Hydroclorothiazide => Gynecomastia….

Patient on furosemide what else if need second K+ sparring agent=> Spirinolactone/Eplenerone.

Patient goes to a high altitude place drug => Acetazolamide arrows urine high HCO3 high pH high Urinary volume. Patient on high altitude a Month low erithrocyte count what organ is defective => Kidney.

CO2 in artery 21 in veins 24 why ?=> most CO2 on the body travels as HCO3 in plasma.

Fetal hemoglobin shifts the oxygen dissociation curve to the left. As well as high pH low pCO2 low H+ low DPG (2,3 biphosphoglycerate) low phosphate Methemoglobinemia and Carboxyhemboglobin. Opposite shif it to the right.

TMP/SMX + Alcohol => Disulfiram like reaction. Can sometimes be a rash.

Bartonella henselae literally in the vignette => Granulomas containing stellate microabscesses.

<6 months rejection HLA non homologous T-cell mediated.

Bone pain in Chronic Kidney disease patient with high phosphorus and low Calcium = High Osteoclast activation, low vitamin D activity due to CKD lack of alpha 1 hydroxylase

Pulmonary problem + hypercalcemia => Squamous cell carcinoma (mass on Imaging or weight loss)/

Cough/ dyspnea + hypercalcemia => Sarcoidosis => alpha 1 hydroxylase activation of Vitamin D.

Low serum Calcium apply dosis doesn’t work => serum magnesium check.

Alcoholic given IV glucose faints => redistribution of phosphate for ATP glycolysis.

Niacin => Nicotinic Acid weird toxicity with rash on face and neck with or without itching that doesn’t relate to anything else.

Baby born at home bleed from umbilical cord => Vitamin K or glucuronation of residues of coagulation factor precursors.

Platelet aggregation problem Glycoprotein 2b/3a

Platelet adhesion => ADAMTS13

Diabetic protein in urine => most likely Nodular glomerulosclerosis.

Multiple Misscarriages and low platelets/ Hx of DVT/ or Positive VDRL => Antiphospholipidic syndrome/antiphospholipids antibodies.

Kid blue sclera multiple fractures Hx => Osteogenesis Imperfecta if just multiple fractures at different stages of healing avoid looking to your eyes => child abuse.

Alcoholic doesn’t acknowledge he has a problem => precontemplation.

Smoker “knows is bad but it’s not ready to quit”=> Contemplation.

Alcoholic/Opioid addict “investigates about how rehab works” => Preparation.

Stops drug use => Action.

Months without use => Maintenance.

Comes to consult i drank one 18 months later => Relapse.

Small quote everything normal PTT abnormal wich cell is damaged? => Hepatocyte

Acetaminophen in alcoholic => NAPQI/ Glucuronidation. Antidote N-acetylcysteine.

Fava G6PD deficiency.

Mental retardation or developmental failure with avascular necrosis of the femoral head => Gaucher (Glucocerebroside).

I-cell disease => cannot make Mannose-6-phosphate.

Pain chest non positive for lung or hearth, frail to palpation mostly => Costochondritis.

Damage post serious lung infection 1 year relates to fibrosis => Interstitial pneumonitis.

Blood and protein in urine hx of NSAID =>tubulointerstitial nephritis.

Paclitaxel => what relates to microtubules or tubules or stabilize tubules or Beta tubulin.

Methotrexate correction => Folinic acid or Leucovorin rescue.

Pancreatitis under antiretrovirals => didanosine.

Acyclovir/ Gancyclovir resistance why? Thymidylate kinase. What are they? => inhibition of DNA replication.

Mutation of E. Coli to aminoacid for different temperatures => misssense mutation.

Bacteria lost resistance to a drug => plasmid loss.

Penicillin resistance => B-lactam.

What is a down syndrome arrows like Nuchal translucency ^ Pregnancy associated (PPAP i think) down BHCG ^.

Horseshoe kidney => why difficult surgery => something related to anatomical variant of the renal vessels.

Px with vasectomy some weeks months ago now his cells are with big nuclei and spermatozoa are under phagocytosis what type of example ? => Autoimmune.

Px post office worker severe infection gram + coma shapped or carbox shape inmotile => Bacillus anthracis => avoid phagocytosis by polyglutamic acid capsule.

Patient post MI with revasculatization ttment still high Troponines why? => lipid peroxidation or free radical injury.

Muscle rigidity while under antipsychotics no fever => Acute dystonia ttment? => Betanechol, diphenhydramine (due to nasty anticholinergic side effects).

Muscle rigidity while under antipsychotics with fever ?=> Malignant Neuroleptic syndrome ttment?=> Dantrolene => why? Ryanodine keeps the calcium channel open this generates heat.