2 Flashcards
Absent or abnormal (incus, malleus, stapes) lead to profound conductive hearing loss. Also see craniofacial abnormalities (mandibular, maxillary, zygomatic bone hypoplasia) due to abnormal development of 1st and 2nd pharyngeal arches
Treacher-Collins syndrome
Learn your arches
Kidney issues:
1) Heroin and pamidronate:
2) Gold therapy
1) FSGS
2) Membranous nephropathy
Most common agents for tubular necrosis?
Aminoglycosides, radiocontrast media, cisplatin, AmpB, foscarnet
Drug induced tubular obstruction
Sulfonamides, MTX (and motabolite), IV acyclovir, triamterene can precipitate in renal tubules and cause failure
Drug induced interstitial nephritis (renal interstitial infiltration)
Methicillin (MC), cephalosporins, acetazolamide, allopurinol, sulfonamides, and NSAIDs
a chloride channel that is activated by cAMP-mediated phosphorylation and subsequently gated by ATP
CFTR (3 base pair deletion that removes a phenylalanine at position delta-508)–>impaired posttranslational processing
Less common CFTR mutations
1) Mutations causing premature termination of the transmembrane protein (nonsense, frameshift)–>complete absence of CFTR (Ashkenazi Jew)
2) Mutation–>defective ATP binding by CFTR–>membrane bound nonfunctional protein
3) Mutation–>impaired chloride conductance through CFTR (milder disease)
4) Mutation–> decreased production of functionally normal CFTR (reduced mRNA or protein stability) also milder
Amlodipine (DHP vasodilator) ADRs
HA, dizziness, flushing, peripheral edema
Indapamide
thiazide diuretic used for HTN tx
Terazosin (alpha-1 antagonist) used in BPH/HTN ADRs
lightheadness, orthostatic hypotension
Prolonged neonatal jaundice beyond 2 weeks due to increased erythrocyte breakdown and immaturity of newborn liver
Glucose-6-phosphate dehydrogenase deficiency
Role of IL-2 and INF-gamma in granuloma formation
IL-2 stimulates the autocrine proliferation of Th1 cells and INF activates macrophages–>promoting granulomas
Metabolism of glucose through hexose monophosphate (HMP) shunt has two major fucntion (all rxns occur in cytoplasm)
1) production of NADPH as a reducing equivalent
2) synthesis of ribose-5 phosphate for nucleotide synthesis (non-oxidative)
Note: in erythrocytes, the HMP shunt is only major pathway that generates NADPH to maintain glutathione in a reduced form via glutathione reductase (protects from free radical damage)
G-6-PD results in denatured hemoglobin (heinz bodies resulting in erythrocyte destruction by spleen. Additionally oxidative stress results in …
stiffening of the erythrocyte membrane and hemolysis in the microvasculature due to an inability of the erythrocyte to deform and fit through capillary beds
Cholesterol gallstone are due to ability of bile salts to solubilize cholesterol being overwhelmed by concentration of cholesterol in bile. These stones are yellow and pale gray and hard. Now what about pigment stones?
Composed of calcium salts and UNCONJUGATED bilirubin (soft and brown-black)
Arise secondary to bacterial (e.coli) or helminthic (Ascaris lumbricoides, Clonorchis sinensis aka liver fluke) infection of biliary tract resulting in release of beta-glucuronidase (hydrolyize bilirubin glucuronides to increase unconjugated bilirubin) by injured hepatocytes and bacteria
Pigment stones (asian populations or hemolytic anemia)
7-alpha-hydroxylase catalyzes the conversion of cholesterol to 7-alpha-hydroxycholesterol
First step in bile salt synthesis (lowers ratio of cholesterol to bile salt) = protective to cholesterol stones
_____ upregulate HMG Co-A reductase to increase cholesterol synthesis
Estrogen
High-oxygen affinity hemoblobin mutations (left shift/lowered P50)
Hemoglobins Chesapeake and Kempsey–>Kidney will increase EPO to keep patient mainly asymptomatic
Sickle cell oxygen-Hb curve shift?
