Septic shock is initiated by bacterial Lipid A (LPS) binding
CD14 on Macrophages
Causes of Eosinophilia
Neoplasia Asthma Allergies Chronic Adrenal Insufficiency Parasites
B Cell markers
CD19, 20 and 21
Cytotoxic T Cell markers
CD3 and 8
Helper T Cell markers
CD3 and 4
Apixaban and Rivaroxaban inhibit
Factor Xa
Argatroban, Bivalirudin and Dabigatran inhibit
Factor IIa (Thrombin)
Alteplase, Reteplase, Streptokinase and Tenecteplase activate
tPA
Pathologic RBC form seen with liver disease and cholesterol dysregulation
Acanthocytes (Spur Cells)
Pathologic RBC form seen with lead poisoning
Basophilic Stippling + Ringed Sideroblast
Pathologic RBC form seen with Sideroblastic Anemia
Basophilic Stippling + Ringed Sideroblast
Pathologic RBC form seen with bone marrow infiltration
Dacrocytes (teardrop cells)
Pathologic RBC form seen with G6PD Deficiency
Dagmacytes (Bite Cells) + Heinz Bodies
Pathologic RBC form seen with end-stage renal or liver disease and Pyruvate Kinase deficiency
Echinocytes (Burr Cells- similar to acanthocytes but more uniform/smaller)
Asymptomatic RBC form seen with mutations in RBC membrane proteins
Elliptocytes
Pathologic RBC form seen with Megaloblastic Anemia
Macro-ovalocytes (also see hyper segmented PMNs)
Pathologic RBC form seen with DIC, TTP/HUS, HELPP Syndrome and mechanical hemolysis
Schistocytes (helmet cells)
Pathologic RBC form seen with mutations in ankyrin or spectrin
Spherocytes
Pathologic RBC form seen with HbC
Target Cells
Pathologic RBC form seen with Asplenia
Target Cells + Howell-Jolly Bodies
Pathologic RBC form seen with Thalassemia
Target Cells
Pathologic RBC form seen with Liver Disease (other than acanthocytes/echiocytes)
Target Cells
Enzymes inhibited by lead
Ferrochelatase and ALA dehydratase
UMP Synthase deficiency
Orotic Aciduria
Triphalangeal thumbs are seen with
Diamond-Blackfan Anemia
Disease indicated by (-) CD55/59
Paroxysmal Nocturnal Hemoglobinuria
Enzyme deficient in Acute Intermitent Porphyria
Porphobilinogen Deaminase
Enzyme deficient in Porphyria Cutanea Tarda
Uroporphyrinogen Decarboxylase
Deficiency in Bernard-Soulier Syndrome
GpIb
Deficiency in Glanzmann Thrombasthenia
GpIIb/IIIa
Enzyme deficient in Thrombotic Thrombocytopenic Purpura
ADAMTS13
Markers for Reed-Sternberg Cells
CD15 and CD30
Translocation of Burkitt Lymphoma
t(8;14)
C-myc (8) for HC Ig (14)
Translocation of Follicular Lymphoma
t(14;18) HC Ig (14) for BCL-2 (14)
Translocation of Mantle Cell Lymphoma
t(11;14) Cyclin D1 (11) for HC Ig (14)
Marker for pre-T Cell
TdT+
Marker for pre-B Cell
CD10, TdT+
Marker for Chronic Lymphocytic Leukemia
CD20, CD5
Histological finding with CLL
Smudge Cells
Marker for Hairy Cell Leukemia
TRAP+
Translocation of Acute Myelogenous Leukemia
t(15;17)
all-trans retinoid acid (Vitamin A)
Cancer associated with Auer Rods
AML
Translocation of Chronic Myelogenous Leukemia
t(9;22) - Philadelphia Chromosome
BCR-ABL
Markers for Langerhans Cell Histiocytosis
S-100 and CD1a
Mutation associated with myeloproliferative disorders
V617F JAK2
Mutation in Achondroplasia
Activation of FGFR3
Translocation of Ewing Sarcoma
t(11;22)
Fusion Protein EWS-FLI 1
Arthritis involving DIP and PIP Joints
Osteoarthritis
Arthritis involving DIP and MIP Joints
Rheumatoid Arthritis
