1 Flashcards
What is component of LPS is responsible for DIC and sepsis?
Lipid A
Phenotype of CAH due to 17 hydroxylase deficiency?
Ambiguous genitalia, decreased androgens, hypokalemia due to increased mineralocorticoids
How does propionyl coa become succinyl coa?
Propionyl CoA becomes methylmalonyl CoA via a carboxylase reaction (with biotin), methylmalonyl CoA becomes succinyl CoA via a mutase reaction with B12
Very first substate to be used in gluconeogenesis
Alanine creates pyruvate via ALT, pyruvate into gluconeogenesis
What does the drug PCP produce in users?
Aggression, amnesia, ataxia.
Trauma is most likely lethal outcome
Why add primaquine to plasmodium vivax/ovale infection?
To prevent relapse.
Thiazide diuretics effect on electrolytes
Hyponatremia (because medullary gradient is still intact), hypercalcemia
How does mutant huntingtin work?
A gain of function due to CAG expansion silences transcription via histone deacetylation (chromatin remains tightly wrapped).
What process uses DNA rearrangement?
VDJ recombination in B and T cells during development. Takes place in bone marrow and thymus
How is CFTR screwed up in CF?
3BP deletion that causes poor post-translational modification of the CFTR and proteosomal degradation.
Findings in down syndrome
Single palmar crease, prominant epicanthic folds, upwards turning eyes, flat nasal bridge.
Major findings in VHL
On chromosome 3 (microdeletion), 40% of VHL will have renal cell carcinoma. Hemangioblastoma and pheochromocytomas too.
What causes turner syndrome genotype
Most commonly paternal meitotic nondisjunction. Loss of X causes missing shox gene which is normally responsible for long-bone growth (so short stature)
Inheritance of Leber hereditary optic neuropathy
Mitochondrial
Two types of elastase in lungs?
What inhibits each type?
Neutrophil elastase, inhibited by alpha 1 antitrypsin.
Macrophage elastase, inhibited by tissue inhibitors of metalloproteinases.
Macrophage elastase degrades alpha 1 antitrypsin, and neutrophil elastase inhibits tissue inhibitor of metalloproteinase (TIMP.
C1 deficiency causes
Infection with encapsulated organisms. Often seen in SLE.
What is one of the major causes of SCID?
Adenosine deaminase deficiency, also IL2 receptor deficiency
Hb2a
Beta 2 delta 2. Increased in beta thalassemia minor, very increased in beta thalassemia major
Amifostene
Decreases nephrotoxicity from cisplatin and carboplatin
23S component of bacterial ribosome?
A component of the 50S subunit, responsible for creating peptide bonds during translation. Macrolides bind here.
MEN1
Parathyroid, pituitary, pancreas tumors
What drug causes a disulfiram reaction with alcohol?
Metronidazole
What does acute lung rejection cause?
CD8+ T cell mediated destruction of the lung vasculature
What does chronic lung rejection (years later) cause?
Bronchiolitis obliterans. Don’t confuse this with chronic renal transplant rejection, which does cause vascular destruction
Stages of aspirin toxicity
Immediately causes respiratory alkalosis (due to direct stimulation of respiratory centers).
Then causes metabolic acidosis (due to build up of salicylate)
Ethambutol
Causes retinopathy, inhibits arabinosyl transferase, decreasing carbohydrate synthesis in bacteria
Conduction speed in heart?
Purkinje fibers>atrium>ventricles>av node
Park at ventura avenue
Cysteinuria is due to… and causes…
Defect in COLA transporter… causes Kidney stones!
Cyp inducers
Modafinil
Carbamazipine
Rifampin
A
Phenytoin
Griseofulvin
Phenobarbital
St. John’s Wort
Nevirapine/chronic alcohol
Cyp450 inhibitors
Acute alcohol Gemfibrozil ciprofloxacin isoniazid grapefruit juice quinidine Amiodarone ketoconzole macrolides sulfonamides cimetidine ritonavir
CYP450
Anti depressants anti epileptics antipsychotics theophylline warfarin statins OCPs
Hemolytic disease of newborn
Destruction of fetal RBC by maternal IgG. Happens when baby is Rh+ and mom is Rh-. Doesn’t happen with ABO because Igs are usually IgM, plus A and B aren’t expressed heavily.