Right (hypoxia-induced hemolysis)
Fever, uticaria, angioedema, eosinophilia
Katayama fever caused by Schistosomia Haematobium
How does Toxic Shock Syndrome present?
Fever, vomiting, diarrhea, desquamation and HYPOTENSION
Loners with longings
Avoidant personality disorder
vs schizoid or schizotypal = content w/ social isolation
10 years post radical mastectomy in setting of persistent lymphedema (chronic dilation of lymphatic channels)
Lymphangiosarcoma- malignant neoplasm of the endothelial lining of lymphatic channels
Cavernous hemangioma
Benign neoplasm of small blood vessel endothelial cells (do not confuse w/ carvernous lymphangioma aka cystic hygroma–differ only by lack of luminal blood cells)
Hypertrophic granulation tissue that grows rapidly as exophytic red nodules attached by a stalk to gingival or oral mucosa
Pyogenic granuloma (pregnancy or trauma)
- Birthmark consisting of malformed, dilated blood vessels in superficial dermis
- Permanent
Nevus fammeus (port-wine stain)
Spindle-shaped cells with markers of both smooth muscle and vascular endothelial markers (biopsy w/ lymphocytic infiltration)
Kaposi Sarcoma (HHV-8)
Integration of viral DNA into cellular genome of the host is considered a trigger for neoplastic change
HPV (cervical cancer) and HBV hepatocellular carcinoma (preceded by HBV induced cirrhosis)
HBx protein activates insulin-like growth factor II and receptors for insulin-like growth factor I thereby stimulating cell proliferation. Name another effect of HBV gene products…
Suppression of p53 and chronic inflammation and regeneration by HBV infection –> mutations in hepatocytes
Pathogenosis of HBV:
Infected hepatocytes express MHC class I and are destroyed by CD8+ T-cells
Tx for TTP
plasma exchange (life saving)
Bicep tendonitis is characterized by tenderness at the bicipital groove. Insertion? Origin? Action?
Origin: Supraglenoid tubercle of scapula
Insertion: Radius
Action: Flexes and supinates the forearm (contributes some to shoulder flexion)
Serratus anterior: O, I, A, Injury?
Origin: lateral surface of first 8 ribs
Insertion: Scapula
Action: Pulls scapula forward and rotate it to raise the glenoid.
Injury: Long thoracic nerd = winged scapula
Supraspinatus muscle assists in abduction of the arm (first 10-15 degrees) and stabalization of glenohumeral joint. Injury to Tendon?
Impingement btw acromion and head of humerus . Most common cause of rotator cuff syndrome
Wheezing and migratory infiltrates in asthma patient. Increased IgE tiders and antibodies to….
Aspergillus are diagnostic of ABPA (allergic bronchopulmonary aspergillosis)
Invasive pulmonary aspergillosis occurs in immunocompromised and neutropenic patients
cough, hemoptysis, pleuritic chest pain, and fever. Necrotizing pneumonia and granuloma formation also occur. Extrapulmonary involvement is common.
Common peroneal nerve is susceptible to injury at the
lateral neck of fibula (caused by compression)–>leads to foot drop due to deep peroneal nerve innervates anterior compartment muscles (tibialis anterior- dorsiflexion) and toe extension (extensor digitorum longus, extensor hallucis longus)
Superficial peroneal nerve injury (concmitant from common peroneal injury) causes impaired
Foot eversion (peroneus longus and brevis) and sensory loss over lateral leg and dorsolateral foot
Femoral nerve injury:
weakness on hip flexion (iliopsoas) and knee extension (quadriceps)
Sensory innervation to posterolateral leg
Lateral sural cutaneous nerve (branch common peroneal nerve)
Sensory loss over the peroneal, tibial, and sural nerve distributions with weakness in the majority of the lower leg muscles (include hamstrings)
Sciatic nerve
Largest terminal branch of sciatic nerve. Damage = difficulty with foot PLANTAR flexion (???muscles???) and decreased sensation over SOLE of foot
Tibial Nerve
Gastrocnemius and Soleus
Unilateral facial pain that worsens with jaw movement, H/A, ear discomfort. Symptoms can originate from TMJ, pathologic contraction of muscles of mastication, and/or hypersensitivity of the nerves that supple the jaw
Temporalmandibular disorder (TMD) (Madibular nerve of trigeminal nerve involved)
V3 (mandibular nerve) of trigeminal nerve contains both motor and sensory components supplies sensation to? and motor to?
