ABISTE Must Know Facts

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ABISTE Must Know Facts
2013-11-20 17:58:42

Thousand Must Know ABSITE FACTS
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  1. Intermediate Filaments:
  2. Phospholipase C act via:
    1. Protein Kinase A
    2. Protein Kinase C
    3. Protein Kinase G
    Protein Kinase C
  3. Protein Kinase C Dependent:
    • HaV1M&M
    • H1, Alpha1, V1, M1, M2 and Angiotensin II

    Increase Ca and DAG
  4. Protein Kinse A dependent:
    • MAD2s Lower cAMP M2,A2, D2
    • B1,B2, D1, H2,V2, Glucagon and PH Increase CMP
  5. ABO blood type antigens are
    1. glycolipids
    2. glycoprtoiens
    • Glycolipids
    • HLA type antigens are glycoproteins.
  6. Transcription occurs in
    5to 3 direction or 3 to 5 direction
    5 to 3 (rem: Cryptology goes backward)
  7. Phases of Cell Cycle:
    • G1 : Longest, Variable, determine cell cycle length
    • S: synthesis of protein, DNA duplication: Sensitive to UV,carcinogen
    • G2: growth last check before actual divisioin
    • M: Mitosis
  8. Mitosis Phases:
    • Prophase- centromere attachment, spindle formation, nucleus disappears
    • Metaphase- chromosome alignment
    • Anaphase-chromosome pull apart
    • Telophase- separate nucleus re-forms around set of chromosomes
  9. Glycolysis
    Occurs in cytoplasm. 1 glucose molecule generates 2 ATP and 2 pyruvate molecules
  10. Kerb Cycle
    inner matrix of mitrochondria, 2 pyruvate generates 36 ATP
  11. Warfarin
    WEPT: Warfarin, Extrinsic, PT
  12. Factors Increase Platelet aggregation:
    Ca, ADP, TXA2, Histamin, 5HT, Alpha2
  13. Factors Decrease Platelet aggregation
    PGI2, cAMP, ASa, Ticlopidine, Plavix, Dipyaradimole
  14. Vitamin K dependent factors
    • II, VII, IX, X; protiens C and S
    • Vitamin K take 6 hours to effect
    • FFP acts immediate and last 6 hours
  15. Normal Half Life:
    • RBC 120days
    • Platelets 7days
    • PMN 1-2 days
  16. Labile factors
    • V and VIII
    • activity lost in stored blood, activity not lost in FFP
  17. PT measures:
    II, V, VII, and X; fibrinogen; best for liver synthetic function

    contrast to II, VII, IX, and X of Vit K
  18. PTT measure
    all factors except VII and XIII (thus do not pick up factor VII deficiency); also measure fibrinogen
  19. MCC of surgical bleeding
    Incomplete Hemostasis
  20. Prostacyclin (PGI2):
    • From Endothelium
    • Decreases platelet aggregation and promotes vasodilation
  21. catecholamine synthesis
  22. DPL Positive If
    • >10cc blood
    • >100,000 RBCs/cc
    • food particles, bile, bacteria
    • >500 WBC/cc
  23. ICP parameter in trauma
    Normal 10. >20 need treatment
  24. Cerebral perfusion pressure
    • CPP = MAP -ICP
    • Keep > 60
  25. Bladder pressure for Abdominal compartment syndrome
  26. Na/K pump
    3 Na out/ 2 K in
  27. ABO vs HLA antigen
    • ABO> glycolipid
    • HLA > Glycoprotein
  28. Cell cycle
    • G1, most variable, determine cell cycle length, growth factor acts
    • S (synthesis, chromosomal duplication)
    • G2
    • M (mitosis), mose sensitive to chemo agents
    • G0 (quisient)
  29. Glycolyis
    2 ATP , 2 puyruvate
  30. Protein kinase C
    • ativated by Calcium and DAG
    • HAVe1 M&M angioII
  31. Protein Kinase A
    • activated by cAmp
    • MAD2s, PTH, Glucagon
  32. Increase Platelet Aggregation
    TXA2, ADP, 5HT, Ca, Histamine, Alpha2
  33. Decrease Platelet Aggregation
    PGI2, cAMP, ASA, Ticlopidine, Plavix, Dipyradimole
  34. Thrombin
    • Key to coagulation
    • Covent fibrinogen to fibrin and fibrin split products
    • Activate factors V and VIII
    • Activate platelets
  35. Antithrombin III
    • Key to anticoagulation
    • Binds and inhibts thrombin
    • Inthibit factors IX, X, XI 
    • Heparin bind AT-III
  36. Function:
    • IL4 cause B cell maturation into plasma cell
    • IL2 cause maturation of cytotoxic T cell, used in tx of melanoma
    • Both are release by Helper T-cell (CD4)
  37. MHC Class
    • MHC Class 1 (A,B,C)
    • CD8 cell acivation
    • present on all nucleated cells
    • single chain with 5 domain
    • Target for cytotoxic T cells