Sxs: jaundice anemia, edema. nucleated reds, HSM
C peptide?
Released with insulin into circulation after cleavage.
Embryonic kidney development
Pronephros- regresses
mesonephros- becomes wolffian structures
metanephros – ureteric bud becomes collecting system (including collecting duct), metanephric mesoderm is the tubules and glomerulus
How to treat toxoplasmosis
Pyrimethamine and sulfadiazine (with folic acid)
Substitute clindamycin if sulfadiazine sensitive.
Why do barbiturates wear off so fast
Tissue redistribution into cells and out of blood.
What is a major side effect of inhaled anesthetics?
Massive hepatic necrosis, especially with halothane.
Daptomycin
used to treat mrsa, depolarizes cell membranes. Causes myopathy and increased CPK. Inactivated by surfactant.
How does linezolid work? Side effects
binds to 50S, causes thrombocytopenia, optic neuritis. high risk for serotonin syndrome.
Rubber factory workers?
Transitional cell carcinoma
What causes green color of sputum during pneumonia?
Myeloperoxidase
Number needed to harm
1/Attributable risk
AR is calculated taking the #complications/total in experimental group - # complications/total in placebo
Short acting benzodiazepine?
Triazolam (Just give it a try)
Long acting benzodiazepine
Diazepam, flurazepam, chlordiazepoxide
Peripheral chemoreceptors
In carotid/aortic bodies, sense hypoxemia.
Central receptors respond to increased CO2
True vocal chords epithelium
Stratified squamous
Mechanism of resistance to aminoglycosides in enterococci
Add modifying groups like acetyls, adenyls, or phosphates
Drug property that predisposes to predominantly hepatic metabolism?
High lipophilicity and large VD
Retinal neovasularization in neonates due to?
O2 supplementation after respiratory distress in premature babies. This is called retinopathy of prematurity
Anaplasia
Primitive cell formation. Often with giant cells
When to use colchicine for acute gout
When in renal failure or with peptic ulcer disease (or other contraindications to NSAID use)
BBB protected by?
Tight junctions and astrocyte foot processes
Diseases of hemidesmosomes
Bullous pemphigoid, junctional epidermolysis bullosa
Breathing pattern of restrictive diseases
Fast and shallow
Breathing pattern of obstructive diseases
Slow and deep
INH needs what to work?
Needs to be activated by bacterial catalase peroxidase in order to work.
Side effect of niacin
Hyperuricemia, hyperglycemia, flushed face that decreases with aspirin
Conversion disorder
Stress related somatiform disorder where neurologic symptoms. Don’t seem concerned
Akathesia
Subjective sensation of restlessnes from D1 blockers
Human placental lactogen
Involved in maternal insulin resistance to provide baby with glucose needed for survival. Increases maternal glucose levels, also increases lipolysis and proteolysis to provide nutrients to mother. Produced by syncitiotrophoblasts.
Where are type I muscle fibers located?
Slow twitch fibers with lots of myoglobin, located in paraspinal and soleus. Mostly use ATP
Which nerve is injured during thyroidectomy?
Superior laryngeal which innervates the cricothyroid (vagus)
EBV in HIV patients
Causes burkiits lymphoma and cns lymphoma
Key lesion in minimal change disease
podocyte effacement
Hydrocele due to
Patent processus vaginalis
How to treat TCA cardiac abnormalities?
Give sodium bicarbonate.
What are the TCA cardiac abnormalities
Longer QT and QRS widening.
If wrong AA is placed on tRNA what ahppens?
Wrong AA is incorporated into protein
Hypokalemia symptoms
Muscle weakness and parasthesias
Trendelenberg gait
Superior gluteal nerve injured (located superiomedially) causes opposite hip to drop when leg is in the air. Due to problems with gluteus medius
Length constant
How far along an axon an electrical signal can propagate. Decreases with demyelination. Time constant increases with demyelination
Prophylaxis when CD
Azithromycin for MAC
Red neurons
Appear 12-48 hours after injury in brain. Really are red.
