UTIs) are common in hospitalized patients with Renal, Pathophysiol 12 RE
infection indwelling urinary catheters. The risk for UTI can be reduced by avoiding Urinary & ogy (Patp)
#### unnecessary catheterization, using sterile technique when inserting the Electrolyte
catheter, and removing the catheter as soon as possible. s (RE)

Urinary tract Urinary tract obstruction causes reflux of urine into the renal tubules Renal, Pathophysiol 4 RE
obstruction and increased tubular hydrostatic pressure. The intraglomerular Urinary & ogy (Patp)
capillary hydrostatic pressure is unchanged, resulting in a decreased Electrolyte
hydrostatic pressure gradient across the glomerular capillary wall and a s (RE)
####
reduction in glomerular filtration. Oncotic pressure is maintained by large
plasma proteins which are not filtered across the glomerular capillary
basement membrane; it is unaffected by a urinary tract obstruction.

ACE inhibitors Patients with bilateral renal artery stenosis have reduced renal perfusion Renal, Pharmacolog 7 RE
(due to atherosclerotic blockage) and are dependent upon angiotensin II- Urinary & y (Phar)
induced efferent vasoconstriction to maintain glomerular filtration rate Electrolyte
ACE inhibitors (lisinopril) block angiotensin ll-mediated s (RE)
694
vasoconstriction, which can reduce systemic blood pressure and lower
renal perfusion In addition, ACE inhibitors cause dilation of the efferent
arteriole, leading to a reduction in glomerular filtration rate and renal
filtration fraction.
ACE inhibitors ACE inhibitors reduce angiotensin II levels and cause efferent arteriole Renal, Pharmacolog 7 RE
dilation, thereby decreasing the glomerular filtration pressure and filtration Urinary & y (Phar)
696 rate This can precipitate acute renal failure in patients with reduced Electrolyte
intrarenal perfusion pressure at baseline (eg, renal artery stenosis, s (RE)
congestive heart failure, hypovolemia).
Acetazolamide Carbonic anhydrase is found in high concentrations in the proximal tubule Renal, Pharmacolog 1 RE
and is responsible for catalyzing reactions necessary for NaHC03 Urinary & y (Phar)
reabsorption. Acetazolamide is a diuretic that works by inhibiting Electrolyte
carbonic anhydrase, which effectively blocks NaHC03 and water s (RE)
682
reabsorption in the proximal tubules resulting in urinary bicarbonate
wasting. Carbonic anhydrase inhibitors are also used to relieve intraocular
pressure in open- angle and angle-closure glaucoma.

Aldosterone Aldosterone is a component of the renin-angiotensin-aldosterone system Renal, Pharmacolog 3 RE

antagonists that acts on the principal and intercalated cells of the renal collecting Urinary & y (Phar)
1533 tubules to cause resorption of sodium and water and loss of potassium and Electrolyte
hydrogen ions. Aldosterone receptor antagonists (eg, spironolactone, s (RE)
eplerenone) inhibit these effects.
 Beta blockers Beta-adrenergic blocking drugs inhibit renin release by blocking beta-1 Renal, Pharmacolog 3 RE
receptor-mediated regulation of the renin-angiotensin-aldosterone system Urinary & y (Phar)
692 This reduces plasma renin activity, with a resulting reduction in Electrolyte
angiotensin I, angiotensin II. and aldosterone levels s (RE)

Chronic kidney Chronic kidney disease can cause hyperphosphatemia due to decreased Renal, Pharmacolog 8 RE
disease renal excretion of phosphorus. Dietary phosphorus restriction is Urinary & y (Phar)
#### recommended, but oral phosphate binders are often needed. Sevelamer is a Electrolyte
nonabsorbable anion-exchange resin that binds intestinal phosphate to s (RE)
reduce absorption.
Diabetic The risk of progression of diabetic nephropathy in patients with proteinuria Renal, Pharmacolog 4 RE
nephropathy can be reduced by appropriate glycemic and blood pressure control. ACE Urinary & y (Phar)
inhibitors (Lisinopril) and angiotensin II receptor blockers are the Electrolyte
151
preferred antihypertensive agents due to their antiproteinuric effects, which s (RE)
are independent from their effects on systemic blood pressure.

Diuretics and Thiazide and loop diuretics cause significant volume depletion, Renal, Pharmacolog 1 RE
electrolyte activating the renin-angiotensin-aldosterone system, which can lead to Urinary & y (Phar)
8884 imbalance hypokalemia and metabolic alkalosis Thiazide diuretics are more likely to Electrolyte
cause hyponatremia and hypercalcemia; loop diuretics cause hypocalcemia. s (RE)

Drug Calcineurin inhibitor nephrotoxicity with resultant impairment of renal Renal, Pharmacolog 2 RE
interaction function is the most signihcant adverse effect of cyclosporine Cytochrome Urinary & y (Phar)
P450 ЗА (CYP3A) is responsible for cyclosporine metabolism in the small Electrolyte
####
intestine and liver Grapefruit juice inhibits this enzyme and increases the s (RE)
nephrotoxicity of cyclosporine by raising circulating drug levels
(pharmacokinetic interaction).
Erythropoietin Erythropoiesis-stimulating agents (ESAs) can substantially improve anemia Renal, Pharmacolog 1 RE
symptoms, avoiding the need for blood transfusions in chronic kidney Urinary & y (Phar)
#### disease and dialysis patients. However, ESAs are associated with Electrolyte
increased risk for hypertension and thromboembolic events. s (RE)

Gout Patients undergoing solid organ transplantation are at increased risk of Renal, Pharmacolog 11 RE
gout due to medications that impair renal clearance of uric acid. Urinary & y (Phar)
#### Cyclosporine is particularly associated with gout in the post transplantation Electrolyte
period due to decreased uric acid excretion. s (RE)

Gynecomastia Spironolactone is an aldo antag commony used to Tx HF. It has significant Renal, Pharmacolog 3 RE
antiandrogenic effects and can cause gynecomastia, decr libido, and Urinary & y (Phar)
687 impotence. Eplerenone is a more selective aldo antagwith fever AEs. Electrolyte
s (RE)

Hyperaldostero Aldosterone excess will cause hypertension, hypokalemia, metabolic Renal, Pharmacolog 5 RE
nism alkalosis and depressed renin Alternatively, hypoaldosteronism is the cause Urinary & y (Phar)
152 of type IV renal tubular acidosis Aldosterone antagonists such as Electrolyte
spironolactone or eplerenone can be used as medical therapy for Conn's s (RE)
syndrome.
Hypokalemia Thiazide diuretics decrease intravascular fluid volume, which stimulates Renal, Pharmacolog 2 RE
aldosterone secretion and leads to increased excretion of potassium and Urinary & y (Phar)
1425 hydrogen ions in the urine This results in hypokalemia and metabolic Electrolyte
alkalosis. s (RE)

Lithium Lithium-induced diabetes insipidus is the result of lithium's antagonizing Renal, Pharmacolog 2 RE
effect on the action of vasopressin on principal cells within the collecting Urinary & y (Phar)
2113 duct system. Electrolyte
s (RE)

Loop diuretics Loop diuretics act by inhibiting the Na-K-2CI cotransporter in the thick Renal, Pharmacolog 3 RE
ascending limb of the loop of Henle, increasing Na*, CI-, and H20 Urinary & y (Phar)
681 excretion. They are the most potent diuretics and are used as hrst-line Electrolyte
therapy for rapid relief of symptoms in patients with acute decompensated s (RE)
heart failure.
Loop diuretics Ototoxicity secondary to loop diuretics (eg, furosemide, torsemide, Renal, Pharmacolog 3 RE
bumetanide), usually occurs with higher dosages, pre-existing chronic Urinary & y (Phar)
renal disease, rapid intravenous administration, or when used in Electrolyte
685
combination with other ototoxic agents (aminoglycosides, salicylates, and s (RE)
cisplatin) Hearing impairment is usually reversible but may be permanent
in some cases
 Mannitol Mannitol is an osmotic diuretic that works by increasing plasma or tubular Renal, Pharmacolog 1 RE
fluid osmolality. Increased plasma and fluid osmolality causes extraction of Urinary & y (Phar)
water from the interstitial space into the vascular space or tubular lumen, Electrolyte
with subsequent diuresis. In the brain, water redistribution from the tissues s (RE)
688
into the plasma helps reduce edema and intracranial pressure in the
setting of cerebral edema. One of the more severe toxicities of aggressive
osmotic diuretics is pulmonary edema

Primary Common side-effects of ACE-inhibitors (Lisinopril)include decreased Renal, Pharmacolog 14 RE

hypertension glomerular filtration rate (GFR), hyperkalemia, and cough. Angioedema is Urinary & y (Phar)
1148 a rare, but life-threatening, side-effect. Electrolyte
s (RE)

Renal artery In renal artery stenosis, increased production of angiotensin II causes Renal, Pharmacolog 9 RE
stenosis increased systemic blood pressure (to increase renal perfusion) and Urinary & y (Phar)
preferential constriction of the glomerular efferent arteriole (to increase Electrolyte
glomerular filtration). Patients with bilateral renal artery stenosis are s (RE)
695 dependent on this response to maintain renal function: initiation of ACE
inhibitors (Ramipril) or angiotensin II receptor blockers can precipitate
acute renal failure. However, urinalysis is typically unremarkable (ie, no
hematuria, proteinuria, or casts)

Renal artery Renal artery stenosis (eg. severe hypertension, abdominal bruits) causes Renal, Pharmacolog 9 RE
stenosis decreased renal artery perfusion, which activates the renin-angiotensin- Urinary & y (Phar)
aldosterone system. Increased secretion of renin leads to increased Electrolyte
production of angiotensin I and angiotensin II, which causes increased s (RE)
#### peripheral resistance and elevated systemic blood pressure Increased
aldosterone secretion causes increased renal Na" reabsorption and K+ and
H* excretion, resulting in relative hypokalemia and metabolic alkalosis.

Renin Angiotensin-converting enzyme (ACE) inhibitors (Ramipril) block the Renal, Pharmacolog 1 RE
angiotensin effect of ACE, decreasing angiotensin II and aldosterone levels. By Urinary & y (Phar)
aldosterone decreasing angiotensin II levels, ACE inhibitors directly interrupt Electrolyte
690 system negative feedback loops, thereby increasing renin and angiotensin I s (RE)
levels. ACE is also responsible for the breakdown of bradykinin(inc);
ACE inhibitors therefore increase bradykinin levels.

Thiazides Thiazide diuretics work by blocking Na+-CI‘ symporters in the distal Renal, Pharmacolog 3 RE
convoluted tubules, causing enhanced Na, Cl, and water excretion. Since Urinary & y (Phar)
683 only a small amount of filtered Na+ reaches the distal tubules, thiazides are Electrolyte
not as efficacious as loop diuretics. Unlike loop diuretics, thiazides can s (RE)
cause hypercalcemia.
Thiazides TZDs effectively incr renal Ca2+ reabs. In ptswith recurrent Ca2+ Renal, Pharmacolog 3 RE
nephrolith, TZDs can help prevent stone formation by decr urine Ca2+ Urinary & y (Phar)
2003 excretion. Electrolyte
s (RE)

Urinary Urge incontinence, or overactive bladder syndrome, is caused by Renal, Pharmacolog 7 RE

incontinence uninhibited bladder contractions (detrusor instability). It results in a sense Urinary & y (Phar)
of urgency accompanied by an involuntary loss of urine. If behavioral Electrolyte
8249
therapy alone is unsuccessful, pharmacologic therapy with an s (RE)
antimuscarinic drug (targeting M3 receptors) can help improve
symptoms.
Urinary Postoperative urinary retention, with incomplete bladder emptying, is a Renal, Pharmacolog 4 RE
retention common complication thought to involve decreased micturition reflex Urinary & y (Phar)
activity, decreased contractility of the bladder detrusor, and/or increased Electrolyte
1211
vesical sphincter tone. This condition may be treated with a muscarinic s (RE)
agonist (bethanechol) or an a1 blocking drug.

ADH and urea Vasopressin and desmopressin cause a V2 receptor-mediated increase in Renal, Physiology 1 RE
clearance water and urea permeability at the inner medullary collecting duct. The Urinary & (Phys)
2012 resulting rise in urea reabsorption (decreased urea clearance) enhances Electrolyte
the medullary osmotic gradient, allowing the production of maximally s (RE)
concentrated urine.
Anemia of Erythropoietin (EPO) is produced primarily by peritubular fibroblast Renal, Physiology 2 RE
chronic disease cells (Peritubular interstitial cells) in the renal cortex in response to Urinary & (Phys)
decreased renal oxygen delivery (eg, decreased blood hemoglobin content). Electrolyte
EPO acts on erythrocyte precursor cells in the bone marrow to stimulate s (RE)
####
red blood cell production. Patients with chronic kidney disease have
inflammatory damage to renal EPO-producing cells and often develop
normocytic anemia due to insufficient EPO.
 Chronic kidney When the glomerular filtration rate (GFR) is normal, relatively large Renal, Physiology 8 RE
disease decreases in GFR result in only small increases in serum creatinine. Urinary & (Phys)
Conversely, when the GFR is signihcantly decreased, small decrements Electrolyte
8881
in GFR produce relatively large changes in serum creatinine. A good s (RE)
rule of thumb is that every time GFR halves, serum creatinine doubles.

