DENTAL ANATOMY: KNOW COLD, BOARDS DA GENERAL FIRST AID, boards memorization aids, BOARDS key associations first aid, BOARDS First Aid Rapid review, Microbiology boards First Aid, USMLE Step 1 Mnemonics, First Aid Mnemonics, Step 1 Mnemonics II: Immun…

Widest tooth mesio-distally
Mandibular first molar

Widest anterior tooth mesio-distally
Maxillary central

Only tooth with pulp wider mesa-distally than face-buccally
Maxillary central

Widest tooth facio-lingually
Maxillary first molar

Widest anterior tooth facio-lingually
Maxillary canine

Only tooth more narrow facially than lingually
Maxillary first molar

Tallest two teeth inciso-gingivally
Maxillary canine then mandibular canine

Top three teeth with the tallest crown
Mandibular canine, maxillary central, maxillary canine

Which tooth has the longest root inciso-gingivally
Maxillary canine

Which tooth is the smallest
Mandibular central-also most symmetrical

Which tooth is most narrowest mesa-distally
Mandibular central

What is the narrowest and smallest rooted premolar
Mandibular 1

What are the top two teeth that are likely to be congenitally missing or malformed
Third molars and then maxillary lateral incisors

Which tooth has the best lingual anatomy
maxillary lateral incisor

Which tooth is most likely to have dense-in-dente
maxillary lateral incisor

What is the most likely premolar to be congenitally missing
Mandibular 2 pre-molar

Which tooth has the most constriction from pulp chamber to canals
Maxillary 1 pre-molar.

Which anterior tooth is most likely to have a bifurcated root
Mandibular canine

Which tooth has 2 triangular ridges on 1 cusp
Maxillary 1 molar

What is the only tooth with a mesio-lingual groove
Mandibular first pre-molar

Which tooth is the only with a medially inclined root
Mandibular canine

Which pre-molar is likely to have 1 root and 1 canal
Mandibular 2 premolar

What two teeth have crown concavities
Maxillary 1 molar (distal) and Maxillary 1 premolar (mesial)

What tooth has a longer mesial maxillary first pre-molar cusp slope than distal
Primary maxillary canine

Which root has facial and lingual depression
the Maxillary first molar palatal root

What is the largest embrasure of the anterior teeth
Between the maxillary canine and lateral incisor.

What is the largest occlusal embrasure
Between the maxillary canine and 1 PM.

Faciolingual inter-proximal contacts of anterior teeth
Middle 3rd of crown

Incisogingval inter-proximal contacts of anterior teeth
Maxillary (starting at midline): I-I, J-J, M-J, M-
Mandibular (starting at midline): I-I, I-I, I-I, M-

Posterior tooth inter-proximal contacts in faciolingual
Middle 3rd of crown, closer to facial.

Posterior tooth inter-proximal contacts in occlusio-gingival
Middle 3rd of crown. Exception: Mesial surface of maxillary and mandibular 1 Molar’s contact is at the junction of the occlusal and middle 3rd’s of the crown’s.

What is the largest embrasure for every tooth
Lingual. Exceptions: Both embrasures of maxillary first molars have larger buccal embrasures. Also, mandibular incisors have equal buccal and lingual embrasures.

Facial and lingual heights of contour for all anterior teeth
Gingival 3rd of crown.

Lingual heights of contour for all posterior teeth
At or near the middle 3rd of crown. Mandibular 2nd premolar lingual is occlusal 3rd. Mandibular 1st approaches the middle 3rd.

Facial heights of contour for all posterior teeth
Gingival 3rd of crown. Exceptions: mandibular posterior teeth are closer to occlusal at the junction of gingival and middle 3rd.

Which anterior tooth has a more convex and full distal surface than mesial surface
The Maxillary canine.

Mandibular eruption dates
679-0161

Maxillary eruption dates
781-0062

WHICH TEETH HAVE A MOST COMMON TRANSVERSE RIDGE
MAXILLARY PREMOLAR AND MANDIBULAR MOLARS

WHICH TOOTH HAS MORE PROMINENT BUCCAL CUSPS RIDGES
MAXILLARY FIRST PREMOLAR

ANATOMICAL OR CLINICAL CROWN: PORTION OF THE TOOTH THAT EXTENDS FROM THE CEMENTOENAMEL JUNCTION TO THE INCISAL EDGE OR THE OCCLUSAL SURFACE (ENAMEL COVERED PORTION OF THE CROWN)
ANATOMICAL CROWN

ANATOMICAL OR CLINICAL CROWN: ENAMEL COVERED PORTION OF THE TOOTH
ANATOMICAL

ANATOMICAL OR CLINICAL CROWN: THE PORTION OF THE TOOTH THAT EXTENDS INCISALLY OR OCCLUSALLY FROM THE GINGIVAL MARGIN (CLINICALLY VISIBLE PORTION OF THE TOOTH)
CLINICAL

ANATOMICAL OR CLINICAL CROWN: CLINICALLY VISIBLE PORTION OF THE TOOTH
CLINICAL

WHAT STRUCTURES DOES THE OCCLUSAL SURFACE CONSIST OF
CUSPS RIDGES AND GROOVES

WHAT STRUCTURES CONSIST OF OCCLUSAL TABLE
WITHIN CUSPS AND MARGINAL RIDGES

TERM: AN EXTRA FORMATION OF ENAMEL ON THE CROWN OF A TOOTH. OFTEN MANIFESTS AS SUPERNUMERARY CUSPS SUCH AS CUSP OF CARABELLI
TUBERCLE

TERM: OFTEN MANIFESTS AS SUPERNUMERARY CUSPS SUCH AS CUSP OF CARABELLI
TUBERCLE

TERM: AN EXTRA FORMATION OF ENAMEL ON THE CROWN OF A TOOTH.
TUBERCLE

WHICH THIRD OF THE ANTERIOR TEETH ARE CINGULA LOCATED
CERVICLE THIRD

TERM: A ROUND EXTENSION OF ENAMEL ON THE INCISAL EDGE OF ALL INCISORS
MAMELONS

HOW MANY MAMELONS ARE THERE USUALLY PER INCISOR
3

TERM: A LARGE ELEVATION OF ENAMEL LOCATED ON THE OCCLUSAL SURFACE OF ALL POSTERIOR TEETH AND THE INCISAL EDGE OF CANINES
CUSP

TERM: LARGE ELEVATION OF ENAMEL
CUSP

WHAT ARE LOBES SEPARATED BY
DEVELOPMENTAL DEPRESSIONS IN ANTERIOR TEETH AND DEVELOPMENTAL GROOVES FOR POSTERIOR TEETH

TERM: A LINEAR ELEVATION OF THE ENAMEL SURFACE
RIDGE

WHAT CUSP ON THE MAXILLARY FIRST MOLAR COMPLETE THE SECOND TRIANGLE
DL CUSP

WHAT DIRECTION IS THE MANDIBULAR LATERAL INCISOR GOING TOWARDS FROM OCCLUSAL ASPECT
DISTO-LINGUALLY

WHAT HELPS FORM THE MESIAL AND DISTAL CONTACT AREAS
LINGUAL HEIGHT OF CONTOURS

WHAT ALLOWS FOR ADEQUATE GINGIVAL HEALTH
LINGUAL HEIGHT OF CONTOURS

WHAT IS THE EXCEPTION FOR LOCATION OF FACIAL HOC
MANIBULAR MOLARS

WHAT IS THE FACIAL HOC FOR MANDIBULAR MOLARS
JUNCTION OF MIDDLE AND CERVICAL THIRD

WHAT IS THE EXCEPTION FOR LINGUAL HOC
MANDIBULAR PM2

WHAT IS THE LOCATION OF LINGUAL HOC FOR MANDIBULAR PM2
OCCLUSAL THIRD

WHERE IS THE MANDIBULAR PRIMATE SPACE BETWEEN
CANINE AND FIRST MOLAR (DISTAL TO CANINE)

WHERE IS THE MANDIBULAR PRIMATE SPACE BETWEEN
LATERAL INCISOR AND CANINE (MESIAL TO CANINE)

THIS TERM: ALLOWS FOR THE PROPER ALIGNMENT OF THE PERMANENT INCISOR
PRIMATE SPACE

THIS TERM OCCURS IN ABOUT 50% OF PRIMARY DENTITION
PRIMATE SPACE

WHAT IS THE ARCH LENGTH OF PRIMARY TEETH FOR THE MAXILLARY AND MANDIBLE
MAXILLARY IS 68.2 AND MANDIBULAR IS 61.8

DESCRIBE THE CENTRAL GROOVE FOR THE MANDIBULAR SECOND MOLAR
STRAIGHT

WHAT ARE THE MOST COMMONLY CONGENITALLY MISSING TEETH IN ORDER
3RD MOLARS 2 MAXILLARY LATERAL INCISORS 3 SECOND PREMOLARS

ARE SUPERNUMERARY TEETH MORE COMMON IN MAXIILLARY OR MANDIBULAR ARCH
MAXILLARY

TERM: A SUPERNUMERARY TEETH LOCATED IN BETWEEN THE CENTRAL INCISORS
MESIODENS

IN ANKYLOSIS, WHAT IS THE TOOTH FUSED TO
THE ALVEOLAR BONE

WHAT TYPE OF TOOTH IS TAURODONTISM MOST ASSOCIATED WITH
MOLAR

WHEN DOES TAURODONTISM GENERALLY OCCUR
PATIENTS WITH AMELOGENESIS IMPERFECTA, KLINEFELTER’S SYNDROME OR DOWN’S SYNDROME

WHAT TEETH IS INVAGINATUS MOSTLY ASSOCIATED WITH
MAXILLARY LATERAL INCISORS

TERM: A PROMINENT DENS EVAGINATUS OFTEN SEEN ON MAXILLARY LATERAL INCISORS
TALON CUSP

TERM: EXCESSIVE DEPOSITION OF CEMENTUM
HYPERCEMENTOSIS

WHAT TEETH DO CERVICAL ENAMEL PROJECTION USUALLY ASSOCIATED WITH
MOLARS

TERM: AN APICAL EXTENSION OF ENAMEL USUALLY LOCATED AT FURCATION ENTRANCE ON MOLAR TEETH
CERVICAL ENAMEL PROJECTION

TERM: A SMALL, FOCAL MASS OF ENAMEL FORMED APICAL TO THE CEJ
ENAMEL PEARL

TERM: FUSION OF TWO COMPLETELY FORMED TEETH AT THEIR ROOTS MUST HAVE CONFLUENT CEMENTUM
CONCRESCENCE

WHAT MUST CONCRECENCE MUST HAPPEN TO OCCUR
CONFLUENT CEMENTUM

TERM: FUSION OF TWO UNIQUE TOOTH BUDS
FUSION

WHAT MUST FUSION HAVE TO OCCUR
MUST HAVE CONFLUENT DENTIN

WHAT DOES THE SEVERITY OF FUSION DEPEND ON
THE STAGE OF TOOTH DEVELOPMENT AT WHICH THE FUSION OCCURS

TERM: DEVELOPMENT OF TWO CROWNS FROM ONE TOOTH BUD
GEMINATION

TERM: SHARE A SINGLE ROOT AND A SINGLE CANAL
GEMINATION

CONTAIN A FREE ANOMERIC CARBON THAT CAN BE OXIDIZED
REDUCING SUGARS

TERM: IF THE OXYGEN ON

curve of wilson
wilson = wide

BULL
buccal upper, lingual lower
-these are the nonworking cusps
(BULLS never work)

V3 innervated muscles
“My Ass Meets The Toilet”
-Mylohyoid
-Anterior digastric
-Muscles of mastication
-Tensor veli palatini
-Tensor tympani

muscles of mastication
“MTPP” (empty pee pee)
-Masseter
-Temporal
-Pterygoid (medial)
-Pterygoid (lateral)

branches of the vagus nerve
“APES CRAP”
-Auricular
-Pharyngeal
-Esophageal
-Superior Laryngeal
-Cardiac branches
-Recurrent laryngeal
-Anterior vagal trunk
-Posterior vagal trunk

cranial nerves (sensory motor or both)
“Some Say Money Matters But My Brother Says Big Brains Matter Most”
S = sensory
M = motor
B = both

Ansa cervicalis innervations
“GENius THinks SOmeone STupid SHot Irene”
GENiohyoid
THyrohyoid
Superior Omohyoid
SternoThyroid
SternoHyoid
Inferior omohyoid

Sterilization rules
critical = enter tissue, must be sterilized
semi-critical = touches mucous membranes, require high level disinfectants

polar amino acids
SERiously CYSter, Gimme THat Ass
Serine
Cystine
Glutamine (not glycine because “gimmie” has an M in it)
Threonine
Asparagine

non polar amino acids
“All International Losers Must Gulp Vampire Poison”
Alanine
Isoleucine
Leucine
Methionine
Glycine
Valine
Proline

3 cardinal rules of tooth eruption
-Ladies first (before boys)
-skinny kids are faster (vs “stocky” kids)
-Mandibular before maxillary

Actinic (solar) keratosis
Precursor to squamous cell carcinoma

Acute gastric ulcer associated with CNS injury
Cushing’s ulcer (?ICP stimulates vagal gastric secretion)

Acute gastric ulcer associated with severe burns
Curling’s ulcer (greatly reduced plasma volume results in sloughing of gastric mucosa)

Alternating areas of transmural inflammation and normal colon
Skip lesions (Crohn’s disease)

Aneurysm, dissecting
Hypertension

Aortic aneurysm, abdominal and descending aorta
Atherosclerosis

Aortic aneurysm, ascending
Marfan’s syndrome (idiopathic cystic medial degeneration)

Atrophy of the mammillary bodies
Wernicke’s encephalopathy (thiamine deficiency causing ataxia, ophthalmoplegia, and confusion)

Autosplenectomy (fibrosis and shrinkage)
Sickle cell anemia (HbS)

Bacteria associated with gastritis, PUD, and stomach cancer
H. pylori

Bacterial meningitis (adults and elderly)
S. pneumoniae

Bacterial meningitis (newborns and kids)
Group B streptococcus (newborns), S. pneumoniae/Neisseria meningitidis (kids)

Benign melanocytic nevus
Spitz nevus (most common in first two decades)

Bleeding disorder with Gp1b deficiency
Bernard-Soulier disease (defect in platelet adhesion to von Willebrand’s factor)

Brain tumor (adults)
Supratentorial: mets > astrocytoma (including glioblastoma multiforme) > meningioma > schwannoma

Brain tumor (kids)
Infratentorial: medulloblastoma (cerebellum) OR supratentorial: craniopharyngioma (cerebrum)

Breast cancer
Infiltrating ductal carcinoma (in the United States, 1 in 9 women will develop breast cancer)

Breast mass
Fibrocystic change, Carcinoma (in postmenopausal women)

Breast tumor (benign)
Fibroadenoma

Cardiac 1° tumor (kids)
Rhabdomyoma (often seen in tuberous sclerosis)

Cardiac manifestation of lupus
Libman-Sacks endocarditis (non bacterial, affecting both sides of mitral valve)

Cardiac tumor (adults)
Metastasis, primary myoma (4:1 left to right atrium; “ball and valve”)

Cerebellar tonsillar herniation
Chiari malformation (often presents with progressive hydrocephalus or syringomyelia)

Chronic arrhythmia
Atrial fibrillation (associated with high risk of emboli)

Chronic atrophic gastritis (autoimmune)
Predisposition to gastric carcinoma (can also cause pernicious anemia)

Clear cell adenocarcinoma of the vagina
DES exposure in utero

Compression fracture
Osteoporosis (type I: postmenopausal woman; type II: elderly man or woman)

Congenital adrenal hyperplasia, hypotension
21-hydroxylase deficiency

Congenital cardiac anomaly
VSD

Congenital conjugated hyperbilirubinemia (black liver)
Dubin-Johnson syndrome (inability of hepatocytes to secrete conjugated bilirubin into bile)

Constrictive pericarditis
Tuberculosis (developing world), systemic lupus erythematosus, SLE (developed world)

Coronary artery involved in thrombosis
LAD > RCA > LCA

Cretinism
Iodine deficit/ hypothyroidism

Cushing’s syndrome
Corticosteorid therapy, Excess ACTH secretion by pituitary, Small cell lung carcinoma

Cyanosis (early; less common)
Tetralogy of Fallot, Transposition of great vessels, Truncus arteriosus

Cyanosis (late; more common)
VSD, ASD, PDA

Death in CML
Blast crisis

Death in SLE
Lupus nephropathy

Dementia
Alzheimer’s disease and Multiple infarct

Demyelinating disease in young women
Multiple sclerosis

DIC
Gram-negative sepsis, DIC, Obstetric complications, Cancer, Burn trauma

Dietary deficit
Iron

Diverticulum in pharynx
Zenker’s diverticulum (diagnosed by barium swallow)

Ejection click
Aortic/pulmonic stenosis

Esophageal cancer
Squamous cell carcinoma (worldwide); Adenocarcinoma (US)

Food poisoning (exotoxin mediated)
Staphylococcus aureus, Bacillus cereus

Glomerulonephritis (adults)
Berger’s disease (lgA nephropathy)

Gynecologic malignancy
Endometrial carcinoma (most common in U.S.); Cervical carcinomam (most common worldwide)

Heart murmur, congenital
Mitral valve prolapse

Heart valve in bacterial endocarditis
Mitral (rheumatic fever); tricuspid (IV drug abuse); aortic (2nd in rheumatic fever)

Helminth infection (U.S.)
Enterobius vermicularis, Ascaris lumbricoides

Hematoma-epidural
Rupture of middle meningeal artery (Trauma; lentiform shaped)

Hematoma-subdural
Rupture of bridging veins (crescent shaped)

Hemochromatosis
Multiple blood transfusions or hereditary HFE mutation (can result in CHF, “bronze diabetes,” and ? risk of hepatocellular carcinoma)

Hepatocellular carcinoma
Cirrhotic liver (often associated with hepatitis B and C)

Hereditary bleeding disorder
von Willebrand’s disease

Hereditary harmless jaundice
Gilbert’s syndrome (benign congenital unconjugated hyperbilirubinemia)

HLA-B27
Ankylosing spondylitis, Reiter’s syndrome, Ulcerative colitis, and Psoriasis

HLA-DR3 or -DR4
Diabetes mellitus type 1, rheumatoid arthritis, SLE

Holosystolic murmur
VSD, tricuspid regurgitation, mitral regurgitation

Hypercoagulability, endothelial damage, blood stasis
Virchow’s triad (results in venous thrombosis)

Hypertension, 2°
Renal disease

Hypoparathyroidism
Accidental excision during thyroidectomy

Hypopituitarism
Pituitary adenoma (usually benign tumor)

Infection 2° to blood transfusion
Hepatitis C

Infections in chronic granulomatous disease
Staphylococcus aureus, E. coli, Aspergillus (catalase positive)

Kidney stones
Calcium = radiopaque, Struvite (ammonium) = radiopaque (formed by urease-positive organisms such as Proteus vulgaris or Staphylococcus), Uric acid = radiolucent

Late cyanotic shunt (uncorrected L ? R becomes R ? L)
Eisenmenger’s syndrome (caused by ASD, VSD, PDA; results in pulmonary hypertension/polycythemia)

Liver disease
Alcoholic cirrhosis

Lysosomal storage disease
Gaucher’s disease

Male cancer
Prostatic carcinoma

Malignancy associated with noninfectious fever
Hodgkin’s lymphoma

Malignant skin tumor
Basal cell carcinoma (rarely metastasizes)

Mental retardation
Down Syndrome and Fragil X syndrome

Metastases to bone
Breast, lung, thyroid, testes, prostate, kidney

Metastases to brain
Lung, breast, skin (melanoma), kidney (renal cell carcinoma), GI

Metastases to liver
Colon, gastric, pancreatic, breast, and lung carcinomas

Mitochondrial inheritance
Disease occurs in both males and females, inherited through females only

Mitral valve stenosis
Rheumatic heart disease

Mixed (UMN and LMN) motor neuron disease
ALS

Myocarditis
Coxsackie B

Neoplasm (kids)
ALL and Cerebellar medulloblastoma

Nephrotic syndrome (adults)
Focal segmental glomerulosclerosis

Nephrotic syndrome (kids)
Minimal change disease (associated with infections/vaccinations; treat with corticosteroids)

Neuron migration failure
Kallmann Syndrome

Nosocomial pneumonia
Klebsiella, E. coli, Pseudomonas aeruginosa

Obstruction of male urinary tract
BPH

Opening snap
Mitral stenosis

Opportunistic infection in AIDS
Pneumocystis jiroveci (formerly carinii) pneumonia

Osteomyelitis
S. aureus

Osteomyelitis in sickle cell disease
Salmonella

Osteomyelitis with IV drug use
Pseudomonas, S. aureus

Ovarian metastasis from gastric carcinoma or breast cancer
Krukenberg tumor (mucin-secreting signet-ring cells)

Ovarian tumor (benign, bilateral)
Serous cystadenoma

Ovarian tumor (malignant)
Serous cystadenocarcinoma

Pancreatitis (acute)
Gallstones, alcohol

Pancreatitis (chronic)
Alcohol (adults); Cystic fibrosis (kids)

Patient with ALL /CLL / AML /CML
ALL: child, CLL: adult > 60, AML: adult ~60, CML: adult 30-60

Pelvic inflammatory disease
Neisseria gonorrhoeae (monoarticular arthritis)

Philadelphia chromosome t(9;22) (bcr-abl)
CML (may sometimes be associated with ALL/AML)

Pituitary tumor
Prolactinoma and Somatotropic “acidophilic” adenoma

Primary amenorrhea
Turner syndrome (45XO)

Primary bone tumor (adults)
Multiple myeloma

Primary hyperaldosteronism
Adenoma of adrenal cortex

Primary hyperparathyroidism
Adenomas, Hyperplasia, Carcinoma

Primary liver cancer
Hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, ?-1 antitrypsin)

Pulmonary hypertension
COPD

Recurrent inflammation/thrombosis of small/medium vessels in extremities
Buerger’s disease (strongly associated with tobacco)

Renal tumor
Renal cell carcinoma: associated with von Hippel-Lindau and adult polycystic kidney disease; paraneoplastic syndromes (erythropoietin [EPO], renin, PTH, ACTH)

Right heart failure due to a pulmonary cause
Cor pulmonale

S3 (protodiastolic gallop)
? ventricular filling (L ? R shunt, mitral regurgitation, LV failure [CHF])

S4 (presystolic gallop)
Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy)

Secondary hyperparathyroidism
Hypocalcemia of chronic kidney disease

Sexually transmitted disease
Chlamydia (usually coinfected with gonorrhea)

SIADH
Small cell carcinoma of the lung

Site of diverticula
Sigmoid colon

Sites of atherosclerosis
Abdominal aorta > coronary > popliteal > carotid

Stomach cancer
Adenocarcinoma

Stomach ulcerations and high gastrin levels
Zollinger-Ellison syndrome (gastrinoma of duodenum or pancreas)

t(14;18)
Follicular lymphomas (bcl-2 activation)

t(8;14)
Burkitt’s lymphoma (c-myc activation)

t(9;22)
Philadelphia chromosome, CML (bcr-abl fusion)

Temporal arteritis
Risk of ipsilateral blindness due to thrombosis of ophthalmic artery; polymyalgia rheumatica

Testicular tumor
Seminoma

Thyroid cancer
Papillary carcinoma

Tumor in women
Leiomyoma (estrogen dependent, not precancerous)

Tumor of infancy
Hemangioma (usually regresses spontaneously by childhood)

Tumor of the adrenal medulla (adults)
Pheochromocytoma (usually benign)

Tumor of the adrenal medulla (kids)
Neuroblastoma (malignant)

Type of Hodgkin’s
Nodular sclerosis (vs. mixed cellularity, lymphocytic predominance, lymphocytic depletion)

Type of non-Hodgkin’s
Diffuse large cell

UTI
E. coli, Staphylococcus saprophyticus (young women)

Viral encephalitis affecting temporal lobe
HSV-1

Vitamin deficiency (U.S.)
Folic acid (pregnant women are at high risk; body stores only 3- to 4-month supply; prevents neural tube defects)

Abdominal Pain, ascites, hepatomegaly
Budd-Chiari Syndrome

Achilles Tendon Xanthoma
Familial hypercholesterolemia (decreased LDL receptor signalling)

Adrenal Hemorrhage, hypotension, DIC
Waterhouse-Friedrichson Syndrome (meningococcemia)

Arachnodactyly, lens dislocation, aortic dissection, hyperflexible joints
Marfan’s syndrome

Athlete with polycythemia
Secondary to erythropoietin injection

Back pain, fever, night sweats, weight loss
Pott’s Disease (vertebral tuberculosis)

Bilateral hilar adenopathy, uveitis
Sarcoidosis (noncaseating granulomas)

Blue sclera
Osteogenesis Imperfecta (Type 1 collagen defect)

Bluish line on gingiva
Lead poisoning (Burton’s line)

Bone pain, bone enlargement, arthritis
Paget’s disease of bone (Increased osteoblastic and osteoclastic activity)

Bounding pulses, diastolic heart murmur, head bobbing
Aortic Regurgitation

“Butterfly” facial rash and Raynaud’s phenomenon in a young female
Systemic Lupus Erythematosus

Cafe-au-lait spots, Lisch nodules (iris hamartoma)
Neurfibromatosis type 1 (+ pheochromocytoma, optic gliomas)

Cafe-au-lait spots, polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities
McCune-Albright Syndrome (mosaic G-protein signaling mutation)

Calf pseudohypertrophy
Muscular Dystrophy (most commonly Duchenne’s): X-linked recessive deletion of dystrophin gene.

