3/28 MSK, Pulm, immuno Flashcards
Mutation in hereditary spherocytosis
Ankyrin, band 3, protein 4.2, spectrin
small round RBCs
splenomegaly
Bacterial transformation
taking up naked DNA (from cell lysis) from environment
SHiN
S. pneumoniae
H. influenza type B
Neisseria
What doe deoxyribonuclease do to bacteria?
degrade naked DNA so see no transformation
viral/bacterial Transduction
Use of phage
Generalized–> lytic phage packages bacterial DNA into viral capsid that can then infect another bacterium
Specialized–> lysogenic phage infects bacterium–viral DNA incorporates into bacterial chr. Excised phage DNA takes flanking genes with it
What drug activates antithrombin?
Heparin–> decreases action of IIa (thrombin) and factor Xa
where are the metastasis coming from if show osteoblastic lesions in the bone?
Prostate
Z line is what
the place where actin attaches to structural proteins (titin and alpha actinin)
sarcomere is defined as the distance between two Z lines
What calculation for a case control study
Odds ratio
Salicyate effect on ABG
Early–> Respiratory alkalosis
Late–> Anion gap metabolic acidosis
what nerve controls protrusion of the tongue
Hypoglossal XII
functions of the glossopharyngeal
somatic: stylopharyngeous muscle (elevates larynx)
Parasympathetic: parotid gland secretions
General sensory: tympanic membrane, tonsillar region, posterior third of tongue, upper pharynx (afferent gag reflex)
carotid body and sinus
Taste: posterior 1/3 of tongue
MOA morphine
mu agonist–> G protein–> increased potassium efflux
Close Ca channels
Host defense against candida
T lymphocytes–> prevent superficial infection (HIV)
Neutrophils–> prevent hematogenous spread (immunocompromised)
Bipolar I vs. Bipolar II
Bipolar I–> just mania +/- depression and hypomania
Bipolar II–>Hypomania + depression
Hypomania vs. mania
Hypomania: less severe, no psychotic features, >4 days
Mania: SEVERE, marked impairment in social or occupational function may require hospitalization. Psychotic features
SIADH body fluid and plasma osm
normal body fluid (increased body fluid–> RAAS–> excretion of sodium)
Low plasma osm
Tx for DKA
Regular insulin
30min start
peak 2-4hr
lasts 5-8
Role of glutathione peroxidase
detoxify free radicals (H2O2)
Role of glutathione reductase
Regenerates reduced glutathione to continue detoxifying free radicals
uses NADPH
Where does CN V3 come out?
Foramen ovale
Where does CN V2 come out?
Foramen rotundum
what goes through the foramen spinosum?
Middle meningeal artery
Cyclosporine
inhibits NFAT–> modulates transcription activity–> decrease release of IL-2
tx for psoriasis
pearly mass behind the tympanic membrane in the middle ear
cholestetomas
collection of squamous cell debris
cause hearing loss from erosion of auditory ossicles
cause: congenital, infection, trauma, surgery
MOA colchicine
inhibit micro tubular polymerization
disrupts chemotaxis, phagocytosis and degranulation
also reduces the formation of LTB4
SE: nausea, ab pain, diarrhea
Zileuton
inhibits 5-lipoxygenase and inhibits leukotriene formation
tx for asthma and allergic rhinitis
Cause of prepatellar bursitis
repeat anterior knee trauma from kneeling
Gardeners, mechanics, plummers, carpet layers
Causes of suprapatellar bursitis
direct blow to the distal thigh or prolonged quadriceps activity (running)
Churg-Strauss vs. PAN
Similar histologically but churg-Strauss effects smaller vessels and has granulomas with eosinophilic necrosis
PAN–fibrinoid necrosis with transmural inflammation
when do you get graft vs. host dz?
Allogenic bone marrow txt
organs rich in lymphocytes (liver)
transfusion of non-irradiated blood
pts severely immunocompromised
MOA in GVHD
immunodeficient host
immunocompetent donor T cells from graft attack host MHC antigens
Features of GVHD
maculopapular rash (palms and soles)
jaundice
diarrhea
hepatosplenomegaly
Precursor vitamin for synthesis of NAD+ coenzyme
Niacin
If deficient can make up for it with tryptophan
What is arginine the precursor to?
NO, urea, ornithine, agmatine and creatine
skin slipping off with gentle pressure (Nikoldky’s sign), epidermal necrolysis, fever, and pain associated with skin rash
Staph scalded skin syndrome
caused by exfoliatin exotoxin
blistering only the superficial epidermis
Pityriasis versicolor
Malassezia species of yeast
Hypo, hyper pigmented or erythematous macule or patches on upper body
hot humid climates and move visible after tanning
Diagnosis of Malassezia
KOH prep of skin
Spaghetti and meatballs
hyphae have short cigar-butt appearance
How is androgenic alopecia inherited?
Polygenic inheritance with variable expressivity
similar to epilepsy, glaucoma, HTN, ischemic heart dz, schizophrenia, DMII
Junctional nevis vs. compound nevis
Junctional–> dermoepidermal junction
flat black to brown pigmented macule with darker coloration in the center
Compound–> extend into dermis
raised papule with uniform brown to tan pigment
Out patient tx for non purulent cellulitis
Cephalexin to cover both beta hemolytic strep and MSSA
empiric Tx for UTI in child
Third generation cephalosporins and AGs
Most common organism in spontaneous bacterial peritonitis
E. Coli
How and how long to treat community acquired pneumonia?
third generation cephalosporin plus a macrolide or Doxycycline
5-7 days
Pneumocystis jiroveci labs
Elevated LDH
also occurs CD4 count
Watery non-bloody diarrhea with WBCs
invasive diarrhea
How to diagnose subcutaneous emphysema?
Fiberoptic bronch
presents with the abrupt onset of colicky abdominal pain, knee flexing, emesis, and bright red blood per rectum.
intussusception
Exam: sausage shaped mass in upper right quadrant
Diagnosis: ultrasound see “Target sign”
Treatment for HSV
Acyclovir
Fever, hemolytic anemia, thrombocytopenia, renal dz and change in mental status
Thrombotic thrombocytopenic purpura (TTP)
inhibition or deficiency of ADAMTS 13 (vWF metalloprotease)–> decreased degradation of vWF multimers
increased large vWF multimers–> increased plt adhesion –> increase plt aggregation and thrombosis
TTP labs
Schistocytes
increased LDH
microangiopathic hemolytic anemia