Sensation: Floor of the mouth, inside of cheeks, anterior tongue, much of skin of lower face
Motor: Muscles of mastication (medial and lateral pterygoid, masseter, temporalis), muscles of floor of the mouth (mylohyoid), tensor veli palatini and TENSOR TYMPANI in the middle ear.
V2 of trigeminal = maxillary division: sensory of
Cheeks, nares, upper lip and teeth, the PHARYNGEAL PALATE, and MAXILLARY SINUSES
= O2 consumption / Ateriovenous O2 difference
CO
Respiratory quotient is ratio of CO2 to O2 across alveolar membrane and is used to estimate
metabolic rate (normal = 0.8)
CO= (135X ____) / [(13XHb) X (SaO2-SvO2)
BSA (body surface area)
Glenohumeral joint is the most commonly dislocated joint in body. Anterior dislocation (MC) classically follows blow to an externally rotated and abducted arm (throwing a football). What nerve is injured? What do you see?
Axillary nerve–> innervates deltoid and teres minor muscles and sensory to skin over lateral shoulder.
Flattening of deltoid and acromial prominence
Shotgun shoulder
Fracture of coracoid process
Acromioclavicular joint subluxation
downward blow to tip of the shoulder. Swelling and upward displacement of the clavicle
Spiral fracture of midshaft humerus (torsion produced falling on an outstretched hand). Nerve than can be injured?
- Radial
- swelling, bone crepitus, ecchymoses of the arm.
Predisposing factors to infective endocarditis in developed nations
MVP (MC), valvular sclerosis, and mechanical valves
RHD in developing is frequent cause
Sharply demarcated, salmon-colored, rounded plaques covered with a loosely adherent white scale. Erupts MC on elbows, knees, lumbosacral and scalp.
Psoriasis
Calcipotriene (calcipotriol), calcitriol, tacalcitol
Topical Vitamin D analogs for psoriasis bind and activate the Vit. D receptor (a nuclear transcription factor that causes inhibition of keratinocyte proliferation and differentiation (inhibits T-cell proliferation and other inflammatory mediators too)
Etanercept MOA in treating moderate to severe plaque-type psoriasis?
Recombinant form of TNF receptor that binds TNF-alpha
Ustekinumab (Stelara) MOA
Monoclonal Ab used in psoriasis that target IL-12 and IL-23. It inhibits differentation and activation of CD4+ TH1 and Th17 cells
DM1 patient on insulin with Addison. What do with dose?