“Cherry-red spot” on macula
Tay-Sachs (ganglioside accumulation) or Niemann-Pick (sphingomyelin accumulation), central retinal artery occlusion.

Chest pain on exertion
Angina (stable: with moderate exertion; unstable: with minimal or no exertion)

Chest pain, pericardial effusion/friction rub, persistent fever following MI
Dressler’s syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 1-12 weeks after acute episode)

Child uses arms to stand up from squat
Gowers’ sign (Duchenne Muscular Dystrophy)

Child with fever later develops red rash on face that spreads to body
“Slapped cheeks” (erythema infectiosum/fifth disease: Parvovirus B19)

Chorea, dementia, caudate degeneration
Huntington’s disease (autosomal-dominant CAG repeat expansion)

Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria
McArdle’s disease (muscle glycogen phosphorylase deficiency)

Cold intolerance
Hypothyroidism

Conjugate lateral gaze palsy, horizontal diplopia
Internuclear ophthalmoplegia (Damage to MLF; bilateral = Multiple Sclerosis; Unilateral = stroke)

Continuous “machinery” heart murmur
PDA (close with indomethacin; open or maintain with misoprostol)

Cutaneous/dermal edema due to connective tissue deposition
Myxedema (caused by hypothyroidism or Grave’s disease = pretibial)

Dark purple skin/mouth nodules
Kaposi’s sarcoma (usually AIDS patients; associated with HHV-8)

Deep, labored breathing/hyperventilation
Kussmaul breathing (diabetic ketoacidosis)

Dermatitis, dementia, diarrhea
Pellagra (niacin/vitamin B3 deficiency)

Dilated cardiomyopathy, edema, alcoholism or malnutrition
Wet beriberi (thiamine/Vitamine B1 deficiency)

Dog or cat bite resulting in infection
Pasteurella multocida (cellulitis at inoculation site)

Dry eyes, dry mouth, arthritis
Sjögren’s syndrome (autoimmune destruction of exocrine glands)

Dysphagia (esophageal webs), glossitis, iron deficiency anemia
Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)

Elastic skin, hypermobility of joints
Ehlers-Danlos Syndrome (Type III collagen defect)

Enlarged, hard left supraclavicular node
Virchow’s node (abdominal metastasis)

Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells
Sézary Syndrome (cutaneous T-cell lymphoma) or mycosis fungoides

Facial muscle spasm upon tapping
Chvostek’s sign (hypocalcemia)

Fat, female, forty, and fertile
Cholelithiasis (gallstones)

Fever, chills, headache, myalgia following antibiotic treatment for syphilis
Jarisch-Herxheimer reaction (rapid lysis of spirochetes results in toxin release)

Fever, cough, conjunctivitis, coryza, diffuse rash
Measles (Morbillivirus)

Fever, night sweats, weight loss
B symptoms (staging) of lymphoma

Fibrous plaques in soft tissue of penis
Peyronie’s disease (connective tissue disorder)

Gout, mental retardation, self-mutilating behavior in a boy
Lesch-Nyhan syndrome (HGPRT deficiency, X-linked recessive)

Green-yellow rings around peripheral cornea
Kayser-Fleischer rings (copper accumulation from Wilson’s disease)

Hamartomatous GI polyps, hyperpigmentation of mouth/feet/hands
Peutz-Jeghers syndrome (inherited, benign polyposis can cause bowel obstruction; increased cancer risk, mainly GI)

Hepatosplenomegaly, osteoporosis, neurologic symptoms
Gaucher’s disease (glucocerebrosidase deficiency)

Hereditary nephritis, sensorineural hearing loss, cataracts
Alport syndrome (mutation in alpha 5 chain of type IV collagen)

Hyperphagia, hypersexuality, hyperorality, hyperdocility
Klüver-Bucy syndrome (bilateral amygdala lesion)

Hyperreflexia, hypertonia, Babinski sign present
Upper Motor Neuron Damage

Hyporeflexia, hypotonia, atrophy, fasciculations
Lower motor neuron damage

Hypoxemia, polycythemia, hypercapnia
“Blue bloater” (chronic bronchitis: hyperplasia of mucous cells)

Indurated, ulcerated genital lesion
Nonpainful: chancre (primary syphilis, Treponema pallidum)
Painful, with exudate: chancroid (Haemophilus ducreyi)

Infant with cleft lip/palate, microcephaly or holoprosencephaly, polydactyly, cutis aplasia
Patau’s syndrome (trisomy 13)

Infant with failure to thrive, hepatosplenomegaly and neurodegeneration
Niemann-Pick disease (genetic sphingomyelinase deficiency)

Infant with hypoglycemia, failure to thrive and hepatomegaly
Cori’s disease (debranching enzyme deficiency)

Infant with microcephaly, rocker-bottom feer, clenched hands, and structural heart defect
Edwards’ syndrome (trisomy 18)

Jaundice, palpable distended non-tender gallbladder
Courvoisier’s sign (distal obstruction of biliary tree)

Large rash with bull’s-eye appearance
Erythema chronicum migrans from Ixodes tick bite (Lyme disease: Borrelia)

Lucid interval after traumatic brain injury
Epidural hematoma (middle meningeal artery rupture)

Male child, recurrent infections, no mature B cells
Bruton’s disease (X-linked agammaglobulinemia)

Mucosal bleeding and prolonged bleeding time
Glanzmann’s thrombasthenia (defect in platelet aggregation due to lack of Gp2b/3a)

Muffled heart sounds, distended neck veins, hypotension
Beck’s triad of cardiac tamponade

Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth
Gardner’s syndrome (subtype of FAP)

Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance
Pompe’s disease (lysosomal alpha-1,4-glucosidase deficiency)

Neonate with arm paralysis following difficult birth
Erb-Duchenne palsy (superior trunk [C5-C6] brachial plexus injury : “waiter’s tip”)

No lactation postpartum, absent menstruation, cold intolerance
Sheehan’s syndrome (pituitary infarction)

Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia
Multiple sclerosis

Oscillating slow/fast breathing
Cheyne-Stokes respirations (central apnea in CHF or increased intracranial pressure)

Painful blue fingers/toes, hemolytic anemia
Cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious mononucleosis)

Painful, pale, cold fingers/toes
Raynaud’s phenomenon (vasospasm in extremities)

Painful, raised red lesions on pad of fingers/toes
Osler’s node (infectious endocarditis, immune complex deposition)

Painless erythematous lesions on palms and soles
Janeway lesions (infectious endocarditis, septic emboli/microabscesses)

Painless jaundice
Cancer of the pancreatic head, obstructing bile duct

Palpable purpura on buttocks/legs, joint pain, abdominal pain (child), hematuria
Henoch-Schönlein purpura (IgA vasculitis affecting skin and kidneys)

Pancreatic, pituitary, parathyroid tumors
MEN1 (autosomal dominant)

Periorbital and/or peripheral edema, proteinuria, hypoalbuminemia, hypercholesterolemia
Nephrotic syndrome

Pink complexion, dyspnea, hyperventilation
“Pink puffer” (emphysema: centriacinar [smoking], panacinar [alpha-1-antitrypsin deficiency])

Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets
Fanconi’s syndrome (proximal tubular reabsorption defect)

Positive anterior “drawer sign”
Anterior cruciate ligament injury

Pruritic, purple, polygonal planar papules and plaques (6 P’s)
Lichen planus

Ptosis, miosis, anhidrosis
Horner’s syndrome (sympathetic chain lesions)

Pupil accommodates but doesn’t react
Argyll Robertson pupil (neurosyphilis)

Rapidly progressive leg weakness that ascends following GI/upper respiratory infection
Guillain-Barré syndrome (acute autoimmune inflammatory demyelinating polyneuropathy)

Rash on palms and soles
Coxsackie A, secondary syphilis, Rocky Mountain spotted fever

Recurrent colds, unusual eczema, high serum IgE
Hyper-IgE syndrome (Job’s syndrome: neutrophil chemotaxis abnormality)

Red “currant jelly” sputum in alcoholic or diabetic patient
Klebsiella pneumonia

Red “currant jelly” stools
Acute mesenteric ischemia (adults), intussusception (infants)

Red, itchy, swollen rash of nipple/areola
Paget’s disease of the breast (represents underlying neoplasm)

Red urine in the morning, fragil RBCs
Paroxysmal nocturnal hemoglobinuria

Renal cell carcinoma (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma
von Hippel-Lindau disease (dominant tumor suppressor gene mutation)

Resting tremor, rigidity, akinesia, postural instability
Parkinson’s disease (nigrostriatal dopamine depletion)

Retinal hemorrhages with pale centers
Roth’s spots (bacterial endocarditis)

Severe jaundice in neonate
Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia)

Severe RLQ pain with palpation of LLQ
Rovsing’s sign (acute appendicitis)

Severe RLQ pain with rebound tenderness
McBurney’s sign (appendicitis)

Short stature, increased incidence of tumors/leukemia, aplastic anemia
Fanconi’s anemia (genetic loss of DNA crosslink repair; often progresses to AML)

Single palmar crease
Simian crease (Down syndrome)

Situs inversus, chronic sinusitis, bronchiectasis, infertility
Kartagener’s syndrome (dynein arm defect affecting cilia)

Skin hyperpigmentation, hypotension, fatigue
Addison’s disease (primary adrenocortical insufficiency causes increased ACTH and increased alpha-MSH production)

Slow, progressive muscle weakness in boys
Becker’s muscular dystrophy (X-linked missense mutation in dystrophin; less severe than Duchenne’s)

Small, irregular red spots on buccal/lingual mucosa with blue-white centers
Koplik spots (measles; rubeola virus)

Smooth, flat, moist, painless white lesions on genitals
Condylomata lata (secondary syphilis)

Splinter hemorrhages in fingernails
Bacterial endocarditis

“Strawberry tongue”
Scarlet fever, Kawasaki disease, toxic shock syndrome

Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema
Turner syndrome (45,XO)

Sudden swollen/painful big toe joint, tophi
Gout/podagra (hyperuricemia)

Swollen gums, mucosal bleeding, poor wound healing, spots on skin
Scurvy (vitamin C deficiency: can’t hydroxylate proline/lysine for collagen synthesis)

Anticentromere antibodies
Scleroderma (CREST)

Antidesmoglein (epithelial) antibodies
Pemphigus vulgarus (blistering)

Anti-glomerular basement membrane antibodies
Goodpasture’s syndrome (glomerulonephritis and hemoptysis)

Antihistone antibodies
Drug-induced SLE (hydralazine, isoniazid, phenytoin, procainamide)

Anti-IgG antibodies
Rheumatoid arthritis (systemic inflammation, joint pannus, boutonnière deformity)

Antimitochondrial antibodies (AMAs)
Primary biliary cirrhosis (female, cholestasis, portal hypertension)

Antineutrophil cytoplasmic antibodies (ANCAs)
Vasculitis (c-ANCA: granulomatosis with polyangiitis [Wegener’s]; p-ANCA: microscopic polyangiitis, Churg-Strauss syndrome)

Anti-proteinase 3 antibodies
aka C-ANCA; Wegener’s granulomatosis

Anti-myeloperoxidase
aka P-ANCA; microscopic polyangiitis, Churg-Strauss syndrome

Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA)
SLE (type III hypersensitivity)

Antiplatelet antibodies
Idiopathic thrombocytopenic purpura

Anti-topoisomerase antibodies
Diffuse systemic scleroderma

Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies
Celiac disease (diarrhea, distention, weight loss)

“Apple core” lesion on abdominal x-ray
Colorectal cancer (usually left-sided)

Azurophilic peroxidase-positive granular inclusions in granulocytes and myeloblasts
Auer rods (acute myelogenous leukemia, especially the promyelocytic [M3] type)

Bacitracin response
Sensitive: Streptococcus pyogenes (group A); resistant: Streptococcus agalactiae (group B)

“Bamboo spine” on x-ray
Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)

Basophilic nuclear remnants in RBCs
Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)

Bloody tap on LP
Subarachnoid hemorrhage

“Boot shaped” heart on x-ray
Tetralogy of Fallot, RVH

Branching gram-positive rods with sulfur granules
Actinomyces israelii

Bronchogenic apical lung tumor on imaging
Pancoast tumor (can compress sympathetic ganglion and cause Horner’s syndrome)

“Brown” tumor of bone
Hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorrhage gives brown color)

Cardiomegaly with apical atrophy
Chagas’ disease (Trypanosoma cruzi)

Cellular crescents in Bowman’s capsule
Rapidly progressive crescentic glomerulonephritis

“Chocolate cyst” of ovary
Endometriosis (frequently involves both ovaries)

Circular grouping of dark tumor cells surrounding pale neurofibrils
Homer-Wright rosettes (neuroblastoma, medulloblastoma, retinoblastoma)

Colonies of mucoid Pseudomonas in lungs
Cystic fibrosis (autosomal-recessive mutation in CFTR resulting in fat-soluble vitamin deficiency and mucous plugs)

Decreased alpha-fetoprotein in amniotic fluid/maternal serum
Down syndrome or other chromosomal abnormality

Degeneration of dorsal column nerves
Tabes dorsalis (tertiary syphilis), subacute combined degeneration (Vitamin B12 or E deficiency; dorsal columns and lateral corticospinal tracts affected)

Depigmentation of neurons in substantia nigra
Parkinson’s disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)

Desquamated epithelium casts in sputum
Curschmann’s spirals (bronchial asthma; can result in whorled mucous plugs)

Disarrayed granulosa cells in eosinophilic fluid
Call-Exner bodies (granulosa-theca cell tumor of the ovary)

Dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia
Koilocytes (HPV: predisposes to cervical cancer)

Enlarged cells with intranuclear inclusion bodies
“Owl’s eye” appearance of CMV

Enlarged thyroid cells with ground-glass nuclei
“Orphan Annie’s eyes” nuclei (papillary carcinoma of the thyroid)

Eosinophilic cytoplasmic inclusion in liver cell
Mallory bodies (alcoholic liver disease)

Eosinophilic cytoplasmic inclusion in nerve cell
Lewy body (Parkinson’s disease)

Eosinophilic globule in liver
Councilman body (toxic or viral hepatitis, often yellow fever)

Eosinophilic inclusion bodies in cytoplasm of hippocampal nerve cells
Negri bodies of rabies (Lyssavirus)

Extracellular amyloid deposition in gray matter of brain
Senile plaques (Alzheimer’s disease)

Giant B cells with bilobed nuclei with prominent inclusions (“owl’s eye”)
Reed-Sternberg cells (Hodgkin’s lymphoma)

Glomerulus-like structure surrounding vessel in germ cells
Schiller-Duval bodies (yolk sac tumor)

“Hair on end” (crew-cut) appearance on x-ray
Beta-thalassemia, sickle cell anemia (marrow expansion)

hCG elevated
Choriocarcinoma, hydatidiform mole (occurs with and without embryo)

Heart nodules (granulomatous)
Aschoff bodies (rheumatic fever)

Heterophile antibodies
Infectious mononucleosis (EBV)

Hexagonal, double-pointed, needle-like crystals in bronchial secretions
Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)

High level of D-dimers
DVT, pulmonary embolism, DIC

Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)
Ghon complex (primary TB: Mycobacterium bacilli)

“Honeycomb lung” on x-ray or CT
Interstitial pulmonary fibrosis

Hypercoagulability (leading to migrating DVTs and vasculitis)
Trousseau’s syndrome of malignancy (adenocarcinoma of pancreas or lung)

Hypersegmented neutrophils
Megaloblastic anemia (B12 deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms)

Hypertension, hypokalemia, metabolic alkalosis
Conn’s syndrome (Primary hyperaldosteronism)

Hypochromic, microcytic anemia
Iron deficiency anemia, lead poisoning, thalassemia (fetal hemoglobin sometimes present)

Increased alpha-fetoprotein in amniotic fluid/maternal serum
Dating error, anencephaly, spina biffida (neural tube defects)

Increased uric acid levels
Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics.

Intranuclear eosinophilic droplet-like bodies
Cowdry type A bodies (HSV or CMV)

Iron-containing nodules in alveolar septum
Ferruginous bodies (asbestosis: increased risk of mesothelioma)

Keratin pearls on a skin biopsy
Squamous cell carcinoma

Large lysosomal vesicles in phagocytes, immunodeficiency
Chédiak-Higashi disease (congenital failure of phagolysosome formation)

“Lead pipe” appearance of colon on barium enema x-ray
Ulcerative colitis (loss of haustra)

Linear appearance of IgG deposition on glomerular basement membrane
Goodpasture’s syndrome

Low serum ceruloplasmin
Wilson’s disease (hepatolenticular degeneration)

“Lumpy bumpy” appearance of glomeruli on immunofluorescence
Poststreptococcal glomerulonephritis (immune complex deposition of IgG and C3b)

Lytic (“hole punched”) lesions on x-ray
Multiple myeloma

Mammary gland (“blue domed”) cyst
Fibrocystic change of the breast

Monoclonal antibody spike
Multiple myeloma (usually IgG or IgA)
Monoclonal gammopathy of undetermined significance (MGUS; normal consequence of aging)
Waldenström’s (M protein = IgM) macroglobulinemia
Primary amyloidosis

Mucin-filled cell with peripheral nucleus
Signet ring (gastric carcinoma)

Narrowing of bowel lumen on barium x-ray
“String sign” (Crohn’s disease)

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis
Granulomatous with polyangiitis (Wegener’s: C-ANCA positive) and Goodpasture’s syndrome (anti-basement membrane antibodies)

Needle-shaped, negatively birefringent crystals
Gout (monosodium urate crystals)

Nodular hyaline deposits in glomeruli
Kimmelstiel-Wilson nodules (diabetic nephropathy)

Novobiocin response
Sensitive: Staphylococcus epidermidis; resistant: Staphylococcus saprophyticus

“Nutmeg” appearance of liver
Chronic passive congestion liver due to right heart failure

“Onion skin” periosteal reaction
Ewing’s sarcoma (malignant round-cell tumor)

Optochin response
Sensitive: Streptococcus pneumoniae; resistant: Viridans streptococcus

Periosteum raised from bone, creating a triangular area
Codman’s triangle on x-ray (osteosarcoma, Ewing’s sarcoma, pyogenic osteomyelitis)

Podocyte fusion or “effacement” on electron microscopy
Minimal change disease (child with nephrotic syndrome)

Polished, “ivory like” appearance of bone at cartilage erosion
Eburnation (osteoarthritis resulting in boney sclerosis)

Protein aggregates in neurons from hyperphosphorylation of protein tau
Neurofibrillary tangles (Alzheimer’s disease) and Pick’s bodies (Pick’s disease)

Psammoma bodies
Meningiomas, papillary thyroid carcinoma, mesothelioma, papillary serous carcinoma of the endometrium and ovary

Pseudopalisading tumor on brain biopsy
Glioblastoma multiforme

RBC casts in urine
Acute glomerulonephritis

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells
Reinke crystals (Leydig cell tumor)

Renal epithelial casts in urine
Acute toxic/viral nephrosis

Rhomboid crystals, positively birefringent
Pseudogout (calcium pyrophosphate dihydrate crystals)

Rib notching
Coarctation of the aorta

Ring-enhancing brain lesion in AIDS
Toxoplasma gondii, CNS lymphoma

Sheets of medium-sized lymphoid cells with scattered pale, tingible body-laden macrophages (“starry sky” histology)
Burkitt’s lymphoma (t[8;14] c-myc activation, associated with EBV; “black sky” made up of malignant cells)

Silver-staining spherical aggregation of tau proteins in neurons
Pick bodies (Pick’s disease: progressive dementia, changes in personality)

“Soap bubble” in femur or tibia on x-ray
Giant cell tumor of bone (generally benign)

“Spikes” on basement membrane, “dome like” subepithelial deposits
Membranous glomerulonephritis (may progress to nephrotic syndrome)

Stacks of RBCs
Rouleaux formation (high ESR, multiple myeloma)

Stippled vaginal epithelial cells
“Clue cells” (Gardnerella vaginalis)

“Tennis racket” shaped cytoplasmic organelles (EM) in Langerhans cells
Birbeck granules (Langerhans cell histiocytosis or histiocytosis X: eosinophilic granuloma)

Thrombi made of white/red layers
Lines of Zahn (arterial thrombus, layers of platelets/RBCs)

“Thumb sign” on lateral x-ray
Epiglottitis (Haemophilus influenzae)

Thyroid-like appearance of kidney
Chronic bacterial pyelonephritis

Tram-track appearance of capillary loops of glomerular basement membranes on light microscopy
Membranoproliferative glomerulonephritis

Triglyceride accumulation in liver cell vacuoles
Fatty liver disease (alcoholic or metabolic syndrome)

“Waxy” casts with very low urine flow
Chronic end-stage renal disease

WBC casts in urine
Acute pyelonephritis

WBCs that look “smudged”
CLL (almost always B cell)

“Wire loop” glomerular capillary appearance on light microscopy
Lupus nephropathy

Yellowish CSF
Xanthochromia (e.g. due to subarachnoid hemorrhage)

What cell wall structure is unique to gram positive bacteria?
lipoteichoic acid

What three cell wall structures are unique to gram negative bacteria?
1. outer cell membrane (LPS and endotoxin)
2. porin
3. periplasmic space (b-lactamase location)

What does the PAS (periodic acid-Schiff) stain?
glycogen, mucopolysaccharides
(PASs the sugar!)

