1 Flashcards by Keegan Sturgill

Most common location of nasal polyps

Middle meatus

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Renal Papillary necrosis is seen in what 4 disorders (gross hematuria, acute flank pain, tissue fragments in urine)

Sickle cell (and trait), DM, pyelonephritis, Analgesics

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Carotid sinus baroreceptors: Located on ICA just above common bifuraction
Afferent: ?
Efferent: ?
Too sensitive (hypersensitivity) = syncope

Afferent: Glossopharyngeal (hering nerve) to medulla centers and vagal nucleus
Efferent: parasympathetics via vagus to induce vasodilation (decreased BP) and decreased CO, HR and SV

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Acidosis, polyuria, hypophosphatemia

Fanconi Syndrome
Fanconi-like syndrome = lead nephropathy, Wilson disease, / expired tetracyclines, etc)
sooo many look it up

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Beta-thal mutations impair what…

Initiation of translation via KOZAK sequence mutation (gcc) gccRccAUGG (R= adenine or Guanine)

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Translocation requires

GTP and EF2

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A–>T causing glutamate to valine @ position 6

sickle cell

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Penicillin MOA

Inhibit transpeptidase thus cross-linking of D-ala D-ala (final step in peptidoglycan cell wall synthesis)

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MOA of Vanc

Acts early than penicillin by directly binding D-ala-D-ala

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Kussmal sign and pulsus paradoxus

pericardial firbrosis (impaired ventricular dilation and diastolic filling)

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Increased monoclonal T-cells–>TGF-B–>increased production of ECM proteins and collagen by fibroblasts

CREST syndrome

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Upper anal canal (above pectinate line) =

lower=

upper= from hindgut
lower= invagination of surface ectoderm

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Imperforate anus associations (cant pass meconium or pass through urethra if fistula present)

GU malfromations (MC): renal agenesis, hypospadias, epispadias, and bladder extrophy
Others: VACTERL 
Vertebral defects, anal atresia, cardiac abnormalities, TE fistulas, renal and limb anomalies

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Binasal hemianopsia (pressure on the lateral areas of optic chiasm): name a cause…

calcified carotid arteria

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Villus atrophy, crypt hyperplasia, and intraepithelial lymphocytic infiltration in duodenum and proximal illeum

Celiac disease (short stature, delayed puberty, anemia in adults)
History of travel: think infection/ tropical sprue

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Hormone sensitive lipase (found in adipose) takes stored TG–>FFA and glycerol (carbon source for gluconeogenesis)–>FFA oxidized by liver into acetyl-coA–> ketones (beta-hydroxybutyrate and acetoacetate)

Inhibited by: insulin

Stimulated by stress hormones: catacholamines, glucagon, ACTH

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Treatment for portal HTN

TIPS (transjugular intrahepatic portosystemic shunt) btw portal vein and hepatic vein percutaneously

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Caput medusa

paraumbilical veins (portal) and superficial and inferior epigastric veins

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Macrocyclic antibiotic related to macrolides that inhibits the sigma unit of RNA polymerase (bactericidal). USED for C.Diff because less effect on normal colonic flora

Fidaxomicin

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Direct transfer of plasmids from one bacterium to another through a sex pilus. Ex: how E.coli acquire their ability to form pili

Conjugation

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Streptococcus pneumoniae bacteria aquire ability to produce capsules via…

Transformation

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Methimazole inhibits thyroid hormone synthesis by supressing iodination and coupling of tyrosine. ADRS?

edema, rash, agranulocytosis

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Increased expression of PDGF (gingival hyperplasia), Ataxia/ nystagmus, Megaloblastic anemia, inducer of P-450, fetal hydantoin syndrome

Phenytoin ADRs

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Functional Hypothalmic Amenorrhea due to loss of pulsatile GnRH from hypothalamus (decreasing LH and FSH–>low circulating estrogen)…caused by:

weight loss, strenuous exercise, systemic illness, or abnormal eating habits

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Dec. production of Neuropeptide Y (normally makes you hungry) in the arcuate nucleus. Stimulates POMC-->cleavage-->alpha-MSH = inhibits food intake (increased satiety)

Leptin

LPS generates an immune response from:

TNF-alpha and IL-1

Leukotrienes role in asthma= produce bronchial constriction and mucosal edema/hypersecretion. Name the two leukotriene D4 receptor ANTAGONISTS

Montelukast and Zafirlukast

Li-Fraumeni syndrome: Breast cancer, sarcomas, brain tumors, leukemia, and adrenocortical tumors at young age

p53 on chromosome 17

Elevated zinc-protoporphyrin levels and ALA levels

Lead posioning

Porphobilinogen deaminase

AIP (acute intermittent porphyria) - Ab pain (acute) - Neuropsych issues - Red-brown urine

Pyruvate kinase deficiency inheritance?

AR Leads to hemolytic anemia Pallor, scleral icterus, splenomegaly

Factors that promote sickling

low oxygen, increased acidity, or low blood volume (dehydration), high levels of 2,3-BPG

Decreased linear growth, high serum GH and low circulating IGF-1 due to GH receptor defect

Laron dwarfisim

Narcolepsy with cataplexy is caused by lack of what 2 neuropeptides and where are they produced? Will be undetectable in CSF due to deficiency.

hypocretin-1* (orexin-A) and hypocretin-2 (orexin-B) produced in the lateral hypothalamus. They function to promote wakefulness and inhibit REM.