Chronic kidney Chronic kidney disease can cause hyperphosphatemia due to impaired Renal, Physiology 8 RE
disease renal excretion of phosphorus. Elevated blood phosphate triggers the Urinary & (Phys)
release of fibroblast growth factor 23, which lowers calcitriol production Electrolyte
####
and intestinal calcium absorption. The resulting hypocalcemia, along with s (RE)
hyperphosphatemia, leads to secondary hyperparathyroidism (inc PTH,
dec 1.25 vit D).
Diabetes The ascending limb of the loop of Henle is impermeable to water Renal, Physiology 5 RE
insipidus regardless of serum vasopressin levels. Reabsorption of electrolytes by the Urinary & (Phys)
1043 Na+/K+/2CI' cotransporter occurs in the thick ascending limb and Electrolyte
contributes to formation of the corticomedullary concentration gradient. s (RE)

Diabetic The kidneys compensate for metabolic acidosis by completely reabsorbing Renal, Physiology 6 RE
ketoacidosis filtered bicarbonate (dec HC03) and excreting excess H+ in the urine. Urinary & (Phys)
Most of the excreted H* is buffered by phosphate (inc H2PO4-) and Electrolyte
2008 s (RE)
ammonium (NH Д which allows for large amounts of acid to be excreted
without precipitously dropping the pH.

Diabetic Diabetic ketoacidosis (DKA) is characterized by polydipsia, polyuria, and a Renal, Physiology 6 RE
ketoacidosis fruity odor to the breath and/or urine. DKA is associated with elevated Urinary & (Phys)
anion gap metabolic acidosis that is usually accompanied by compensatory Electrolyte
2014 respiratory alkalosis. This combination yields a low pH, low serum s (RE)
bicarbonate, and low PaC02.

Diffusion Diffusion speed across a semipermeable membrane increases with higher Renal, Physiology 1 RE
molecular concentration gradients, larger membrane surface areas, Urinary & (Phys)
and increased solubility of the diffusing substance. Diffusion speed Electrolyte
1988
decreases with increased membrane thickness, smaller pore size, s (RE)
higher molecular weights, and lower temperatures.

Excretion rate Renal excretion of a drug is dependent on: Renal, Physiology 1 RE

• Glomerular filtration (reduced with low renal blood flow, kidney disease, Urinary & (Phys)
and high drug protein binding) Electrolyte
2011
• Renal tubular secretion (reduced by coadministration of drugs with s (RE)
overlapping substrate specificity)
• Tubular reabsorption (may be altered by changes in urine pH)
Filtration The glomerular filtration rate (GFR) can be estimated by the inulin or Renal, Physiology 2 RE
fraction creatinine clearance, while the renal plasma flow (RPF) is calculated using Urinary & (Phys)
the para-aminohippuric acid clearance. The filtration fraction (FF = GFR / Electrolyte
1555
RPF) is the fraction of the RPF that is filtered across the glomerular s (RE)
capillaries into Bowman's space. It is usually equal to 20% in healthy
individuals.
Filtration The filtration fraction is the fraction of plasma flowing through the Renal, Physiology 2 RE
fraction glomeruli that is filtered across the glomerular capillaries into Bowman's Urinary & (Phys)
1982 space (FF = GFR/RPF). Renal plasma flow can be determined from renal Electrolyte
blood flow by multiplying the renal blood flow by (1 - Hematocrit). s (RE)

GFR Selective vasoconstriction of the efferent arteriole (up to certain extent) Renal, Physiology 6 RE
increases hydrostatic pressure in the glomerular capillaries, and tfierefore Urinary & (Phys)
increases the glomerular filtration rate. As efferent arteriolar constriction Electrolyte
1017 continues to increase, the glomerular filtration rate begins to decrease due s (RE)
to a flow-mediated rise in oncotic pressure in the glomerular capillaries.
The filtration fraction always increases with increasing efferent arteriole
constriction.
GFR The net filtration pressure is a result of pressure gradients formed by Renal, Physiology 6 RE
Starling forces and is calculated by subtracting the oncotic pressure Urinary & (Phys)
gradient from the hydrostatic pressure gradient Angiotensin II Electrolyte
1354
preferentially constricts the efferent arteriole, resulting in an increased s (RE)
hydrostatic pressure gradient and an increased net filtration pressure.

GFR The concentrations of creatinine and urea increase as fluid runs along Renal, Physiology 6 RE
the proximal tubule, whereas the concentrations of bicarbonate, glucose, Urinary & (Phys)
1617 and amino acids decrease. Sodium and potassium are reabsorbed with Electrolyte
water in the proximal tubule, resulting in no concentration cfiange. s (RE)
 GFR Increases in the capillary hydrostatic pressure or the Bowman's space Renal, Physiology 6 RE
oncotic pressure will increase GFR (constriction of the efferent Urinary & (Phys)
arteriole). while increases in capillary oncotic pressure or Bowman's space Electrolyte
hydrostatic pressure will decrease GFR. The filtration fraction (FF) can be s (RE)
1618 calculated by dividing the GFR by the renal plasma flow (RPF). Increases
in GFR or decreases in RPF will increase the FF. (Which of the following
is most likely to both decrease renal plasma flow and increase the
filtration fraction?)

GFR Acute ureteral constriction or obstruction decreases the glomerular Renal, Physiology 6 RE
filtration rate and filtration fraction. Urinary & (Phys)
1651 Electrolyte
s (RE)

GFR At normal plasma concentrations of glucose, the renal tubules reabsorb the Renal, Physiology 6 RE
entire filtered load of glucose because it is below the maximum tubular Urinary & (Phys)
reabsorption ability (transport maximum of glucose). At higher plasma Electrolyte
2010 concentrations, glucose is excreted when the filtered amount exceeds the s (RE)
transport maximum. The serum concentration at which glucosuria begins,
called the threshold of glucose, is approximately 200 mg/dL.

Glucose Glc is normally filtered at the glom and completely reabsorbed by the PCT. Renal, Physiology 1 RE
clearance Inhib of Na+-coupled, carrier-mediated transport of Glc by the PCT would Urinary & (Phys)
1559 cause the Glc clearance to approach the value of the GFR, which is Electrolyte
typically estimated by calculating the clearance of inulin. s (RE)

High altitudeAt high altitude, the low partial pressure of inspired oxygen (РiO2) leads Renal, Physiology 3 RE
illness to hypoxemia with consequent hyperventilation and respiratory alkalosis. Urinary & (Phys)
The hypoxemia and alkalemia can cause symptoms of altitude sickness (eg: Electrolyte
6792 s (RE)
headache, fatigue, lightheadedness). The kidneys respond by creating a
compensatory metabolic acidosis and by increasing erythropoietin
secretion.
Hyperaldostero Elevated serum aldosterone levels (because of Juxtaglomerular cell Renal, Physiology 5 RE
nism tumer) can manifest with hypertension, hypokalemia and muscle Urinary & (Phys)
2013 weakness. Increased levels of both renin and aldosterone are indicative Electrolyte
of secondary hyperaldosteronism, which can be caused by renovascular s (RE)
disease and renin-secreting tumors.
Hypokalemia Hypokalemia can result from the intracellular shift of potassium, which Renal, Physiology 2 RE
can occur due to beta-adrenergic hyperactivity (eg. beta-2 agonists, Urinary & (Phys)
#### endogenous epinephrine release), increased insulin levels, elevated Electrolyte
extracellular pH, or increased cell production (eg. acute leukemia). s (RE)

Hypovolemia Regardless of the patient's hydration status, the majority of water Renal, Physiology 1 RE
reabsorption in the nepliron occurs in the proximal tubule passively with Urinary & (Phys)
1524 the reabsorption of solutes. Electrolyte
s (RE)

Loop diuretics Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin Renal, Physiology 3 RE
synthesis. Patients with intravascular volume depletion (eg, cirrhosis) are Urinary & (Phys)
dependent on the vasodilatory effects of prostaglandins to maintain Electrolyte
684 adequate renal plasma flow and glomerular filtration. NSAID use in this s (RE)
population reduces glomerular filtration rates and blunts the effects of
loop diuretics, leading to sodium and water retention.

Nephron Antidiuretic hormone (ADH) acts primarily on the collecting ducts, Renal, Physiology 2 RE
osmolarity increasing their permeability to water. In the absence of ADH, the tubular Urinary & (Phys)
1607 fluid is most concentrated at the junction between the descending and Electrolyte
ascending limbs of the loop of Henle and most dilute in the collecting s (RE)
ducts.
Nephron Dehydration stimulates ADH secretion. ADH acts on the collecting ducts, Renal, Physiology 2 RE
osmolarity increasing their permeability to water. Thus, in the presence of ADH, the Urinary & (Phys)
1608 collecting ducts contain the most concentrated fluid in the nephron, while Electrolyte
the distal convoluted tubule contains the most dilute fluid. s (RE)

PAH clearance PAH is freely filtered from the blood in the glom caps to the tubular fluid Renal, Physiology 1 RE
in BS. It's also secreted from the blood into the tubular fluid by the cells of Urinary & (Phys)
1619 the PCT by a carrier protein-mediatedprocess. The secretion of PAH can Electrolyte
be saturated at high blood concs. s (RE)

Para- • PAH is primarily secreted into the nephron by the proximal tubule, but Renal, Physiology 1 RE
aminohippuric some is also freely filtered by the glomerulus. • PAH is not reabsorbed by Urinary & (Phys)
1588 acid any portion of the nephron. • Therefore, tubular fluid concentration of Electrolyte
PAH is lowest in Bowman's space. s (RE)
 Renal artery Unilateral renal arter stenosis causes hypoperfusion and activation of the Renal, Physiology 9 RE
stenosis renin-angiotensin-aldosterone system. Angiotensin II causes arteriolar Urinary & (Phys)
vasoconstriction and increases aldosterone and antidiuretic hormone Electrolyte
#### synthesis. The resultant hypertension fielps reduce the decline in s (RE)
glomerular filtration rate in the affected kidney, but causes a pressure
natriuresis with increased sodium excretion in the unaffected kidney.

Renal blood The RBF refers to the volume of blood that flows thru the kidney per unit Renal, Physiology 1 RE
flow time and can be calculated by dividing the RPF by (1 - Hct). Urinary & (Phys)
1556 Electrolyte
s (RE)

Urinalysis Antidiuretic hormone acts on the medullary segment of the collecting Renal, Physiology 2 RE
duct to increase urea and water reabsorption, allowing for the production Urinary & (Phys)
1161 of maximally concentrated urine. Electrolyte
s (RE)