What is a silver stain used for?
-legionella
-fungi
-helicobacter pylori

What type of stain is best for Cryptococcus neoformans (an encapsulated yeast)?
india ink

What type of stain is best for acid fast bacteria such as nocardia and mycobacteria?
Ziehl-Neelsen (carbol fuchsin)

What stain is best for detection of malarial infection?
giemsa stain-detects the parasite plasmodium which is the cause of malaria

Chlamydia, Borrelia, Rickettsia, Trypanosomes and Plasmodium are all best detected by which stain?
giemsa stain

What media is needed for isolation of H. influenza?
chocolate agar

What media is needed for the isolation of N. gonorrhoeae and N. meningitidis?
Thayer-Martin agar

What media is best used to isolate lactose-fermenting enterics?
MacConkey agar
(fermentation produces acid causing colonies to turn PINK)

What media is best used to isolate E. coli?
eosin-methylene blue (EMB) agar
(colonies with green metallic sheen)

What type of media is best used to isolate M. tuberculosis?
Lowenstein-Jensen agar

What bacterial structure protects against phagocytosis?
capsule

What bacterial structure makes bacteria resistant to dehydration, heat and chemicals?
spore

What bacterial structure gives bacteria a rigid structure and protects against osmotic pressure?
peptidoglycan

What is the chemical composition of plasmid?
DNA

What structure of bacteria contains a variety of genes for antibiotic resistance, enzymes and toxins?
plasmid

What type of media is best used to isolate fungi?
Sabouraud agar

(SAB’s a FUN GUY!)

What media is best used to isolate M. pneumoniae?
Eaton agar
(requires cholesterol)

Name 7 encapsulated bacteria.
SHiNE SKiS
1. Streptococcus pneumoniae
2. Haemophilus influenza
3. Neisseria meningitidis
4. E. coli
5. Salmonella
6. Klebsiella pneumoniae
7. group B Strep

*remember capsule serves as anti-phagocytic virulence factor!!!!

Which bacteria is known for causing rice water stools?
vibrio cholerae

What bacteria is responsible for whooping cough?
bordetella pertussis

Which toxin prevents the release of INHIBITORY (GABA and glycine) neurotransmitters from Renshaw cells in the spinal cord?
Clostridium tetani

*causes spasticity, rises sardonicus (spasm of facial muscles as if pt. was grinning), and “lockjaw”

Which toxin produces flaccid paralysis by preventing the release of STIMULATORY (ACh) signals at neuromuscular junctions?
Clostridium botulinum

What bacteria is associated with myonecrosis (gas gangrene) and hemolysis (“double zone” of hemolysis on blood agar)?
Clostridium perfringens

What bacteria is associated with Toxic Shock Syndrome Toxin (TSST-1)?
staphylococcus aureus

Which bacteria is associated with exotoxin A and can manifest to toxic shock syndrome?
streptococcus pyogenes

You gram stain an organism and it shows gram positive with branching filaments. It’s anaerobic and negative for acid fast. What is most likely the organism?
actinomyces

You gram stain an organism and it shows gram positive with branching filaments. It’s aerobic and positive for acid fast. What is most likely the organism?
nocardia

Your gram stain shows gram positive cocci in clusters and that is catalase positive. What is most likely the organism?
staphylococcus

Your gram stain shows gram positive cocci in chains and are catalase negative. What is most likely the organisms?
streptococcus

neisseria
gram negative cocci

moraxella catarrhalis
gram negative cocci

Name 3 examples of bacteria that are aerobes.
“Nagging Pests MustBreathe”

1. Nocardia
2. Pseudomonas aeruginosa
3. MycoBacterium tuberculosis

Name 4 examples of bacteria that are anaerobes.
“Frankly Can’t Breathe Air”

1. Fusobacterium
2. Clostridium
3. Bacteroides
4. Actinomyces

Which drug class is ineffective against anaerobes because they require O2 to enter into bacterial cell?
Aminoglycosides

Where is the only place in the body that anaerobes are considered normal flora?
GI tract

Since encapsulated bacteria have antiphagocytic virulence factor how are they removed from the body?
-they are opsonized and then cleared by the spleen
-asplenics are therefore at an increased risk for infection

People with chronic granulomatous disease (NADPH oxidase deficiency) have recurrent infections with which type of organisms?
catalase positive organisms

Staph is catalase _______ and strep is catalase ________.
staph= catalase positive

strep= catalase negative

What pigment is associated with actinomyces israelii?
yellow “sulfur” granules composed of filaments of bacteria

What pigment is associated with S. aureus?
yellow pigment (think PUS)

What pigment is associated with pseudomonas aeruginosa?
blue-GREEN

What color pigment is associated with serratia marcenscens?
red pigment

Which virulence factor binds to Fc region of IgG?
Protein A

-prevents oponization and phagocytosis
-expressed by S. aureus

Which virulence factor is an enzyme that cleaves IgA?
IgA protease

-secreted by: S. pneumoniae, H. influenza type B, Neisseia
-in order to colonize respiratory mucosa

-“SHiN”

Which virulence factor helps prevent phagocytosis, is expressed by group A streptococci, shares similar epitotes to human cellular proteins and possible underlies the autoimmune response seen in acute rheumatic fever?
M protein

What is needle like protein appendage that facilities direct delivery of toxins from certain gram negative bacteria to host eukaryotic cells?
-type III secretion system
-aka injectisome

What type of bacteria can have the type III secretions system (injectisome)?
gram negative bacteria

-pseudomonas
-salmonella
-shigella
-e. coli

Endotoxin is specific to which type of bacteria and structure?
gram negative bacteria-outer cell membrane

true or false? Exotoxin can be feature of both gram positive and gram negative bacteria.
true

review exotoxin vs endotoxin chart-pg 123 FA

What is exotoxin for pseudomonas aeruginosa?
-mechanism of action ?
-exotoxin A
-MOA= inactivate elongation factor (EF-2)

What is the mechanism of action of the exotoxin diphtheria of corynebacterium diphtheria?
inactivate the elongation factor (EF-2)

What is the mechanism of action of the exotoxin shiga toxin of shigella spp.?
inactivate 60s ribosome by removing adenine from rRNA

What is the exotoxin for the bacteria enterohemorrhagic E. coli (EHEC)?
Shiga-like toxin (SLT)
-same mechanism as shiga toxin–>inactivate 60s ribosome by removing adenine from rRNA

What bacteria/toxin is most likely responsible for edematous borders of black eschar in cutaneous anthrax?
bacillus anthracis
-edema toxin

What is the exotoxin for clostridium perfringens?
alpha toxin
-degrades phospholipids
-causes gas gangrene

What is the exotoxin for streptococcus pyogenes (group A strep)?
streptolysin O
-degrades cell membrane

MEMORIZE flow chart pg 127 FA-gram positive algorithm

Listeria
gram positive rods (bacilli)

corynebacterium
gram positive rods (bacilli)
-CLUB SHAPED

clostridium
gram positive rods (bacilli)
-anaerobe

bacillus
gram positive rods (bacilli)
-aerobe

Which type of hemolysis shows partial hemolysis (green)?
alpha hemolysis

Which type of hemolysis shows complete hemolysis (clear)?
beta hemolysis

If an organism shows no hemolysis it is said to be which type?
gamma hemolysis

Group D strep shows which type of hemolysis?
gamma hemolysis (no hemolysis)

Group A and Group B strep show which type of hemolysis?
beta hemolysis (complete)

S. pneumoniae and viridans streptococci show which type of hemolysis?
alpha hemolysis (partial)

Which gram positive cocci is resistant to novobiocin?
S. saprophyticus

Which gram positive cocci is sensitive to novobiocin?
S. epidermidis

What are the two type of enterococci that are most common commensal organisms in human colonic flora?
-E. faecalis
-E. faecium

What type of bacteria can cause bacteremia, subacute endocarditis and is associated with colon cancer?
streptococcus bovis

What bacteria will show as black colonies on cystine-tellurite agar?
corynebacterium diphtheria

-remember: gram positive rods (bacilli) that are club shaped

Lab results show a gram positive rod with metachromatic (blue/red) granules and +Ekek test for toxin. What bacteria?
corynebacterium diphtheria

What is the second most common cause of UTI in young women?
Staphylococcus saprophyticus

What is the first most common cause of UTI in young women?
E. coli

What bacteria infects prosthetic devices and intravenous catheters by producing adherent biofilms?
Staphylococcus epidermidis

Lancet-shaped, gram-postive diplococci
streptococcus pneumoniae

What is the most common cause of meningitis?
streptococcus pneumoniae

What is the most common cause of otitis media in children?
streptococcus pneumoniae

What is the most common cause of both pneumonia and sinusitis?
streptococcus pneumoniae

A patient has “rusty” sputum. What is mot likely the causative agent?
streptococcus pneumoniae

alpha hemolytic and optochin sensitive gram positive cocci
streptococcus pneumoniae

What bacteria are alpha hemolytic, cause dental caries and are normal flora of the oropharynx?
viridians group streptococci

Viridian group streptococci are optochin__________.
optochin resistant

group A strep is also know as _______________.
streptococcus pyogenes

The bacteria that is beta hemolytic and resistant to bacitracin is?
streptococcus agalactiae (group B strep)

The bacteria that is beta hemolytic and sensitive to bacitracin is?
streptococcus pyogenes (group A strep)

group B strep is also know as _______________.
streptococcus agalactiae

Where does group B strep (streptococcus agalactiae) colonize?
vagina

What is best for detecting a recent S. pyogenes infection?
ASO titer

What causes scarlet fever?
group A strep (S. pyogenes)

strawberry tongue, sandpaper like rash, circumoral pallor, subsequent desquamation
scarlet fever–>Caused by group A strep (S. pyogenes)

What needs to be done to potentially kill spores?
autoclave at 121 degrees celcius for 15 min

What are the two best drugs used for psuedomembranous colitis?
1. metroconidizole (flagyl)
2. oral vancomycin

What is the only bacteria with a polypeptide capsule (contains D-glutamate)?
B. anthracis

What bacteria has been known to cause reheated rice syndrome and causes a watery, non bloody diarrhea with GI pain within 8-18 hours?
Bacillus cereus

Bacteria acquired from unpasteurized dairy products and cold deli meats
Listeria monocytogenes

What is the ONLY gram positive organism to produce endotoxin?
listeria monocytogenes

bacteria that forms “rocket tails” that allow for cell to cell spread across cell membranes thereby avoiding antibody
listeria monocytogenes

What is the DOC for actinomyces infections?
PCN

What is the DOC for nocardia infections?
sulfonamides

What is the reservoir for leprosy in the U.S?
armadillos

Haemophilus influenza requires which two factors?
factors V and X

Which gram negative diplococci is a maltose fermenter?
N. meningitidis

Which gram negative bacteria produce hydrogen sulfide, H2S?

What media is used to test if it is a hydrogen sulfide producer?

1. Proteus
2. salmonella
3. Yersinia

media= TSI agar (triple sugar iron)

Pontiac fever is caused by what organism?
Legionella pneumophila

Which organism is most often associated with wound infection in burn victims?
Pseudomonas aeriginosa

Hot tub folliculitis
Pseudomonas aeriginosa

Which organism is most often cause of osteomyelitis in puncture wounds?
Pseudomonas aeriginosa

Which organism is cause of ecthyma gangrenosum?
Pseudomonas aeriginosa

What is the most common serotype for EHEC (entrohemorrhagic E. coli) in the U.S?
O157:H7

What intestinal flora causes lobar pneumonia in diabetics and alcoholics when aspirated?
klebsiella

Which gram negative bacteria are curved (comma or s shaped)?
-vibrio
-campylobacter
-h. pylori

At what temperature does campylobacter jejuni grow?
42 degrees celcius

What type pf diarrhea does campylobacter jejune cause?
bloody

What is the only species of salmonella that has a reservoir of humans only?
salmonella typhi

*all other species of salmonella have a reservoir of both humans and animals

What is the reservoir for shigella?
humans only

Which species of salmonella has a vaccine?
-salmonella typhi

*oral vaccine contains live attenuated S. top
*IM vaccine contains Vi capsular polysaccharide

What is the treatment for typhoid fever caused by salmonella typhi?
ceftriaxone or fluoroquinolone

What is the mechanism of the enterotoxin of vibrio cholerae?
cholerae toxin permanently activates Gs thus increasing cAMP

What are two dangerous risk factors for peptic ulcers caused by H. pylori?
1. adenocarcinoma
2. MALT lymphoma

What is the best way to visualize treponemes?
dark field microscopy and fluorescent antibody staining

*this is because they are thin!!

Spiral shaped bacteria with axial filaments
spirochetes

What are they three type of spirochetes?
1. Borrelia (biggest-only one able to visualize with aniline dyes-Wright stain or Giemsa)
2. Leptospira
3. Treponema-very thin, seen with dark field microscopy

*BLT

What organism causes Weil disease?
leptospria interrogans

Where is leptospira interrogates most common?
among surfers in the tropics (ex: Hawaii)

What bacterial species causes Lyme Disease?
Borrelia burgdorferi (a gram negative spirochete!)

*transmitted by Ixodes deer tick

What transmits Lyme disease?
Ixodes deer tick

*caused by bacteria Borrelia burgdorferi

What bacteria causes Syphilis?
Treponema pallidum (gram negative spirochete)

true or false: Syphilis lesions are painless.
true

Which type of syphilis is localized disease presenting with painless chancre?
primary

Which type of syphilis is systemic and presents with maculopapular rash over body and can include palms and soles and condylomata lat (smooth, moist, painless, wart-like lesions on genitals)?
secondary

What test is widely used for dx of syphilis and is very sensitive but not specific?
VDRL

*need a specific test to confirm dx such as FTA-ABS

What are the three organisms that are transmitted through Ixodes ticks?
1. Borrela burgdorferi-lyme disease
2. anaplasma species-anaplasmosis
3. babesia-babesiosis

What bacteria is known to be transmitted by parrots and other birds?
chlamydophila psittacosis

What species of bacteria causes cat scratch disease?
Bortonella

*Bartonella henselae or Bartonella quintana

What bacteria species causes Q fever?
coxiella burnetti

What is the classic triad of symptoms for Rocky Mountain Spotted Fever?
1. Fever
2. headache
3. rash (rash typically starts at wrists and ankle then spreads to trunk, palms and soles)

Which species of Rickettsia causes Rocky Mountain Spotted Fever?
Rickettsia rickettsii

What is the vector for Rocky Mountain Spotted Fever?
dog tick

(Dermacentor variabilis, Rocky Mountain wood tick (Dermacentor andersoni), and brown dog tick-Rhipicephalus sanguineus)

What is the vector for Rickettsia typhi?
fleas

Describe the differences in the presentation on rashes in Rickettsia rickettsii and Rickettsia typhi.
Rickettsia rickettsii-rash typically starts at wrists and ankle then spreads to trunk, palms and soles

Rickettsia typhi-rash starts centrally (trunk) and spreads sparing the soles and palms

What is the vector for the bacterial infection Ehrlichiosis?
tick

Which bacterial infection histologically shows MONOCYTES with morulae (berry like inclusions) in the cytoplasm?
Ehrlichiosis

Which bacterial infection histologically shows GRANULOCYTES with morulae (berry like inclusions) in the cytoplasm?
Anaplasmosis

What disease is caused when spores of Coxiella burnetti are inhaled from cattle/sheep?
Q fever

What is the treatment for chlamydiae infections?
-azithromycin (one time treatment-favored)
or
-doxycycline

Q fever is result of which bacteria?
coxiella burnetti

Does Q fever involve an arthorpod?
no-although closely related to the rickettsia genus it is not in the genus and does NOT involve arthropod

What are the two forms of chlamydiae?
1. elementary body-infectious, enters the cell via endocytosis and transforms into a reticulate body

2. reticulate body-replicates in cell by fission, reorganizes into elementary bodies

What is the classic case of atypical “walking” pneumonia?
mycoplasma pneumoniae

At what temperatures are dimorphic fungi molds and what temperature are they yeasts?
cold (20 degrees celsius) = mold

heat (37 degrees celsius)= yeast

What is best to treat a systemic fungal infection?
amphotericin B

Fungal infection in bird or bat droppings
histoplasmosis

fungus with broad-base budding
blastomycosis

budding yeast with “captain’s wheel” formation
paracoccidioidomycosis

Which fungus is not dimorphic and forms as a sheprule in tissue (not yeast)?
coccidioidomycosis

Which fungus is predominantly in Mississippi, the Ohio River Valley and the midwest?
histoplasmosis

Which fungus is predominantly east of the Mississippi River and in Central America?
Blastomyces

Which fungus is predominantly in the Southwestern US, California and is known fro the San Joaquin Valley fever?
coccidiomycosis

Which fungus is predominantly located in Latin America?
paracoccidioidomycosis

What do dermatophytes require for growth?
keratin

Name the three main groups of dermatophytes.
1. microsporum
2. trichophyton
3. epidermophyton

fungal infection that occurs on the head or scalp
tinea capitis

fungal infection that occurs on the body
tinea corporis

fungal infection that occurs in the inguinal area
tinea cruris

fungal infection that occurs on the nails
tinea unguium (onychomycosis)

What cutaneous fungal infection is caused by Malassezia fur fur?
tinea versicolor

You see a spaghetti and meatball appearance on a microscopy slide. What is most like the cause and condition?
malassezia fur fur; tinea versicolor

Causative agent of oral thrush (white patches in mouth)
candida albicans

Causative agent of vulvovaginitis
candida albicans

septate hyphae that branch at 45 degree angles (ACUTE angles)
aspergillus fumigatus

fungus that is heavily encapsulated, found in pigeon droppings and form soap bubble lesions in brain
cryptococcus neofromans

fungal infection that shows as diffuse bilateral ground glass opacities on chest X-ray and CT
pneumocystis jirovecii

-causes pneumocystis pneumonia (PCP)–>a diffuse interstitial pnuemonia

dimorphic, cigar shaped budding yeast
sporothrix schenckii

Which fungus found on vegetation can typically be transmitted through a thorn (rose gardner’s disease)?
sporothrix schenckii

*causes ascending lymphangitis

protozoa commonly infects hikers and campers who drink untreated water
giardia lamblia

protozoa that are transmitted by cysts in water and cause bloating, flatulence and foul-smelling, fatty diarrhea
giardia lamblia

protozoa that is transmitted by cysts in water and cause bloody diarrhea, liver abscess (“anchovy paste” exudate), and RUQ pain
entamoeba histolytica

protozoa that histologically shows a flask shaped ulcer
entamoeba histolytica

oocysts in water that cause severe diarrhea in AIDS patients and mild diarrhea in immunocompetent hosts
cryptosporidium

Which congenital infection can occur when pregnant women change cat litter boxes?
tocoplasma gondii (toxoplamsosis)

What is the most common transmission of toxoplasma gondii?
cysts in meats

-but can also be transmitted by oocysts in cat feces

rapidly fatal meningeoncephalitis contracted from swimming in freshwater lakes
naegleria fowleri

African sleeping sickness contracted by the bite of a tsetse fly is caused by what organism?
trypanosoma brucei

What is the vector for the organism babesia?
ixodes tick

What organisms can be transmitted through the IXODES tick?
1. borrelia burgdorferi (lyme disease)
2. babesia (babesiosis)
3. anaplasma spp. (anaplasmosis)

What organism is spread by the redivide bug (the “kissing bug”)?
trypanosoma cruzi

-causes chagas disease

Which protozoa organism causes vaginitis, a foul smelling, greenish discharge?
trichomonas vaginalis

What is the number 1 cause of anal itching in children?
enterobius vermicularis (pinworm)

What is the proper name for the giant roundworm?
ascaris lumbricoides

Which nematode (roundworm) have larvae found in soil and penetrate the skin?
strongyloides stercoralis

Intestinal infection causing microcytic anemia by sucking blood from intestinal walls
hookworms! (they penetrate the skin)

-ancylostoma duodenale
-necator americanus

Which nematode (roundworm) enters the bloodstream via fecal/oral or undercooked meats (especially pork) and then infects striated muscle causing inflammation of muscle?
trichinella spiralis

Which nematode (round worms) is contracted by a female mosquito and then takes 9 months to 1 year to cause elephantiasis by the worms blockage of lymphatic vessels?
wuchereria bancrofti

Which tapeworm is ingested from raw freshwater fish?
diphyllobothrium latum

-can cause vit b12 deficiency and megaloblastic anemia

Which tapeworm is caused by the ingestion of eggs from dog feces?
echinococcus granulosus

-sheep are immediate host

Which tapeworm is caused by ingestion of larvae in undercooked pork?
taenia solium

Which trematodes come from snail hosts?
schistosoma

Which species of schistosoma is known to cause bladder cancer?
schistosoma haemoatobium

Which species of schistosomas are known to cause portal hypertension?
1. schistosoma mansoni (africa, latin america)
2. schistosoma japonicum (asia)

Which viral vaccines are live vaccines?
1. smallpox
2. chickenpox (varicella)
3. yellow fever
4. polio-sabin
5. influenza (nasal spray only)
6. MMR (measles, mumps, rubella)Wh

Which serotypes belong to HPV?
types 6, 11, 16, 18

*6, 11 warts (1, 2)
*16, 18 cervical cancer

All DNA viruses are double stranded with the exception of which one?
parvovirus
(it is the smallest DNA virus)

Live viral vaccines induce which type(s) of immunity?
both humoral and cell-mediated immunity

Killed viral vaccines induce which type(s) of immunity?
only humoral immunity

All DNA viruses are linear except for which ones?
1. papillovirus
2. polyomavirus
3. hepadnavirus

*these are all CIRCULAR

Cause of sporadic encephalitis with altered mental status and seizures
HSV-1

Which herpesvirus is latent in sacral ganglia?
HSV-2

Which herpesvirus is latent in mononuclear cells?
CMV (HSV-5)

mononucleosis with a negative mono spot test
CMV (HSV-5)

mononucleosis with a positive mono spot test
EBV (HSV-4)

Which herpesvirus is associated with lymphomas (endemic Burkitt lymphoma and Hodgkin lymphoma)?
EBV (HSV-4)

Which herpesvirus has cells characteristic of owl eye inclusions?
CMV (HSV-5)

What cells are effected in EBV (HSV-4)?
-B cells through CD21
-irregular lymphocytes seen on blood smear are reactive cytotoxic T cells and not the infected B cells

What type of smear is used for open skin herpes vesicles to detect giant cells (commonly seen in HSV-1, HSV-2, VZV (HSV3))?
Tzanck smear

*Tzanck heavens I don’t have herpes.

