1 Flashcards
Most common location of nasal polyps
Middle meatus
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
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
Acidosis, polyuria, hypophosphatemia
Fanconi Syndrome
Fanconi-like syndrome = lead nephropathy, Wilson disease, / expired tetracyclines, etc)
sooo many look it up
Beta-thal mutations impair what…
Initiation of translation via KOZAK sequence mutation (gcc) gccRccAUGG (R= adenine or Guanine)
Translocation requires
GTP and EF2
A–>T causing glutamate to valine @ position 6
sickle cell
Penicillin MOA
Inhibit transpeptidase thus cross-linking of D-ala D-ala (final step in peptidoglycan cell wall synthesis)
MOA of Vanc
Acts early than penicillin by directly binding D-ala-D-ala
Kussmal sign and pulsus paradoxus
pericardial firbrosis (impaired ventricular dilation and diastolic filling)
Increased monoclonal T-cells–>TGF-B–>increased production of ECM proteins and collagen by fibroblasts
CREST syndrome
Upper anal canal (above pectinate line) =
lower=
upper= from hindgut lower= invagination of surface ectoderm
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
Binasal hemianopsia (pressure on the lateral areas of optic chiasm): name a cause…
calcified carotid arteria
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
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
Treatment for portal HTN
TIPS (transjugular intrahepatic portosystemic shunt) btw portal vein and hepatic vein percutaneously
Caput medusa
paraumbilical veins (portal) and superficial and inferior epigastric veins
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
Direct transfer of plasmids from one bacterium to another through a sex pilus. Ex: how E.coli acquire their ability to form pili
Conjugation
Streptococcus pneumoniae bacteria aquire ability to produce capsules via…
Transformation
Methimazole inhibits thyroid hormone synthesis by supressing iodination and coupling of tyrosine. ADRS?
edema, rash, agranulocytosis
Increased expression of PDGF (gingival hyperplasia), Ataxia/ nystagmus, Megaloblastic anemia, inducer of P-450, fetal hydantoin syndrome
Phenytoin ADRs
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
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
