COMSAE ALL
Treatment glaucoma: alpha agonists; epinephrine, brimonidine - ✔️✔️dec AH
synthesis> vasoconstriction; mydriasis alpha 1 (don't use in closed angle glaucoma)
blurry vision, ocular hyperemia, foreign body sensations ocular allergy, pruritis
Beta blockers: timolol, betaxolol, carteolol - ✔️✔️dec AH synthesis; no pupil/vision
changes
Diuretics; acetazolamide - ✔️✔️dec AH synthesis by inhibiting carbonic anhydrase; no
vision/pupil change
Cholinomimetics M3; direct pilocarpine carbachol; indirect physostigmine,
echothiophate - ✔️✔️inc outflow of AH via contraction of ciliary muscle/open trabecular
mesh; pilocarpine in ER--very effective open meshwork into Canal schlemm,
lead to miosis--and cyclospasm
Crigler Najjar - ✔️✔️ABSENT UDP glucuronsyltransferase; early in life; die few years
find: jaundice, kernicterus (in brain) inc unconjugated bilirubin;
tx: plasmapheresis and phototherapy; type II respond phenobarbital
Dubin Johnson - ✔️✔️Conjugated hyperbilirubinemia b/c defective liver excretion;
grossly black liver
Benign
Rotor syndrome - ✔️✔️milder in presentation w/o black liver
impaired hepatic uptake and excretion
wilson Disease - ✔️✔️copper transporting ATPase; ATP7B on Chromosome 13
s/s: before 40 yo, liver dz, neurodisease, psych dz, Kayser Fleischer ring, hemolytic
anemia, renal dz;
find: dec serum ceruloplasmin, inc urine copper
tx: chelation w/ penicillamine or Tridentine, oral zinc
,Hemochromatosis - ✔️✔️recessive, HFE, chromosome 6; abnormal iron sensing,
increase intestinal absorb
find: inc ferritin, inc iron, dec TIBC, inc transferrin saturation
identify w/ Prussian blue stain/ liver MRI
Hemochromatosis finds - ✔️✔️after age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy, hypogonadism,
arhtropathy; HCC is common cause death
Treatment Hemochromatosis - ✔️✔️repeat phlebotomy, chelation deferasirox,
deferoxamine, oral deferiprone
Wolff Parkinson White Syndrome - ✔️✔️MC ventricular pre excitation syndrome
abnml fast atria to ventricle (bundle of Kent); bypasses AV node>> ventricles begin
partially depolarization earlier (NOTED BY DELTA WAVE ON EKG) widened QRS and
shortened PR
Conduction pathway heart - ✔️✔️SA node> atira> AV node> bundle HIS, R and L
bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
Edema - ✔️✔️inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
COCAINE intoxication - ✔️✔️impaired judgement, pupil dilate, hallucination (coke
bugs) sudden cardiac death; paranoid ideations, angina
Tx: alpha blockers/ benzos
caution B block bc can cause unopposed alpha
Osteoporosis histo - ✔️✔️trabecular and cortical bone lose mass and interconnection
despite normal bone mineralization
assoc w/ Colles fracture- distal radial fracture; fracture of femoral neck
Gilbert Syndrome - ✔️✔️mild dec UDP glucuronosyltransferase conjugation and
impaired bilirubin uptake; asymptomatic or mild jaundice>> inc unconjugated bilirubin
w/o hemolysis; w/ fasting and stress
, Celiac Disease - ✔️✔️setting: 14 mo kid losing weight eating lots of foods;
histology: crypt abnormalities (hyperplasia); villous atrophy, lymphocytic infiltration
presents as malabsorbtion (diarrhea etc in kids)
in adults= short stature, anemia delayed puberty
Musculocutaneous nerve C5-C7 - ✔️✔️upper trunk compression cause injury; loss
forearm flexion/supination; loss sensation over lateral forearm
Axillary nerve C5-C6 - ✔️✔️flat deltoid; loss arm abduction, loss sensation over deltoid
and lateral arm
Radial C5-T1 - ✔️✔️mid shaft fracture humerus, compression axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior arm, dorsal hand
Median C5-T1 - ✔️✔️supracondylar fracture humerus (proximal) CTS, wrist laceration
(distal)
ape hand pope's blessing
loss wrist flexion, flex of lateral fingers, thumb opposition, lumbricals 2nd and 3rd digit;
loss sensation over thenar eminence and dorsal and palmar aspects of lateral 3 1/2
fingers w/ proximal
Ulnar C8-T1 - ✔️✔️Fracture medial epicondyle humerus; fractured hook hamate (distal
lesion)
ulnar claw on extension; radial deception wrist upon flexion (proximal lesion)
loss wrist flex, flex of medial fingers, abduction and adduction fingers; medial 2
lumbricals;
loss sensation over 1 1/2 fingers including hypothenar eminence
Recurrent branch median nerve - ✔️✔️superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
Prostaglandin- bimatoprost, iatanoprost PGF2 alpha - ✔️✔️inc outflow AH; darken iris
(brown); eyelash growth