HLA associated with Rheumatoid Arthritis
HLA-DR4
Disease associated with Anti-Cirtullinated Peptide Antibody
Rheumatoid Arthritis
Antibodies found with Sögren’s Syndrome
SS-A (anti-Ro) and SS-B (anti-La)
Antibody found in Mixed Connective Tissue Disease
Anti-U1 RNP Antibodies
Diseases associated with Anti-Jo 1, Anti-SRP and Anti-Mi 2 antibodies
Dermatomyositis and Polymyositis
Antiboby associated with diffuse scleroderma
Anti-SCL-70 (anti-DNA topoisomerase I)
Antibody associated with CREST
Anti-Centromere Antibody
Proteins making up Gap Junctions
Connexins
Proteins making up Tight Junctions
Claudins/Occludins
Proteins making up Adherens Junctions
Cadherins
Proteins making up Desmosomes
Cadherins (Desmoglein)
Proteins making up Hemidesmosomes
Integrins
Signs of Psoriasis (5)
1) Acanthosis (epidermal hyperplasia of S. Spinosum)
2) Munro Microabscesses
3) Auspitz Sign
4) Decreased S. Granulosum)
5) Parakeratosis (nuclei in S. corneum)
IgG Antibodies against desmoglein
Pemphigus Vulgaris
Immunofluorescence pattern/Nikolsky result of Pemphigus Vulgaris
Reticular/Net-like pattern; Nikolsky +
Immunofluorescence pattern/Nikolsky result of Bullous Pemphigoid
Linear pattern at the epidermal/dermal border; Nikolsky -
IgG against hemidesmosomes
Bullous Pemphigoid
Tumor marker for Melanoma
S-100
Common mutation in Melanoma
BRAF Kinase
Nerve injured in a fracture of the surgical neck of the humerus
Axillary Nerve
Nerve injured in an anterior dislocation of the humerus
Axillary Nerve
Levels of the Axillary Nerve
C5-C6
Nerve injured in an upper trunk compression
Musculocutaneuos
Levels of the Musculocutaneuos Nerve
C5-C7
Nerve injured in a midshaft fracture of the humerus
Radial Nerve
Nerve injured due to compression from crutches
Radial Nerve
Levels of the Radial Nerve
C5-T1
Nerve injured in a supracondylar fracture of the humerus
Median Nerve
Nerve injured in carpal tunnel syndrome
Median Nerve
Nerve injured in wrist laceration
Median Nerve
Levels of the Median Nerve
C5-T1
Nerve injured in fracture of the medial epicondyle of the humerus
Ulnar Nerve
Nerve injured in fracture of hook of hamate
Ulnar Nerve
Levels of the Ulnar Nerve
C8-T1
Nerve injured in superficial laceration of the palm
Recurrent Branch of the Median Nerve
Nerve injury causing flattening of deltoid + loss of aBduction past 15 degrees + loss of sensation over lateral arm
Axillary Neve
Nerve injury causing loss of forearm flexion/supination + loss of sensation over the lateral forearm
Musculocutaneous Nerve
Nerve injury causing wrist drop + decreased grip strength + loss of sensation over the posterior arm, forearm and dorsal hand (lateral, not digits)
Radial Nerve
Nerve injury causing loss of sensation over thenar eminence, dorsal and palmar aspects of lateral 3 1/2 digits
Median Nerve
Nerve injury causing radial deviation of wrist + loss of wrist flexion + loss of sensation over medial 1 1/2 digits
Ulnar Nerve
Nerve injury causing loss of thenar muscle group (opposition, aBduction and flexion)
Recurrant Branch of the Median Nerve
Nerve injury causing Erb Palsy (Waiter’s Tip)
Tear of upper trunk (C5-C6)
-Traction on neck during delivery
Nerve injury causing Klumpke Palsy (Total Claw Hand)
Tear of lower trunk (C8-T1)
-Grabbing a tree branch to break a fall; Thoracic Outlet Syndrome