Urinalysis К- is freely filtered by the glomeruli and is mostly reabsorbed in the Renal, Physiology 2 RE
proximal tubule and loop of Henle. As such, the late distal and cortical Urinary & (Phys)
collecting tubules are the primary sites for regulation of K* excretion in the Electrolyte
1554
urine. K- depletion stimulates а-intercalated cells to reabsorb extra s (RE)
potassium; principal cells secrete K* under conditions of increased K*
load.
Ankle trauma Lateral ankle sprain is due to inversion of a plantar-flexed foot and most Rheumatol Anatomy 1 RH
commonly involves the anterior talofibular ligament. Stronger forces can ogy, (Anat)
cause joint instability by injuring additional ligaments. Orthopedi
####
cs &
Sports
(RH)
Brachial plexus Dissection of the axillary lymph nodes (by mastectomy) can injure the Rheumatol Anatomy 7 RH
long thoracic nerve. This results in weakness of the serratus anterior with ogy, (Anat)
winging of the scapula and impaired abduction of the shoulder past the Orthopedi
1812
horizontal. cs &
Sports
(RH)
Brachial plexus The latissimus dorsi is a large thoracolumbar muscle that originates from Rheumatol Anatomy 7 RH
the iliac crest and lumbar fascia to the spinous processes of T7-12 and ogy, (Anat)
lower ribs, and inserts at the bicipital groove of the humerus. It is Orthopedi
####
innervated by the thoracodorsal nerve. Primary functions include cs &
extension, adduction, and medial rotation of the humerus. Sports
(RH)
Bursitis A bursa is a fluid-filled synovial sac that serves to alleviate pressure from Rheumatol Anatomy 1 RH
bony prominences and reduce friction between muscles and tendons. ogy, (Anat)
Acute trauma or chronic repetitive pressure can cause injury, leading Orthopedi
1491
to localized pain and tenderness. Prepatellar bursitis causes anterior cs &
knee pain and is usually due to repetitive or prolonged kneeling. Sports
(RH)
Carpal tunnel The carpal tunnel is formed by the carpal bones and the transverse carpal Rheumatol Anatomy 3 RH
syndrome ligament (flexor retinaculum). Carpal tunnel syndrome results from ogy, (Anat)
compression of the median nerve as it passes through the carpal tunnel Orthopedi
####
with 9 flexor tendons. Longitudinal incision of the transverse carpal cs &
ligament can decrease pressure within the carpal tunnel, improving Sports
patients' symptoms. (RH)
Clavicle The clavicle is commonly fractured in children after a fall on an Rheumatol Anatomy 1 RH
fracture outstretched arm. In a distal clavicle fracture, the deltoid muscle and the ogy, (Anat)
weight of the arm cause inferolateral displacement of the distal fragment, Orthopedi
1702
whereas the sternocleidomastoid and trapezius muscles cause superomedial cs &
displacement of the proximal fragment. Sports
(RH)
Femoral The medial femoral circumflex artery and its branches provide the Rheumatol Anatomy 1 RH
fracture majority of the blood supply to the femoral head and neck. Injury to these ogy, (Anat)
vessels due to a displaced femoral neck fracture can cause osteonecrosis of Orthopedi
1956
the femoral head. cs &
Sports
(RH)
Femoral Femoral nerve mononeuropathy can occur due to trauma: compression Rheumatol Anatomy 1 RH
neuropathy from a retroperitoneal hematoma or abscess, or injury during surgery or ogy, (Anat)
childbirth. Findings include quadriceps weakness, decreased patellar Orthopedi
8671
reflex, and sensory loss over the anterior and medial thigh and medial cs &
leg. Sports
(RH)
 Hand injury The lunate bone is the more medial (ulnar) of the 2 proximal carpal bones Rheumatol Anatomy 1 RH
that articulate with the radius. A fall onto an outstretched hand can cause ogy, (Anat)
dislocation of the lunate bone with resulting compression of the Orthopedi
1682
median nerve (eg. wrist pain: numbness in the first 3.5 digits). cs &
Sports
(RH)
Hip fracture The greater trochanter of the femur serves as the site of insertion for Rheumatol Anatomy 2 RH
the gluteus medius muscle, which is responsible for hip abduction and ogy, (Anat)
stabilization of the pelvis during ambulation. Fractures of the greater Orthopedi
#### trochanter (eg, fragility fracture from a fall) can disrupt the integrity of the cs &
gluteus medius tendon and result in lateral hip pain with gait instability Sports
and weakness of hip abduction. (RH)

Humerus The deep brachial (profunda brachii) artery and radial nerve run Rheumatol Anatomy 1 RH
fracture together along the posterior aspect of the humerus. Midshaft fractures of ogy, (Anat)
the humerus risk injury to these structures. Orthopedi
1704
cs &
Sports
(RH)
Iliopsoas Muscles used when sitting up from the supine position include the Rheumatol Anatomy 1 RH
muscle external abdominal obliques, the rectus abdominis, and the hip flexors. The ogy, (Anat)
iliopsoas muscle is the most important of the hip flexors and includes the Orthopedi
7621
psoas major, psoas minor, and iliacus. The rectus femoris, sartorius, cs &
tensor fascia lata, and the medial compartment of the thigh also contribute Sports
to hip flexion. (RH)
Knee trauma The anterior cruciate ligament (ACL) can be damaged by sudden Rheumatol Anatomy 4 RH
changes in direction or awkward landings (eg, excessive internal ogy, (Anat)
rotation or valgus stress) during sports activity (soccer). ACL tears are Orthopedi
1697
typically associated with rapid-onset hemarthrosis. Physical examination cs &
shows anterior laxity (trasnlation) of the tibia relative to the femur Sports
(eg, Lachman test, anterior drawer test). (RH)
Knee trauma The posterior cruciate ligament prevents posterior displacement of the Rheumatol Anatomy 4 RH
tibia relative to the femur. It originates from the anterolateral surface of the ogy, (Anat)
medial femoral condyle and inserts into the posterior intercondylar area of Orthopedi
1968
the tibia. Its integrity can be tested in the clinical setting by using the cs &
posterior drawer test. Sports
(RH)
Volar dislocation of the lunate from its normal position within the floor of Rheumatol Anatomy
the carpal tunnel can cause median nerve compression and/or injury. ogy, (Anat)
Median nerve injury at the level of the carpal tunnel may result in Orthopedi
####
weakness of thumb abduction, flexion, and opposition. cs &
Sports
(RH)
Knee trauma The posterior cruciate ligament prevents posterior displacement of the Rheumatol Anatomy 4 RH
tibia relative to the femur when the knee is flexed. It attaches to the ogy, (Anat)
posterior part of the intercondylar area of the tibia and the anterior part of Orthopedi
1969
the lateral surface of the medial epicondyle of the femur. cs &
Sports
(RH)
Knee trauma Patella fractures are most commonly due to a direct impact to the anterior Rheumatol Anatomy 4 RH
aspect of the knee. Signs include an acutely swollen knee, focal patella ogy, (Anat)
tenderness, inability to extend the knee against gravity, and a palpable Orthopedi
####
gap in the extensor mechanism. cs &
Sports
(RH)
Lateral Lateral epicondylitis (ie. tennis elbow) is characterized by overuse of wrist Rheumatol Anatomy 1 RH
epicondylitis extensor muscles (eg. extensor carpi radialis. extensor digitorum), leading ogy, (Anat)
to angiofibroblastic tendinosis at their attachment on the lateral epicondyle. Orthopedi
####
cs &
Sports
(RH)
Fracture of the posterior vertebral arch often occurs at the pars Rheumatol Anatomy
interarticularis (ie, spondylolysis). Bilateral disruption of the pars ogy, (Anat)
interarticularis can lead to anterior displacement of the vertebral body Orthopedi
####
(ie, spondylolisthesis). cs &
Sports
(RH)
Medial The medial (tibial) collateral ligament resists force that pushes the knee Rheumatol Anatomy 1 RH
collateral medially. Increased laxity of the knee with the valgus stress test indicates ogy, (Anat)
ligament injury injury to the medial collateral ligament. Orthopedi
####
cs &
Sports
(RH)
 Osgood- The quadriceps muscle group is connected to the patella, which is attached Rheumatol Anatomy 1 RH
Schlatter to the tibial tubercle by the patellar ligament. Repetitive quadriceps ogy, (Anat)
disease contraction (eg. jumping, basketball) in adolescents can result in Osgood- Orthopedi
####
Schlatter disease, which is characterized by focal anterior knee pain and cs &
swelling due to chronic avulsion of the tibial tubercle. Sports
(RH)
Peripheral Injections given in the superomedial quadrant of the buttock have a high Rheumatol Anatomy 3 RH
neuropathy risk of injuring the superior gluteal nerve, resulting in gluteus medius ogy, (Anat)
weakness and Trendelenburg gait. The superolateral quadrant of the Orthopedi
1640
buttock is a relatively safe site for intragluteal injections, although the cs &
anterolateral gluteal region is preferred. Sports
(RH)
Peroneal The common peroneal nerve is vulnerable to injury (football player) Rheumatol Anatomy 3 RH
neuropathy where it courses around the neck of the fibula. Fibular neck fractures can ogy, (Anat)
injure this nerve, causing weakness of dorsiflexion (deep peroneal nerve) Orthopedi
1803
and eversion (superficial peroneal nerve) of the foot as well as loss of cs &
sensation over the dorsum of the foot. Sports
(RH)
Psoas abscess The psoas muscle originates from the anterior surface of the transverse Rheumatol Anatomy 2 RH
processes and lateral surface of the vertebral bodies and functions primarily ogy, (Anat)
as a hip flexor. Psoas abscess may form due to direct spread of infection Orthopedi
1885
from an adjacent structure (eg, vertebral bodies, appendix, hip joint) or cs &
from hematogenous seeding from a distant site. Sports
(RH)
Psoas abscess Psoas abscess presents with fever, back or flank pain, an inguinal mass, Rheumatol Anatomy 2 RH
and difficulty walking. Inflammation of the psoas muscle leads to pain with ogy, (Anat)
extension at the hip (ie, psoas sign). Psoas abscess can develop due to Orthopedi
8710
hematogenous or lymphatic seeding from a distant site, particularly in cs &
patients with diabetes mellitus, intravenous drug use, and Sports
immunosuppression (eg, HIV infection). (RH)
Radial head Radial head subluxation (ie: nursemaid's elbow) is the displacement of the Rheumatol Anatomy 1 RH
subluxation annular ligament into the radiohumeral joint, classically resulting from ogy, (Anat)
sudden axial traction (eg. pulling) on the arm of a child age <5. Although Orthopedi
8579
most patients do not have any obvious swelling or deformity, they avoid cs &
moving the arm due to pain and hold it with the elbow flexed and forearm Sports
pronated. (RH)
Radial Supracondylar humeral fractures commonly occur after hyperextension Rheumatol Anatomy 3 RH
neuropathy of the elbow as a result of a fall onto an outstretched arm. The radial ogy, (Anat)
nerve runs along the anterolateral aspect of the elbow and is the structure Orthopedi
most likely to be injured with anterolateral displacement of the proximal cs &
####
fracture fragment. The brachial artery runs with the median nerve on the Sports
anteromedial aspect of the elbow and will usually be spared in these (RH)
patients (eg, intact radial pulse).

Radiculopathy Motor and sensory deficits across multiple peripheral upper extremity Rheumatol Anatomy 3 RH
nerves (eg: radial and median) indicate a lesion in the brachial plexus ogy, (Anat)
proximal to the formation of the terminal branches. In the absence of Orthopedi
####
history of trauma or malignancy the most likely cause is nerve root cs &
compression due to cervical spondylosis (cervical radiculopathy). Triceps Sports
reflex - C7 (RH)
Rectus muscle The Valsalva maneuver increases vagal tone and can be used to abolish Rheumatol Anatomy 1 RH
and Valsalva paroxysmal supraventricular tachycardia. The rectus abdominis is the ogy, (Anat)
most important muscle in achieving the increased intraabdominal and Orthopedi
1730
intrathoracic pressure of the Valsalva maneuver. cs &
Sports
(RH)
Rotator cuff The supraspinatus muscle assists in abduction of the arm and Rheumatol Anatomy 4 RH
stabilization of the glenohumeral joint. The supraspinatus tendon is ogy, (Anat)
vulnerable to injury due to impingement between the acromion and the Orthopedi
1732
head of the humerus. Supraspinatus tendinopathy is the most common cs &
cause of rotator cuff syndrome. Sports
(RH)
Rotator cuff The rotator cuff muscles attach to the proximal humerus and move the arm Rheumatol Anatomy
at the shoulder. Infraspinatus and teres minor are primarily responsible for ogy, (Anat)
external rotation. When one is torn, the other hypertrophies to compensate, Orthopedi
####
resulting in preserved strength in external rotation. cs &
Sports
(RH)
Rotator cuff The most commonly injured structure in rotator cuff syndrome is the Rheumatol Anatomy 4 RH
tendon of the supraspinatus muscle. Because the supraspinatus is an ogy, (Anat)
abductor of the humerus, injury to its tendon causes pain on abduction of Orthopedi
1733
the arm. cs &
Sports
(RH)
 Rotator cuff The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and Rheumatol Anatomy 4 RH
subscapularis) all insert onto the humeral head, allowing them to stabilize ogy, (Anat)
the shoulder joint and move the arm at the shoulder. An infraspinatus Orthopedi
####
injury would result in shoulder pain and weak, painful external rotation cs &
of the arm against resistance Sports
(RH)
Scaphoid Fracture of the scaphoid bone may result from a fall on an outstretched Rheumatol Anatomy 1 RH
fracture hand and should be suspected if examination shows tenderness in the ogy, (Anat)
anatomic snuff box. Scaphoid fracture can disrupt retrograde blood supply Orthopedi
8670
to the proximal scaphoid, increasing risk of avascular necrosis. cs &
Sports
(RH)
Sciatic The piriformis muscle passes through the greater sciatic foramen and is Rheumatol Anatomy 3 RH
neuropathy involved with external hip rotation. Muscle injury or hypertrophy can ogy, (Anat)
compress the sciatic nerve in the foramen, causing piriformis syndrome. Orthopedi
####
cs &
Sports
(RH)
Shoulder Flattening of the deltoid muscle (football player) with acromial Rheumatol Anatomy 1 RH
dislocation prominence after a shoulder injury suggests an anterior humerus ogy, (Anat)
dislocation. This injury most commonly results from a blow to an Orthopedi
1924
externally rotated and abducted arm. There is often associated axillary cs &
nerve injury, resulting in deltoid paralysis and loss of sensation over the Sports
lateral shoulder. (RH)
Spinal stenosis Spinal stenosis occurs most commonly in the lumbar region and presents Rheumatol Anatomy 1 RH
with posture-dependent lower extremity pain, numbness/paresthesia, ogy, (Anat)
and weakness. The most common cause is degenerative arthritis of the Orthopedi
#### spine, which results in narrowing of the spinal canal due to intervertebral cs &
disc herniation, ligamentum flavum hypertrophy, and osteophyte Sports
formation affecting the facet joints. (RH)