Pathogenesis of ARDS
Endothelial damage causes formation of hyaline membranes
Vaginal infection after birth caused by
Bacterioides. Endometritis has foul smell
MSUD caused by
Defect in branched chain alpha ketoacid dehydrogenase, which requires B1 to function.
What do sertoli cells make?
Androgen binding protein. Binds testosterone, makes it less lipophilic so it can remain in seminiferous tubules and epididymis
How to treat hyperhydrosis
Botox at thoracic ganglion to block the release of ACh from sympathetic cholinergic postganglionic fibers
PE breathing defect?
Metabolic alkalosis due to increased PaCO2 which the respiratory centers try to blow off ASAP.
Vancomycin side effects
Nephrotoxicity, ototoxicity, and thrombophlebitis.
Also red man syndrome – rash and pruritus especially when dehydrated and with fast infusion rate. Treat with antihistamines
What does elevated baseline insulin mean?
Some degree of peripheral insulin resistance
Which nerve fibers are unmyelinated?
C fibers– pain and temp
And autonomic postgangionic fibers
Thromboangiitis obliterans
AKA buerger’s disease. Seen in male smokers. Has segmental thrombosing vasculitis that involves arteries, veins, and nerves. Causes fibrous tissue to encase the structures
Myxomatous degeneration
The hallmark of cystic medial necrosis
Kussmaul sign
Increase in JVP on inspiration due to constrictive pericarditis
What is a sign of very advanced mitral regurgitation?
The presence of an S3
Why does lipofuscin accumulate in heart?
Due to lipid peroxidation and free radical injury over time.
What structure makes of the majority of the anterior heart surface?
Right ventricle
Dipyridamile and cilostazol
Platelet phosphodiesterase inhibitor that causes an increase in cAMP (decreased aggregation), and vasodilation
Pulsus paradoxus
A paradoxical decrease in peripheral pulse on inspiration. Caused by constrictive pericarditis, cardiac tamponade, asthma, COPD, PE.
What happens to FRC when lungs increase in elasticity?
FRC decreases. This occurs in pulmonary fibrosis
What happens to FRC when chest wall increases pull or elasticity of lungs decreases?
FRC increases (emphysema)
Secondary amyloidosis
Due to AA accumulation (SAA is an acute phase reactant). Occurs in bronchiectasis, rheumatoid arthritis, IBD. Basically anything with chronic inflammation
Caplan Syndrome
Coal worker’s pneumoconiosis plus rheumatoid arthritis
Berylliosis causes…
Noncaseating granulomas. Can definitely be confused with sarcoid so careful! These granulomas also produce 1alpha hydroxylase which can cause hypercalcemia.
Increased risk for lung cancer.
Body parts affected by sarcoidosis
Lungs, uvea, skin (erythema nodosum), lacrimal/salivary glands (can mimic sjogren’s syndrome).
Where does lung cancer met to most often?
Adrenals.
Can recurrent PE cause pulmonary hypertension?
Yes
What is the genetic defect that causes PHTN
BMPR2 INACTIVATION causes proliferation of vascular smooth muscle
What are the causes of NRDS (hyaline membrane disease)
Maternal diabetes (fetal insulin causes decreased surfactant synthesis)
Prematurity
c-section
What are the main causes of lung cancer
Asbestos, smoking (polycyclic hydrocarbons), radon ->uranium
Causes of benign coin lesions?
Histoplasma (causes granulomas), benign bronchial hamartomas (which include cartilage!)
Lung hamartoma components
Lung tissue and CARTILAGE
Symptoms of legionaires disease
Hyponatremia, confusion, diarrhea, lung infiltrates, bradycardia.
Effect of hyperventilation on cerebral blood flow
less cerebral blood flow with less CO2
Does reid index include cartilage?