What test is done to identify herpes encephalitis?
CSF PCR (polymerase chain reaction)

All RNA viruses are single stranded with the exception of which virus?
reovirus

Which virus is the number one cause of fatal diarrhea in children?
Rotavirus
-an RNA virus part of the reovirus family

HAV is part of which viral family?
picornavirus (ss-linear RNA virus)

What medication is used to treat RSV?
ribavirin

Which is the only double stranded RNA virus?
Reovirus family

Which is the only double stranded RNA virus?

Which viral vaccines are subunit vaccines?
-HBV (anitgen= HBsAg)
-HPV

Which two viruses cause the common cold?
-rhinovirus (picornavirus family)
-coronavirus

Which virus causes croup?
parainfluenza (paramyxovirus family)

Influenza virus is part of what family?
orthomyxovirus family

A flavivirus transmitted by Aedes mosquitos
yellow fever virus

(it causes jaundice and fever -hence yellow fever virus
and also causes black vomitus)

Which is worse a genetic shift of influenza virus or a genetic drift of the virus?
gentic shift is worse than genetic drift

-shift–>causes pandemics
-drift–>causes epidemics

Infant is born and has a blueberry muffin like appearance
congenital rubella virus
-togavirus family
-rubella virus is a torches infection!

seal like barking cough in child
parainfluenza (croup)
-paramyxovirus family

protein that all paramyxoviruses (mumps, measles, parainfluenza, RSV) contain that causes respiratory epithelial cells to fuse and form multinucleated cells
surface F (fusion) protein

steeple sign on neck X-ray of the trachea (narrowing of trachea and subglottis)
croup
-croup is caused by the parainfluenza virus
-parainfluenza virus is part of the paramyxovirus family

prodromal fever with cough, coryza, conjunctivitis and eventually koplik spots (buccal mucosa) followed by maculopapular rash
measles (rubeola) virus
-paramyxovirus family

uncommon viral disease that causes parotitis, orchitis (inflammation of the testes) and aseptic meningitis
Mumps
-paramyxovirus

butllet shaped virus with negri bodies in infected neurons
rabies virus
-rhabdovirus family

a filovirus that targets endothelial cells, phagocytes and hepatocytes and is transmitted by direct contact with bodily fluids or fomites
ebola virus

Which hepatitis virus is a picornavirus?
HAV

Which hepatitis virus is a DNA hepadnavirus?
HBV

Which hepatitis virus is a flavivirus?
HCV

Which hepatitis virus is a delta virus?
HDV

Which hepatitis virus is a hepevirus?
HEV

What serologic marker is best to detect current acute infection of hepatitis A?
anti-HAV (IgM)

What serologic marker is best to detect previous infection or prior vaccination of hepatitis A?
anti-HAV (IgG)

What antigen is found on the surface of HBV and indicates hepatitis B infection?
HBsAg

What is the antibody to HBsAg and indicates immunity to hepatitis B?
Anti-HBs

What antigen is associated with the core of HBV?
HBcAg

Antigenic determinant of HBV core and indicates viral replication and highly transmittable
HBeAg

What are the tests used to diagnose HIV?
1. ELISA is done first to rule out.
-sensitive
2. Western blot assay is done if ELISA is positive to rule in.
-specific

Antibody to HBeAg and indicates low transmissibility
Anti-HBe

Capsid protein in the HIV virus
p24

What synthesizes dsDNA from genomic RNA in the HIV virus?
Reverse transcriptase

Transmembrane protein for fusion and entry into host cell in HIV virus
gp41

Capsid protein in the HIV virus
p24

What synthesizes dsDNA from genomic RNA in the HIV virus?
Reverse transcriptase

Diagnosis of AIDS has a CD4+ count of?
<200 CD4+

Docking glycoprotein for attachment to host CD4+ T cell in HIV virus
gp120

What is the antibody to the core serologic marker HBcAg of hepatitis B infection?
Anti-HBc

-IgM indicates acute/recent infection
-this could be sole positive marker during window period
-IgG indicates prior exposure or chronic infection

normal alpha helical protein (PrP^c) is changed to beta pleated form (PrP^sc) and is transmitted to CNS related tissues and this new form resists protease degradation and facilities more conversions of the proteins
prions disease
-creutzfeldt-jakob disease-rapid progressive dementia
-bovine spongiform encephalopathy-aka mad cow disease
-kuru-cannibalism

What is another name for a urinary tract infection?
cystitis

What is the 3rd leading cause of UTI?
klebsiella pnuemoniae

Which infections can cause meningitis in neonates?
1. group B strep
2. e. coli
3. listeria

cherry red epiglottis and thumbprint sign on X-ray
H. influenza type B

grayish oropharayngeal exudate and painful throat
corynebacterium diphtheriae

Hardy Weinberg and Maggie May Do Not Smoke
No: Mutation, Migration, Drift, Non-Random Mating, Selection of Locus

Cell Cycle:
D4-E2
A2-B1
CyclinD binds CDK4 & CyclinE binds CDK2-> initiates S Phase (Phosphorylate Rb–> free E2F T.Factor)
CyclinA binds CDK2 & CyclinB binds CDK1 –> cdc25 initiates mitosis

Golgi Transport- COPI goes back to get COPII
COPI- Retrograde
COPII- Anterograde

Blotting- SNoW DRoP
Southern- DNA
Northern- RNA
Western- Protein

Angelman’s Syndrome- SAMI the happy puppet
Seizures, Ataxia, Mental Retardation, Inappropriate laughter

Pader-Willi Syndrome- MOHHH the fatty
Mental Retardation, Obesity, Hyperphagia, Hypotonia, Hypogonadism

6 C’s of Huntington
Ch4, CAG, Low ACh/GABA, Caudate Nucleus atrophy, Chorea, Crazy

MARFAN
MVP, Aneurysm (Aortic/Berry), Retinal detachment/lens subluxation, Fibrillin, Arachnodactyly, Negative Nitroprusside test (diff. from homocystinuria)

Neurofibromatosis 1 (CH17): CAFESPOT
Cafe-au-lait spots, Axillary/Inguinal freckles, Fibromas, Eye (Lisch nodules), Scoliosis, Pheochromocytoma, Optic gliomas

Tuberous Sclerosis: TUBEROUS
TUberocalcification in the perivent & astrocytomas
Blood in urine (Renal cysts & angiomyolipomas)
Eye (retinal hamartomas)
Rhabdomyosarcoma/Retardation
Off-white skin (Ash Leaf Spots)
sUb-Ungual fibromas
Shagreen Patches & Sebaceous Adenomas

von Hippel Landau (CH3): HIPPEL
Hemangioma (retina, cerebellum, & medulla)
Increased RCC (bilaterally)
Pheochromocytoma
Pancreatic serous cystadenoma
Eye dysfunction
Liver, Pancreas, & Kidney Cysts

Cystic Fibrosis: CFPANCREAS
Chronic bronchitis/bronchiectasis
Failure to thrive
Pancreatic Insufficiency (steatorrhea & low ADEK)
Alkalosis
Neonatal GI obstruction (meconium ileus)
Clubbing of fingeRs
Elevated electrolytes in sweat (Cl>60)
Atresia of vas deferens (infertility)
Staph/Pseudomonas in sputum

Fragile X Syndrome
Xtra large ears, jaw, and testes

Trinucleotide Repeats: CAG, CTG, CGG, GAA
Huntington’s Disease
MyoTonic Dystrophy
FraGile X Syndrome
Friedreich’s Ataxia

DEP 21, 18, 13
Down Syndrome
Edward’s Syndrome
Patau’s Syndrome

22q11: CATCH22
Cleft palate, Abnormal facies, Thymus aplasia, Cardiac defects, Hypocalcemia

Riboflavin (B2, 2ATP, 2C’s)
Niacin (B3, 3ATP, 3D’s for Pellagra)
R- Cheilosis & Corneal vascularization
N- Diarrhea, Dermatitis, Dementia

ABC for Carboxylases
ATP, Biotin, & CO2

Essential AA: PVT TIM HALL
Phenylalanine, Valine, Threonine, Tryptophan, Isoleucine, Methionine, Histidine, Arginine, Leucine, & Lysine

Glucogenic AA- His Valentine Met Arg
Ketogenic AA- Key to Loosing is Lying
G- Histidine, Valine, Methionine, Arginine
K- Leucine & Lysine

AA with Three Titratable Curves: CHAGLAT
Cysteine, Histidine, Aspartic Acid, Glutamic Acid, Lysine, Arginine, Tyrosine

Urea Cycle: Coffee And Alcohol For Aggressive Urine Overload
Citrulline, Aspartate, Arginosuccinate, Fumurate, Arginine, Urea, & Ornithine

Cystinuria AA- COLA
Cysteine, Ornithine, Lsyine, Arginine
-Hereditary defect of renal tubular AA transporter
-can lead to Cystine stones (staghorn)

Maple Syrup Urine Disease- I Love Vermont maple syrup from Branched trees
Isoleucine, Leucine, Valine (branched AA)

Glycogen Storage Diseases- Very Poor Carb Metabolism
von Gierke’s (I)- Glycogen-6-phosphate
Pompe’s (II)- Lysosomal a-1,4- glucosidase (acid maltase)
Cori’s (III)- a-1,6-glucosidase (debranching enzyme)
McArdle’s (V)- Glycogen Phosphorylase

Fabulous gay* Fabry has a hand/foot* fetish, fabulous shades*, raised red-purple skin blemishes*, ceramic tiles*, and enjoys creamy cum from Alpha males
Fabry’s Disease, Peripheral Neuropathy, Cloudy Cornea, Angiokeratomas, Ceramide Trihexoside, Alpha-Galactosidase A

Wrinkly* old Gaucher sitting in a wheel chair* & eating sweet brain candy* + has HSM
Gaucher’s Disease, wrinkly looking G cells, aseptic necrosis of femur/bone crisis, B-glucocerebrosidase

Neimann* Marcus is having a swinging* sale, all neurons cut at half price*. You buy a cherry-red* foam* sofa for HSM
Neimann Pick Disease, Sphingomyelinase, Progressive Neurodegeneration, Cherry-Red spot on macula, Foam Cells, Hepatosplenomegaly

Taysach’s Disease- TAYSACHS
Testing Recommended
Amaurosis Fugax/Cherry-red spot on macula
Young death (<4) Slow development delays Ashkenazi Jews CNS Degeneration Hexosaminidase A Storage of GM2 ganglioside in lysosomes with onion skinning (and no HSM)

Blind* galactic* Crabs* come to eat the peripheral nerves* of children with their globoid* goblets
Krabbe’s Disease, Optic atrophy, Galactocerebrosidase, Peripheral Neuropathy, Developmental Delay, Globoid Cells

Hurler’s Syndrome- HURLER
HSM
Ugly gargoyle faces
Recessive
L-idouronidase (a)
Eyes clouded
Retardation
Short stubby fingers

Aggressive Hunter with eagle vision
Hunter’s Syndrome- mild Hurler’s but with aggression and no corneal clouding

X-linked recessive disorders- Be Wise, Fool’s GOLD Heeds, Silly Hopes
Bruton’s Agammaglobulinemia, Wiskott-Aldrich Syndrome, Fabry’s Disease, G6PD Deficiency, Ocular Albinism, Lesch-Nyhan Syndrome, Duchenne (&Becker’s) Muscular Dystrophy, Hunter’s Syndrome, Hemophilia A/B

Aortic Arch Derivatives
1 is Maximal, second=S, 3=C, 4=4 limbs (systemic), 6=P
1- Maxillary Artery
2- Stapedial & Hyoid Artery
3- Common Carotid (& prox ICA)
4- Aortic Arch (left) and Prox Subclavian (right)
6- Pulmonary Artery (DA)

Branchial Apparatus- CAP
Cleft- Ectoderm
Arch- Mesoderm
Pouch- Endoderm

A-I Activates Lcat
B-100-Binds to LDL receptor mediates VLDL secretion
C-II -cofactor for lipoprotein lipase.
b-48- mediates chylomicrone secretion.
E- mediates Extra – remnant- uptake

T-ALL, Teenagers, Thymic Mass
T-ALL common in teenagers as a mediastinal (thymic) mass

Hairy Cell Leukemia is TRAP +
Trapped in red pulp
Trapped in fibrosed BM
& Can’t enter lymph nodes
HCL: TRAP+, Splenomegaly, Dry Tap, & absent lymphadenopathy

TCA’s: AACIDD-N
Amoxapine
Amitriptyline
Clomipramine
Imipramine
Desipramine
Doxepin
Nortriptyline

SSRI’s: Effective For Sadness, Panic, & Compulsions
Escitalopram, Fluoxetine/Fluvoxamine, Sertraline, Paroxetine, & Citalopram

Serotonin Syndrome may cause HARM
Hyperthermia
Autonomic instability
Rigidity
Myoclonus
(antidote: cyproheptadine- 5HT2 antagonist)

MAOi- TIPS
Tranylcypromine
Isocarboxacid
Phenelzine
Selegiline (MAO-B)

Parasympathetic: DUMBELSS
Diarrhea
Urination
Miosis
Bradycardia/Bronchospasm
Emesis
Lacrimation
Salivation/Sweating

Radial nerve innervates the BEST muscles
Brachioradialis
Extensors of wrist/fingers
Supinator
Triceps

PEA drugs have zero-order elimination
Phenytoin
Ethanol
Aspirin

Therapeutic Index- TILE
TI=LD50/ED50

qiss & qiq till your siq of sqs
a1, a2, b1, b2, m1, m2, m3, d1, d2, h1, h2, V1, & V2

Hemolysis in G6PD Deficiency: hemolysis IS PAIN
Isoniazid, Sulfonamides, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin (Dapsone)

Pulmonary Fibrosis: GO BAN ME
What do pneumocytes release that causes fibrosis?
Gold, Bleomycin/Busulfan, Amiodarone/Acyclovir/Azathioprine, Nitrofurantoin, Melphalan/MTX
(TFG-B)

Gynecomastia: Some Drugs Create Awesome Knockers
Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole

Nephrotoxicity/Ototoxicity: CLAV
Cisplatin, Loop Diuretics, Aminoglycosides, Vancomycin

P-450 Inducers: BCG PQRST
Barbiturates
Carbamezapine/Chronic Alcohol
Griseofulvin
Phenytoin
Quinidine
Rifampin
St. John’s Wort

P-450 Inhibitors: ICA KEGS
Isoniazid
Cimetidine
Alcohol (acute)
Ketoconazole
Erythromycin
Grapefruit Juice/Gemfibrozil
Sulfonamides

Aminoglycosides: GNATS
Gentomycin, Neomycin, Amikicin, Tobramycin, Streptomycin

R’s of Rifampin
RNA polymerase inhibition
Revs up CYP450
Red/Orange urine & secretions
Resistance increased if used alone

Micro: Nagging Pests Must Breath O2 &
Anaerobes Can’t Breathe Air
-Nocardia, Pseudomonas, Mycobacterium (TB), Bacillus
-Clostridium, Bacteroides, Actinomyces

Facultative Anaerobes- Some Nasty Bugs May Live FacultativeLy
Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Legionella

Micro- PUNCH K
Proteus, Ureaplasma, Nocardia, Cryptococcus, H pylori, Klebsiella

Micro- No SPACE for Kats
Nocardia, Staph aureus/Serratia Marscencans, Pseudomonas capecia, Aspergillus/Actinomyces, Candida, E. coli, & Klebsiella

Which toxins are carried on specialized lysogenic phages (transduction)? (ABCDE)
shigA-like toxin
Botulinum Toxin
Cholera Toxin
Diphtheria Toxin
Erythrogenic Toxin (S pyogenes)

Corynebacterium diphtheria (ABCDEFGH)
ADP-Ribosylation
Beta-Prophage
C
Diphtheria
Elongation Factor-2
Granules (metachromic)
Heart (myocarditis/arrhythmia)

French legionnaire with his silver helmet, sitting around campfire with his iron dagger; he’s not sissy
Legionella pneumophilia
Silver stain
Charcoal yeast extract (Iron & Cysteine)

PSEUDOmonas
Pneumonia (cystic fibrosis)
Sepsis (black lesion on skin)
External otitis (swimmer’s ear)
UTI (catheter)
Druggie/Diabetics- Osteomyelitis
Hot Tub Folliculitis

Tetracyclines VACUUM the BedRoom but Stones stop it
Vibrio cholera, Acne, Chlamydia, Ureaplasma, Tularemia, Mycoplasma pneumonia, H. pylori, Borrelia burgdorferi, Rickettsia
(milk, antacids, & iron ingestion prevent absorption)

Chlamydia trachomatis serotypes
Types A, B, C: Africa/Blindness/Chronic Infection
Types D-K: STD diseases
Types L1-3: Lymphogranuloma venereum & primary ulcers/rectal disease (mistaken for IBD)

Leukemia ages
0-14: ALL
15-39: AML
40-59: AML (30% Blasts)/CML
60+: CLL

Nematodes EATSANd (roundworms)
(Ingested)
Enterobius vermicularis
Ascaris lumbricoides
Trichinella spiralis
(Cutaneous)
Strongyloides stercoralis
Ancylostoma duodenale
Necator americanus

Fever in Post-Op Period
Wind
Water
Wound
Walking
Wein
Wonder Drugs
Wind: Atelectasis (1-2)
Water: UTI (3-5)
Wound: Infection (5-7)
Walking: DVT
Wein: Thrombophlebitis
Wonder Drugs: Antibiotic

+ Strand RNA: Pico Called Flavio To Return Renzo’s Corona
Picorna
Calici
Flavi
Toga
Retro
Reo
Corona

HHAPPPPy Virus
Herpesvirus, Hepadnavirus, Adenovirus, Parvovirus (B19), Papillomavirus (HPV), Polyomavirus (JC), Poxvirus

Picornavirus- PERCH
PolioV, EchoV, RhinoV, CoxsackieV, HAV)

PaRaMyxovirus
Parainfluenza (Croup)
RSV (Bronchiolotis)
Rubeola (Measles)
Mumps

Influenza: Oh Shift vs Drift
-Genetic *Shift* (pandemic) due to *reassortment* (deadly)
-Genetic *Drift* (epidemic) due to *random* mutation

TORCHeS infections
-TOxoplasmosis: Chorioretinitis, Hydrocephalus, Intracranial calcifications
-Rubella: PDA, Cataracts, Deafness (+blueberry muffin rash)
-CMV: Unilateral deafness, seizures, petechial rash
-HSV: Temporal encephalitis, vesicular lesions
-HIV: recurrent infections, chronic diarrhea (zidovudine for mom)
-Syphilis

Ampicillin & Amoxicillin HELPS
HiB, E coli/Enterococci, Listeria, Proteus, Salmonella
(Also Gram + from penicillin)

Aztreonam kills PESKy bugs when the kidney can’t handle aminoglycosides
Proteus, E coli, Serratia, Pseudomonas

Vancomycin is bad to G+, but NOT good for our histamine
Nephrotoxicity, Ototoxicity, Thrombophlebitis
Red Man Syndrome (Histamine; give antihistamines)

“Navir tease a SRINA protease S/E”
-Saquinavir: HyperG, LipoD
-Ritonavir: Pancreatitis
-Indinavir: HyperG, LipoD, Nephrolithiasis, Hyperbilirubinemia
-Nelfinavir: ?
-Amprenavir: HyperG, LipoD

HIV NRTI: ZDZ SLATEr is competitive (& S/E)
-Zidovudine: BM suppression, Megaloblastic Anemia & GI intolerance
-Didanosine: Peripheral Neuropathy, Pancreatitis, Hepatic Steatosis
-Zalcitabine: ”
-Stavudine: ”
-Lamivudine, Abacavir, Tenofovir, Emtricitabine
-Most: Lactic acidosis (not abacavir)

HIV NNRTI: NED is noncompetitive (& S/E)
-Nevirapine, Efavirenz, Declaviridine
-Same as NRTI + Rash

AVRP
Accuracy=Valid
Reliable=Precision

Gluconeogenesis Irreversible Enzymes: Pathway Produces Fresh Glucose
Pyruvate Carboxylase (M): Pyruvate -> Oxaloacetate
PEP Carboxykinase (C): Oxaloacetate -> PEP
Fructose-1,6-BPase (C; RLS): F-1,6-BP -> F6P
Glucose-6-Phosphatase (ER): G6P -> Glucose

My homie ty is fuming and is going to bust a cap in your bones
Deficiency in Homogentisic Acid Oxidase in pathway of Tyrosine to Fumurate. AR/Benign.
-Dark CT, Brown sclera, urine darkens, debilitating arthlagias

Papez Circuit: MATCH
Mammillary Bodies
Anterior Thalamic Nucleus
Cingulate Gyrus
Hippocampus

Hypothalamus (TALE)
Limbic System (5 F’s)
-Temp, Appetite, Libido, Emotions
-Feeding, Fleeing, Fighting, Feeling, Sex

Cerebellar Deep Nuclei: Don’t Eat Greasy Food
Dentate, Emboliform, Globose, Fastigial (L->M)

Wallenberg’s Horny ADVICe
Horner’s Syndrome (Descending Symp. Tract)
Ataxia (ICP)
Dysphagia (Nucleus Ambiguus)
Vertigo, Nystagmus, N/V (Vestibular Nuclei)
Ipsilateral pain/temp loss of face (TTT)
Contralateral pain/temp loss of body (STT)

PSaMMoma
Papillary carcinoma of the thyroid/RCC/Prolactinoma
Serous cystadenocarcinoma of the ovary/endometrium
Meningioma
Mesothelioma

MC Brain Tumors in Adults (MGM-Studios) & Kids (AMEy)
Adults: Mets, GM, Meningioma, Schwannoma
Kids: Astrocytoma, Medulloblastoma, Ependymoma

Charcot’s Triad (MS)
Scanning Speech
Nystagmus
Intention Tremor

Got SANDDy drugs for my epilepsy
Sedation
Ataxia
Nystagmus
Diplopia
Dizziness

Phenytoin Side Effects
P-450 activation
Hirsutism
Enlarged gums
Neuropathy (peripheral)
Yellow-browining of skin
Teratogen (fetal hydantoin syndrome)
Osteomalacia
Interferes B12 metabolism
Nystagmus