Thoracic outlet Thoracic outlet syndrome (TOS) is most often caused by compression of Rheumatol Anatomy 1 RH
syndrome the brachial plexus as it passes through the scalene triangle, the space ogy, (Anat)
bordered by the anterior and middle scalene muscles and the first rib. Orthopedi
#### Symptoms typically include upper extremity numbness, tingling, and cs &
weakness that worsen with repetitive overhead arm movements. The Sports
presence of an anomalous cervical rib is a risk factor for TOS. (RH)

Tibial nerve The tibial nerve may be injured at the level of the popliteal fossa due to Rheumatol Anatomy 1 RH
injury deep penetrating trauma or knee surgery. Patients typically have weakness ogy, (Anat)
on foot plantarflexion, foot inversion, and toe flexion, with sensory loss Orthopedi
1638
over the sole, unable to stand on his tiptoes. cs &
Sports
(RH)
Ulnar nerve The ulnar nerve can be injured at the medial epicondyle of the humerus Rheumatol Anatomy 2 RH
neuropathy ("funny bone") or in Guyon's canal near the hook of the hamate and ogy, (Anat)
pisiform bone in the wrist. Patients often have sensory loss over the medial Orthopedi
1634 1.5 digits and hypothenar eminence, and weakness on wrist cs &
flexion/adduction, finger abduction/adduction, and flexion of the Sports
fourth/fifth digits. The hypothenar eminence may flatten due to muscle (RH)
atrophy.
Alkaptonuria Alkaptonuria is an autosomal-recessive disorder caused by a deficiency of Rheumatol Biochemistr 2 RH
homogentisic acid dioxygenase, an enzyme involved in tyrosine ogy, y (Bioc)
metabolism. Excess homogentisic acid causes diffuse blue-black deposits Orthopedi
1503
in connective tissues. Adults have sclerae and ear cartilage cs &
hyperpigmentation along with osteoarthropathy of the spine and large Sports
joints. (RH)
Gout Gout occurs with increased frequency in patients with activating mutations Rheumatol Biochemistr 11 RH
involving phosphoribosyl pyrophosphate synthetase due to increased ogy, y (Bioc)
production and degradation of purines. (in joints) Orthopedi
2090
cs &
Sports
(RH)
Gout Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapy for Rheumatol Biochemistr 11 RH
treating acute gouty arthritis. They inhibit cyclooxygenase and exert a ogy, y (Bioc)
broad anti-inflammatory effect that includes inhibition of neutrophils. Orthopedi
When NSAIDs are contraindicated (eg, peptic ulcer disease, renal cs &
2091
impairment), colchicine is useful in the acute management of gout as it Sports
inhibits neutrophil chemotaxis and phagocytosis by preventing microtubule (RH)
formation.
 Marfan Marfan syndrome is due to a defect in fibrillin-1, an extracellular Rheumatol Biochemistr 2 RH
syndrome glycoprotein that acts as a scaffold for elastin. It is abundant in the zonular ogy, y (Bioc)
fibers of the lens, periosteum, and aortic media. Aortic root dilation with Orthopedi
1250
dissection and rupture is a common cause of death. cs &
Sports
(RH)
snRNP Small nuclear RNA (snRNA) is synthesized by RNA polymerase II in the Rheumatol Biochemistr 1 RH
function nucleus and complexes with specific proteins to form small nuclear ogy, y (Bioc)
ribonucleoproteins (snRNPs). snRNPs are an essential component of Orthopedi
spliceosomes, which remove introns from pre-mRNA (Removal of cs &
361
introns from RNA transcripts) to form mature mRNA. Patients with Sports
systemic lupus erythematosus can have autoantibodies directed against (RH)
snRNPs (eg, anti-Smith antibody).

Myasthenia Myasthenia gravis is associated with abnormalities of the thymus (e.g. Rheumatol Embryology 10 RH
gravis thymoma, thymic hyperplasia). The thymus and inferior parathyroid ogy, (Embr)
glands arise from the 3rd pharyngeal pouch. Orthopedi
756
cs &
Sports
(RH)
Mitochondrial The presence of lactic acidosis and ragged skeletal muscle fibers Rheumatol Genetics 4 RH
disorders histologically suggests a mitochondrial myopathy. Variable clinical ogy, (Gene)
expressions in affected family members can occur due to heteroplasmy, Orthopedi
1935
which is the coexistence of distinct versions of mitochondrial genomes in cs &
an individual cell. Sports
(RH)
Muscle A single sarcomere is defined as the distance between two Z lines. Thin Rheumatol Histology 8 RH
structure & (actin) filaments in the band are bound to structural proteins (antibodies ogy, (Hist)
physiology most likely bind) at the Z line, whereas thick (myosin) filaments in the A Orthopedi
1734
band are bound to structural proteins at the M line. cs &
Sports
(RH)
Osteocyte Osteocytes have long intracanalicular processes that extend through the Rheumatol Histology 1 RH
connections ossified bone matrix. These cytoplasmic processes send signals to and ogy, (Hist)
exchange nutrients and waste products with the osteocytes within Orthopedi
1159
neighboring lamellae via gap junctions. Osteocytes can sense mechanical cs &
stresses and send signals to modulate the activity of surface osteoblasts, Sports
thereby helping to regulate bony remodeling. (RH)
Ankylosing The seronegative spondyloarthropathies include ankylosing spondylitis, Rheumatol Immunology 2 RH
spondylitis reactive arthritis, psoriatic arthritis, and arthritis associated with ogy, (Immu)
inflammatory bowel disease. Individuals expressing HLA B27 are at Orthopedi
752
increased risk for the seronegative spondyloarthropathies. (specific human cs &
leukocyte antigen class I serotype) Sports
(RH)
Apoptosis The Fas receptor acts to initiate the extrinsic pathway of apoptosis. Rheumatol Immunology 4 RH
Mutations involving the Fas receptor or Fas ligand can prevent ogy, (Immu)
apoptosis of autoreactive lymphocytes, thereby increasing the risk of Orthopedi
298
autoimmune disorders such as systemic lupus erythematosus. cs &
Sports
(RH)
Primary Leukocyte adhesion deficiency is due to absence of CD18 antigens Rheumatol Immunology 7 RH
immunodeficie necessary for the formation of integrins. Clinical features are caused by ogy, (Immu)
ncy disorder failure of leukocyte chemotaxis and include recurrent skin and mucosal Orthopedi
538
infections without purulence, delayed separation of the umbilical cord, cs &
and persistent leukocytosis. Sports
(RH)
Rheumatoid Rheumatoid arthritis results from an immune response directed against Rheumatol Immunology 10 RH
arthritis autoantigens in the joints. Infiltrating CD4+ T cells secrete cytokines that ogy, (Immu)
promote inflammatory synovitis. They also stimulate B cells to produce Orthopedi
754
rheumatoid factor (IgM antibody specific for Fc component of IgG) and cs &
anti citrullinated protein antibodies that contribute to chronic Sports
inflammation and joint destruction. (RH)
Serum sickness Serum sickness is a type III hypersensitivity reaction to nonhuman proteins Rheumatol Immunology 1 RH
characterized by vasculitis resulting from tissue deposition of circulating ogy, (Immu)
immune complexes. Clinical findings include fever, pruritic skin rash, Orthopedi
741
arthralgias, and low serum C3 and C4 complement levels. cs &
Sports
(RH)
Clostridial Lecithinase (alpha toxin) is the main toxin produced by Clostridium Rheumatol Microbiolog 3 RH
myonecrosis perfringens. It degrades lecithin, a component of cellular phospholipid ogy, y (Micr)
membranes, which leads to membrane destruction, cell death, and Orthopedi
1395
widespread necrosis and hemolysis. cs &
Sports
(RH)
 Necrotizing Necrotizing fasciitis is a severe infection of the subcutaneous tissue andRheumatol Microbiolog 1 RH
soft tissue deep fascia that is a surgical emergency. The infection is often ogy, y (Micr)
infections polymicrobial, but monomicrobial cases due to Streptococcus pyogenes Orthopedi
8857
(group A strep) can also occur. S pyogenes is a pyrrolidonyl arylamidase cs &
(PYR)-positive, beta-hemolytic, Gram-positive cocci that grows in chains. Sports
(RH)
Osteomyelitis Hematogenous osteomyelitis is predominantly a disease of children that Rheumatol Microbiolog 4 RH
most frequently affects the long bones. Staphylococcus aureus is ogy, y (Micr)
implicated in most cases secondary to a bacteremic event. Streptococcus Orthopedi
646
pyogenes (group A streptococcus) is the second most common cause of cs &
hematogenous osteomyelitis. minor scrapes to his knees and elbows Sports
(RH)
Osteomyelitis Vertebral osteomyelitis should be suspected in patients with new or Rheumatol Microbiolog 4 RH
worsening back pain, fever, and recent endocarditis or bacteremia ogy, y (Micr)
(especially Staphylococcus aureus). It should also be suspected if there are Orthopedi
####
new neurologic findings and fever with or without back pain. MRI of the cs &
spine is preferred for diagnosis. Sports
(RH)
Bone tumor Osteosarcoma is the most common primary bone tumor in children and Rheumatol Pathology 3 RH
young adults and typically arises near the metaphyses of long bones. ogy, (Path)
Patients usually have slowly worsening pain and soft-tissue swelling. X-ray Orthopedi
####
typically reveals a lytic bone lesion, and biopsy classically shows cs &
pleomorphic, spindle-shaped tumor cells that generate osteoid and thin Sports
trabeculae of neoplastic bone. (RH)
Churg-Strauss Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) is a Rheumatol Pathology 1 RH
syndrome small to medium vessel vasculitis characterized by late-onset asthma, ogy, (Path)
rhinosinusitis, and eosinophilia. Mononeuritis multiplex due to Orthopedi
667
involvement of the epineural vessels of peripheral nerves is common, cs &
(Serum antibodies against neutrophil myeloperoxidase are positive.). Sports
(RH)
Duchenne Duchenne muscular dystrophy is an X-linked recessive myopathy that Rheumatol Pathology 2 RH
dystrophy manifests with proximal muscle weakness and enlargement of the calf ogy, (Path)
muscles in boys age 2-5. It most often results from frameshift deletions Orthopedi
affecting the dystrophin gene. Dystrophin provides a stabilizing interaction cs &
1265
between the sarcolemma and the intracellular contraction apparatus, and Sports
disruption of the protein results in membrane damage and myonecrosis. (RH)
(Mutation affecting a sarcolemma-cytoskeleton linker protein)

Duchenne Duchenne muscle dystrophy manifests with proximal muscle weakness and Rheumatol Pathology 2 RH
dystrophy atrophy. True hypertrophy of the distal muscle is noted early in the disease ogy, (Path)
as distal muscles compensate for weak proximal ones. Muscle fibers of the Orthopedi
1266
distal extremities are later replaced by fat and connective tissue cs &
(pseudohypertrophy). Sports
(RH)
Giant cell Giant cell arteritis is characterized by granulomatous inflammation of Rheumatol Pathology 5 RH
arteritis the media with intimal thickening and predominantly involves branches of ogy, (Path)
the carotid artery, especially the temporal artery. It is strongly associated Orthopedi
450
with polymyalgia rheumatica; both conditions respond promptly to cs &
glucocorticoid therapy. berry aneurysm, headaches, fatigue, and Sports
muscle pain. (RH)
Giant cell Giant cell arteritis (GCA) is characterized by granulomatous inflammation Rheumatol Pathology 5 RH
arteritis of the media with fragmentation of the internal elastic lamina most often ogy, (Path)
affecting the medium and small branches of the carotid artery. Ischemic Orthopedi
461
optic neuropathy with irreversible blindness is a potential complication of cs &
GCA; therefore, patients with suspected GCA require immediate Sports
glucocorticoid therapy. (RH)
Giant cell Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) Rheumatol Pathology 5 RH
arteritis have very high sensitivity for giant cell (temporal) arteritis. Patients with ogy, (Path)
suspected giant cell arteritis who have an elevated ESR or CRP level Orthopedi
914
should be referred for temporal artery biopsy to confirm the diagnosis. cs &
Sports
(RH)
Hip fracture McCune-Albright syndrome is characterized by the triad of fibrous Rheumatol Pathology 2 RH
dysplasia of the bone, endocrine abnormalities, and cafe-au-lait spots. ogy, (Path)
The condition results from an activating mutation in the G Orthopedi
####
protein/CAMP/adenylate cyclase signaling pathway. cs &
Sports
(RH)
 Lambert-Eaton Lambert-Eaton myasthenic syndrome (LEMS) is a neuromuscular disorder Rheumatol Pathology 2 RH
myasthenic characterized by autoantibodies against presynaptic voltage-gated calcium ogy, (Path)
syndrome channels. It causes progressive proximal muscle weakness and decreased Orthopedi
1900 deep tendon reflexes that improve with exercise (postexercise facilitation); cs &
cranial nerve involvement and autonomic symptoms may also occur. Sports
LEMS is strongly associated with small cell lung cancer. (RH)