    • MHC Class II (DR, DP and DQ)
    • CD4 cell activation
    • present on B cells, dendrites, monocytes and antigen presenting cells
    • 2 chain with 4 domain each
    • Activator of helper T cell
    • stimulate Antibody formation
    • IL-1  HOT
    • IL-2 stimulate Tcell
    • IL-3 stimulate bone marrow
    • IL-4 Stimulate B Cell to produce antibodies
    • IL-5 Promote IgA
    • IL-6 Acute phase reactant
  39. Anaphylotoxins
    C3a, C4a, C5a
  40. Membrane attack complex
  41. Opsonization
    C3, IgG
  42. Chemostaxis
    C3a and C5a
    LTC4, LTD4, LTE4- slow reacting substances of anaphylaxis: bronchoconstriction, vasoconstrictioni, inc. permeability

    LTB4 - Chemotactic
  44. Order of cell arival in wound
    • Platelets
    • PMNs
    • Macrophages
    • Fibroblasts
    • Lymphocytes
  45. Predominant cell type in healing
    • 0-2 - PMNs
    • 3-4 - macrophages
    • Days 5 and on - fibroblasts
  46. Platelet granules
    • Alpha granule
    • Platelet factor 4 - aggregation (HIT igbG antibody against PF4)
    • Beta thrombomodulin - binds thrombin
    • PDGF- chemoattract
    • TGF-beta - key compponent of tissue repair

    • Dense granules 
    • adenosine, serotonin and calcium
  47. Collagen types
    • I - MC type, skin bone, tendons. primary collagen in healed wounds
    • II - Car2lage
    • III- haeling wound, in blood vessels, skin, KELOID
    • IV- Basement membrane
    • V- cornea
  48. GCS
    • <14 head CT <10 intubation <8 ICP monitor
  49. Neck Zone Trauma management
  50. Neck zone
  51. LeForte Facial Fracture
  52. Approach to esophageal injury
    • Neck - left side
    • Upper 2/3- right thoracotomy
    • Lower 1/3- left thoracotomy
  54. Splenic laceration
  55. Bacteriostatic Antibiotics
    Clindamycin, Chloramphenicol, Erythromycin (macrolides), Linezolid, Tetracycline, Tegacycline, Bactrim.
  56. Antibiotic 30 vs 80 ribosome blockers
    • Buy AT 30
    • Aminoglycoside, Tetracycline

    • CEL at 50
    • Clindamycin, Erythromycin (macrolides), Lincomycin
  57. Beta-Lactamase Inhibitor
    • Calvulinic Acid
    • Sulbactam
    • Tazobactam
  58. Anti-pseudomonal Coverage
    • Antipseudomonal pencillins (ticarcillin/piperacillin aka Timentin/Zosyn)
    • 3rd Generation cephalosporins
    • Meropenem/Imepenem
    • Aminoglycoside
    • Flouroquinolones