Nerve injury causing Winged Scapula
Lesion of Long Thoracic Nerve (C5, C6, C7)
-Axillary node dissection post-mastectomy
Nerve injured from pelvic surgery
Obturator Nerve
Level of the Obturator Nerve
L2-L4
Nerve injured from pelvic fracture
Femoral Nerve
Level of the Femoral Nerve
L2-L4
Nerve injured from trauma to the lateral aspect of the leg
Common Peroneal Nerve
Nerve injured from fibular neck fracture
Common Peroneal Nerve
Level of the Common Peroneal
L4-S2
Nerve injured from knee trauma of a Baker Cyst
Tibial Nerve
Nerve injured from Tarsal Tunnel Syndrome
Tibial Nerve
Level of the Tibial Nerve
L4-S3
Nerve injured from IM injection to upper medial gluteal region
Superior Gluteal Nerve
Level of the Superior Gluteal Nerve
L4-S1
Nerve injured from a posterior hip dislocation
Inferior Gluteal Nerve
Level of the Inferior Gluteal Nerve
L5-S2
Nerve injury causing decreased thigh sensation + decreased adDuction
Obturator Nerve
Nerve injury causing decreased thigh flexion + decreased leg extension
Femoral Nerve
Nerve injury causing foot drop + loss of sensation of dorsum of foot
Common Peroneal Nerve
PED: Peroneal Everts and Dorsiflexes
Nerve injury causing inability to curl toes + loss of sensation of sole of foot + loss of plantarflecion
Tibial Nerve
TIP: Tibial Inverts and Plantarflexes; if injured cannot stand on TIPtoes
Nerve injury causing Trendelenburg Gait (contralateral hip drops when lesion is used as weight baring leg)
Superior Gluteal Nerve
Nerve injury causing difficulty climbing stairs + loss of hip extension
Inferior Gluteal Nerve
Signs of radiculopathy at L3-L4
Weak knee extension + decreased patellar reflex
Signs of radiculopathy at L4-L5
Weak dorsiflexion + poor heel-walking
Signs of radiculopathy at L5-S1
Weak plantarflexion + poor toe walking + decreased Achilles Reflex
Region of the hypothalamus –> Hunger
Lateral Area
Region of the Hypothalamus –> Satiety
Ventromedial Area
Damage to the Lateral Hypothalamus causes
Anorexia
Damage to the Ventromedial Hypothalamus causes
Hyperphagia
Sleep Pneumonic meaning of BATS Drink Blood
Beta EEG - Awake w/ eyes open Alpha EEG - Eyes closed Theta- N1 Sleep Spindles + K Complexes - N2 Delta EEG - N3 Beta EEG - REM Sleep
Chromosome associated with Huntington Disease
4
Syndrome of disinhibited behavior caused by lesion to the amygdala
Klüver-Bucy Syndrome
Arterial occlusion causing contralateral paralysis and sensory loss to the face/upper limb + aphasia (dominant) or hemineglect (non-dominant)
Middle Cerebral Artery
Arterial occlusion causing contralateral paralysis and sensory loss of the lower limb
Anterior Cerebral Artery
Arterial occlusion causing contralateral paralysis and sensory loss without cortical signs
Lenticulo-Striate Artery
Arterial occlusion causing contralateral paralysis of upper and lower limb + decreased contralateral proprioception + hypoglossal dysfunction (tongue deviates towards the lesion)
Paramedian Branches of the Anterior Spinal Artery (Medial Medullary Syndrome)
Could be vertebral arteries as well
Arterial occlusion causing dysphagia + hoarsness + decreased gag reflex + lateral medullary (Trigeminal, Spinothalamic and Cerebellar symptoms) + Horner’s
Posterior Inferior Cerebellar Artery (Lateral Medullary/Wallenberg)