Leukocytoclasti Cutaneous small vessel vasculitis is associated with medication (eg, Rheumatol Pathology 1 RH
c vasculitis penicillins, cephalosporins) use and typically presents with palpable ogy, (Path)
purpura in the lower extremities. Characteristic histopathologic findings Orthopedi
####
include marked perivascular inflammation of small blood vessels with cs &
fibrinoid necrosis and a predominance of neutrophils and fragmented Sports
neutrophilic nuclei (leukocytoclastic vasculitis). (RH)
Lipoma Lipomas are common, benign tumors that arise from the subcutaneous fat Rheumatol Pathology 1 RH
and present as soft, mobile masses that are stable or enlarge slowly over ogy, (Path)
time. The diagnosis is usually made clinically, but histopathology shows Orthopedi
####
well-differentiated, mature adipocytes with a fibrous capsule. cs &
Sports
(RH)
Osteoarthritis Osteoarthritis of the hands is characterized by osteophyte formation Rheumatol Pathology 2 RH
leading to hard bony enlargement of the distal interphalangeal joints ogy, (Path)
(Heberden nodes) and proximal interphalangeal joints (Bouchard nodes). Orthopedi
1771
Brief morning stiffness may be present. cs &
Sports
(RH)
Osteoarthritis Osteoarthritis is characterized by progressive Assuring and erosion of Rheumatol Pathology 2 RH
articular cartilage. Risk factors include advancing age, obesity, joint ogy, (Path)
trauma, and repetitive stress. Patients may have mild effusion and crepitus Orthopedi
7556
on physical examination, but signs of synovitis (eg, redness, warmth) are cs &
less prominent than in the classic inflammatory arthritic disorders. Sports
(RH)
Osteogenesis Osteogenesis imperfecta results from defective synthesis of type 1 collagen Rheumatol Pathology 1 RH
imperfecta osteoid production by osteoblasts. Clinical findings include a history of ogy, (Path)
fractures after only minimal trauma, blue sclerae, and small, malformed Orthopedi
702
teeth. In most patients, osteogenesis imperfecta is transmitted by autosomal cs &
dominant inheritance. Sports
(RH)
Osteomyelitis Hematogenous osteomyelitis occurs most commonly in children. It usually Rheumatol Pathology 4 RH
affects the metaphysis of long bones due to the presence of slow-flowing ogy, (Path)
sinusoids that are conducive to bacterial seeding. Fever and refusal to Orthopedi
721
bear weight are common manifestations in young children who are unable cs &
to localize the pain. Sports
(RH)
Osteomyelitis Mycobacterium tuberculosis spondylitis (Pott disease) is usually the Rheumatol Pathology 4 RH
result of hematogenous seeding of vertebrae from primary pulmonary ogy, (Path)
infection. Manifestations typically arise months or years later (due to Orthopedi
####
reactivation) and include chronic, progressive back pain, fever, and cs &
radiographic evidence of vertebral bone destruction and fluid collection. Sports
(RH)
Osteonecrosis Osteonecrosis (avascular necrosis) occurs due to impaired blood supply Rheumatol Pathology 1 RH
to a segment of bone. The femoral head is the most common location. ogy, (Path)
Common causes include sickle cell disease, glucocorticoid therapy, Orthopedi
316
vasculitis, and alcoholism. cs &
Sports
(RH)
Osteoporosis Initially in osteoporosis, bone loss predominantly affects trabecular bone, Rheumatol Pathology 10 RH
leading to trabecular thinning and perforation with loss of interconnecting ogy, (Path)
bridges. Over time, cortical bone, which composes most of the Orthopedi
629
appendicular skeleton, also becomes involved. cs &
Sports
(RH)
Paget disease Paget disease of bone is characterized by disordered bone formation. Rheumatol Pathology 4 RH
of bone Involvement of long bones can lead to bone pain, bowing, fracture, or ogy, (Path)
arthritis of adjacent joints. Serum alkaline phosphatase is elevated due to Orthopedi
####
increased production of new bone, but calcium and phosphorus levels cs &
remain normal. Sports
(RH)
Paget disease Paget disease of bone is characterized by excessive and disordered bone Rheumatol Pathology 4 RH
of bone formation. It commonly affects the skull, long bones, and vertebral column. ogy, (Path)
The increased formation of new bone is associated with an elevated serum Orthopedi
####
alkaline phosphatase level. Radiographs shows lytic or mixed lytic- cs &
sclerotic lesions, thickening of cortical and trabecular bone, and bony Sports
deformities. (RH)
 Parvovirus Parvovirus B19 causes erythema infectiosum (fifth disease) in children Rheumatol Pathology 3 RH
and arthritis in adults. Parvovirus arthritis can mimic rheumatoid ogy, (Path)
arthritis but is usually self-resolving. Orthopedi
1896
cs &
Sports
(RH)
Polyarteritis Polyarteritis nodosa (PAN) is a systemic vasculitis characterized by Rheumatol Pathology 2 RH
nodosa constitutional manifestations and ischemic symptoms in the kidneys, skin, ogy, (Path)
gastrointestinal tract, and neurologic system. Biopsy will show segmental, Orthopedi
457 transmural arterial inflammation with fibrinoid necrosis and damage to cs &
the internal and external elastic lamina. PAN is often associated with Sports
underlying viral hepatitis В and C. (RH)

Polymyositis Dermatomyositis is characterized by proximal muscle weakness (similar to Rheumatol Pathology 5 RH

and polymyositis) and dermal manifestations (eg, heliotrope rash, Gottron ogy, (Path)
dermatomyositi papules). Laboratory testing shows elevated muscle enzymes (eg, creatine Orthopedi
940
s kinase) and autoantibodies (eg, antinuclear, anti-Jo-1). Initial treatment cs &
includes systemic glucocorticoids and evaluation for potential underlying Sports
malignancy. (RH)
Pseudogout Synovial fluid analysis showing rhomboid-shaped calcium pyrophosphate Rheumatol Pathology 1 RH
crystals is diagnostic of pseudogout. These crystals are positively ogy, (Path)
birefringent under polarized light. The knee joint is involved in >50% of Orthopedi
1451
cases. cs &
Sports
(RH)
Rheumatic The primary cause of morbidity in acute rheumatic fever is heart failure Rheumatol Pathology 5 RH
fever from severe pancarditis. Mitral stenosis develops years or decades after ogy, (Path)
the original illness. Joint involvement is usually transient. Orthopedi
239
cs &
Sports
(RH)
Rheumatoid Rheumatoid arthritis causes progressive joint destruction involving the Rheumatol Pathology 10 RH
arthritis hands, wrists, elbows, and knees. Cervical spine involvement can lead to ogy, (Path)
spinal instability and cord compression. Orthopedi
####
cs &
Sports
(RH)
Rheumatoid Joint destruction in rheumatoid arthritis is characterized by synovial Rheumatol Pathology 10 RH
arthritis hyperplasia, an inflammatory infiltrate, and synovial angiogenesis. The ogy, (Path)
joint space often becomes replaced by pannus, an invasive mass composed Orthopedi
####
of fibroblast-like synovial cells, granulation tissue, and inflammatory cells cs &
that can erode into the articular cartilage and underlying bone. Sports
(RH)
Rheumatoid Rheumatoid arthritis is characterized by synovial hyperplasia with Rheumatol Pathology 10 RH
arthritis inflammatory infiltrates. The accelerated metabolic rate of the inflamed ogy, (Path)
synovium causes local hypoxia, which leads to synovial angiogenesis. As Orthopedi
#### the disease progresses, the joint space is replaced by a rheumatoid pannus cs &
(an invasive mass of fibroblast-like synovial cells, granulation tissue, and Sports
inflammatory cells) which can destroy the articular cartilage and (RH)
underlying subchondral bone.
Septic arthritis A high synovial fluid leukocyte count (>100,000/mm3) and absent crystals Rheumatol Pathology 4 RH
on microscopic examination strongly suggest bacterial joint infection. ogy, (Path)
Septic arthritis requires antibiotic treatment to prevent joint destruction, Orthopedi
1835
osteomyelitis, and sepsis. cs &
Sports
(RH)
Septic arthritis Synovitis is char by pain, erythema, swelling, and reduced range of Rheumatol Pathology 4 RH
motion in a joint. Acute synovitis may represent serious path (e.g. SA), esp. ogy, (Path)
if accompanied by fever or leucocytosis; it should be eval urgentlywith Orthopedi
####
synovial fluid analysis. cs &
Sports
(RH)
Sjogren Sjogren syndrome is an autoimmune disorder characterized by Rheumatol Pathology 2 RH
syndrome inflammation of exocrine glands. Biopsy of the labial salivary glands shows ogy, (Path)
periductal lymphocytic infiltrates (focal lymphocytic sialadenitis), often Orthopedi
####
with germinal centers; the glandular tissue is typically atrophic and fibrotic. cs &
Sports
(RH)
Sjogren Sjogren syndrome (SS) is an autoimmune disorder characterized by Rheumatol Pathology 2 RH
syndrome lymphocytic inflammation in exocrine glands (eg, lacrimal, salivary ogy, (Path)
glands). It presents with dry eyes (keratoconjunctivitis sicca) and dry Orthopedi
####
mouth (xerostomia). Chronic В-cell proliferation in patients with SS cs &
increases the risk of developing non-Hodgkin lymphoma. Sports
(RH)
 SLE Systemic lupus erythematosus is characterized by loss of immune self- Rheumatol Pathology 7 RH
tolerance with production of autoantibodies (decrease C3, C4) against ogy, (Path)
nuclear antigens. Binding of autoantibodies to self antigens leads to Orthopedi
####
deposition of immune complexes in tissues and consumption of cs &
complement. Sports
(RH)
Systemic CREST syndrome (limited scleroderma) manifests with calcinosis, Rheumatol Pathology 4 RH
sclerosis Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and ogy, (Path)
telangiectasias. Anti-centromere antibodies are found in about 40% of Orthopedi
340
patients with CREST syndrome. Anti-DNA topoisomerase I (Scl-70) cs &
antibodies are highly specific for systemic sclerosis. Sports
(RH)
Vitamin D Rickets is characterized by an excess of unmineralized osteoid matrix Rheumatol Pathology 4 RH
deficiency and epiphyseal cartilage due to vitamin D deficiency. Clinical ogy, (Path)
manifestations include frontal bossing, craniotabes, costochondral Orthopedi
630
junction deformity ("rachitic rosary"), and bowed legs. cs &
Sports
(RH)
Wound healing During wound healing, excessive matrix metalloproteinase activity and Rheumatol Pathology 1 RH
myofibroblast accumulation in the wound margins can result in ogy, (Path)
contracture. Contractures produce deformities of the wound and Orthopedi
1874
surrounding tissues, most often on the palms, soles, anterior thorax, or at cs &
serious burn sites. Sports
(RH)
Enthesitis Enthesitis (inflammation at the bony insertions of tendons, ligaments, and Rheumatol Pathophysiol
joint capsules) is a prominent manifestation of spondyloarthritis (eg. ogy, ogy (Patp)
ankylosing spondylitis). Common clinical syndromes include Achilles Orthopedi
#### tendinitis, plantar fasciitis, and dactylitis. Achilles tendinitis affects the site cs &
of insertion of the Achilles tendon on the calcaneus and presents with Sports
severe pain at the posterior aspect of the foot. (RH)

Achondroplasia Unlike the process of intramembranous ossification that forms flat bones, Rheumatol Pathophysiol 2 RH
endochondral ossification proceeds along a cartilage template and is ogy, ogy (Patp)
responsible for the formation of long bones. Achondroplasia is Orthopedi
700 characterized by an exaggerated inhibition of chondrocyte proliferation in cs &
the growth plates of long bones and manifests with proximal limb Sports
shortening, midface hypoplasia, and macrocephaly. (RH)

