ABISTE Must Know Facts

• KERATIN EPITEHILAIL (HAIR/NAILS)
• DESMIN MUSCLE
• VIMENTIN CONNECTIVE TISSUE
• NEUROFILAMENTS NEURONS
• GFAP NEUROGLIA

Protein Kinase C

• HaV1M&M
• H1, Alpha1, V1, M1, M2 and Angiotensin II

Increase Ca and DAG

• MAD2s Lower cAMP M2,A2, D2
• B1,B2, D1, H2,V2, Glucagon and PH Increase CMP

• Glycolipids
• HLA type antigens are glycoproteins.

5 to 3 (rem: Cryptology goes backward)

• 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

• Prophase- centromere attachment, spindle formation, nucleus disappears
• Metaphase- chromosome alignment
• Anaphase-chromosome pull apart
• Telophase- separate nucleus re-forms around set of chromosomes

Occurs in cytoplasm. 1 glucose molecule generates 2 ATP and 2 pyruvate molecules

inner matrix of mitrochondria, 2 pyruvate generates 36 ATP

WEPT: Warfarin, Extrinsic, PT

Ca, ADP, TXA2, Histamin, 5HT, Alpha2

PGI2, cAMP, ASa, Ticlopidine, Plavix, Dipyaradimole

• II, VII, IX, X; protiens C and S
• Vitamin K take 6 hours to effect
• FFP acts immediate and last 6 hours

• RBC 120days
• Platelets 7days
• PMN 1-2 days

• V and VIII
• activity lost in stored blood, activity not lost in FFP

II, V, VII, and X; fibrinogen; best for liver synthetic function

contrast to II, VII, IX, and X of Vit K

all factors except VII and XIII (thus do not pick up factor VII deficiency); also measure fibrinogen

Incomplete Hemostasis

• From Endothelium
• Decreases platelet aggregation and promotes vasodilation

• >10cc blood
• >100,000 RBCs/cc
• food particles, bile, bacteria
• >500 WBC/cc

Normal 10. >20 need treatment

• CPP = MAP -ICP
• Keep > 60

>25

3 Na out/ 2 K in

• ABO> glycolipid
• HLA > Glycoprotein

• G1, most variable, determine cell cycle length, growth factor acts
• S (synthesis, chromosomal duplication)
• G2
• M (mitosis), mose sensitive to chemo agents
• G0 (quisient)

2 ATP , 2 puyruvate

• ativated by Calcium and DAG
• HAVe1 M&M angioII

• activated by cAmp
• MAD2s, PTH, Glucagon

TXA2, ADP, 5HT, Ca, Histamine, Alpha2

PGI2, cAMP, ASA, Ticlopidine, Plavix, Dipyradimole

• Key to coagulation
• Covent fibrinogen to fibrin and fibrin split products
• Activate factors V and VIII
• Activate platelets

• Key to anticoagulation
• Binds and inhibts thrombin
• Inthibit factors IX, X, XI 
• Heparin bind AT-III

• 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)

• 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

C3a, C4a, C5a

C5b-9b

C3, IgG

C3a and C5a

LTC4, LTD4, LTE4- slow reacting substances of anaphylaxis: bronchoconstriction, vasoconstrictioni, inc. permeability

LTB4 - Chemotactic

• Platelets
• PMNs
• Macrophages
• Fibroblasts
• Lymphocytes

• 0-2 - PMNs
• 3-4 - macrophages
• Days 5 and on - fibroblasts

• 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

• 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

• 
• <14 head CT <10 intubation <8 ICP monitor

• Neck - left side
• Upper 2/3- right thoracotomy
• Lower 1/3- left thoracotomy

Clindamycin, Chloramphenicol, Erythromycin (macrolides), Linezolid, Tetracycline, Tegacycline, Bactrim.

• Buy AT 30
• Aminoglycoside, Tetracycline

• CEL at 50
• Clindamycin, Erythromycin (macrolides), Lincomycin

• Calvulinic Acid
• Sulbactam
• Tazobactam

• Antipseudomonal pencillins (ticarcillin/piperacillin aka Timentin/Zosyn)
• 3rd Generation cephalosporins
• Meropenem/Imepenem
• Aminoglycoside
• Flouroquinolones

Double cover pseudomonas

• 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

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)

• VANCOMYCIN drug of Choice
• LInezoid, Synercid second line

• INH- Hepatotoxicity, B6 deficiency
• Rifampin- Hepatototoxicity
• Pyrazinamide- Gout
• Ethambutol- Retrobulbar Neuritis

Vanco, Timentin/Zosyn, Ampicillin/amoxicillin, gent with ampicillin

• 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

• 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

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.

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.

 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%)

(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.

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.

• 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