Inhaled Anesthetics: MSHINE
Methoxyflurane
Sevoflurane
Halothane
Isoflurane
N2O
Enflurane

68/95/99 Rule
Standard Deviations
1=68%
2=95%
3=99.7%

Can’t See, Can’t Hear, Can’t Pee
Alport’s Syndrome (Type IV Collagen defect)

Cholinergic intoxication: (SLUDGE)
Salivation
Lacrimation
Urination
Diaphoresis and defecation
GI upset
Excessive brady- or tachycardia (muscarinic or nicotinic)

DM Antibodies
Anti-Insulin Ab
Anti-Islet Cell cytoplasm Ab
Anti-glutamic acid decarboxylase Ab (GAD)
Anti-Tyrosine phosphatase Ab

Viruses a/w DM 1
Rubella, Coxsackie, Mumps

Metabolic Syndrome (3/5)
Abdominal Obesity
Triglycerides >150
HDL <40 (<50) Fasting Glucose >100
BP >135/85

Diabetic Retinopathy
-Background retinopathy: no neovascularization, cotton wool spots; hemorrhages, exudates, microaneurysms, venous dilatation, & macular edema
-Proliferative retinopathy: neovascularization with risk of vitreal hemorrhage (fragile) & retinal detachment (Laser photocoagulation)

Treatment for hypoglycemia
Diazoxide

How is acromegaly diagnosed?
-Increase in GH 1-2hrs after 100g glucose load (normally d/t insulin)
-IGF-1 is also elevated

Standard test for diagnosing Chronic Adrenal Insufficiency
Cosyntropin test

Drugs that Induce Pancreatitis
Furosemide, Thiazides, sulfasalazine, 5-ASA, Azathioprine, L, Asparginase, Valproid Acid, Didanosine, Pentamidine, Metronidazole, Tetracyclines

Neutrophils Like Making Everything Better
WBC differential from highest to lowest:
Neutrophils (54-62%)
Lymphocytes (25-33%)
Monocytes (3-7%)
Eosinophils (1-3%)
Basophils (0-0.75%)

Causes of eosinophilia: NAACP
Neoplastic
Asthma
Allergic processes
Collagen vascular diseases
Parasites (invasive)

Basophilic staining
Basophilic – staining readily with basic stains

MHC classes
MHC x CD = 8
class II x CD4 = 8
class I x CD 8 = 8

Basophilic stippling: BASte the ox TAiL
thalassemias
anemia of chronic disease
lead poisoning

teardrop cell: RBC “sheds a tear”
RBC “sheds a tear” because it’s been forced out of its home in the bone marrow –> BM infiltration (myelofibrosis)

target cells: “HALT” said the hunter to his target
HbC disease
Asplenia
Liver disease
Thalassemia

Lead poisoning: LEAD
Lead Lines on gingivae (Burton’s lines) and on metaphyses of long bones on x rays
Encephalpathy and Erythrocyte basophilic stippling
Abdomninal colic and sideroblastic Anemia
Drops (wirst and foot drop)
Dimercaprol and EDTA = 1st line treatment

WARM weather is GGGreat
warm agglutinin in autoimmune hemolytic anemia = IgG

COLD ice cream – yuMMM
cold agglutinin in autoimmune hemolytic anemia = IgM

the 7 “P”‘s of acute intermittent porphyria
affect enzyme = Porphobilinogen deaminase
accumulated substrate = Porphobilinogen (+delta-ALA, uroporphyrin)
Painful abdomen
Port wine-colored urine
Polyneuropathy
Psychological disturbances
Precipitated by drugs

DIC causes: “STOP Making New Thrombi”
Sepsis (gram-negative)
Trauma
Obstetric complications
acute Pancreatitis
Malignancy
Nephrotic syndrome
Transfusion

Multiple Myeloma: CRAB
hyperCalcemia
Renal insufficiency
Anemia
Bone lytic lesions/Back pain

the M’s of multiple myeloma
Multiple Myeloma: Monoclonal M protein

Philadelphia CreaML cheese
Philadelphia chromosome (t9;22) associated with CML

warfarin: “The EX-PresidenT went to WAR(farin)”
EXtrinsic pathway –> increased PT

Dactinomycin: “children act out”
used to treat childhood tumors (Wilm’s tumor, Ewing’s sarcoma, rhabdomyosarcoma)

Vinblastine Blasts bone marrow (suppression)
tx: solid tumor, leukemias, lymphomas

vincristine & vinblastine: “Microtubules are the vines of your cells”
vincristine and vinblastine bind to tubulin in M phase & block polymerization of microtubules

Lead Poisoning: “It SUCks to be a kid who eats lead”
Succimer used for chelation for kids

teardrop cells: the Bone marrow is crying because it’s fibrosed
myelofibrosis

Paclitaxel: “It is taxing to stay polymerized”
hyperstabilizes polymerized microtubules in M phase

Gram Stain Limitations: “These Rascals May Microscopically Lack Color”
Treponema
Rickettsia
Mycobacteria
Mycoplasma
Legionella pneumophila
Chlamydia

Giemsa Stain: “Certain Bugs Really TRY my Patience”
Chlamydia
Borrelia
Rickettsiae
TRYpanosomes
Plasmodium

PAS (periodic acid-Schiff) stains: “PASs the SUGAR”
stains glycogen and mucopolysaccharides

special culture requirements: “to connect to Neisseria, please use your VPN client”
Thayer Martin Media =
Vancomycin
Polymyxin
Nystatin

special culture: Bordet for Bordetella
Bordet-Gengou agar for Bordetella pertussis

special culture: “Sab’s a fun guy!”
Sabouraud’s agar for Fungi

obligate aerobes: “Nagging Pests Must Breathe”
Nocardia
Pseudomonas aeruginosa
Mycobacterium tuberculosis
Bacillus

obligate anaerobes: “anaerobes Can’t Breathe Air”
Clostridium
Bacteroides
Actinomyces

obligate intracellular bugs: “Stay inside when it is Really Cold”
Rickettsia
Chlamydia

facultative intracellular bugs: “Some Nasty Bugs May Live FacultativeLY”
SSalmonella
Neisseria
Brucella
Mycobacterium
Listeria
Francisella
Legionella
Yersinia pestis

encapsulated bacteria: “Quellung = capsular “Swellung”
positive quellung reaction – if encapsulated bug is present, capsule swells when specific anticapsular antisera are added

encapsulated bugs: “SHiNE SKiS”
streptococcus penumoniae
Haemophilus influenzae type B
Neisseria meningitidis
Escherichia coli
Salmonella
Klebsiella pneumoniae
group B Strep

Catalase positive bugs: “you need PLACESS for your CATs”
Pseudomonas
Listeria
Aspergillus
Candida
E. coli
S. aureus
Serratia

urease positive bugs: “CHuck Norris hates PUNKSS”
cryptococcus
H. pylori
Proteus
Ureaplasma
Nocardia
Klebsiella
S. epidermidis
S. saprophyticus

pigment producing bacteria: “ISRAEL has YELLOW SAND”
actinomyces israeli – yellow “sulfur” granules

pigment producing bacteria: “aureus = Latin for gold”
s. aureus – yellow pigment

pigment-producing bacteria: “AERUGula is GREEN”
pseudomonas aeruginosa = blue-green pigment

pigment producing bacteria: “red maraschino cherries”
serratia marcescens – red pigment

IgA protease: “SHiN”
secreted by:
S. pneumoniae
H. influenze type B
Neisseria

ETEC toxins: “LABILE in the Air, STABLE on the Ground”
heat-labiel toxin overactivates Adenylate cyclase

Heat stable toxin overactivates guanylate cyclase

ENDOTOXIN
Edema
Nitric Oxide
DIC/Death
Outer membrane
TNF-alpha
O-antigen
eXtremely heat stable
Il-1
Neutrophil chemotaxis

transformation (bacterial genetics): “SHiN”
s. pneumnoiae
H. influenzae type B
Neisseria

lysogeny (specialized transduction): “ABCDE”
shigA-like toxin
Botulinum toxin
Cholera toxin
Diphtheria toxin
Erythrogenic toxin of strep pyogenes

STAPHylococci identification: “On the office’s STAPH retreat, there was NO StRESs”
NOvobiocin:
Saprophyticus = Resistent
Epidermidis = Sensitive

Streptococci identification: OVRPS
Optochin:
Viridians = Resistant
Pneumoniae = Sensitive

Streptococci Identification: B-BRAS
Bacitracin:
group B strep = Resistant
group A strep = Sensitive

“Staph makes catalase because they have more “staff””
Staph = Catalase Positive

Streptococcus Pneumoniae: “S. pneumoniae MOPS are Most OPtochin Sensitive”
Strep pneumo = most common cause of:
Meningitis
Otitis media (in children)
Pneumonia
Sinusitis

Viridans group streptococci: “Viridans group strep live in the mouth because they are not afraid OF-THE-CHIN”
= op-to-chin resistant

= normal flora of the oropharynx

Streptococcus pyogenes (group A) – diagnosis of Rheumatic Fever = “J<3NES" criteria
Joints – polyarthritis
<3 = Carditis N = Nodules (subcutaneous) E = Erythema marginatum S = Sydenham's chorea

strep pyogenes: “PHaryngitis can result in rheumatic “PHever” and glomerulonePHritis”
previous pharyngitis infection can result in rheumatic fever and acute glomerulonephritis

strep agalactiae (group B strep): “Group B for Babies!”
group B strep causes pneumonia, meningitis, and sepsis mainly in babies

Strep bovis (group D strep): “Bovis in the Blood = Cancer in the Colon”
Bovis causes bacteremia and subacute endocarditis in colon cancer patients

Corynebacterium diphtheriae: “ABCDEFG”
A = ADP-ribosylation (MOA)
B = Beta-prophage (exotoxin = encoded on)
C = Corynebacterium
D = Diphtheria
E/F = Elongation Factor 2 (inhibits)
G = Granules (lab dx based on metachromatic (blue and red) granules

C. botulinum: “BOTulinum is from bad BOTtles of food and honey”
in babies: ingestion of spores in honey
in adults: ingestion of preformed toxin in cans

C. difficile: “DIfficile cause DIarrhea”
can cause watery or bloody diarrhea

Actinomyces vs. Nocardia: “SNAP”
Sulfur granules = Actinomyces
Nocardia = Pulmonary infection

“LEpromatous leprosy can be LEthal”

lactose-fermenting bacteria: “Lactose is KEE therefore test with macConKEES agar”
Citrobacter
Klebsiella
E. coli
Enterobacter
Serratia

Grow pink colonies on MacConkey’s agar

Neisseria: “MeninGococci ferment Maltose and Glucose. Gonoccoci ferment Glucose”
Meningococci = ferments maltose and glucose
Gonococci ferment glucose

haEMOPhilus causes?
E = epligottitis (cherry red in children)
M = meningitis
O = otitis media
P = pneumonia

Haemophilus influenzae: “When a child has the flu, mom goes to five (V) and dime (X) store to buy some chocolate”
Culture of H. influenzae on chocolate agar requires factors V (NAD+) and X (hematin) for growth

can also be grown with S. aureus, which provides factor V

Legionella pneumophila: “Think of a French SOLDIER with his SILVER helmet, sitting around a CAMPFIRE with his IRON dagger – he is no SISSY”
soldier = Legionnaire
Silver = silver stain
campfire = charcoal yeast extract (culture)
Iron = culture with Iron
Sissy = cysteine (culture with cysteine)

PSEUDOmonas aeruginosa causes?
P = pneuomonia (esp. in CF pts)
S = sepsis (black lesions on skin)
E = external otitis (swimmer’s ear)
U = UTI
D = drug use
DO = diabetic osteomyelitis

also: hot tub folliculitis

AERuginosa = AERobic
pseudomonas aeruginosa = aerobic organism

EIEC
I = invasive –> dysentery

ETEC
T = Traveler’s diarrhea (watery)

EPEC
P = Pediatric – diarrhea in children

EHEC
H = causes Hemolytic-uremic syndrome

Kelbsiella: 4A’s
Aspiration pneumonia
Abscess in lungs and liver
Alcoholics
di-A-betics

SALMONella = salmon swim
salmonella have flagella

“CAMPylobacter likes the hot CAMPfire”
grows @ 42?

spirochetes: “BLT”
B = Borrelia
L = Leptospira
T = Treponoma

Borrelia: B is Big
Borrelia is the only spirochete that can be visualized using aniline dyes

Lyme Disease: “FAKE a key LYME pie”
F = facial nerve palsy (typically bilateral)
A = arthritis
K = kardiac block
E = erythema migrans

VDRL false positives: “VDRL”
V = viruses (mono, hepatitis)
D = drugs
R = rheumatic fever
L = lupus and leprosy

Gardnerella Vaginalis: “I don’t have a CLUE why I smell FISH in the VAGINA GARDEN!”
CLUE cells
FISHy smelling discharge
VAGINA = vaginosis
GARDEN = gardnerella

“Rickettsii on the wRists, Typhus on the Trunk”
rash of Rickettsii starts at wrists adn ankles then spreads to trunk, palms, and soles

rash of Tyhpus starts on the trunk

rashes: “you drive CARS using your PALMS and SOLES”
Palm and sole rash seen in:
Coxsackievirus A
Rocky mountain spotted fever
secondary Syphilis

“Q fever is Queer”
unusual because it has no rash or vector and its causative organism can survive outside in its endospore form

2 forms of Chlamydia: Elementary vs. Reticulate
Elementary body is “Enfectious” and Enters cell via Endocytosis

Reticulate body Replicates in cell by fission

Chlamydia trachomatis serotypes: Types ABC
ABC = Africa/Blindness/Chronic infection

HIstoplasmosis HIdes
histoplasmosis resides within macrophages

Blastomycosis: Blasto Buds Broadly
Broad-base budding

Coccidiomycosis: “Coccidio Crowds”
spherule filled with endospores

Paracoccidioidomycosis: “Paracoccidio parasails with the CAPTAIN”S WHEEL all the way to LATIN AMERICA”
Latin America
budding yeast with Captain’s wheel” formation

Aspergillus fumigatus: Think A
A for Acute Angles in Aspergillus

sporothrix schenckii: “plant a ROSE in the POT”
ROSE = rose gardner’s disease (spores are introduced into skin by thorn prick)

POT = tx with potassium iodide

Giardia lamblia: “FAT-rich GHIRARDELLI chocolates”
fatty stools of Giardia

Naegleria fowleri: “NALGENE bottle filled with FRESHWATER containing NAEGLERIA”
transmission = swimming in freshwater lakes

Trypanosoma: “it SURe is nice to go to sleep; MELAtonin helps with sleep”
SURe = SURamin for blood born dx tx
MELA = MALErsoprol tx for CNS penetration

Nematodes (worms) tx: “worms are BENDy”
tx with a BENDazole

Onchocerca volvulus: “black flies, black skin nodules, black sight”
transmission = female black fly bite
black skin nodules = hyperpigmented skin
black sight = river blindness

IVERmectin for rIVER blindness
tx for river blindness (onchocerca volvulus) = ivermectin

Nematode routes of infection: ingested
“You’ll get sick if you EAT these!”
E = Enterobius
A = Ascaris
T = Trichinella

Nematode routes of infection: cutaneous
“These get into your feel from the SANd”
S = strongyloides
A = Ancylostoma
N = Necator

Live attenuated vaccines: “LIVE! one night only! see SMALLY YELLOW CHICKENs get vaccinated with SABIN’s and MMR! It’s INcredible!”
LIVE = live attenuated
SMALL = smallpox
YELLOW = yellow fever
CHICKENs = chicken pox
SABIN’s = Sabin’s polio virus
MMR = MMR (measles, mumps, rubella)
IN = influenza (intranasal)

Killed vaccines: “salK = Killed, RIP Always”
R = rabies
I = influenza (injected)
P = salk Polio
A = HAV

DNA viral genomes: “All are dsDNA, except for “PART-OF-A-VIRUS” is ssDNA”
“PART-OF-A-VIRUS” = parvovirus = ssDNA

RNA viral genomes: “all are ssRNA except “REpeat-O-virus” is dsRNA”
“REpeat-O-virus” = REOvirus

viral envelopes: “give PAPP smears and CPR to a NAKED HEPpy”
P = papillomavirus
A = adenovirus
P = picornavirus
P = polyomavirus
C = calcivirus
P = parvovirus
R = reovirus
HEP = hepevirus

NAKED = nonenveloped

DNA viruses = HHAPPPPy viruses
H = hepadno
H = herpes
A = adenovirus
P = poxvirus
P = parvovirus
P = papilloma virus
P = polyoma virus

cytomegalovirus: “SIGHTomegalovirus”
causes AIDS retinitis in immunosuppressed patients

polyoma virus:
JC = Junky Cerebrum
BK = Bad Kidney
JC virus causes progressive multifoca leukoencephalopathy

BK virus targets the kidney

“TZANCK heavens I do not have herpes”
HSV identification with Tzanck test to detect multinucleated giant cells

Picornaviruses = PERCH
P = poliovirus
E = echovirus
R = rhinovirus
C = coxsackievirus
H = HAV

PaRaMyxoviruses
P = parainfluenza
R = RSV
M = measles, mumps

Negative-stranded viruses: “Always Bring Polymerase Or Fail Replication”
virion brings its own RNA-dependent RNA

A = arenaviruses
B = bunyaviruses
P = paramyxoviruses
O = rthomyxoviruses
F = filoviruses
R = rhabdoviruses

segmented viruses: BOAR
B = bunyaviruses
O = orthomyxoviruses (influenza)
A = arenaviruses
R = reoviruses

Rhinovirus: “RHINO has a runny NOSE”
causes the common cold

ROTAvirus = “Right Out The Anus”
= most important global cause of infantile gastroenteritis

major cause of acute diarrhea in the US during winter, especially day care centers and kindergartens

genetic shift/drift: “Sudden Shift is more deadly than graDual Drift”
drift = minor changes based on random mutation

shift = high frequency recombination

3 C’s of measles
cough
coryza
conjunctivitis

Mumps: “Mumps makes your parotid glands and tests as big as POM-poms”
P = parotitis
O = orchitis (swelling of testes)
M = aseptic Meningitis

Hepatitis A virus
A Virus
Asymptomatic
Acute
Alone (no carriers)

Hepatitis C virus
C virus
Chronic
Cirrhosis
Carcinoma
Carrier

Hep D virus
D virus
Defective virus
Dependent on HBV

Hep E virus
E virus
Enteric
Expectant mothers
Epidemic

“HAV and HEV are fecal-oral: the vowels hit your bowels”
naked viruses do not rely on an envelope so they are not destroyed by the gut

Four stages of HIV infection: F
1. Flu-like (acute)
2. Feeling fine (latent)
3. Falling count
4. Final crisis

“Food poisoning from reheated rice? BE SERIOUS!”
Bacillus cereus

common causes of pneumonia in children (4 weeks – 18 yo):
“Runts May Cough Chunky Sputum”
R = rsv
M = mycoplasma
C = chlamydia trachomatis (infants – 3 yr)
C = chlamydia pneumoniae (school age children)
S = streptococcus pneumoniae

ToRCHeS infections
= microbes that may pass from mother to fetus

To = toxoplasma gondii
R = rubella
C = CMV
H = HIV
He = herpes simplex virus 2
S = syphilis

STD chancroid: “it’s so painful, you “DO CRY”
Haemophilus DUCREYI

= painful genital ulcer

Pseudomonas aeruginosa: “presume pseudomonas “AIRuginosa” when AIR or burns are involved”

asplenic patient is at risk for SHiN infections
S = s. pneumoniae
H.I = H. influenzae type B
N = N. meningitidis

“Use naf for staph”
nafcillin

AMinoPenicillins are AMPed-up penicillin
= wider spectrum

coverage of ampicillin: ampicillin/amoxicillin HELPSS kill enterococci
H = haemophilus influenzae
E – e. coli
L = listeria monocytogenes
P = proteus mirabilis
S = salmonella
S = shigella
enterococci

B-lactamase inhibitors: CAST
CA = clavulanic Acid
S = sulbactam
T = tazobactam

“Organisms typically not covered by cephalosporins are LAME”
L = listeria
A = atypicals (chlamydia, mycoplasma)
M = MRSA
E = enterococci

1st generation cephalosporins: “PEcK”
P = proteus mirabilis
Ec = E. coli
K – klebsiella pneumonia

2nd generation cephalosporins: “HEN PEcKS”
H = haemophilus influenzae
E = enterobacter aerogenes
N = neisseria spp
P = proteus mirabilis
Ec = e. coli
K = klebsiella pneumoniae
S = serratia marcescens

with imipenem, “the kill is LASTIN’ with ciLASTATIN”
imipenim is always administered with cilastatin (inhibitor of renal dehydropeptidase I)

Vancomycin: does NOT have many problems (only a few)
N = nephrotoxicity
O = ototoxicity
T = thrombophlembitis

Resistance to Vancomycin: “pay back 2 D-ALAs (dollars) for VANdalizing (vancomycin)”
R occurs with amino acid change of D-ala D-ala to D-ala D-lac

protein synthesis inhibitors: “Buy AT 30 CCEL (sell) @ 50”
30s inhibitors:
A = aminoglycosides
T = Tetracylines

50s inhibitors:
C = chloramphenicol
C = clindamycin
E = erythromycin
L = linezolid

Aminoglycosides: “MEAN (aminoglycoside) GNATS caNNOT kill anaerobes”
G = gentamicin
N = neomycin
A = amikacin
T = tobramycin
S = streptomycin

N = nephrotoxicity
N = neuromuscular blockade
O = ototoxicity
T = teratogen

MOA aminoglycosides: “A initiates the Alphabet”
MOA = inhibits the formation of initiation complex

Demeclocyline acts as a Diuretic in SIADH

Macrolides toxicity: “MACRO”
M = motility issues
A = arrhythmia caused by prolonged QT
C = acute Cholestatic hepatitis
R = rash
O = eOsinophilia

Trimethoprim toxicity: TMP
TMP = Treats Marrow Poorly

causes: megaloblastic anemia, leukopenia, granulocytopenia

Fluoroquinolone toxicity: “fluoroquinoLONES hurt attachments to your BONES”
can cause tendonitis and tendon rupture

metronidazole: “GET GAP on the Metro with Metronidazole!”
G = giardia
E = entamoeba
T = trichomonas
G = gardnerella vaginalis
A = anaerobes (C. difficile, bacteroides)
P = H. Pylori

TB tx: “RIPE for treatment”
R = rifampin
I = isoniazid
P = pyrazinamide
E = ethambutol

Isoniaid (INH) toxicity: “INH Injures Neurons and Hepatocytes”
Neurotoxicity
hepatotoxicity