Elevated 14-3-3 in CSF

Creutzfeldt-Jakob Disease

Decreased homovanillic acid in CSF

parkinsons

Block oxidative deamination of 5-HT, NE, and Dopa. USED in atypical subtype of major depression and treatment-resistant depression.

MAOIs= phenelzine, tranylcypromine, selegiline

Mood reactivity, leaden paralysis (heavy arms and legs) and rejection sensitivity (sensitive), increased sleep and appetite

Atypical depression

Antidepressants with no sexual side effects

Bupropion and mirtazapine

Lipid synthesis, carbohydrate metabolism, and detoxification of harmful substances

Smooth ER

What two vitamins are not present in adequate amounts (if at all) in breast milk

Vitamins D and K K= given IM at delivery to prevent hemorrhagic disease in the newborn D= Supplementation to prevent RICKETS (not needed if formula fed)

Iron supplementation recommendations for infants

>4 months until solid food intake provides adequate amount. (breast milk gucci until 4 months)

Amyloid-beta plaque is an abnormal fragment of amyloid precursor protein (APP) which is normally involved in ....

synaptic formation and repair

Familial amyloid polyneuropathy or family amyloid cardiomyopathy results in a misfolding and extracellular deposition of transthyretin protein (prealbumin) located on...

TTR gene

Apolipoprotein E mutations result in impaired synthesis and impaired clearance of amyloid-beta from brain...associated with an increased risk of...

Late-onset alzheimer disease

Suspensory ligament of the ovary (infundibulopelvic ligament) is a fold of peritoneum that attaches the ovary to the pelvic sidewall and contains:

Ovarian artery, vein, lymphatics and nerves (must be ligated during oophorectomy) *Ureter runs underneath (DO NOT CUT) Water under the bridge

Transverse cervical ligament (cardinal ligament) contains the _________ artery in its superior portion

Uterine

Promimal _______ nerve lesions may result in sensory loss over the first 3 digits and impairment of the thumb flexion/opposition, flexion of second/third digits and wrist flexion and abduction

Median

Umbilical hernia, protruding tongue, large anterior fontanelle, and nonpitting edema (puffy face)

Congenital Hypothyroidism

Galactosemia (jaundice, vomiting, hepatomegaly, and lethargy and CATARACTS after ingesting breast milk or formula in the first few days of life) is caused by deficiency in what?

Galactose-1-phosphate uridyltransferase

Musty body odor, development delay, light pigmentation

PKU (most commonly caused by phenylalanine hydroxylase deficiency)

Triptans are used as abortive therapy for migraines but should be avoided in patients with

Cardiac or cerebral disease

Foscarnet (pyrophosphate analog) used for ganciclovir-resistant CMV. Forscarnet can chelate calcium (hypocalcemia) and other ADRs include

Hypomagnesemia (renal wasting) and reduction in PTH release (hypocalcemia) --> seizures

Acyclovir toxicities

Crystal nephropathy and neurtoxicity (tremor or delirium)

NRTI Lamivudine (unusual ADR for class)

peripheral nephropathy and lactic acidosis

Sofosbuvir inhibits nonstructural protein 5B (NS5B), an RNA-dependent RNA polymerase needed for Hep. C replication: ADRs =

fatigue and nausea

Ganciclovir (or prodrug Valganciclovir) side effects

Neutropenia which can be exacerbated by other bone marrow suppressing agents (zidovudine, TMX, etc.)

Diethylcaramazine is indicated for Tx of...

Loa Loa (loiasis) and Wuchereria bancrofti (lymphatic filariasis)

Ivermectin treats...

Strongyloidiasis and Ochocerciasis

Testicular germ cell tumors or gestational trophoblastic disease may develop high serum hCG leading to

``` paraneoplastic hyperthyroidism (identical alpha unit and very similar beta) Also FSH and LH share alpha unit ```

What drains the right lymphatic duct?

``` brachiocephalic vein (innominate) *unilateral SVC syndrome ```

What does the external jugular vein drain?

Scalp and portion of the lateral face

What does the internal jugular vein drain?

Brain and superficial face and neck

Bile acid-bind resins + statin =

MAJOR LDL decrease/ synergism

Amphotericin B side effects

- RENAL TOXICITY (renal vasoconstriction, decrease GFR, ATN, RTA)--> HYPOKALEMIA and HYPOMAGNESEMIA - Anemia (via decreased EPO)

Mucormycosis patient originally responds to AMP-B can be switched to posaconazole but now you must do what because on an AZOLE

Monitor LIVER function tests

Daptomycin ADR

rhabdomyolysis--> CCK elevated

Dermatitis herpetiformis: Bilateral and symmetrical on extensor surfaces (elbows, knees) and upper back and buttocks. Histo shows:

Microabseccess containing fibrin and neutrophils at dermal papillae tips. Overlying basal cells vacuolated.

Increased intraepithelial lymphocytes, a variable loss of villus height, crypt HYPERPLASIA, and steatorrhea

Celiac disease