Ankylosing Ankylosing spondylitis is characterized by stiffness and fusion of axial Rheumatol Pathophysiol 2 RH
spondylitis joints (ankylosis) and inflammation at the site of insertion of tendons into ogy, ogy (Patp)
bone (enthesitis), positive HLA-B27 antigen, fusion of the sacroiliac Orthopedi
753
joints. Involvement of the thoracic spine and costovertebral and cs &
costosternal junctions can limit chest wall expansion, leading to Sports
hypoventilation. (RH)
Atrophy Pathologic atrophy can be caused by decreased physical workload, loss of Rheumatol Pathophysiol 1 RH
innervation, decreased blood supply, inadequate nutrition, absent ogy, ogy (Patp)
endocrine stimulation, aging, or mechanical pressure. Similar to Adrenal Orthopedi
295
glands during prolonged glucocorticoid therapy cs &
Sports
(RH)
Fibromyalgia Fibromyalgia occurs most commonly in women age 20-55 and presents Rheumatol Pathophysiol 1 RH
with diffuse musculoskeletal pain (at morning), fatigue, and ogy, ogy (Patp)
neuropsychiatric disturbances. It is characterized by abnormal central Orthopedi
867
processing of painful stimuli. Although initially painful, aerobic exercise cs &
helps to improve pain and functioning in these patients. Sports
(RH)
Giant cell Cell-mediated immunity is the primary mechanism underlying giant cell Rheumatol Pathophysiol 5 RH
arteritis arteritis. The production of cytokines, in particular interleukin-6, is an ogy, ogy (Patp)
important driver of this process and closely correlates with the severity of Orthopedi
####
symptoms cs &
Sports
(RH)
Gout Gout results from the deposition of monosodium urate crystals in the joints Rheumatol Pathophysiol 11 RH
and soft tissues. Under polarized light, urate crystals appear needle-shaped ogy, ogy (Patp)
and negatively birefringent. Conditions that increase uric acid production Orthopedi
1450
or decrease uric acid clearance (CKD, polycythemia vera) can increase cs &
the risk of gout. Sports
(RH)
Myasthenia Myasthenia gravis results from an autoimmune type II (antibody-mediated) Rheumatol Pathophysiol 10 RH
gravis hypersensitivity reaction against skeletal myocyte surface acetylcholine ogy, ogy (Patp)
receptors. Goodpasture syndrome similarly involves autoantibodies Orthopedi
740
against basement membrane collagen in the renal glomeruli and lung cs &
alveoli. Sports
(RH)
 Osteoporosis The receptor activator of nuclear factor kappa B (RANKY/RANK ligand Rheumatol Pathophysiol 10 RH
(RANK-L) interaction is essential for the formation and differentiation of ogy, ogy (Patp)
osteoclasts. Osteoprotegerin blocks binding of RANK-L to RANK and Orthopedi
reduces formation of mature osteoclasts. Low estrogen states cause cs &
640
osteoporosis by decreasing osteoprotegerin production, increasing RANK- Sports
L production, and increasing RANK expression in osteoclast precursors. (RH)
(Increased bone resorption)

Osteoporosis Patients with osteoporosis have low bone mass, resulting in increased Rheumatol Pathophysiol 10 RH
susceptibility to fragility fractures (ie, those occurring with minimal or no
ogy, ogy (Patp)
trauma). In primary osteoporosis (not caused by a medical disorder), Orthopedi
982
serum calcium, phosphorus, and parathyroid hormone levels are cs &
typically normal. Sports
(RH)
Paget disease Bone pain and elevated alkaline phosphatase level in an elderly patient Rheumatol Pathophysiol 4 RH
of bone can occur with osteoblast metastases and Paget disease of bone (PDB). ogy, ogy (Patp)
Biopsy showing a mosaic pattern of lamellar bone is diagnostic for PDB Orthopedi
987
The initial phase in PDB is characterized by an increase in osteoclastic cs &
activity. Sports
(RH)
Polymyositis Polymyositis causes symmetric proximal muscle weakness. Muscle biopsy Rheumatol Pathophysiol 5 RH
and reveals inflammation, necrosis, and regeneration of muscle fibers. Over- ogy, ogy (Patp)
dermatomyositi expression of major histocompatibility complex class I proteins on the Orthopedi
748
s sarcolemma leads to infiltration with CD8+ T lymphocytes and myocyte cs &
damage. Sports
(RH)
Polymyositis Polymyositis and dermatomyositis are characterized by symmetric proximal Rheumatol Pathophysiol 5 RH
and muscle weakness and are associated with antinuclear and anti-tRNA ogy, ogy (Patp)
dermatomyositi synthetase (anti-Jo-1) autoantibodies. Biopsy in polymyositis shows Orthopedi
s patchy endomysial inflammatory mononuclear infiltrate (ie. direct cs &
####
invasion of individual muscle fibers), whereas dermatomyositis causes Sports
perifascicular inflammation (ie, localized around blood vessels and the (RH)
septa between muscle fascicles).

Ganglion cyst Ganglion cysts are benign, fluid-filled masses that occur due to mucoid Rheumatol Pathophysiol RH
degeneration of periarticular tissue. They present as painless, smooth, ogy, ogy (Patp)
rubbery, round structures that overlie joints (eg, wrist) or tendons and Orthopedi
####
transilluminate with a penlight. Most resolve spontaneously without cs &
intervention. Sports
(RH)
Polymyositis Dermatomyositis is characterized by proximal muscle weakness Rheumatol Pathophysiol 5 RH
and resembling polymyositis, with additional inflammatory features involving ogy, ogy (Patp)
dermatomyositi the skin (heliotrope rash, Gottron papules). Both dermatomyositis and Orthopedi
####
s polymyositis may occur alone or as a paraneoplastic syndrome associated cs &
with an underlying adenocarcinoma (eg, ovary, lung, pancreas). Sports
(RH)
Reactive Reactive arthritis is a spondyloarthropathy associated with HLA-B27 Rheumatol Pathophysiol 2 RH
arthritis that can occur following infection with Chlamydia, Campylobacter, ogy, ogy (Patp)
Salmonella, Shigella, or Yersinia. It presents with sterile arthritis due to Orthopedi
1600
deposition of immune complexes. cs &
Sports
(RH)
Rheumatoid Rheumatoid arthritis is characterized by symmetric polyarthritis (involving Rheumatol Pathophysiol 10 RH
arthritis the metacarpophalangeal and proximal interphalangeal joints) with ogy, ogy (Patp)
prolonged morning stiffness and associated fatigue. Antibodies to Orthopedi
8802
citrullinated peptides/proteins have a high specificity for the condition. cs &
Sports
(RH)
Rheumatoid The pathogenesis of rheumatoid arthritis involves early activation of CD4+ Rheumatol Pathophysiol 10 RH
arthritis T cells (especially Th1 and Th17 subsets) with release of cytokines such ogy, ogy (Patp)
as tumor necrosis factor-alpha and IL-1 that cause destruction of Orthopedi
#### cartilage and bone. Monoclonal antibodies that inhibit tumor necrosis cs &
factor-alpha or IL-1 receptors can slow progression of the disease. Sports
morning stiffnes, overt synovitis(swelling, warmth, tenderness) (RH)