Rifampin: 4 R’s
RNA polymerase inhibitor
Revs up microsomal P-450
Red/orange body fluids
Rapid resistance if used alone

“AmphoTERicin “TEARs” holes in the fungal membrane by forming pores”
binds ergosterol and forms membrane pores that allow leakage of electrolytes

“AMPHOTERRIble”
amphotericin toxicity:
fever/chills
hypotension
nephrotoxicity
arrhythmias
anemia
IV phlebitis

FOScarnet = pyroFOSphate analog
foscarnet binds to the pyrophosphate-biding site of viral DNA polymerase and inhibits

ABX to avoid during pregnancy: “SAFe Children Take Really Good Care”
S = sulfonamides
A = aminoglycosides
F = fluoroquinolones
C = clarithromycin
T = tetracyclines
R = ribavirin
G = griseofulvin
C = chloramphenicol

splenic dysufnction –> increased susceptibility to encapsulated organisms: SHiN SKiS
S = strep pneumo
H = haemophilus influnzae type B
N = neisseria meningitidis
S = salmonella
K = klebsiella pneumoniae
S = group B streptococci

HLA subtype B27 disease associations: PAIR
P = psoriasis
A = ankylosing spondylitis
I = inflammatory bowel disease
R = reiter’s syndrome

Fc portion of antibody: C’s
Constant
Carboxy terminal
Complement binding @ CH2
Carbohydrate side chains

complement activation of classic pathway: “GM makes CLASSIC cars”
classic pathways = IgG or IgM mediated

complement functions: “C3b binds bacteria”
C3b – opsonization

complement functions: “C3a and C5a = anaphylaxis”

cytokines: “Hot T-Bone stEAk”
IL-1 = fever (hot)
IL-2 = stimulates T cells
IL-3 = stimulates BONE marrow
IL-4 = stimulates IgE production
IL-5 = stimulates IgA production

Il-8: “CLEAN UP on AISLE 8”
Il-8 recruits neutrophils to clear infections

cell surface proteins for B cells: “you can drink Beer @ the Bar when you’re 21”
B = B cells
B = epstein-Barr virus
21 = CD-21

“Interferons Interfere with viruses”
interferons = proteins that place uninfected cells in an anti-viral state; induce the production of a ribonuclease that inhibits viral protein

Passive immunity: ” To Be Healed Rapidly”
“after exposure to Tetanus toxin, Botulinum toxin, HBV, or Rabie virus, patients are given preformed AB ” To Be Healed Rapidly”

Type 1 hypersensitivty: “First and Fast”
First = first type
Fast = anaphylaxis

Type 2 hypersensitivity: “type 2 is cy-2-toxic”
cytotoxic (antibody mediated)

Type 3 hypersensitivity: “imagine an immune complex as 3 things stuck together”
antigen-AB-complement

Type 4 hypersensitivity = “4th and last”
delayed

Type 4 hypersensitivity = 4 T’s
T lymphocytes
Transplant rejections
TB skin tests
Touching

hypersensitivities: ACID
A = anaphylactic and atopic (1st)
C = cytotoxic (2nd)
I = immune complex (3)
D = delayed (4)

Bruton’s agammaglobulinemia: Think B’s
Bruton’s
Boys
no B cells maturation

Hyper-IgE syndrome (Job’s syndrome): FATED
F = coarse Facies
A = staphylococcal Abscesses
T = retained primary Teeth
E = increased IgE
D = dermatologic problems (eczema)

Wiskott-Aldrich syndrome: Triad TIE
T = thrombocytopenic purpura
I = infections
E = eczema

fetal erythropoiesis: “Young Liver Synthesizes Blood”
Y = yolk sac (3-10 wk)
L = liver (6wk – birth)
S = spleen (15-30 wk)
B = bone marrow (22 wk – adult)

umbiLical arteries become what postnatal derivative?
mediaL umbilical ligaments

allaNtois becomes postnatal derivative?
urachus aka mediaN umbilical ligament

cardiac output variables: SV CAP
Stroke Volume is affected by:
C = contractility (directly)
A = afterload (inversely)
P = preload (directly)

JVP:
a = a
c = c
v = v
A wave = Atrial contraction
C wave = RV Contraction
V wave = increased right atrial pressure due to filling against a closed tricuspid Valve

sx of aortic stenosis = SAD
S = syncope
A = angina
D = dyspnea on exertion

5T’s of right-to-left shunt –> early cyanosis (blue babies)
Tetralogy (of fallot)
Transposition (of great vessels)
Truncus (persistent t. arteriosus)
Tricuspid (atresia)
TAPVR (total anomalous pulmonary venous return – pulmonary veins drain into SVC)

Tetralogy of Fallot: PROVe
P = pulmonary infundibular stenosis
R = RVH
O = Overriding aorta
V = VSD

INfantile type of coarctation of aorta:
INfantile = IN close to the heart

aDult type of coarctation of aorta
aDult: Distal to Ductus

Patent Ductus Arteriosus: ENDomethacin ENDs patency of PDA while PGE kEEps it open
Indomethacin – close PDA
PGE – keep it open

etiologies of dilated (congestive) cardiomyopathy: ABCCCD
A = alcohol abuse
B = wet Beriberi
C = coxsackie B virus myocarditis
C = chronic cocaine use
C = chagas disease (trypanosoma cruzi)
D = doxorubicin toxicity

most = idiopathic
others: hemochromatosis & peripartum

bacterial endocarditis: “don’t TRI DRUGS”
tricuspid valve endocarditis associated with IV drug abuse

sx of bacterial endocarditis: “bacteria FROM JANE”
F = fever
R = roth’s spots
O = osler’s nodes
M = murmur
J = janeway lesions
A = anemia
N = nail-bed hemorrhage
E = emboli

sx of Rheumatic Fever: “FEVERSS”
F = fever
E = erythema marginatum
V = valvular damage
E = ESR increased
R = red-hot joints (migratory polyarthritis)
S = subcutaneous nodules
S = Sydenham’s chorea

Class Ia anti-arrhythmics: “the Queen Proclaims Diso’s PYRAMID”
Quinidine
Procainamide
Disopyramide

class 1b anti-arrhytmics: “1’d Buy LIDy’s MEXIcan Tacos”
Lidocaine
Mexicletine
Tocainide

class 1b anti-arrhythmics: “1B is Best post-MI”
1B = useful in acute ventricular arrhythmias especially post-MI

class 1c anti-arrhythmics: “1C is Contraindicated in structural heart disease and post-MI”
flecainide and propafenone = contraindicated in structural heart disease or post-MI

class III anti-arrhythmics (K+ channel blockers): “AIDS”
A = amiodarone
I = ibutilide
D = dofetilide
S = sotalol

epidermal layers: “California Like Girls in String Bikinis”
C = corneum
L = lucidum
G = granulosum
S = spinosum
B = basale

CADherins
= CAlcium dependent ADhesion proteins

INTEGRIns
integrins = membrane proteins that maintain integrity of BM by binding to laminin in BM

BULLOus pemphigoid
= BULLOw the BM –> autoantibodies against hemidesmosomes

Rotator cuff muscles: “SItS”
S = supraspinatus
I = infraspinatus
t = teres minor
S = subscapularis

wrist bones: “So Long To Pinky, Here Comes The Thumb”
S = scaphoid
L = lunate
T = triquetrum
P = pisiform
H = hamate
C = capitate
T = trapezoid
T = trapezium

Radial nerve muscle innervation: “BEST extensors”
B = brachioradialis
E = extensors of wrist and fingers
S = supinator
T = triceps

“Pope’s blessing”
caused by proximal median nerve lesion

Hand Muscles: OAF
Oppose, Abduct, Flex

interosseous hand muscles: DAB
Dorsals ABduct

interosseous hand muscles: PAD
Palmars ADduct

peroneal nerve: PED
Peroneal Everts and Dorsiflexes

if injured, foot dropPED

tibial nerve: TIP
Tibial Inverts and Plantarflexes

if injured, can’t stand on TIPtoes

muscle contraction: HIZ shrinkage
shortening of H and I bands and between Z lines

muscle contraction: A band is Always the same length
A band remains the same length

“1 slow red ox”
Type 1 muscle fibers
slow twitch
red fibers
increased oxidative phosphorylation

oteoBlasts
osteoBlasts Build Bone

Ewing’s Sarcoma: “going out for Ewings and onion rings”
onion skin appearance in bone

Patrick EWING’s jersey # = 11 + 22 = 33
associated with translocation t(11;22)

gonoccocal arthritis is an STD
S = synovitis
T = tenosynovitis
D = dermatitis

seronegative spondyloarthropathies: PAIR
P = psoriatic arthritis
A = ankylosing spondylitis
I = inflammatory bowel disease
R = reactive arthritis

Reactive Arthritis: “can’t see, can’t pee, can’t climb a tree”
classic triad: conjunctivitis, urethritis, arthritis

SLE: “I’M DAMN SHARP”
I = immunoglobulins (anti-dsDNA, anti-Sm, antiphospholipid)
M = malar rash
D = discoid rash
A = antinuclear antibody
M = mucositis
N = neurologic disorders
S = serositis
H = hematologic disorders
A = arthritis
R = renal disorders
P = photosensitivity

scleroderma: C for Crest
C = antiCentromere antibody
C = calcinosis
R = raynaud’s phenomenon
E = esophageal dysmotility
S = sclerodactyly
T – telangiectasia

6’s P’s of Lichen Planus
pruritic
purple
polygonal
planar
papules
plaques

ABCDE of melanoma
A = asymmetry
B = border irregularity
C = color variation
D = diameter >6mm
E = evolution over time

L for Lipoxygenase and Leukotriene
lipoxygenase pathway yields leukotrienes

Neutrophils arrive B4 others
LTB4 is a neutrophil chemotactic agent

PGI2
Platelet gathering inhibitor

etanerCEPT is a TNF decoy reCEPTor

The L’s of the left lung
Left has 2 Lobes and a Lingula

relation of pulmonary artery to bronchus: RALS
Right Anterior
Left Superior

T12 of diaphragm: “@ T-1-2 it’s the red, white, and blue”
red = aorta
white = thoracic duct
blue = azygos vein

“I ate ten eggs at twelve”
I = IVC
ate = T8
ten = T10
eggs = esophagus
at = aorta
twelve = T12

C3, 4, 5 keeps the diaphragm alive
diaphragm is innervated by C3, 4, and 5 = phrenic nerve

muscles of respiration for inspiration during exercise: “S”
inSpiration, Scalene muscles, Sternocleidomastoids

physiologic dead space: “Taco, Paco, PEco, Paco”
order of variables in the equation:

VT x ((PaCO2 – PECO2)/PaCO2)

hemoglobin: Taut in Tissue, Relaxed in Respiratory
Taut form has low affinity for O2 –> delivers O2 to tissue
Relaxed form has high affinity for O2 –> acquires O2 in lungs

METHemoglobinemia can be treated with METHylene blue

causes of a Right shift in oxy-hemo dissociation curve:
C-BEAT
C = Co2 (increased)
B = BPG (increased)
E = exercise
A = acid/altitude
T = termperature

types of PE: an embolus moves like a FAT BAT
F = fat
A = air
T = thrombus
B = bacteria
A = amniotic fluid
T = tumor

SPHERE of complications in lung cancer
S = superior vena cava syndrome
P = pancoast tumor
H = horner’s syndrome
E = endocrine (paraneoplastic)
R = recurrent laryngeal symptoms
E = effusion (pleural or pericardial)

lung cancer types not associated with cancer: think “br”
BRonchioloalveolar (adenocarcinoma)
BRonchial carcinoid tumor

“A”‘s of small cell carcinoma
ACTH
ADH
Antibodies against presynaptic calcium channel
amplification of myc oncogenes

“C”s of squamous cell carcinoma
cavitation
cigarettes
hyperCalcemia

Babies who can’t “Pee” in utero develop “Potter’s”
potter’s syndrome – caused by oligohydramnios

“water under the bridge”
ureters pass under the uterine artery and the vas deferens

HIKIN’: HIgh K INtracellular
potassium located intracellularly

DO Insulin LAB work for patients with hyperkalemia?
shifts K+ OUT of cells:
Digitalis
hyperOsmolarity
Insulin deficiency
Lysis of cells
Acidosis
Beta-blockers

INsulin shifts K+ INto cells
insulin can cx hypokalemia

high serum concentrations of calcium: “stones, bones, groans, psychiatric overtones”
renal stones
bone pain
abdominal pain
anxiety, altered mental status

increased anion gap: “MUDPILES”
Methanol (formic acid)
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tablets or INH
Lactic acidosis
Ethylene glycol
Salicylates (late)

normal anion gap: “HARD-ASS”
Hyperalimentation
Addison’s disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Sprionolactone
Saline infusion

nephrItic syndrome
= an Inflammatory process

WAGR complex
wilm’s tumor
aniridia
genitourinary malformation
retardation

transitional cel carcinoma is associated with problems in your “Pee SAC”
Phenacetin
Smoking
Aniline dyes
Cyclophosphamides

“ACID”azolamide causes ACIDosis
acetazolamide causes hyperchloremic metabalic acidosis

furosemide toxicity: “OH DANG”
Ototoxicity
Hypokalemia
Dehydration
Allergy (sulfa)
Nephritis (interstitial)
Gout

HCTZ toxicity: “HyperGLUC”
hyperglycemia
hyperlipidemia
hyperuricemia
hypercalcemia

K+ sparing diuretics: “the K+ STAys”
spironolactone (and eplerenone)
triamterene
amiloride

toxicity: captopril’s CATCHH
Cough
Angioedema
Teratogen
Creatinine increase
Hyperkalemia
Hypotension

3 M’s of Mesoderm
Microglia like Macrophages originate from Mesoderm

the hypothalamus wears TAN HATS
Thirst and water balance
Adenohypophysis control
Neurohypophysis releases hormones produced in the hypothalamus
Hunger
Autonomic regulation
Temperature regulation
Sexual urges

lateral area of the hypothalamus: “if you zap your lateral nucleus, you shrink laterally”
lateral areas controls hunger –> destruction causes anorexia and failure to thrive

ventromedial area of hypothalamus: “if you zap your ventromedial nucleus, you grow ventrally and medially”
ventromedial nucleus controls satiety –> desctruction causes hyperphagia

A/C = anterior cooling
anterior nucleus of hypothalamus = cool off (cooling, parasympathetic)

posterior nucleus of they hypothalamus: “if you zap your posterior hypothalamus, you become a poikilotherm”
posterior nucleus = gets fired up (heating, sympathetic)

suprachiasmatic nucleus of the hypothalamus: “you need sleep to be charismatic”
suprahciasmatic nucleus controls circadian rhythm

“Makeup goes on the face”
vpM nucleus – face sensation and taste

Lateral = Light
LGN – vision

Medial = Music
MGN – hearing

the famous 5 F’s of the limbic system
Feeding
Fleeing
Fighting
Feeling
Sex

deep nuclei of the cerebellum (lateral –> medial): “Don’t Eat Greasy Foods”
Dentate
Emboliform
Globose
Fastigial

D1 Receptor of basal ganglia = D1Rect pathway

INdirect pathway of the bg = INhibitory

parkinson’s dx: Your body becomes a TRAP
Tremor
cogwheel Rigidity
Akinesia
Postural instability

5 C’s of Huntington’s
CAG repeats
Caudate loses ACh and GABA
Chorea
Chromosome 4
Crazy (dementia)

Huntington’s: CAG
expansion of CAG repeats

Caudate lose Ach and Gaba

Broca’s Broken Boca

Wernicke’s is Wordy but makes no sense – Wernicke’s = What?

“don’t PICK A HORSE that CAN’T”
PICA stroke: hoarseness and dysphagia

“FACIAL DROOP means AICA’s POOPED”
AICA stroke –> paralysis of face

foramina of Luschka = Lateral

foramen of Magendie = Medial

“wet, wobbly, and wacky”
clinical triad of normal pressure hydrocephalus:
urinary incontinence
ataxia
cognitive dysfunction

lumbar puncture: to keep the cord alive, keep teh spinal needle between L3 and L5

Legs are Lateral in Lateral corticospinal and spinothalamic tracts

Lower MN lesions = everything is LOWERED
less muscle mass, decreased muscle tone, decreased reflexes, downgoing toes

UPper MN = everything UP
increased tone, increased DTRs, toes up

Friedreich’s ataxia: Friedreich is Fratastic: he’s your favorite FRAT brother, always stumbling, staggering and falling
staggering gait
frequent falling

Horner’s syndrome: PAM is HORNy
Ptosis
Anhidrosis
Miosis

T4 @ the teat pore
T4 = nipple

T10 @ the belly butTEN
T10 = umbilicus

L1 is IL
Inguinal Ligament

Down on ALL 4’s (L4)
L4 includes the kneecaps

S2, 3, 4 keep the penis off the floor
S2, S3, S4 keep the penis off the floor

CNs that lie medially @ brainstem: 3(x2) = 6(x2) = 12
III, VI, and XII

your eyes are above your ears, and the superior colliculus (visual) is above the inferior colliculus (auditory)

Cranial Nerves: Some Say Money Matters But My Brother Says Big Boobs Matter Most
S = sensory
M = motor
B = both

S = 1, 2, 8
M = 3, 4, 7, 11, 12
B = 5, 9, 10

nucleus Solitarius = visceral Sensory information

nucleus aMbiguus = Motor innervation of pharynx, larynx, and upper esophagus

Divisions of CN V exit owing to Standing Room Only
V1 = Superior orbital fissure
V2 = foramen Rotundum
V3 = foramen Ovale

M’s Munch and Lateral Lowers
Masseter, teMporalis, and Medial pterygoid close jaw
Lateral pterygoid opens

LR6SO4R3
6 innervates the Lateral Rectus
4 innervates the superior oblique
3 innervates the rest of the extraocular muscles

IOU: to test the inferior oblique, have the patient look up

Charcot’s classic triad of MS is a SIN
Scanning speech
Intention tremor, Incontinence, Internuclear opthalmoplegia
Nystagmus

Tuberous Sclerosis: HAMARTOMAS
Hamartomas in CNS and skin
Adenoma sebaceum
Mitral regurgitation
Ash-leaf spots
cardiac Rhabdomyoma
Tuberous Sclerosis
autosomal dOminant
Mental retardation
renal Angiomyolipoma
Seizures

“tram it all” in with tramadol
tramadol works on multiple neurotransmitters

ethosuximide: EFGH
Ethosuximide
Fatigue
GI
Headache

barbiDURATes increase DURATion

FREnzodiazepines increase FREquency
they increase the frequency of the chloride channel opening

IV anesthetics: BB King on OPIOIDS PROPOses FOOLishly
Barbituates
Benzodiazepines
Ketamine
Opioids
Propofol

amIdes have 2 I’s in name
lidocaine
mepivacaine
bupivacaine

dopamine agonists: BALSA
Bromocriptine
Amantadine
Levodopa
Selegiline
Antimuscarinics

sumatriptan: a SUMo wrestler TRIPs ANd falls on your HEAD
used to tx cluster headache attacks

HeteroChromatin = Highly Condensed

Methylation makes DNA Mute
histone methylation inactivates transcription of DNA

Acetylation makes DNA Active
histone acetylation relaxes DNA coiling, allowing for transcription

PURe As Gold
Purines = A & G

CUT the PYRamid
pyrimidines = C, U, and T

THYmine has the meTHYl
thymine has a methyl group

amino acids necessary for purine synthesis: GAG
Glycine
Aspartate
Glutamine

nucleoSide
base + ribose (Sugar)

nucleoTide
base + ribose + phosphaTe

Lesch-Nyhan Syndrome: “He’s Got Purine Recovery Trouble”
absence of HGPRT enzyme

STOP the NONSENSE!
nonsense mutation = change resulting in early stop codon

types of RNA: Rampant, Massive, and Tiny
rRNA = most abundant
mRNA = longest
tRNA = smallest

codons: AUG inAUGurates protein synthesis
AUG = start codon

stop codons:
UGA = U Go Away
UAA = U Are Away
UAG = U Are Gone

INtrons are INtervening sequences and stay IN the nucleus, whereas EXons EXit and are EXpressed

tRNA: CCA: Can Carry Amino acids
CCA is attached at 3′ end of tRNA and amino acid is covalently bound to the 3′ end

Eukaryotes = Even
40S + 60S –> 80S

prOkaryotes = Odd
30S + 50S –> 70S

ATP tRNA Activation (charging)

GTP – tRNA Gripping and Going places (translocation)

tRNA: elongation think of “going APE”
A site = incoming Aminoacyl-tRNA
P site = accommodates growing Peptide
E site = holds empty tRNA as it Exits

collagen: Be So Totally Cool, Read Books
B = bone
S = skin
T = tendon
C = cartilage
R = reticulin
B = books

type 1 collagen: bONE

type II collagen: cartwolage

type III collagen: THREE-D
defective in Ehlers-Danlos

type IV collagen: under the floor (BM)
basement membrane

blotting procedures: SNoW DRoP
southern = DNA
northern = RNA
western = protein

16 letters in “polycystic kidney”
ADPKD associated with mutated gene on chromosome 16

5 letters in “polyp”
familial adenomatous polyposis = mutated APC gene on chromosome 5

“Hunting 4 food”
huntington’s disease – repeat on chromosom 4

17 letters in “von Recklinghausen”
von recklinghausen’s disease (neurofibromatosis type 1) associated with chromosome 17

type 2 = 22
neurofibromatosis type 2 associated with gene on chromosome 22

von hippel-lindau = 3 words
associated with deletion of VHL gene on chromosome 3

X-linked recessive disorders: Be Wise Fool’s GOLD Heeds Silly HOpe
Bruton’s agammaglobulinemia
Wiskott-Aldrich syndrome
Fabry’s disease
G6PD deficiency
Ocular albinism
Lesch-Nyhan Syndrome
Duchenne’s (and Becker’s) muscular dystrophy
Hunter’s Syndrome
Hemophilia A and B
Ornithin transcarbamoylase deficiency

Duchenne’s = Deleted Dystrophin

Fragile X = eXtra large testes, jaw, ears

trinucleotide repeat do: “Try hunting for my fried eggs”
trinucleotide
huntington’s
myotonic dystrophy
friedreich’s ataxia

trinucleotide repeats: “X-Girlfriend’s First Aid Helped Ace My Test”
fragile X = cGg
Friedreich’s ataxia = gAa
Huntington’s = cAg
MYotonic dystrophy = cTg

Trisomies:
Drinking Age = 21
Election Age = 18
Puberty = 13
trisomy 21 = Down’s
trisomy 18 = Edwards
trisomy 13 = Pataus

CATCH-22
cleft palate
abnromal facies
thymic aplasia
cardiac defects
hypocalcemia 2? to Parathyroid aplasia
chromosome 22q11

PAIR
Seronegative arthropathies, associated with HLA-B27:

P – Psoriatic arthritis
A – Ankylosis spondylitis (SI joint)
I – Inflammatory bowel dz (UC)
R – Reiter’s syndrome (“can’t see, can’t pee, can’t climb a tree”)

NO Rheumatic factor

Hot T-Bone stEAk
Important interleukin cytokines:

IL-1: fever (hot)
IL-2: T cell stimulator
IL-3: Bone marrow stimulator (sim to GM-CSF)
IL-4: IgE (class switching from IgG), B cell growth
IL-5: IgA, eosinophils

GM makes classic cars
IgG and IgM activate the classic complement pathway (Ag:Ab complexes –> C1…)

C3a, C5a
Anaphylaxis

C3b
opsonization. Binds Bacteria.