Treatment glaucoma: alpha agonists; epinephrine, brimonidine - ✔️✔️dec AH
synthesis> vasoconstriction; mydriasis alpha 1 (don't use in closed angle glaucoma)
blurry vision, ocular hyperemia, foreign body sensations ocular allergy, pruritis
Beta blockers: timolol, betaxolol, carteolol - ✔️✔️dec AH synthesis; no pupil/vision
changes
Diuretics; acetazolamide - ✔️✔️dec AH synthesis by inhibiting carbonic anhydrase; no
vision/pupil change
Cholinomimetics M3; direct pilocarpine carbachol; indirect physostigmine,
echothiophate - ✔️✔️inc outflow of AH via contraction of ciliary muscle/open trabecular
mesh; pilocarpine in ER--very effective open meshwork into Canal schlemm,
lead to miosis--and cyclospasm
Crigler Najjar - ✔️✔️ABSENT UDP glucuronsyltransferase; early in life; die few years
find: jaundice, kernicterus (in brain) inc unconjugated bilirubin;
tx: plasmapheresis and phototherapy; type II respond phenobarbital
Dubin Johnson - ✔️✔️Conjugated hyperbilirubinemia b/c defective liver excretion;
grossly black liver
Benign
Rotor syndrome - ✔️✔️milder in presentation w/o black liver
impaired hepatic uptake and excretion
wilson Disease - ✔️✔️copper transporting ATPase; ATP7B on Chromosome 13
s/s: before 40 yo, liver dz, neurodisease, psych dz, Kayser Fleischer ring, hemolytic
anemia, renal dz;
find: dec serum ceruloplasmin, inc urine copper
tx: chelation w/ penicillamine or Tridentine, oral zinc
,Hemochromatosis - ✔️✔️recessive, HFE, chromosome 6; abnormal iron sensing,
increase intestinal absorb
find: inc ferritin, inc iron, dec TIBC, inc transferrin saturation
identify w/ Prussian blue stain/ liver MRI
Hemochromatosis finds - ✔️✔️after age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy, hypogonadism,
arhtropathy; HCC is common cause death
Treatment Hemochromatosis - ✔️✔️repeat phlebotomy, chelation deferasirox,
deferoxamine, oral deferiprone
Wolff Parkinson White Syndrome - ✔️✔️MC ventricular pre excitation syndrome
abnml fast atria to ventricle (bundle of Kent); bypasses AV node>> ventricles begin
partially depolarization earlier (NOTED BY DELTA WAVE ON EKG) widened QRS and
shortened PR
Conduction pathway heart - ✔️✔️SA node> atira> AV node> bundle HIS, R and L
bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
Edema - ✔️✔️inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
COCAINE intoxication - ✔️✔️impaired judgement, pupil dilate, hallucination (coke
bugs) sudden cardiac death; paranoid ideations, angina
Tx: alpha blockers/ benzos
caution B block bc can cause unopposed alpha
Osteoporosis histo - ✔️✔️trabecular and cortical bone lose mass and interconnection
despite normal bone mineralization
assoc w/ Colles fracture- distal radial fracture; fracture of femoral neck
Gilbert Syndrome - ✔️✔️mild dec UDP glucuronosyltransferase conjugation and
impaired bilirubin uptake; asymptomatic or mild jaundice>> inc unconjugated bilirubin
w/o hemolysis; w/ fasting and stress
, Celiac Disease - ✔️✔️setting: 14 mo kid losing weight eating lots of foods;
histology: crypt abnormalities (hyperplasia); villous atrophy, lymphocytic infiltration
presents as malabsorbtion (diarrhea etc in kids)
in adults= short stature, anemia delayed puberty
Musculocutaneous nerve C5-C7 - ✔️✔️upper trunk compression cause injury; loss
forearm flexion/supination; loss sensation over lateral forearm
Axillary nerve C5-C6 - ✔️✔️flat deltoid; loss arm abduction, loss sensation over deltoid
and lateral arm
Radial C5-T1 - ✔️✔️mid shaft fracture humerus, compression axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior arm, dorsal hand
Median C5-T1 - ✔️✔️supracondylar fracture humerus (proximal) CTS, wrist laceration
(distal)
ape hand pope's blessing
loss wrist flexion, flex of lateral fingers, thumb opposition, lumbricals 2nd and 3rd digit;
loss sensation over thenar eminence and dorsal and palmar aspects of lateral 3 1/2
fingers w/ proximal
Ulnar C8-T1 - ✔️✔️Fracture medial epicondyle humerus; fractured hook hamate (distal
lesion)
ulnar claw on extension; radial deception wrist upon flexion (proximal lesion)
loss wrist flex, flex of medial fingers, abduction and adduction fingers; medial 2
lumbricals;
loss sensation over 1 1/2 fingers including hypothenar eminence
Recurrent branch median nerve - ✔️✔️superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
Prostaglandin- bimatoprost, iatanoprost PGF2 alpha - ✔️✔️inc outflow AH; darken iris
(brown); eyelash growth