No
TB virulence factors
Cord factor inactivates neutrophils, serves as main virulence factor. Releases TNF alpha, destroys mitochrondria.
Sulfatides - inhibit phagolysosome fusion.
ARDS Histology
Hyaline membranes due to capillary destruction
Theophylline overdose
Causes seizures, abdominal pain
Rifampin
Blocks DNA dependent RNA polymerase
How does N-acetylcysteine break up mucus
Breaks disulfide bonds
Nystatin and amphotericin
Binds to cell membrane (ergosterol) and poke holes
Caspofungin
Inhibits glucan synthesis for fungal cell wall
Where to perform thoracocentesis
Midclavicular, above 7
Midaxillary, above 9
Posterior scapular- above 11
Bronchioalveolar carcinoma
Caused by clara cells. Carcinoma in situ. Mucus producing. Doesn’t invade.
What is the CFTR
An ATP pump that creates hypotonic sweat
How does sed rate increase
Fibrinogen is an acute phase reactant (il6 mediated). Binds RBCs and causes rouleaux formation
Sxs of fat embolism
Shortness of breath, petechial rash , confusion.
SOB is dues to local toxic ards.
Symptoms of glucagonoma
New onset DM, but more likely tested is necrolytic migratory erythema, which are erythematous papules on face, perineum, extremities. Bronze colored central indurated area with peripheral blistering.
Why give beta blockers for hyperthyroidism
Decrease Beta activation (increased HR), but also block peripheral conversion of t4 to t3
Myoedema
Swelling after hitting skin due to hypothyroidism. Ca is not taken up quickly into SR causing edema.
Where is erythropoetin produced?
In the renal peritubule interstitial cells
How does RCC spread?
Via the renal vein, but also spreads lymphatically to the retroperitoneal LN
Where does bladder adenocarcinoma come from? Where is it located?
From remnant of urachus. Located at the dome of the bladder.
Acyclovir side effect
Obstructive crystalline nephropathy if not adequately hydrated.
Upper portion of ureter supplied by what artery?
Renal artery
Il-2
Activates natural killer cells in addition to t cells
Digoxin clearance?
Renal!
Why doesn’t creatinine increase with decreased GFR with aging?
Because older people have less muscle.
How to treat crigler najjar type II
Phenobarbital which increases liver enzyme synthesis
How to treat hepatic encephalopathy
Rifaximin (which kills gut bacteria), lactulose
What are mallory bodies
Degenerated intermediate filaments in hepatocytes in response to alcoholic hepatitis.
How to treat wilson’s disease
penacillamine or trientine.
How is copper normally excreted?
Into bile by atp pump encoded by ATP7b
Histology of PBC
Lymphocytic invasion and granuloma formation around intralobular bile ducts
Histology of PSC
Onion skinning and beads on a string of intra and extrahepatic bile ducts.
IL1 effect on bone
Increased in osteoporosis, activates osteoclasts.
Also implicated in multiple myeloma
How to treat recurrent CDiff Colitis?
Fidaxomicin. Which blocks RNA polymerase, stops protein synthesis and causes cell death. Has minimal systemic absorption and also doen’t affect colon flora as much as vanc or metro.
Spread of haemophilus meningitis vs neisseria?
Haemophilus uses lymphatics, neisseria uses the blood and choroid plexus.
Foscarnet side effects
Renal toxicity and magnesium wasting, but also chelates calcium and can cause seizures. Use for CMV retinitis in AIDS patients
Vitiligo
Autoimmune destruction of melanocytes
Interferon alpha and beta
Decrease protein synthesis in neighboring cells in the event of viral infection.
Marginal zone lymphoma caused by?
Sjogrens (parotid), Hashimotos, H.Pylori
Mixed connective tissue disease antibody
U1 Ribonucleoprotein
Job Syndrome
Autosomal dominant hyper IgE syndrome caused by a STAT 3 mutation in TH17 cells. Causes FATED. Abnormal facies, noninflammed staph abscesses, retained primary teeth, and eczema.
How to treat TCA cardiac abnormalities (long QT, tachycardia)?
Sodium bicarb