To Be Healed Rapidly
Exposure to the following is indication for receiving preformed Ab’s (i.e., passive immunity):

T – Tetanus toxin
B – Botulinum toxin
H – HBV
R – Rabies virus, RSV

Note IgG half life = 21 days

ACID
Types of hypersensitivity:

Type I: Anaphylactic and Atopic
Type II: Cytotoxic (antibody-mediated)
Type III: Immune complex
Type IV: Delayed (cell mediated)

4 T’s
4 T’s of Delayed (T-cell-mediated) type hypersensitivity (IV).

T lymphocytes
Transplant rejections
TB skin tests
Touching (contact dermatitis – poison ivy)

MECH – sensitized T cells encounter Ag –> release lymphokines –> mac activation.

NO Ab involved!

FATED
Hyper-IgE syndrome (Job’s):

F – Facies (coarse)
A – Abscesses – COLD!, noninflammed staph
T – Teeth – retained primary
E – increased IgE!
D – Dermatologic (eczema)

MECH – cells fail to produce IFN-gamma –> inability of neutrophils to respond to chemotactic stimuli

TIE
Triad of Wiskott-Aldrich syndrome:

T – Thrombocytopenic purpura
I – Infections
E – Eczema

MECH – XR, progressive deletion of B and T cells

Labs: decreased IgM, (& increased IgE and IgA)

REd =
REd = REperfusion

Red (hemorrhagic) infarcts occur in loose tissues with collaterals (liver, lungs, intestine) following reperfusion –> damage by free radicals.

Neutrophils love the feeling of CILK
Neutrophil chemotactic factors:

C – C5a
I – IL-8
L – Leukotriene B4
K – Kallikrein

“What Grade did you get in Histo?
Tumor grading is the degree of cellular differentiation based on histological appearance.

TNM
Tumor staging system:

T – size of Tumor
N – Nodal involvement
M – Metastases

Stage = Spread

L-myc, N-myc
Oncogenes. Gain of function mutation in one allele –> cancer.

L-myc: Lung tumor
N-myc: Neuroblastoma (adrenal!)

K-ras, H-ras, N-ras
Oncogenes. Gain of function mutation in one allele –> cancer.

K-ras: Kolon, panKreatic
H-ras: (Hematuria) – bladder and kidney tumors
N-ras: melaNomas

DPC, DCC
Tumor suppressor genes:

DPC – Deleted in Pancreatic Cancer
DCC – Deleted in Colon Cancer

TRAP the hairy B cell
Tumor marker for hairy cell leukemia – a B cell neoplasm

Tartrate-resistant acid phosphatase.

PSaMMoma
Psammoma bodies – laminated, concentric, “rings on a tree” spherical calcifications:

P – Papillary (adenocarcinoma of thyroid)
S – Serous (cystadenoma of ovary)
M – Meningioma
M – Mesothelioma (asbestos exposure)

Lots of Bad Stuff Kill Glia
Metastases to brain (# metastases = # primary brain tumors):

Lung, Breast, Skin (melanoma), Kidney (RCC), GI

Typically, multiple well-circumcribed tumors at gray-white border.

Cancer Sometimes Penetrates Benign Liver
Metastases to liver (metastases >> primary liver tumors):

Colon, Stomach, Pancreas, Breast, Lung.

*Think breast & lung, plus what is drained by portal venous system to liver.

P.T. Barnum Loves Kids
Metastases to bone (metastases >> primary):

Prostate, Thyroid, Breast, Lung, Kidney

Lung = Lytic (IL-1)
Prostate = blastic

PEA
Drugs with zero order elimination

P – Phenytoin
E – Ethanol
A – Aspirin (at high or toxic concentrations)

Rate of elimination is constant, regardless of concentration.

Constant amount (NOT fraction) of of drug eliminated per unit time.

TILE
Therapeutic Index equation:

TI = LD50 / ED50

Safer drugs have higher TI’s

“Qiss and qiq till you’re siq of sqs”
G-protein linked 2nd messengers:

q – alpha 1 – vasoconstriction –> inc BP
i – alpha 2 – dec sympathetic outflow
s – beta 1 – inc HR, contractility, renin, lipolysis
s – beta 2 – vaso-/bronchodilation, inc HR

q – M1 – CNS, ENS
i – M2 – dec HR, dec contractility of atria
q – M3 – peristalsis, gastric acid, bronchoconstriction, miosis, accommodation

“Qiss and qiq till you’re siq of sqs”
G-protein linked 2nd messengers:

s – D1 – relaxes renal vascular sm muscle
i – D2 – modulates NT release, esp in brain
q – H1 – (nasal, bronchial mucus production)

s – H2 (gastric acid secretion)
q – V1 – vasopressin (sm m contraction)
s – V2 – vasopressin (inc H2O permeability)

HAVe 1 M&M
Receptors that use the Gq pathway:

H1, alpha-1, V1, M1, M3

Gq -> phospholipase C -> -> IP3 (-> Ca++ from ER) + DAG (-> Protein Kinase C)

MAD 2’s
Receptors that use the Gi pathway:

M2, alpha-2, D2

Gi –> inhibition of Adenylate cyclase –> dec cAMP –> dec protein kinase A

DUMBBELSS
S/S of cholinesterase inhibitor poisining (i.e., excessive parasympathetic activity):

D – diarrhea
U – urination
M – miosis
B – bradycardia
B – bronchospasm
E – excitability of skeletal musles
L – lacrimation
S – sweating
S – salivation

Caused by parathion = organophosphate = insecticide

Antidote = atropine + pralidoxime (regenerates active cholinesterase)

Side effects of atropine
Hot as a hare (inc body temp)
Dry as a bone (dry mouth, skin)
Red as a beet (flushed skin)
Blind as a bat (cycloplegia, mydriasis)
Mad as a hatter (delirium)
Bloated as a toad (constipation, urinary retention)

Blow
low doses of epinephrine are selective for beta-1 receptors –>

Adrenal Cortex (zones/hormones)
GFR – Salt/Sugar/Sex (outer to inner)
zona Glomerulosa (aldosterone)
zona Fasciculata (Cortisol, sex)
zona Reticularis (sex hormones)

Anterior Pituitary
“B-FLAT”
– Basophils – FSH, LH, ACTH, TSH
“PiG”
– Acidophils: GH, prolactin

Insulin Independent Glucose Uptake
“BRICK-L” = Insulin Independent
-Brain, RBCs (Glut 1)
-Intestine (Glut 2)
-Cornea
-Kidney (Glut 2)
-Liver (Glut 2)

Summary of Cortisol Action
“Cortisol is BBIIIG”
– maintains Blood pressure (upregulates alpha1 which increases sensitivity to catecholamines)
– Bone formation decreases
– anti-Inflammatory (leukotrienes, prostoglandins, histamine, neutrophil adhesion, IL-2)
– Insulin resistance (diabetogenic)
– Inhibits Fibroblasts (thinning of connective tissue leads to striae)
– Gluconeogenesis, lipolysis, proteolysis

Actions of PTH
“Buy Calcium and Phosphate Declines”
– Bone resorption of Ca, PO4-
– Ca reabsorption in DCT
– PO4: decrease reabsorption in PCT
– D3 (calcitriol): increase in active vitamin D (PTH Stimulates kidney 1alpha hydroxylase)

Endocrine Hormones Signalling through Gs/AC/cAMP
“FLAT ChAMP”
– FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2 receptor – kidney), MSH, PTH
– Calcitonin, GHRH, Glucagon

Endocrine Hormones Signalling through cGMP
– ANP
– NO (EDRF)

Endocrine Hormones Signalling through Gs/PLC/IP3-DAG-Ca
“GOAT HAG”
– GnRH, Oxytocin, ADH (V2 receptor – smooth muscle), TRH
– Histamine (H1), Angiotensin II, Gastrin

Endocrine Hormones Signalling through Steroid Receptor
“VETTT CAP”
Vitamin D, Estrogen, Testosterone, T3/T4, Cortisol, Aldosterone, Progesterone

Endocrine Hormones Signalling through Intrinsic Tyrosine Kinase (MAP Kinase pathway)
Insulin, IGF-1, FGF, PDGF, EGF
– think growth factors
also VEGF, NGF, M-CSF

Endocrine Hormones Signalling through non-receptor Tyrosine Kinase (JAK/STAT pathway)
“PIG”
-Prolactin
-Immunomodulators (e.g. cytokines: IL-2, IL-6, IL-8, IFN)
-GH
Think acidophiles and cytokines
also erythropoeitin, alpha/gamma-interferon, GM-CSF

Thyroid Hormone Function (especially T3 in tissue)
“4 B’s”
-Brain maturation (cretinism)
-Bone Growth (synergism with GH)
-Beta-adrenergic (mainly beta1?) effects (increase CO, HR, SV, contractility)
– Basal Metabolic Rate Increases via Na/K ATPase activity = Increase 02 consumption, RR, body temp

Pheochromocytoma Characteristics
“Rule of 10’s”
-10% malignant, 10% bilateral, 10% extra-adrenal, 10% calcify, 10% kids
“5-P’s”
– Pressure (increase BP), Pain (headache), Perspiration, Palpitations (tachycardia), Pallor

Cretinism
“5 P’s”
-Pot-bellied
-Pale
-Puffy-faced child with Protruding umbilicus and Protuberant tongue

primary tooth that has the most distinctly prominent facial cervical ridge is
mn 1st molar

which primary tooth tooth usually has cusp of carabelli?
mx 2nd molar

primary tooth that has oblique ridge?
mx 2nd molar

primary 2nd molar has ____ cusps than primary 1st molar
more cusps

cervical ridge is most prominent for primary MAX tooth on the _____ surface of the ____
MF surface of mx 1st molar

last primary teeth to erupt is
mx 2nd molar

only primary posterior tooth to have oblique and transverse ridges and DL groove
2nd molar

mandibular primary primate space is between
canine and first molar

primary maxillary 1st molar has crown that resembles what permanent teeth?
permanent premolar

primary maxillary 1st molar has roots that resembles what permanent teeth?
permanent molar

facial view of primary mn 1st molar, the CEJ is most apically positioned towards what
mesial 1/3

usual pattern for eruption for primary teeth is
central, lateral, 1st molars, canines, 2nd molars

(mn before mx except lateral incisors)

primary mn 1st molar usually exhibits
distal triangular fossa

primary central incisors exhibits prominent cervical ridge where
facial and lingual surfaces

from facial view, crown of primary canine has mesio-incisal slope _____ than the distoincisal
longer

cusp tip of primary canine is generally off set to the
distal

T/F: primary molar lacks identifiable root trunk
true

which teeth has the smallest faciolingual crown dimension of all teeth
primary mn central incisors

which primary tooth has most distinct transverse ridge?
primary mn 1st molar

roots are more divergent in primary tooth than in permanent tooth

primary teeth that differs most from permanent teeth is
1st molars

highest and sharpest cusp on primary mn1 st molar is
ML cusp

calcification of primary roots is usually done at
3-4 years of age

primary max 1st molar most often bears the greatest resemblance to
premolar

primary 1st mn molar does not look like any permanent tooth

primary 1st max molar resembles
premolar

primate space develops in maxillary primary dentition between
laterals and canines

primate space develops in mandibular primary dentition between
canines and 1st molars

direction of primary enamel rods in the cervical third is in a _____ direction
occlusal

primary teeth are ____ mineralized than permanent teeth. Therefore, they are ____
less mineralized

therefore, more worn

primary spacing for anterior teeth is most frequently caused by
growth of the dental arches

difference in space from primary to permanent dentition is
2-4 mm

mamelons that remain beyond age 10 generally indicate
open bite

groove pattern for the mn 1st molar is considered a
Y or Dryopethicus pattern

groove pattern for the mn 2nd molar is considered a
+ or cross pattern

occlusal outline from an occlusal view for the mx 1st molar is
rhomboid

cross section of the mn canine at the CEJ is
ovoid but wider mesiodistally at the labial side.

occlusal outline from an occlusal view for the mn 1st premolar is
diamond

crown form of canines from a facial view is
pentagonal

when viewed from the occlusal , the arrangement of teeth are
parabolic

viewed from the occlusal, the 4 posterior teeth in the mn arch are aligned in _____
a straight line

viewed from the occlusal, the basic coronal outline of a mn 2nd premolar is
pentagonal

geometric form of anterior teeth when viewed from the proximal is
triangular

from facial or lingual view, canines have a ______ outline
pentagonal

cervical cross section of the max 1st premolar exhibits ____ shaped root outline
kidney shaped

cervical cross section of the max 1st premolar exhibits ____ shaped pulp chamber floow
kidney shaped

cross sectional outline at the cervical is roughly _______ for the permanent max 2nd molars
triangular

in cross section, the root of the mn canine is
irregularly ovoid

max 3rd molars from an occlusal view frequently have _____ shape because they are missing the DL cusp
heart shaped

non-working condyle moves
1. downward
2. forward
3. medial

side shift of the mandible is also known as the
Bennett movement

the upper compartment of the TMJ is that space between
disc and the articular fossa and eminence

thickest section of the articular disc when seen in the sagittal plane is the
posterior section

anterior guidance plays the greatest role in disoccluding the posterior teeth in ______
latero-protrusive manner

anterior guidance describes
the influence on mandibular movement provided by the contact between the anterior teeth as the mandible moves through excursive movements

Mandibular movement provided by the contact between the anteriors as the mandible moves through excursive movements
anterior guidance

During protrusive movements, the (anterior/posterior) teeth should disclude immediately
posterior

In optimal occlusion, the condyles are resting on the (anterior/posterior) slopes of the articular eminences
posterior

In optimal occlusion, the condyles are in their most super (posterior/anterior) position
anterior

ligaments associated with teh TMJ serve to
1. protect surrounding and supporting tissues from damage

physiological rest position is established when mastication muscles are in
tonic equilibrium

principle muscle that retrudes the mandible are
posterior fibers of the termporalis m

what ligament limits the extend of jaw opening?
temporomandibular ligament

temporomandibular ligament initiates _______ of the condyle down the articular eminence
translation

extrinsic muscle of the tongue that causes tongue to retract?
styloglossus

bennet movement occurs during the ______ earliest stage of lateral movement
earliest

muscles primarily for protrusive movement?
lateral pterygoid muscles

prime mover in effecting left working movement
right lateral pterygoid

TMJ has how many synovial cavities?
2 (upper and lower)

condyle on the working side generally rotates about a ______ axis and translates ______
rotates about a vertical axis and translates laterally

Bennett movement is the bodily shift of the mandible towards the _____ condyle
working condyle

TMJ is protected by
synovial fluid
fibrocartilage
ligament suspension
masticatory muscles

dsk of the TMJ is moved forward mainly by
superior head of the lateral pterygoid

intercuspal position is mainly determined by
tooth contact

physiological rest position is a ____ guided position
muscle guided

centric relation is a _____ guided position
ligament guided

centric occlusion =
intercuspal position

teeth contact in intercuspal position during ______
NON masticatory swallowing

forward movement of the condyle from the articular fossa is done by
lateral pterygoid m

physiological rest is a also called
postural position

in posselt’s envelop of motion, which is the most superior point
maximum intercuspal position

in posselt’s envelop of motion, which is the most inferior point
maximum opening

glenoid fossa is a
depression in the temporal bone, just anterior to the auditory canal

what covers the articulating osseous structures of the TMJ?
dense avascular fibrous CT

which muscle does not elevate the mandible?
lateral pterygoid m.

lower compartment of the TMJ is located between
condyle and disk

when the mandible moves from CO (centric occlusion) to edge to edge, the condyles move
forward and downward

An increased horizontal overlap necessitates (shorter/taller) cusps on posterior teeth
shorter

An increased horizontal overlap necessitates (shallower/deeper) grooves on posterior teeth
shallower

A decreased horizontal overlap accommodates (shorter/taller) cusps on posterior teeth
taller

An decreased horizontal overlap necessitates (shallower/deeper) grooves on posterior teeth
deeper

Protrusive path is also known by what 2 other names?
1. angle of eminence
2. condylar inclination (CI)

(Steep/flat) condylar inclination produces rapid disclusion
steep

The (posterior/anterior) teeth control guidance of the mandible, whereas the (posterior/anterior) teeth determine it’s superior closing movement
anterior, posterior

transverse ridge results from the union of
facial and lingual triangular ridges

for multi-rooted teeth, dentin continues to form MOST rapidly at the
floor and the roof of the pulp chamber

dentin that is most highly mineralized is
intra or peritubular dentin

there a total of ___ teeth in the permanent dentition that normally have cingulums
12

(all anterior teeth generally have cingulums)

softest dental tissue
cementum

hardest dental tissue
enamel

all premolars are wider
FL than MD

_____ fibers of the PDL provide the major support for a tooth during function
Oblique fibers

pulp chamber of a major tooth contains
blood vessels and nerves

occlusal table of a posterior tooth makes up _____ of the total FL dimension
55-65%

in a healthy mouth, the alveolar process is thinnest around _____
facial of the mandibular central incisors

epithelial attachment is always an actual part of a tooth’s periodontium

continued eruption of a tooth through the surrounding tissue makes the clinical crown appear ____
longer

for molar teeth, the root canals join the pulp chamber ______ to the CEJ
apical

_____ periodontal fibers travel from 1 root to an adjacent root surface
transseptal

overjet and overbite provide some degree for protection for lips, cheeks and tongue

caries stimulate the production of
tertiary dentin

hypercementosis is
excess of calcified tissue formation at the root apex

predominant CT in PDL fibers is
collagen (produced by fibroblasts)

facial view: the apex of the lingual root is in line with the _______
facial groove of the tooth

the number of lobes that form the anterior teeth is
4

curve of spee
anterior posterior curvature of the occlusal surfaces as seen in a facial view

oblique PDL ligament fibers reduce the likelihood of a
forceful impaction into the alveolus

height of contour is in the _______ for the facial surfaces of all teeth
gingival 1/3

concrescence
cemtnal union of 2 fully formed teeth that were originally separate entities

apex of a tooth is fully formed _____ years after it erupts in the mouth
2-3 years

number of lobes that form the posterior teeth
coincides with the number of cusps

cervical line of permanent teeth has the greatest depth of curvature on the _____ aspect
mesial

from the proximal view, the incisal ridge of the crown is in line with the
center of the root

perikymata are the result of
normal enamel apposition

oblique periodontal ligament fibers are most likely to be found in the _____ of the root
middle 1/3

accessory pulp canals may be found in the ____ 1/3 of the root
cervical

accessory pulp canals may contain _____
nervous and vascular tissue

accessory pulp canals may be found in the furcation areas of molars

accessory pulp canals allow the pulp tissue to communicate with the ____
PDL space

function of the pulp is
to form and supply nutrients to dentin and transmit sensory stimuli

primary function of the dental pulp is to form
dentin

shortest interdental papilla is between
mandibular 2nd premolar and 1st molar

percentage of dentin that is organic is
20-30%

interradicular fibers are NOT periodontal fibers

approximately ____ of permanent root formation is completed at the time the tooth erupts
50%

development grooves separates cusp ridges from
marginal ridges

facial masticatory mucosa (attached gingival) is narrowest for
mn 1st premolar

DEJ occurs at the junction of
the dental papilla and inner enamel epithelium

maintenance of the epithelial attachment is NOT a function of the PDL

PDL fibers are made up of
collagen

PDL fibers support the tooth connecting to the dental alveolar bone via the
cementum

supernumerary teeth when seen in the maxillar are usually found between
centrals or as 4th molars

main component of enamel
inorganic matter (not collagen)

direction of the enamel rods in permanent teeth in the cervical 3rd s in a _____ direction
gingival

usual overjet is ____ mm
2-4 mm

difference in space from primary to permanent dentition is ____ mm
2-4

all teeth have distal and mesial marginal ridges

primary pulp horns are _____ in primary molars
higher

pulp chambers of primary tooth are ____
larger

crowns of primary anterior teeth are______MD and shorter incisocervically than permanent counterparts
wider

roots of primary anterior teeth taper _______ than their permanent counterparts
more rapidly

roots of primary molars are _____ and _____ than permanent counterparts
longer and mores lender

enamel ends on primary teeth ends abruptly at the cervical line which is different from permanent teeth
enamel of permanent becomes thinner at the cervical line

occlusal table of primary mn 1st molar
rhomboid

with DF angle as botuse

primary 1st and 2nd molars 1st show calcification at _____
5-6 months in uteral

when are the roots of a deciduous tooth completely formed?
in about 1 year after eruption of that tooth

first tooth to ever erupt
primary mn central incisor

*at about 6.5 months

1st permanent tooth to begin calcification
mn 1st molar (at birth)

1st succedaneous tooth to erupt
mn central incisor

(around 6-7 yrs old)

mn and mx molars are NOT succedaneous

permanent max central incisors erupt at around
7-8 years of age

permanent max lateral incisors erupt at around
8-9 years of age

hardest tooth to have class II cavity prep
primary mn 1st molar

only incisor with MD diameter greater than crown height
max inciors

largest permanent tooth
max 1st molar

largest primary tooth
mn 2nd molar

permanent occlusal pit groove pattern of primary max 1st molar is
H shaped

permanent mn 1st molar most closely resembles which primary tooth?
primary mn 2nd molar

primary teeth to have the greatest FL diameter
primary 2nd molars

primary teeth with most noticeable morphologic deviations from permanent teeth are
1st molars

apnea occuring after hyperventilation is due to
decreased carbon dioxide tension

apnea
temporary cessation of breathing, especially during sleep

strong stimulation of spindles in the masseter muscle causes
contraction of the muscle

Lecithin hydrolysis yields
2 fatty acids, 1 glycerol, 1 phosphoric acid and 1 choline residue

pantothenic acid is an integral part of
coenzyme A

which AA lessens the need for phenylalanine?
tyrosine

type of bond that link AA to form proteins
amide

most immediate source of oxaloacetic acid during metabolism is
aspartic acid

neutral fats contain mixtures of 1 or more fatty acids esterfied with
glycerol

vitamin A functions to
promote differentiation of epithelial cells

starch
1. insoluble
2. energy store in plants
3. large amount of a-glucose molecules