“Don’t PICA hoarse that can’t eat”
Arterial occlusion causing facial paralysis + decreased lacrimation/salivation + decreased taste from the anterior 2/3 of tongue + lateral pons signs (Trigeminal, Spinothalamic and Cerebellar symptoms)
Anterior Inferior Cerebellar Artery (Lateral Pontine Syndrome)
“Facial Droop means AICA’s pooped”
Arterial occlusion causing Locked-In Syndrome
Basilar Artery
Arterial occlusion causing contralateral hemianopia + macular sparing
Posterior Cerebral Artery
Cause of absent ankle reflex
Compression of S1 Nerve Root
Trinucleotide repeat pneumonic
eX Girlfriend's First Aid Helped Ace MY Test fragile X --> cGg Friederich ataxia --> gAa Huntington disease --> cAg MYotonic dystrophy --> cTg
Chromosome associated with Friedreich Ataxia
Chromosome 9
Reflex Pneumonic
1, 2 buckle my shoe (S1, 2 = Achille’s Reflex)
3, 4 kick the door (L3, L4 = Patellar Reflex)
5, 6 pick up sticks (C5, C6 = Biceps Reflex)
7, 8 lay them straight (C7, C8 = Triceps Reflex)
————-
1, 2 Testicles Move (L1, L2 = Cremaster Reflex)
3, 4 Winks galore (S3, S4 = Anal Wink Reflex)
Cranial Nerves in the Pons
5-8
Cranial Nerves in the Medulla
9-12 (11 is really Spinal Cord)
Medial Cranial Nerves
3, 4, 6, 12 (the “M”s)
Cranial Nerves in the Midbrain
3 and 4
Structures passing through the Superior Orbital Fissure
CN III, IV and VI and V-1
Nerve exiting through the Foramen Rotundum
V-2
Nerve exiting through the Foramen Ovale
V-III
Inclusions in Frontotemporal Lobe Degeneration are of
Hyperphosphorylated Tau or Ubiquinated TDP-43
Diagnostic findings of MS
Oligoclonal Bands + Increased IgG and Myelin Basic Protein in CSF
Inheritance pattern of Charcot-Marie-Tooth Disease
Autosomal Dominant
Krabbe disease –> demyelination via
Deficiency of galactocerebrosidase w/ subsequent accumulation of galactocerebroside and psychosine
Metachromatic Leukodystrophy –> demyelination via
Arylsulfatase A Deficiency w/ subsequent accumulation of sulfatides
Gene mutation associated with Sturge-Weber
GNAQ Gene activating mutation
Mutation associated with Neurofibromatosis Type I
NF1 Tumor Suppressor (negative regulator of RAS) on Ch 17
Schwannoma Marker
S-100
Total, ICF and ECF body water percentages
Total = 60% ICF = 40% ECF = 20% (15% interstitial; 25% plasma)
Equation for filtration fraction
GFR/RPF
Equation for Filtered Load
GFR x Px
Equation for Excretion Rate
V x U
Factors that shift K+ out of the cell (causing hyperkalemia)
Digitalis, hyperOsmolarity, Lysis of cells, Acidosis, B-blockers and Sugar (diabetes)
“DO LABS”
Factors that shift K+ into the cell (causing hypokalemia)
Hypo-osmolarity, Alkalosis, B-adrenergic agonists and Insulin
Winter’s Formula
PCO2 = 1.5 [HCO3] + 8 +/-2
Anion Gap Equation
Gap = Na - (Cl + HCO3)
Underlying cause of Type 1 Renal Tubular Acidosis
Alpha Intercalated cells cannot secrete H+ –> No new bicarbonate formed –> Metabolic Acidosis
Underlying cause of Type II Renal Tubular Acidosis
Defect in PCT bicarbonate reabsorption –> Metabolic Acidosis
Underlying cause of Type II Renal Tubular Acidosis
Hypoaldosteronism –> HYPERKALEMIA –> decreased NH3 synthesis in PCT –> Decreased NH4+ excretion
Genetics of Alport Syndrome
X-Linked Dominant
Immunotherapy for RCC
Aldesleukin
Chromosome abnormality associated with RCC