Biologic agents Tumor necrosis factor-alpha (TNF-α) inhibitors impair cell-mediated Rheumatol Pharmacolog 2 RH
immunity. All patients beginning treatment with TNF-α inhibitors should ogy, y (Phar)
be evaluated for latent tuberculosis. (Tuberculin skin test) Orthopedi
720
cs &
Sports
(RH)
 Corticosteroids Osteoporosis is a common cause of fragility fractures, which occur in the Rheumatol Pharmacolog 3 RH
absence of significant trauma. Chronic, systemic use of glucocorticoids ogy, y (Phar)
such as prednisone promotes osteoporosis and increases the risk of Orthopedi
1773
fractures. cs &
Sports
(RH)
COX 2 Selective cyclooxygenase 2 (COX 2) inhibitors relieve pain with lower risk Rheumatol Pharmacolog 1 RH
inhibitor of bleeding and gastric ulceration than nonselective nonsteroidal anti- ogy, y (Phar)
inflammatory drugs. Orthopedi
716
cs &
Sports
(RH)
Gout Colchicine is used for treatment of acute gouty arthritis in patients who Rheumatol Pharmacolog 11 RH
cannot take nonsteroidal anti inflammatory drugs. It inhibits leukocyte ogy, y (Phar)
migration and phagocytosis by blocking tubulin polymerization. Orthopedi
858
Significant side effects of colchicine include nausea and diarrhea. cs &
Sports
(RH)
Gout Colchicine inhibits tubulin polymerization into microtubules and can be Rheumatol Pharmacolog 11 RH
used for acute treatment and prophylaxis of gout, affect on Cytoskeleton. ogy, y (Phar)
Important side effects of colchicine include nausea, abdominal pain, and Orthopedi
859
diarrhea. cs &
Sports
(RH)
Gout Nonsteroidal anti-inflammatory drugs are the first-line treatment for acute Rheumatol Pharmacolog 11 RH
gouty arthritis. They inhibit cyclooxygenase and therefore decrease ogy, y (Phar)
prostaglandin synthesis and exert a broad anti-inflammatory effect that Orthopedi
860
includes inhibition of neutrophils. cs &
Sports
(RH)
Gout Chronic uric acid-lowering therapy is recommended for patients with gout Rheumatol Pharmacolog 11 RH
who have frequent gouty attacks, uric acid kidney stones, tophi, or chronic ogy, y (Phar)
joint destruction from gout. Xanthine oxidase inhibitors are the preferred Orthopedi
861
treatment. cs &
Sports
(RH)
Gout Colchicine is a second-line agent for treating acute gouty arthritis. It Rheumatol Pharmacolog 11 RH
inhibits tubulin polymerization and microtubule formation in ogy, y (Phar)
leukocytes, reducing neutrophil chemotaxis and emigration to sites Orthopedi
1168 inflamed by tissue deposition of monosodium urate crystals. cs &
Gastrointestinal mucosal function is also impaired by microtubule Sports
disruption, leading to diarrhea and, less commonly, nausea, vomiting, and (RH)
abdominal pain.
Gout Azathioprine is an immunosuppression drug that is metabolized into Rheumatol Pharmacolog 11 RH
active metabolites by HGPRT and, conversely, inactivated by xanthine ogy, y (Phar)
oxidase. Coadministration with a xanthine oxidase inhibitor (eg, Orthopedi
####
allopurinoL febuxostat) shunts azathioprine metabolism toward the cs &
production of active metabolites, resulting in increased immunosuppression Sports
and risk of cellular toxicity. (RH)
Azathioprine (management of autoimmune hepatitis) is an Rheumatol Pharmacolog
immunosuppressant that functions via inhibition of purine synthesis by its ogy, y (Phar)
pharmacologically active 6-thioguanine metabolites. In addition to the Orthopedi
#### desired effect of reduced lymphocyte proliferation, the proliferation of cs &
other hematologic cell lines (eg. neutrophils, erythrocytes, platelets) is Sports
reduced, leading to a common adverse effect of pancytopenia. ( make (RH)
CBC test)
Lyme disease Early Lyme disease causes flu-like symptoms and erythema chronicum Rheumatol Pharmacolog 3 RH
migrans. The second stage of Lyme disease may involve atrioventricular ogy, y (Phar)
block and facial palsy. Late Lyme disease can cause chronic asymmetric Orthopedi
1897
large joint arthritis and encephalopathy. Lyme disease is easily treated with
cs &
doxycycline or penicillin-type antibiotics (eg, ceftriaxone). Sports
(RH)
NSAIDs Cyclooxygenase-2 (COX-2) is an inducible enzyme upregulated during Rheumatol Pharmacolog 4 RH
inflammation by interleukin-1 and TNF-α. Selective COX-2 inhibitors (eg, ogy, y (Phar)
celecoxib) decrease inflammation by inhibiting COX-2 production of pro- Orthopedi
7792
inflammatory arachidonic acid metabolites. Because they do not affect cs &
COX-1, they have minimal gastroduodenal toxicity. Sports
(RH)
 Osteoporosis Selective estrogen receptor modulators exhibit estrogen antagonist and Rheumatol Pharmacolog 10 RH
agonist properties in a tissue-specific manner Raloxifene has estrogen ogy, y (Phar)
agonist activity on bone, which decreases bone resorption and improves Orthopedi
1795 bone density. Raloxifene has an estrogen antagonist effect on breast tissue cs &
and can decrease the risk of breast cancer; it also acts as an estrogen Sports
antagonist in the uterus, and does not increase the risk of endometrial (RH)
cancer.
Osteoporosis Long-term acid suppression with proton pump inhibitors (Omeprazole) Rheumatol Pharmacolog 10 RH
may be associated with an increased risk of osteoporotic fractures, possibly ogy, y (Phar)
due to decreased calcium absorption. Other medications associated with an Orthopedi
####
increased risk of osteoporosis include glucocorticoids, aromatase cs &
inhibitors, and anticonvulsants that induce cytochrome P450. Sports
(RH)
Osteoporosis Bisphosphonates have a chemical structure similar to that of pyrophosphate Rheumatol Pharmacolog 10 RH
and attach to hydroxyapatite binding sites on bony surfaces to inhibit bone ogy, y (Phar)
resorption by osteoclasts. Orthopedi
####
cs &
Sports
(RH)
Rheumatoid Methotrexate is the preferred disease-modifying treatment for patients Rheumatol Pharmacolog 10 RH
arthritis with moderate to severe rheumatoid arthritis. Significant adverse effects ogy, y (Phar)
include stomatitis, bone marrow suppression, and liver function Orthopedi
718
abnormalities. cs &
Sports
(RH)
Rheumatoid The foundation of management for rheumatoid arthritis is disease- Rheumatol Pharmacolog 10 RH
arthritis modifying antirheumatic drugs, which alleviate pain and inflammation and ogy, y (Phar)
reduce long-term joint destruction. However, the response to treatment Orthopedi
719
may take several weeks. Nonsteroidal anti-inflammatory drugs and cs &
glucocorticoids (Prednisone) can provide rapid symptom relief in the Sports
interim. (RH)
Rheumatoid Ocular manifestations in giant cell arteritis (temporal arteritis) can lead to Rheumatol Pharmacolog
arthritis rapid: severe, and irreversible vision loss. Involvement of the ciliary ogy, y (Phar)
arteries in GCA leads to anterior ischemic optic neuropathy, which Orthopedi
####
presents with a painless, rapidly progressive decrease in visual acuity. cs &
Treatment includes systemic glucocorticoids (eg, prednisone, Sports
methylprednisolone). (RH)
SLE Drug-induced lupus erythematosus (DILE) is characterized by abrupt onset Rheumatol Pharmacolog 7 RH
of lupus symptoms (eg, fever, arthralgias, pleuritis) with positive ogy, y (Phar)
antihistone antibodies. It has been linked to drugs metabolized by N- Orthopedi
1253
acetylation in the liver (eg, procainamide, hydralazine, isoniazid). cs &
Genetically predisposed individuals who are slow acetylators are at greater Sports
risk for developing DILE. (RH)
Thiazides Thiazide diuretics (Hydrochlorothiazide) increase calcium absorption in Rheumatol Pharmacolog 3 RH
the distal convoluted tubules within the nephron. Thiazides are associated ogy, y (Phar)
with increased bone mineral density and are recommended for treatment of Orthopedi
993
hypertension in patients at risk for osteoporosis. Loop diuretics increase cs &
urinary calcium loss. Sports
(RH)
Bone Bone-specific alkaline phosphatase levels (increased when using Ca Rheumatol Physiology 1 RH
remodeling and Vitamin D) correlate with osteoblast activity. Other markers of ogy, (Phys)
osteoblast activity include N-terminal propeptide of type 1 procollagen, Orthopedi
638
which is released during post-translation cleavage of type 1 procollagen. cs &
Sports
(RH)
Muscle Transverse tubules (T-tubules) are invaginations of the sarcolemma that Rheumatol
Physiology 8 RH
structure & transmit depolarization signals to the sarcoplasmic reticulum to trigger the ogy, (Phys)
physiology release of calcium and induce muscle contraction. The uniform distribution Orthopedi
824 of T-tubules in striated muscle fibers ensures that each myofibril contracts cs &
at the same time, which is necessary for efficient contraction. Sports
(Uncoordinated contraction of myofibrils within affected muscle (RH)
fibers)
Muscle During skeletal muscle contraction, calcium is released from the Rheumatol Physiology 8 RH
structure & sarcoplasmic reticulum and binds troponin C, thereby allowing the ogy, (Phys)
physiology binding of actin to myosin. Orthopedi
1558
cs &
Sports
(RH)
Muscle The H band is the region of the sarcomere that contains only thick Rheumatol Physiology 8 RH
structure & (myosin) filaments. The H band is the part of the A band (which is on ogy, (Phys)
physiology either side of the M line) where thick filaments have no overlapping thin Orthopedi
1664
(actin) filaments. cs &
Sports
(RH)
 Muscle During the skeletal muscle contraction cycle, ATP binding to myosin Rheumatol Physiology 8 RH
structure & causes release of the myosin head from its binding site on the actin ogy, (Phys)
physiology filament. Orthopedi
1665
cs &
Sports
(RH)
Muscle Postural skeletal muscles such as the soleus and paraspinal muscles Rheumatol Physiology 8 RH
structure & contain predominantly Type I, slow twitch muscle fibers that derive ATP ogy, (Phys)
physiology primarily via oxidative (aerobic) metabolism, myoglobin-rich, glycogen- Orthopedi
1858
poor fibers with many mitochondria. cs &
Sports
(RH)
Muscle The contractile mechanism in skeletal muscle depends on proteins (myosin Rheumatol Physiology 8 RH
structure & II, actin, tropomyosin, and troponin) (normally released from the ogy, (Phys)
physiology sarcoplasmic reticulum) as well as calcium ions. Orthopedi
7592
cs &
Sports
(RH)
Muscle The muscle spindle system is a feedback system that monitors and Rheumatol Physiology 8 RH
structure & maintains muscle length, while the Golgi tendon system is a feedback ogy, (Phys)
physiology system that monitors and maintains muscle force. GTOs are exquisitely Orthopedi
8266
sensitive to increases in muscle tension but are relatively insensitive to cs &
passive stretch. Sports
(RH)
Osteoporosis Regular exercise leads to increased peak bone mass, a reduced rate of Rheumatol Physiology 10 RH
bone loss, and a decreased risk of osteoporosis. ogy, (Phys)
Orthopedi
628
cs &
Sports
(RH)
Paget disease Osteoclasts originate from hematopoietic progenitor cells. Macrophage Rheumatol Physiology 4 RH
of bone colony-stimulating factor and receptor for activated nuclear factor ogy, (Phys)
kappa-B ligand (RANK-L) play an important role in osteoclast Orthopedi
639
differentiation. Paget's disease of bone is characterized by increased cs &
numbers of abnormal osteoclasts, nucleis, excessive bone turnover and Sports
disorganized bone remodeling. (RH)
Resting When a specific ion channel opens, the respective ions (Potassium) will Rheumatol Physiology 5 RH
membrane flow across the membrane in a direction that brings the resting membrane ogy, (Phys)
potential and potential closer to that ion's equilibrium potential. Orthopedi
1381
action potential cs &
Sports
(RH)
Resting The resting membrane potential is the difference in the electrical charges Rheumatol Physiology 5 RH
membrane across the cell membrane under steady-state conditions. The ions that are ogy, (Phys)
potential and most permeable to the cell membrane make the largest contribution to the Orthopedi
1382 action potential resting membrane potential. In general, a high potassium efflux and some cs &
sodium influx are responsible for the value of the resting potential, Sports
which is typically about -70 mV. (RH)

Systemic Systemic sclerosis (SS) is an autoimmune disease characterized by the Rheumatol

sclerosis widespread fibrosis of multiple organ systems. Histology demonstrates ogy,
expansion of the dermal layer with diffuse collagen deposition and Orthopedi
####
atrophy of the intradermal adipose tissue and dermal appendages. cs &
Pulmonary complications are common (eg. interstitial lung disease, Sports
pulmonary hypertension). (RH)
Myositis ossificans is characterized by the formation of lamellar bone in Rheumatol
extraskeletal tissues (ie, heterotopic ossification), often triggered by ogy,
trauma. It typically presents as a painful, firm, mobile mass within a muscle
Orthopedi
####
(eg, quadriceps). Histologic examination shows benign metaplastic bone cs &
and proliferating fibroblast without mitotic atypia Sports
(RH)
Brachial plexus The brachial artery runs alongside the median and ulnar nerves in the Rheumatol
medial bicipital groove of the upper arm. Proximal to the elbow, the ogy,
median and ulnar nerves diverge, and the brachial artery continues with the Orthopedi
####
median nerve through the cubital fossa Injury to the median nerve at the cs &
cubital fossa frequently injures the brachial artery. Sports
(RH)
Dupuytren contracture is caused by progressive fibrosis of the superficial Rheumatol
palmar fascia due to excessive fibroblast proliferation (thicker). ogy,
Pathognomonic fibrotic nodules and cords form along the flexor tendons, Orthopedi
####
limiting extension of the affected digits. cs &
Sports
(RH)
 Sciatic Posterior hip dislocation (ie, femoral head displaced posteriorly from the Rheumatol
neuropathy acetabulum) can occur in motor vehicle collisions in which the knee strikes ogy,
the dashboard or from falls in elderly patients. On examination, the leg Orthopedi
####
appears shortened and internally rotated, with the hip held in flexion and cs &
adduction. The sciatic nerve is vulnerable to injury in posterior hip Sports
dislocation. (RH)
Abortion Physicians are not required to provide medical services that are against Social Behavioral 3 SS
their personal beliefs. In such cases, the physician should provide referral Sciences Science
####
to providers who will perform the requested procedure. (SS) (Beha)

Advance The admission process should include discussion of ADs and code status to Social Behavioral 3 SS
1235 directives ensure that medical personnel adhere to the pt's specific wishes in the event Sciences Science
that the pt becomes incapacitated. (SS) (Beha)
Advance Advance directives take precedence over the wishes of family members. Social Behavioral 3 SS
#### directives Physicians should respect patient autonomy and adhere to patients' wishes Sciences Science
as outlined in advance directives. (SS) (Beha)
Advance A health care proxy is a person legally designated to make medical Social Behavioral 3 SS
directives decisions in the event the patient loses decision-making capacity. The Sciences Science
####
proxy overrules all other possible surrogate decision makers, including (SS) (Beha)
family members.
Beneficence The EMTALA was enacted by Congress to prevent hospitals from Social Behavioral 1 SS
inappropriately transferring, discharging, or refusing to Tx indigent pts. All Sciences Science
#### patients who Px to the ED must receive an appropriate screening medical (SS) (Beha)
Ex and stabilization of their condition, regardless of ability to pay.

Child abuse Physicians should contact Child Protective Services immediately if there is Social Behavioral 2 SS
1107 suspicion of child abuse. Sciences Science
(SS) (Beha)
Health literacy Low health literacy is a common and underrecognized barrier to health Social Behavioral SS
care. It is important to assess patients' understanding of provided Sciences Science
####
information without shaming or causing embarrassment. (SS) (Beha)

Decision When patients are unable to make their wishes known and there is no Social Behavioral 5 SS
making written documentation of them, the responsibility for medical decision- Sciences Science
capacity making falls to their designated health care proxy. If a pt has not (SS) (Beha)
1124
designated a surrogate decision maker, medical decisions default to the
NOK. In the case of a married person, the NOK is usually the spouse.

Communicating the news of a suspected diagnosis of Down syndrome at Social Behavioral SS

the time of delivery requires an empathic approach. A shift from "breaking Sciences Science
#### bad news" to "sharing unexpected news" can help prepare the parents (SS) (Beha)
to receive the information without imposing negative value judgments.

Decision The capacity to refuse treatment requires the ability to express a choice, Social Behavioral 5 SS
making understand the relevant medical information, appreciate the consequences Sciences Science
1179 capacity of treatment options, and offer a rationale for the decision. Patients with (SS) (Beha)
decision-making capacity have the right to refuse medical treatment.

Decision patients who are temporarily incapacitated should not be allowed to make Social Behavioral 5 SS
2058 making important health care decisions. Acutely intoxicated patients should be Sciences Science
capacity reAx when sober. (SS) (Beha)
Decision Parents' authority to make medical decisions for their children can be Social Behavioral 5 SS
making challenged in cases in which a child is at significant risk for harm. Sciences Science
####
capacity Physicians are justified in obtaining a court injunction to proceedwith life- (SS) (Beha)
saving medical Tx of the child.
Decision In the absence of an AD and designated health care proxy, a family Social Behavioral 5 SS
making member of an incapacitated pt should be contacted to act as a surrogate Sciences Science
#### capacity decision maker, followed by a person who cares about and knows the pt's (SS) (Beha)
wishes. In an emergency, the physician can Tx an incapacitated ptwitho
obtaining consent.
Elder abuse & Clinicians have a legal and ethical obligation to report elder abuse, neglect, Social Behavioral 1 SS
neglect and exploitation. If there is reason to suspect possible mistreatment, the Sciences Science
8457
patient should be interviewed alone to avoid intimidation by potential (SS) (Beha)
perpetrators.
Emancipated Minors can consent for medical Tx in certain circumstances, including Social Behavioral 1 SS
2057 minor legal emancipation (eg, parent, married), emergency care, and specific Sciences Science
conditions (eg, STI, pregnancy, substance abuse). (SS) (Beha)
End of life care When patients are unable to make end-of-life decisions for themselves Social Behavioral 2 SS
and no written advance directives exist, responsibility for those decisions Sciences Science
1128 falls to the next of kin. However, all surrogate medical decisions, including (SS) (Beha)
next-of-kin decisions, must be based on the best estimation of what the
patient would have wanted.
 End of life care Ptswith advanced metastatic ca or other terminal illnesses and a life Social Behavioral 2 SS
#### expectancy of <6 months should be evaluated for hospice care. Sciences Science
(SS) (Beha)
Ethical Consent of a married or unmarried significant other is not required for a pt Social Behavioral 3 SS
principles in to undergo any type of procedure, including sterilization. Physicians should Sciences Science
1125
healthcare counsel the pt regarding the risks and benefits of, and alternatives to, any (SS) (Beha)
procedure or Tx.
Ethical Romantic and sexual relationshipswith current patients as well as former Social Behavioral 3 SS
principles in psych patients are always unethical. Relationshipswith former non-psych Sciences Science
####
healthcare patients may be acceptable provided the physician-pt relationship is (SS) (Beha)
terminated well beforehand.
Health A HMO is an insurance planwith low monthly premiums, low copayments Social Behavioral 3 SS
insurance and deductibles, and low total cost for the pt. HMOs ↓ utilization by Sciences Science
confining patients to a limited panel of providers, requiring referral from a (SS) (Beha)
####
PCP prior to specialist consultations, and denying payment for services that
do not meet established guidelines.