Amylose
straight chain

amylopectin
highly branched with alpha 1,6 linkages

diassacharide are 2 sugar units joined together by ______ bond
covalent

maltose
2 glucose molecules

lactose
glucose and galactose

sucrose
glucose and fructose

miosis
constriction of the pupil of the eye

(done by short ciliary nerves of the eye for accomodation, which are innervated by parasympathetics from CN III)

myopia
nearsightedness

*eye is too long for refractive power of the lens
*focus at point in front of retina

in myopia, cornea is
steeper and eye is longer than nomral eye

to treat myopia, you need _____ lenses
concave

hyperopia
farsightedness

*eye is too short for refractive power of the lens
*focus at point behind of retina

in hyperopia, cornea is
flatter and eye is shorter

to treat hyperopia, you need _____ lenses
convex

GAG in synovial fluid and ECM of loose CT?
hyaluronate

GAG in cartilage, bone and heart valves?
Chondroitin sulfate

GAG in basement membranes?
heparan sulfate

GAG in in mast cells?
heparin

GAG in skin, blood vessels and heart valves?
dermatan sulfate

GAG in Cornea, bone, cartilage =?
Keratan sulfate

most abundant GAG?
chondroitin sulfate

most heterogenous GAG?
keratan sulfate

which form of sugars are the most common in nature?
D

ground substance of ECM is made up of
proteoglycan molecules (GAGs)

which enzyme promotes depolymerization of ECM?
hyaluronidase

one of the building blocks of GAGs is always a
amino sugar

dextran
polysaccharides of glucose produced by bacteria and yeast

what enzyme produces dextrans?
glucosyltransferase (dextran sucrase)

*substrate is sucrose

Levans
fructans

*side product of dextran production

reserve nutrients for bacteria
fructans

saturated fat contains ______ double bonds
None

unsaturated fats contain _____ double bonds
one or more

cell derive energy from fatty acids through
beta oxidation

linoleic acid
polyunsaturrated fatty acid

steatorrhea
fat malabsorption

lecithin hydrolysis yields
1. 2 fatty acid
2. glycerol
3. phosphoric acid
4. choline

water soluble emulsifiers

cephalins
phospholipids found in nervous tissue of brain and spinal cord

*like lecithin but contain serine or ethanolamine in place of choline

sphingomyelin hydrolysis yilds
1. sphingosine
2. choline
3. fatty acid
4. phosphoric acid

least dense lipoprotein
chylomicrons

most dense lipoprotein
HDL

*highest in protein content, lowest in triglyceride content

primary plasma carriers of cholesterol are
LDLs

LDLs are rich in
cholesterol

VLDL are rich in
triglycerides

HDL are rich in
protein

ketone bodies are only formed in the
liver

can brain use ketone bodies? what about fatty acids
brain can use ketone bodies but NOT fatty acids

can liver use ketone bodies?
NO

rate limiting step in the synthesis of ketone bodies?
HMG-CoA synthase

key intermediate/rate limiting step in the synthesis of fatty acids is
malonyl-CoA

*formed from acetyl-CoA, bicarb and ATP

pantothenic acid (vitamin B5) is important for what?
coenzyme A

ketosis occurs when_____
occurs when fatty acids are not completely metabolized

*occurs with starvation, fasting and alcoholism

symptoms of ketosis
1. ketones in urine
2. ketone bodies in blood
3. potassium loss in urine
4. fruity odor of acetone on breath

fatty acid synthesis takes place where?
in the cytosol

fatty acid breakdown occurs where?
mitochondria

fatty acid are oxidized by which pathway?
beta-oxidation

beta oxidation also produces acetyl-CoA for the TCA cycle

are triglycerides part of the membrane?
NO

hypoglycemia _______ secretion of glucagon
increases 2-3x the

hyperglycemia _______ secretion of glucagon
reduced to .5x

unlike insulin, glucagon acts almost _____ on the liver
exclusively

what activates adenylate cyclase in the adipocyte plasma membrane?
glucagon and epinephrine

activation of adenyl cyclase raises
intracellular concentration of cAMP

glucagon and epinephrine stimulates what?
triacylglycerol lipase —> stimulates lipolysis

rate limiting steps in kreb cycle
1. citrate synthase
2. isocitrate dehydrogenase
3. alpha-ketoglutarate dehydrogenase complex

cori cycle
lactic acid cycle

where does gluconeogenesis occur?
in the cytoplasm

Collagen: location of types
Type 1: bONE (majority; bone)
Type 2: carTWOlage (cartilage)
Type 3: reTHREEcular fibers (fibers of reticular lamina in basement membranes; product of CT)
Type 4: “Four on the Floor” (primary material of basement membranes)
Type 7: anchoring fibrils of basement membrane (3+4=7; anchors basal lamina to reticular lamina)

3 types of ducts in salivary gland
1. Intercalated duct: (think “international flights”)
-transports saliva to larger ducts
-lined by simple cuboidal epithelium

2. Striated duct: (think of a PEZ dispenser)
-modifies salivary electrolytes (resorbs Na/Cl, secretes K/HCO3) (think of tiny PEZ candy)
-lined by simple low columnar epithelium (PEZ dispensers are column-like)

3. Terminal excretory duct: (self explanatory)
-transports saliva to oral cavity
-lined by pseudostratified columnar epithelium

Perichondrium locations
“Perichondrium is not a FAN of these locations”

Fibrocartilage (ex. TMJ articular disc, intervertebral discs, etc.)

Articular cartilage of joints

Nasal/costal cartilage

*Note perichondrium the surface of all other types of all other cartilage!

Elastic cartilage locations?
All start with “E”

External ear, Eustachian tube, Epiglottis

*Hyaline (precursor to endochondral bone formation) = nose, trachea, bronchi, larynx, ribs, articular surfaces, and long bones

*Fibrocartilage = intervertebral discs, TMJ articular disc, symphysis of pubis, meniscus of knee.

Cartilage growth types
Appositional = on the surface of existing cartilage (think apical)

Interstitial = within existing cartilage (think inter) via “centers”

Bone growth types
Intramembranous ossification: (“IntraMembranous involves IMmature bone”)
mesenchymal cells – osteoblasts – immature woven bone secretion (around collagen) – osteoclast resorption – osteoblasts replace with mature bone – final calcification

Endochondral ossification: (think chondral for preliminary cartilage layer)
bony cuff around hyaline cartilage (grows to replace/kill chondrocytes) – calcification – resorption of calcified cartilage – new osteoblastic matrix forms mature bone

Bone remodeling?
“HHHow’s the remodeling?”

-Howship’s lacunae (Hollow resorption bays on bone surface)
-Hydrolytic enzymes (produced by osteoclasts)
-pH lowered to dissolve bone matrix

Types of mature bone
Cancellous (spongy w/ branches of trabeculae – some of it is “cancelled” out)

Compact (solid)

White blood cell relative concentrations
“Never Let Monkeys Eat Bananas” (greatest to least)

Neutrophils (65%)
Lymphocytes (25%)
Monocytes (6%)
Eosinophils (3%)
Basophils (1%)

Bradycardia vs. Tachycardia
Remember that Tom Brady is a slow runner!

Bradycardia: <60bpm Tachycardia: >100bpm

Layers & Tunica’s
*Blood Vessel Layers: (lumen to outermost)*
1. Tunica intima (SSE; basement membrane)
-arteries have additional elastic layer (int. elastic mem.)

2. Tunica media (smooth m. & elastic fibers (thicker in a’s))

3. Tunica adventitia (collagen & elastic fibers (thicker in v’s))
-large vessels contain vaso vasora

*Upper Digestive Layers: (inner to outer)*
1. Mucosa
-epithelium
-lamina propria (CT & Lymphatic tissue)
-muscularis mucosae (smooth m.)

2. Submucosa (dense irregular CT, glands, nerves)

3. Muscularis externa (smooth m.; PERISTALSIS)
-circular & longitudinal

4. Serosa
-mesothelium (SSE)
-CT (adipose, vasculature, lymphatics)

5. Adventitia (loose CT)

Tunica albuginea: thick outer fibrous layer of CT in penis, testes, and ovaries (think “ginea” for “genitals”)

Spermatic cord contents?
VALT

Vas deferens (aka ductus deferens)
Autonomic nerves
Lymph vessels
Testicular arteries & veins

Penis Tissues
Corpora cavernosa – 2 dorsal sections of erectile tissue (think of a “cave” covering a hole (the urethra))
Corpora spongiosum – 1 ventral section containing urethra (think: the spongy layer is more delicate so it hides underneath)

*remember that the tunica albuginea is the capsule that surrounds them all

Layers of Adrenal Cortex
Layers of Adrenal Cortex
GFR corresponds w/ salt, sugar, sex

Glomerulosa ? mineralcorticoids (e.g. aldosterone)
Fasciculata ? glucocorticoids (e.g. cortisol, hydrocortisone)
Reticularis ? gonadocorticoids (e.g. sex steroids, androgens)

Epidermal layers?
“Bad Sprinters Get Leg Cramps” (inner to outer)

1. Stratum Basale (mitotic activity; melanocytes, keratinocytes)

2. Stratum Spinsoum (spinous cell layer – cytoplasmic processes & Langerhan cells)

3. Stratum Granulosum (flattened; keratohyalin Granules)

4. Stratum Lucidum (clear layer in thick skin)

5. Stratum Corneum (keratinized layer) (“Korn”)

Oral mucosa layers?
“California Girls’ String Bikinis”
(outer to inner)

1. Stratum Corneum (Korny Keratinized layer)

2. Stratum Granulosum (Keratohyalin granules)

3. Stratum Spinosum (prickle layer; langerhans)

4. Stratum Basale (mitotic activity; least differentiated)

Subepithelial CT of oral mucosa?
ALL forms of epithelium (e.g. lining, masticatory, specialized) have a LAMINA PROPRIA (2 layered: papillary & dense)
DEEP TO THE BASEMENT MEMBRANE.

Lamina Propria contains the Papillary layer with Papillae (Progections interdigitating with ePithelial rete Pegs (ridges)).

*Reticular layer also included in the lamina propria.

Sweat glands of sympathetic NS?
Sympathetic = Apocrine (think A for Arousal)

Parasympathetic = eccrine

Remember:
Eccrine (aka merocrine) = solely secretion from granules (“me alone”)

Apocrine = secretion w/ portion of cytoplasm (think A for “apex” (just the tip))

Holocrine = secretion with a portion of the cell (think “whole” portion of the cell)

Oral tissue origins
IEE = Enamel

Dental Papilla = Dentin, Pulp

Dental follicle = Cementum, Alveolar Bone, PDL (it connects the 2 previous ones!)

Tomes fibers vs. Tomes process
Tomes fibers: odontoplastic processes (dentin!)

Tomes processes: ameleoblastic processes (enamel)

Enamel tufs vs. spindles vs. lamellae?
Enamel tufts: hypocalcified, inner 1/3 of enamel (from DEJ) (think of tufts – 3 more years)

Enamel spinDles: short Dentinal tubules that became trapped during apposition of enamel and got enamel calcified around them

Enamel lamellae: partially calcified vertical defects in enamel that look like cracks (traverse entire length of grown from surface to DEJ)

Widest mesio-distally
mandibular first molar

only tooth with a pulp wider M-D than F-L
Max. central incisor

Widest F-L
Permanent Max. 1st molar, primary 2nd max molar

Only tooth that is narrower facially than lingually
maxillary first molar

Tallest tooth inciso-gingivally
1) Max. canine
2) Mand. canine

Tallest crown inciso-gingically
Mandibular canine

Longest root inciso-gingivally
Maxillary canine

Most symmetrical
Mandibular central

Smallest
Mandibular central

Narrowest-M-D
Mandibular central

Narrowest and smallest-rooted pre-molar
Mandibular first Pm

Most congenitally malformed or missing
1) 3rd molars
2) maxillary lateral

Premolar most likely to be congenitally missing
Mandibular second Pm

Best developed lingual anatomy
Maxillary lateral (lingual pit and lingual groove)

Most likely to have dens-in-dente
Maxillary lateral

Greatest constriction from pulp chamber to canals
Maxillary first Pm

Premolar most likely to have 1 root and 1 canal
Mandibular second Pm

Anterior tooth most likely to have a bifurcated root
Mandibular canine

Only tooth with 2 triangular ridges on 1 cusp
Maxillary first molar

Only tooth with a M-L groove
Mandibular first Pm

Only tooth with a root that is inclined mesially
Mandibular canine

Only tooth with crown concavities
1) Maxillary first Pm (mesial)
2) Primary maxillary canine

Contact points for maxillary teeth
IJ, JM, JM, MM, MM, MM, MM, M
I: Incisal 1/3
J: Junction of incisal and middle 1/3s
M: Middle 1/3

Contact points for mandibular teeth
II, II, IM, MM, MM, MM, MM, M

Facial heights of contour are most prominent on
mandibular posterior teeth

Facial heights of contour are least prominent on
Mandibular anterior teeth

Height of contour for teeth (facial and lingual)
Facial: Anterior AND posterior at cervical 1/3, except for mandibular 1st molars (junction of cervical and middle 1/3)
Lingual:
Anterior: cervical 1/3
Posterior: middle 1/3, except for mandibular 1st Pm(occlusal 1/3)

the CEJ dips deeper on
Anterior than posterior
Mesial than distal
Maxillary than mandibular

Facial embrasures are narrower than lingual embrasures except for
Maxillary first molar(facial wider) and between Mandibular centrals (same)

Largest incisal embrasure is between
Maxillary lateral and canine

Second largest incisal embrasure is between
Mandibular lateral and canine

Largest overall occlusal embrasure is between
Maxillary canine and first Pm

Primary teeth show evidence of calcification in utero in ___ trimester
2nd

Which tooth shows the first evidence of calcification at birth?
Permanent mandibular molars

Permanent anterior shows the first evidence of calcification before age ___
1

Permanent Pms show the first evidence of calcification around age ___
2

Wisdom teeth show the first evidence of calcification around age ______
7-9

Maxillary teeth usually erupt before mandibular teeth (True/false)
FALSE
Mandibular teeth usually erupt before maxillary

When a tooth erupts, its root is about _____% formed
50%

The roots of primary teeth will complete about ___ years after eruption; the roots of permanent teeth will complete about ____ years after eruption
1.5
2.5

Maxillary incisors have incisal edges that are centered/lingual/labial to the long axis of the tooth
centered

Mandibular incisors have incisal edges that are centered/lingual/labial to the long axis of the tooth
lingual

Maxillary canines have incisal edges that are centered/lingual/labial to the long axis of the tooth
facial

Mandibular canines have incisal edges that are centered/lingual/labial to the long axis of the tooth
Lingual/centered

From a facial view, all teeth have a crown shaped like a
trapezoid

From a proximal view, what is the shape of anterior and posterior teeth?
Anterior: triangle
Max. post: trapezoid
Mand. post: rhomboid

Teeth with one facial cusp have a mesial cusp slope that is shorter/longer than the distal cusp slope, except for primary maxillary canine and permanent maxillary first Pm
shorter

Crowns of teeth tend to get shorter from ____ to _____
canine to third molar

All teeth develop from ___ lobes except permanent first molars and mandibular 2nd Pm
4 lobes
Permanent first molars and mandibular 2nd Pm have 3-cusp type, developing from 5 lobes

The distal side of a tooth is typically bigger than the mesial side (true/false)
false. the mesial side is usually bigger

Enamel is the hardest substance in the human body. it is about _____% calcified.
97%

The roots of all teeth are inclined __________, except for mandibular canine
Distally
mandibular canine inclines mesially

If one root has 2 canals, they will be oriented _________ and _________
facially and lingually

Teeth erupt with as many pulp horns as they have cusps. (True/false)
true

All DNA viruses are ds except
parvo

All RNA viruses are ss except
reo

Positive stranded RNA viruses
Retro, Toga, Flavi, Coronoa, Hepe, Calici, Picorna
I went to a retro toga party and drank flavored corona while eating hippy california pickles.

All viruses are haploid except
Retroviruses have 2 identical ssRNA

All DNA viruses replicate in nucleus except
pox (carries own DNA-dependent RNA polymerase)

All RNA viruses replicate in cytoplasms except
influenzea and retro

Naked Viruses
Papilloma, Adenoa, Parvo, Polyoma, Calci, Picorno, Reo, Hep
DNA=PAPP RNA=CPR to a naked hepe

Enveloped viruses get their membranes from cell membranes except
Herpes – from nuclear membrane

DNA are linear except
Papilloma, polyoma, hepadna

Are icosahedral except
Pox

Negative stranded viruses
Must bring RNA dependent RNA polymerase to code for Sense strand to allow cell to translate
Arena, Bunya, Paramyxo, Orthomyxo, Filo, Rhabdo
Always Bring Polymers Or Fail Replication

Segmented Viruses
BOAR
Bunya, Orthomyxo, Arena, Reo

Picornoviruses
PERCH
Polio, Echo, Rhino, coxsackie, HAv
Rna translated to one large polypeptide that is cleaved by proteasess. All can pass through stomach acidity except rhinovirus.

Amelogenesis – 2 step process
-first step produces a partially mineralized (30%) enamel
-second step: involves significant influx of additional mineral coincident with the removal of organic material and water to attain the greater than 96% mineral content

-Stages-
1. Morphogenetic stage
2. Histodifferentiation stage
1. cells of inner enamel epithelium
-late cap-bell stage
2. late bell-early matrix deposition

-Stages-
3. Presecretory-Initial secretory
-differentiating ameloblasts acquire their phenotype, change polarity, develop an extensive protein synthetic apparatus, and prepare to secrete the organic matrix of enamel
-lacks Tome’s processes (removal of basla lamina and deposition of aprismatic [initial] enamel)

-Stages-
4. Secretory stage
-ameloblasts elaborate and organize the entire enamel thickness – resulting in formation of a highly ordered tissue
-well defined Tome’s processes
-whole thickness of enamel is deposited at this stage

-Stages-
5: Maturation stage
-removal of organic material
-maturation and thickening of mineral crystals
-modulation between 2 ameloblast morphologies: ruffle-ended and smooth-ended

-the protective phase is the last stage

Preameloblasts
-cells differentiate, develop secretory phenotype:
-cell polarization
-development of secretory apparatus

-preameloblast-preodontoblast interactions are essential for their coordinated co-differentiation

a) basal terminal web
b) blunt processes
a) exists between preameloblasts
b) of preameloblasts are seen extending into the stratum intermedium

presecretory ameloblasts
fully developed secretory cells
-disintigration of the basal lamina between odontoblasts
-extend their cell processes through the basal lamina into the dentin

early secretory ameloblasts
-start to secrete mineralized enamel matrix
-this can only occur when the basal lamina is gone and upon mineralization of the underlying dentin matrix
-lack distal tome’s processes

Responsible for deposition of the initial aprismatic enamel?
early secretory ameloblasts

Mature ameloblasts form…
Tomes processes

Tomes processes
-consist of proximal and distal parts
-apical terminal web separates Tome’s processes from the ameloblast cell body

a) apical terminal web
b) basal terminal web
a) distal junctional complex
-separates the Tome’s processes from the ameloblast cell bodies
b) proximal junctional complex

a) Type 1 face
b) Type 2 face
a) secretory face of tomes process
-enamel matrix is released here
b) the “sliding” face

Secretory granules
-contain enamel matrix proteins

First mineral in secretory enamel?
amorphous calcium phosphate
-its morphology and organization is identical to older crystalline secretory enamel

What regulates the formation and organization of mineral particles?
enamel matrix proteins found in secretory enamel

Enamel matrix protiens
-**Amelogenin** [major ECM protein- 90%]
-Ameloblastin [ECM protein]
-Enamelin [ECM protein]
-DSPP – main or noncolllagenous protein of dentin [only at very early stages]
-DMP1 – major non collagenous protein of dentin (only at very early stages)
-MMP20 [Enamelysin] matrix metaloproteinase

-Amelogenin
-90% of organic component in secretory enamel
-hydrophobic
-proline and glutamine rich protein containing short hydrophobic C-terminal domain

…Amelogenin
-undergoes proteolytic cleavage during the secretory stage
-cleavage products are important in amelogenesis
-it assembles into spherical aggregates of 15-50nm in diameter called nanospheres
-regulates crystal morphology
-inhibits crystal nucleation and transiently stabilizes amorphous calcium phosphate

Amelogenin mutations lead to what?
X-linked Amelogenesis imperfecta

2 Gene versions of Amelogenin:
a) AMELX
b) AMELY
a) on X chromosome – functional
b) on Y chromosome – nonfunctional
-Y is used in the forensics for sex determination

Amelogenin structure
-hydrophobic
-rich in Pro and Glu
-has a beta strand conformation
-Central portion contains XYP repeats – adopts extended PPII conformation (like collagen type 1)
-13 amino acid C-terminal telopeptide is hydrophilic with no identifiable structure

-What cleaves Amelogenin?
MMP20
-this is essential for proper enamel formation

MMP20 [Enamellysin] Tooth-Specific Metaloproteinase
-Expressed in enamel during the secretory stage, also expressed in dentin
-Cleaves Enamel matrix proteins: Amelogenin, Ameloblastin, and Enamelis in a specific manner
-Also cleaves DSPP
-Specific proteolytic cleavages by MMPP20 are ESSENTIAL for proper enamel formation

Mutations in MMP20
also lead to Amelogenesis imperfecta

Ameloblastin
-Acidic enamel matrix protein
-5% of enamel matrix
-negatively charged, polar, hydrophobic
-cleaved immediately after secretion
-expressed by ameloblasts in all stages of enable formation

Ameloblastin KO
-failure of enamel epithelium to differentiate into ameloblasts and to attach to dentin

What is an important cell-matrix adhesion protein?
-Ameloblastin!

Enamelin
-Enamel glycoprotein
-least abundant enable protein (2-3% in secretory enamel)
-largest enamel protein
-acidic glycoprotein of secretory enamel
-cleaved immediately after its secretion
-mutations cause autosomal dominant AI

32 KDa Enamelin fragment
-Enamelin is normally cleaved immediately after secretion
-but 32 KDa fragment remains in deep enamel
-MMP20 can only cleave this after de-glycosylation

Mineral thickening
-starts at the secretory stage
-primarily due to the cleavage and removal of C-terminal fragment of amelogenin

-Enamel matruation
-Crystal size increases dramatically
-length stays the same, but width and thickness greatly increase
-the removal of organic matrix is accompanied by thickening of crystals
-basal lamina is deposited by ameloblasts over enamel at the beginning of maturation stage

KLK4
enzymatically degrades enamel proteins
-it is a nonspecific serene proteinase

Modulation cycle
-maturation ameloblasts modulate between smooth and ruffle morphologies
-respond to 2 phases of maturation cycle: protein removal and mineral deposition
-maturation begins with the first ruffle ended maturation ameloblast

ruffle ended ameloblasts
-tight apical junctions
-open basal junctions
-60%

smooth ended ameloblasts
-well developed basal junctions
-open apical junctions
-20%

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