    Double cover pseudomonas
  59. Antibiotic Common side Effects.
    • Ceftriaxone- Cholestasis
    • Carbapnem- Seizure
    • Aminoglycoside- Nephrotoxicity/ototoxicity
    • Vancomycin- Redman syndrome, Nephrotoxicity
    • Bactrim- Hemolytic An, Steven johnson
    • Clindamycin- C Diff colitis
    • Flagyl- Disulfiram like reaction, teratogenic, peripheral neuropathy
  60. What is Health care associted MRSA?
    MRSA infection occur >48 hour following hospitalization or MRSA infection occur outside of hospital within 12 month exposure to healthcare (h/o surgery, hospitalization, dialysis or residence in long term care facility)
  61. Coverage for MRSA?
    • VANCOMYCIN drug of Choice
    • LInezoid, Synercid second line
    • INH- Hepatotoxicity, B6 deficiency
    • Rifampin- Hepatototoxicity
    • Pyrazinamide- Gout
    • Ethambutol- Retrobulbar Neuritis
  63. Effective Against Enterococccus
    Vanco, Timentin/Zosyn, Ampicillin/amoxicillin, gent with ampicillin
  64. DRUG MOA
    • quinolone -inhibit DNA Gyrase
    • rifampin- inhibit RNA polymerase
    • metronidazole- produce o2 radiclar break DNA
    • sulfonamide- PABA analogue
    • trimethoprim- inhibit dihydrofolate reductase
    • acyclovir- inhibit DNA polymerase
    • isoniazid- inhibit mycolic acid
    • amphotericin-bind sterols in wall and alter membrane permeability
  65. Classification of Diverticulitis
    • Stage I
    • Diverticulitis with associated pericolic abscess

    • Stage II
    • Diverticulitis associated with distant abscess (retroperitoneal or pelvic)

    • Stage III
    • Diverticulitis associated with purulent peritonitis

    • Stage IV
    • Diverticulitis associated with fecal peritonitis
  66. Hinche classification subdivision
    Stage I has been subdivided into Ia that is pericolic inflammation. Stage Ib is diverticulitis associated with pericolic abscess. Stage IIa is distant abscess amenable to percutaneous drainage.Stage IIb is complex abscess with or without fistula.
  67. When should you get surgery after diverticulitis?
    Elective resection has generally been offered to patients who have suffered two attacks of acute diverticulitis in a short period of time, but recommendations have ranged from one to four episodes.  Data suggest recurrences of up to 67%, with higher morbidity (up to 60%) and mortality associated with recurrent diverticulitis particularly after two episodes.
  68. Layers of TRUS
  69. Accuracy of TRUS for Rectal cancer?
     TRUS is superior for T staging of rectal cancer. The range of the accuracy of TRUS is 80–95% compared with 65–75% for CT scan, 75–85% for MRI, and 62% for DRE.

    TRUS understages more frequently than overstages the primary rectal tumor. However, TRUS understages the cancer less often than CT scan (15 vs 39%)
  70. PET for rectal Cancer
    (FDG-PET) is effective in assessing the extent of pathologic response of primary rectal cancer to preoperative chemoradiation and may predict long-term outcome.

    that PET scans not be used routinely in the standard workup of a rectal cancer.
  71. Stage of Rectal cancer
    In stage I disease, the tumor may invade into the muscularis propria. In stage II disease, the tumor invades completely through this layer into the perirectal fat (T3) or adjacent organs (T4). Any lymph node metastasis represents stage III disease, and metastatic spread denotes stage IV disease.
  72. TNM of rectal cancer
    • T1- Tumor invades submucosa
    • T2-Tumor invades muscularis propria
    • T3- Tumor invades through muscularis propria into the subserosa or into nonperitonealized pericolic or perirectal tissues
    • T4a- Tumor perforates visceral peritoneum
    • T4b - Tumor directly invades other organs or structures

    Regional lymph nodes (N) 

    • N1 - Metastasis in 1–3 regional lymph nodes 
    • N1a - Metastasis in 1 regional lymph node 
    • N1b - Metastasis in 2–3 regional lymph nodes 
    • N1c Tumor deposit(s) in the subserosa, mesentery, or nonperitonealized pericolic or perirectal tissues without regional nodal metastasis

    • N2- Metastasis in 4 or more regional lymph nodes 
    • N2a  -Metastasis in 4–6 regional lymph nodes 
    • N2b -Metastasis in 7 or more regional lymph nodes