Impaired Physicians are ethically and legally obligated to report ( the supervisor) Social Behavioral 1 SS
colleague impaired colleagues in a timely manner. Reporting protects patient safety Sciences Science
####
and can assist the impaired physician in receiving appropriate evaluation (SS) (Beha)
and treatment.
Although physicians should be responsive to patient requests, they should Social Behavioral SS
not feel pressured to make a recommendation before fully evaluating the Sciences Science
####
patient. The best approach is to validate the patient’s concerns and gather (SS) (Beha)
more information
Informed Physicians must ensure the appropriate use of medical interpreters to Social Behavioral 3 SS
consent promote adequate patient understanding and participation in the Sciences Science
####
decisionmaking process. This is particularly important when obtaining (SS) (Beha)
informed consent for treatment
Informed Informed consent should be obtained by a provider who has sufficient Social Behavioral 3 SS
consent knowledge to give an accurate description of the intervention, the risks and Sciences Science
####
benefits of Tx, and available alternative Tx and to answer all of the pt's (SS) (Beha)
questions.
Informed The process of informed consent involves understanding a pt's knowledge Social Behavioral 3 SS
#### consent about Tx, responding to specific concerns, and discussing the risks and Sciences Science
benefits of Tx and the risks of refusing Tx. (SS) (Beha)
Intimate patients experiencing intimate partner violence should be approached in a Social Behavioral 1 SS
partner supportive, nonjudgmental, open-ended manner. A thorough safety Ax and Sciences Science
####
violence development of an emergency safety plan are essential. (SS) (Beha)

Medical errors Physicians should disclose Rx errors and provide an apology in a timely Social Behavioral 8 SS
#### fashion regardless of whether harm has occurred. Sciences Science
(SS) (Beha)
Professional Romantic and sexual relationships with current patients as well as former Social Behavioral 4 SS
conduct psychiatric patients are always unethical. Relationships with former Sciences Science
####
nonpsychiatric patients may be acceptable provided the physician-patient (SS) (Beha)
relationship is terminated well beforehand.
Failure of oral medications is common in long-standing type 2 diabetes Social Behavioral SS
mellitus due to progressive loss of pancreatic beta cell function Patients Sciences Science
#### should be counseled that because of the natural history of the condition, (SS) (Beha)
the need for supplemental insulin is common and does not represent a
personal failure.
Medical errors Root cause analysis is a quality improvement measure that identifies what, Social Behavioral 8 SS
how, and why a preventable adverse outcome occurred. The first step Sciences Science
####
involves collecting data mainly through interviewing multiple individuals (SS) (Beha)
involved in the steps leading to the outcome.
Medical errors Communication failures between physicians during patient handoffs are a Social Behavioral 8 SS
major cause of medical errors and can be reduced by use of a Sciences Science
####
standardized handoff process including systematic sign-out notes. (SS) (Beha)

Patient Under the Health Insurance Portability and Accountability Act, physicians Social Behavioral 5 SS
confidentiality may disclose patient information to friends and family members in Sciences Science
emergency situations or when the patient is otherwise incapacitated, (SS) (Beha)
784 depending on what is in the best interest of the patient. Otherwise patient
information may be disclosed only when the patient gives explicit
permission or does not object when given a reasonable opportunity

Patient Pt confidentiality is strongly protected because patients must feel free to Social Behavioral 5 SS
confidentiality disclose details of all aspects of their lives so that physicians can provide Sciences Science
optimal care. Exceptions to pt confidentiality include suspected child, (SS) (Beha)
1129
disabled person, or elder abuse; knife or gunshot wounds; Dx of a
reportable communicable disease; and patients at risk of physically
harming themselves or others.
 Patient It is unethical to discuss any information regarding a pt's Dx and Txwith Social Behavioral 5 SS
confidentiality another individual, including a physician who is not involved in the pt's Sciences Science
7733
care. Likewise, the physician should neither confirm nor deny whether the (SS) (Beha)
person of interest is, in fact, a pt.
Patient Physicians must be cautious about discussing protected pt health Social Behavioral 5 SS
confidentiality information in public places, including public settingswithi the hospital, Sciences Science
#### evenwith other medical personnel. Conversations regarding patients should (SS) (Beha)
be deferred to a later time when a more private setting can be arranged.

Patient The Health Insurance Portability and Accountability Act protects health Social Behavioral 5 SS
confidentiality information by requiring verbal or written authorization for release of Sciences Science
information. Family members who contact the physician for (SS) (Beha)
####
information about their relative should not be given any information
about the patient without the patient's consent.

Patient safety
Health care providers working on a team should employ closed-loop Social Behavioral 1 SS
communication, in which team members repeat back the information Sciences Science
#### received to ensure that the correct information has been conveyed. This (SS) (Beha)
highly effective form of communication ↓ the risk of medical errors in the
health care setting.
Physician Physicians are frequently asked to evaluate whether a pt is entitled to Social Behavioral 11 SS
patient disability benefits. When interactingwith demanding pts, it is best to Sciences Science
1123
communication explain that the physician has a responsibility to perform a thorough Ax (SS) (Beha)
prior to making this determination.
Physician In situations in which a parent's presence may interferewith obtaining Social Behavioral 11 SS
patient honest answers from an adolescent pt, physicians should politely ask the Sciences Science
1126 communication parent to wait outside and interview the pt privately. This is also important (SS) (Beha)
when discussing drugs, alcohol, tobacco, and sexual activitywith teenagers.

Physician Delivering bad news effectively requires determining the pt's perception of Social Behavioral 11 SS
patient the situation, providing appropriate details in an empathic manner, and Sciences Science
communication allowing the pt time to react emotionally and express concerns. Empathic, (SS) (Beha)
1145
supportive communication should be directed at understanding the pt's
wishes and beliefs while maintaining cultural and religious sensitivity.

Physician Physicians should respond to disclosure of past sexual abusewith empathy Social Behavioral 11 SS
patient and concern. Clearly acknowledging the trauma and communicating Sciences Science
2054
communication willingness to discuss it when the pt is ready will help strengthen the (SS) (Beha)
physician-pt relationship.
Physician patients have the right to refuse to receive medical information. Physicians Social Behavioral 11 SS
patient must understand and respect the beliefs of cultures that value beneficence Sciences Science
communication and nonmaleficence over autonomy. In these cultures, family members may (SS) (Beha)
2059
be expected to make medical decisions to avoid perceived harm, disrespect,
or mental distress caused by direct disclosure to the pt.

Physician In nonemergent settings, trained language interpreters should be used to Social Behavioral 11 SS
patient ensure optimal medical care; this applies to deaf patients using ASL. Sciences Science
7487
communication (SS) (Beha)

Physician Physicians should ask patients their preferred form of address. When in Social Behavioral 11 SS
patient doubt, patients should be addressed formally unless they indicate otherwise Sciences Science
####
communication when asked. (SS) (Beha)

Physician Physicians should remain alert to ptswith a low level of literacy as this can Social Behavioral 11 SS
patient often impair communication and result in low-quality medical care and Sciences Science
####
communication poor adherence. Alternate learning methods (eg, visual resources) should (SS) (Beha)
be used to address this challenge.
Professional Physicians are ethically obligated to inform patients of medical errors, Social Behavioral 4 SS
conduct regardless of whether harm has occurred. Disclosure should be timely and Sciences Science
1181
accompanied by an explanation of what happened and an apology. (SS) (Beha)

Professional It is ethically problematic for physicians to accept expensive gifts as they Social Behavioral 4 SS
conduct may influence or appear to influence physician behavior. These gifts Sciences Science
7767
should be declined after expressing appreciation for the gesture. (SS) (Beha)

Professional When treating patients who have been referred for specialty care or a Social Behavioral 1 SS
disagreements second opinion, it is imperative to not undermine the patient's relationship Sciences Science
among with the primary physician. A physician should avoid making negative (SS) (Beha)
1239
providers comments about the quality of care rendered by that practitioner unless
practices are imminently dangerous or far outside acceptable standards of
care.
 Requests to Patients have the right to have information withheld from them regarding Social Behavioral 1 SS
withhold their medical condition. Physicians must respect their wish not to know, Sciences Science
1237 information but should also explore the patient concerns to better understand their (SS) (Beha)
preferences and maximize their involvement in subsequent medical
decision making.
Terminal Patients faced with terminal illness may experience stages of grief, Social Behavioral 1 SS
illness including denial, anger, bargaining, depression, and acceptance. Denial Sciences Science
####
that does not impair relationships or interfere with patient care should not (SS) (Beha)
be confronted.
Acute Acute respiratory distress syndrome is a severe inflammatory reaction that
respiratory occurs in the lungs and results in hypoxemia and noncardiogenic
distress pulmonary edema. Pulmonary injury leads to an inflammatory response
#### syndrome resulting in breakdown of the capillary-alveolar barrier (created by type I
pneumocytes and endothelial cells), increased capillary permeability,
intraalveolar fluid accumulation, and hyaline membrane formation.

Ionizing Ionizing radiation induces DNA damage (eg. double-strand breakage,

radiation free radical generation) that predominantly affects highly proliferative
cells (eg, skin stem cells, hematogenous progenitors, intestinal crypt
####
cells). These rapidly dividing cells are the first to be lost following
significant radiation exposure, resulting in hair loss, pancytopenia,
diarrhea, and nausea/vomiting.
Ionizing Ionizing radiation causes cellular and DNA damage primarily through
radiation generation of reactive oxygen species, which can trigger progressive
inflammation and tissue damage In the gastrointestinal tract, the acute
#### effects of radiation exposure typically occur several weeks after
radiotherapy is initiated and manifest as abdominal pain and diarrhea
due to mucosal denudation, inflammation, and edema

Type I muscle fibers (slow-twitch or red fibers) primarily use oxidative

phosphorylation and contain high quantities of lipids, myoglobin, and
mitochondria. They specialize in sustained, low force contraction, and
#### their function is amplified by endurance training. Type II muscle fibers
(fast-twitch or white fibers) primarily use glycolysis and specialize in rapid
bursts of high force contraction. Their function is amplified by resistance
training.
von Hippel- Von Hippel-Lindau (VHL) disease chromosome 3 is an autosomal
Lindau disease dominant condition caused by a mutation in a tumor suppressor gene,
which is associated with the development of pheochromocytomas, retinal
and cerebellar hemangioblastomas, and renal cell carcinomas. Because of
#### the potential for serious complications from these tumors, patients with
VHL should receive annual surveillance, including plasma
metanephrines, abdominal imaging, ophthalmologic examination, and
MRI of the brain and spine

Transporter associated with antigen processing (TAP) proteins are

necessary for loading of cytoplasmic (eg. viral) proteins onto major
histocompatibility complex (MHC) class I molecules. The MHC class l-
####
peptide complex can then activate CD8+ cytotoxic T cells through
interaction with the T cell receptor and CD8 coreceptor.

Immunosenescense is the normal age-related decline that impairs most

aspects of immune function, including the production of naive В and T
cells. This results in a diminished antibody-based immune response to
#### novel antigens (eg, infections, vaccinations). The immune response to
previously experienced pathogens is typically intact due to normal or
increased levels of memory В and T cells and preserved antibody quality.

Adalimumab is a recombinant human IgG that binds tumor necrosis factor-

alpha (TNF-alpha). Antidrug antibodies can develop against
adalimumab (or other immunoglobulin-based anti-TNF agents) that can
####
block its interaction with TNF-alpha, preventing the drug from functioning
and leading to more rapid drug clearance.

Major histocompatibility complex (MHC) class II molecules are encoded

by the HLA-DP, HLA-DQ, and HLA-DR genes and present extracellular
antigens processed in acidified lysosomes by antigen-presenting cells
####
(eg, B cells, macrophages). Absence of MHC class II expression impairs
activation of B and T cells, resulting in a form of severe combined
immunodeficiency.
Path

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