Ch. 3 (von Hippel-Lindau)
Genetic cause of Wilms Tumor
Loss of function mutation of WT1 or WT2 on Chromosome 11
Components of the WAGR syndrome and underlying mutation
Wilms tumor, Aniridia, Genitourinary malformations and mental Retardation
WT1 mutation
Components of Denys-Drash syndrome and underlying mutation
Wilms tumor, nephrotic syndrome and male pseudohermaphroditism
WT1 mutation
Components of Beckwith-Wiedemann Syndrome
Wilms tumor, Macroglossia, Organomegaly and emihypertrophy
WT2 mutation
Consequences of Renal Failure
"MAD HUNGER" Metabolic Acidosis Dyslipidemia Hyperkalemia Uremia Na+/H2O retention Growth retardation Erythropoiesis Renal Osteodystrophy
Drugs causing acute interstitial nephritis (tubulointerstitial nephritis)
"The 5 P's" Pee (diuretics) Pain-free (NSAIDs) Penicillins/cephalosporins Proton-pump inhibitors rifamPin
Causes of renal papillary necrosis
"SAAD papa (papillary necrosis)" Sickle Cell Acute pyelonephritis Analgesics (NSAIDs) Diabetes
Mutations associated with ADPKD
PKD1 on Ch. 16 or PKD2 on Ch. 4
Pneumonic for mesodermal defects
VACTERL
Vertebral defects, Anal atresia. Cardiac defects, TE fistulas, Renal defects and Limb defects
1st Aortic Arch derivative
Maxillary Artery (1st is Max)
2nd Aortic Arch derivative
Stapedial
3rd Aortic Arch derivatives
Common Carotid and Internal Carotid (C is the 3rd letter)
4th Aortic Arch derivatives
Left- Aortic Arch and Right- Subclavian (4th arch = 4 limbs (systemic))
6th Aortic Arch derivatives
Pulmonary arteries and Ductus Arteriosus
Derivative of the 1st Branchial Cleft
External Auditory Meatus
Branchial Pouch derivatives pneumonic
"Ear, Tonsils, Bottom to Top" Pouch 1 = Ears Pouch 2 = Tonsils Pouch 3 = Inferior Parathyroid "Bottom" Pouch 3 = Thymus "to" Pouch 4 = Superior Parathyroids "Top"
Male and female derivatives of the Genital Tubercle
Male- Glans Penis + Corpus Cavernosum and Spongiosum
Female- Clitoris + Vestibular Bulbs
Male and female derivatives of the Urogenital Sinus
Male- Bulbourethral Glands of Cowper + Prostate
Female- Greater Vestibular Glands of Bartholin + Urethral/Paraurethral Glands of Skene
Male and female derivatives of the Urogenital Folds
Male- Penile Urethra
Female- Labia Minora
Male and female derivatives of the Labioscrotal Swelling
Male- Scrotum
Female- Labia Majora
Ligament containing the Ovarian Vessels
Infundibulopelvic Ligament (Suspensory Ligament of the Ovary)
Ligament containing the Uterine Vessels
Cardinal Ligament
Ligaments that are derived from the Gubernaculum
Round Ligament (uterus –> labia majora) and Ovarian Ligament (ovary –> uterus)
Pneumonic for the consequences of menopause
“HAVOCS”
Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease and Sleep disturbances
Specific marker for menopause
Increased FSH
Increased lab value with Choriocarcinoma
B-HCG
Lab value used to evaluate ovarian cancer recurrence
CA 125
Features of Meigs Syndrome
1) Ovarian Fibroma
2) Ascites
3) Hydrothorax (Pleural Effusion)
Tumor markers for Dysgerminoma
hCG and LDH
Tumor marker for Yolk Sac Tumors (Endodermal Sinus Tumors)
AFP
Mutation in Idiopathic Pulmonary Arterial HTN
BMPR2
Markers for mesothelioma
Cytokeratin and Calretinin +
Markers for Small Cell Carcinoma
Chromogranin A +
Enolase +