Descrease! (glucocorticoids increase insulin resistance and this hoe ain’t got any)
DM1 patients prone to developing
Autoimmune endocrinopathies including Addisons, Hashimoto, Graves
Primary adrenal insufficiency electrolyte abnormalities
Hyponatremia, Hyperkalemia, Hyperchloremia, and NON-anion gap metabolic acidosis
Block Na/Cl in distal tubule…more Na+ reach collecting tubule–>increased K+ and H+ excretion. Hyponatremia, hypokalemia, and metabolic alkalosis
Thiazide diuretics
Isolated Hyperkalemia causes
Excess in diet, cell lysis, B1 antagonist, decreased shift into cells due to insulin deficiency
Normal serum sodium in the setting of hypokalemia and hyperchloremic metabolic acidosis suggest
Distal hypokalemic or proximal RTA
Mineralcorticoid (primary hyperaldo) electrolyte imbalance
Metabolic alkalsosis (increased HCO3 in serum and loss of H+ in urine), Hypernatremia (mild due to ADH intact), Hypokalemia (loss in urine)
Restrictive pericarditis change on juglar venous tracing
Rapid Y-descent that becomes deeper and steeper during inspiration
Causes of restrictive pericarditis (slow progressive dyspnea, peripheral edema, ascites)
Radiation therapy of chest, cardiac surgery, TB
Increases risk of preeclampsia, spontaneous abortion, fetal demise, and placental abruption
Prenatal coke use
Fetal macrosomia, caudal regression syndrome, hypoglycemia, hypocalcemia, and hypertrophic cardiomyopathy are associated with…
Gestation diabetes
Burning on urination and urgency may be seen in hemorrhagic cystitis caused by:
Cyclophosphamide or ifosfamide
Doxorubicin is an _____ and _____
anthracycline antibiotic and chemotherpeutic intercalating agents (ADR= CHF)
ADR of bleomycin
- Dry cough and exertional dyspnea= pulmonary toxicity/fibrosis
- Flagellate skin discoloration
Tarry stool (melena) and fatigue can be seen with all chemo drugs affecting rapidly dividing cells but most commonly…
alkylating agents
Cell death in cells with high turnover rate: hair, skin, and the mucosa of the GI system
Melena is most commonly cause by:
Upper GI bleed
Mercaptopurine (S-phase) ADR
Abdominal pain and jaundice. Cholestasis and hepatitis. Patients using it chronically like RA watch out for liver cirrhosis
Forty, fat, female, and fertile
Gallbladder disease (usually cholecystitis)
CCK is produced by _____
Produced by I cells in duodenum and jejunum
Promotes bicarb secretion from pancreatic ductal epithelium
Secretin
Stimulates gastic acid secretion and motility.
Gastrin
Made in response to low pH. Inhibits release of GH, TSH, Gastrin, CCK, VIP, Secretin, insulin, and glucagon. Inhibited by vagal stimulation.
Somatostatin
Spore often contaminate animal hides:
C.Burnetii
MacConkey agar contains what that will inhibit growth of contaminant organisms
Bile
Inhibits mitochondrial gycerophosphate dehydrogenase and complex I (first electron transport chain enzyme)—>decreased energy stores causes AMPK activation—> decreased hepatic gluconeogenesis
Metformin
Avoid metformin in what patients
CHF or alcoholism due to increased risk for lactic acidosis
Diagnosis of gestational diabetes
3-hour glucose tolerance test
VMA is screening tool for
pheochromocytoma
Sulfonylureas are associated with
blood dyscrasias
Thyroid test for what two drugs most commonly
lithium and amiodarone
calcium dependent (Gardos) potassium channel blockers
Prevent intracellular dehydration by reducing K+ and water efflux–>reducing polymerization of Hb S in sickle cell
Hydroxyurea increases Hb F synthesis. It is reserved in sickle cell patients with
PAIN CRISIS
Subtype of social anxiety disorder is given to patients who have symptoms only in performance situations (eg. speaking or performing in public)
“performance-only” social anxiety disorder
Excessive fears of scrutiny or embarrassment in social or performance situations, resulting in significant distress and functional impairment
social anxiety disorder
Livedo reticularis (purplish network-patterned discoloration) and palpable purpura (small infarcts sometimes with ulceration) seen in
1/3 of PAN patients (segmental, TRANSMURAL, necrotizing inflammation of medium small sized arteries)
Heterophile Ab- negative mono-like syndrome (2 negative agglutination tests) include
CMV, HHV-6, HIV, and Toxo
Aspectic meningitis and herpangina (fever, posterior pharyngeal gray vesicles/ulcers) in children
Coxsackie A virus
Fanconi Anemia (AR or hypersensitivity to DNA-crosslinking agents)
impaired DNA repair
Bloom syndrome inheritance
AR (impaired DNA)
