3/3 Flashcards
Why does SIADH present with euvolemic hyponatremia?
The excess ADH leads to water reabsorption, leads to RAAS activation, leads to natriuresis, leading to normalized volume with low sodium
In assessing viral HBV infection, what viral process does HBeAg indicate?
HBeAg = viral replication, increased infectivity
Indicates increased risk of neonatal infx if seen in mother
In homocystinuria, what AA becomes essential?
Cysteine
What are common sx of homocystinuria?
Hypercoagulability Premature atherosclerosis Ectopia lentis (displacement of ocular lens) Osteoporosis Mental retardation
Warfarin MoA?
Inhibits vit K dependent carboxylation of glutamic acid residues in factors 1972CS
CGD patients are susceptible to infection by what type of bugs?
Bacterial and fungal infections that are CATALASE POSITIVE
Staph. aureaus, Burholderia cepacia, Serratia marcescens, Nocardia, Aspergillus
What are some common catalase positive bugs?
Staph aureus, burkholderia cepacia, Serratia marscencens, Nocardial, Aspergillus
Tx for trichomonas vaginitis and bacterial vaginosis (Gardnerella)?
Metronidazole
Disulfram-like rxn
Tx for chlamydial urethritis?
Doxycycline or azithromycin
Tx for candida vaginitis?
Fluconazole
Niacin (vit B3) MoA in treating hyperlipidemia?
Decreasing synthesis of TG and VLDL
Also increases HDL by 25-30%, best one!
Prominent side effect of niacin?
Flushing
Bile acid binding resins effect on TG?
Increase
Ezetimibe MoA?
Decrease intestinal absorption of cholesterol
What drug reduces tobacco withdrawal cravings and attenuates rewarding effects of nicotine?
Varenicline
Partial agonist of nicotinic ACh-Rs
Selective COX2 inhibitor?
Celecoxib
Celecoxib MoA?
Selective COX2 inhibitor
When is celecoxib (selective COX2 inhibitor) useful?
To avoid platelet aggregation impairment
Diphenoxylate MoA?
Binds to mu opiate receptors to slow GI motility
Opiate
What to give for secretory diarrhea?
Octreotide
What nerve for foot dorseiflexion? Plantar flexion?
Dorsiflexion: Common peroneal
Plantar flexion: Tibial
Incomplete obliteration of the processus vaginalis can lead to what two similar pathologies?
Hydrocele (small opening remains)
Indirect inguinal hernia (large opening remains)
What is the single most important risk factor in development of intimal tears leading to aortic dissection?
HTN
What congenital disease is associated with aortic dissection?
Marfan syndrome (esp in younger pts)
The most common cause of death from TCAs?
Arrhythmias from inhibition of Na channel conduction
Rule of 2s for Meckel’s diverticulum?
2% of population 2 feet from ileocecal valve 2 inches in length 2% are symptomatic 2 times as likely in males
Wernicke’s syndrome triad?
Opthalmoplegia, ataxia, confusion
In Wernicke’s syndrome, where do you find hemorrhage and necrosis in the brain?
Mamillary bodies and periaqueductal gray matter
What causes Wernicke’s syndrome?
Chronic thiamine (B1) deficiency
Thiamine (B1) is a cofactor for which enzymes?
- Pyruvate dehydrogenase
- alpha-ketoglutarate dehydrogenase
- Transketolase
Ankylosing spondylitis is a chronic inflammatory disorder of what?
Sacroiliac joints and axial skeleton
“Bamboo spine” on xray describes what disease?
Ankylosing spondylitis
What are the seronegative (lacking serum rheumatoid factor) spondyloarthropathies?
Ankylosing spondylitis
Reactive arthritis
IBD associated arthritis
Psoriatic arthritis
(Associated with HLA B27)
The portal triad that runs through the hepatoduodenal ligament contains what vessels?
Hepatic artery
Portal vein
Common bile duct
Where are S cells (secretin releasing) located?
Duodenum
Secretin causes release of bicarb from what organ?
Exocrine pancreas
Pancreatic juice normally has the same [Na] and [K] as plasma. Is the [HCO3] and [Cl] higher or lower? How do they change with flow rate?
[HCO3] is higher than plasma, and goes higher with higher flow rate.
[Cl] is lower than plasma and goes lower with higher flow rate.
Digoxin MoA
Inhibits Na/K pump, increases intracellular [Na], reducing Ca efflux, increasing intracellular [Ca]
This decreases conductivity through AV node and increases contractility of myocyte
Familial chylomicronemia is an AR condition cause by deficiency of what enzyme? What is the common presenting disease?
Lipoprotein lipase deficiency, presenting in childhood with recurrent acute pancreatitis
Which virus, HBV or HCV, persists in the host genome to continue risk of HCC?
HBV, a DNA virus, injects into host chromosome, allowing transcription of HBx protein.
HBx inactivates p53.
Systolic crescendo decrescendo murmur
Aortic stenosis
Malaria tx?
Chloroquine if sensitive, mefloquine if chloroquine -resistant
Pantothenic acid (coenzyme A) is particularly important for which step of the TCA?
First step: oxaloacetate to citrate
Multiple ring-enhancing lesions on contrast MRI in an HIV pt points to what bug?
Toxoplasmosis
Aplastic anemia pathogenesis?
BM failure due to deficiency in CD34 hematopoietic stem cells
Causes of aplastic anemia?
Autoimmune
Infections (parvovirus B19, EBV)
Drugs (carbamazepine, chloramphenicol, sulfonamides)
Radiation/toxins (benzene, solvents)
PABA blocks what type of UV rays?
UVB (the Bad one)
What drug gives red/orange discoloration to secretions (urine, breast milk, tears)?
Rifampin
‘rifAMPin AMPlifies’ CYP450
Used for Neisseria meningitidis prophylaxis
What is the precursor for serotonin?
Tryptophan
What is tyrosine the precursor for?
Dopamine, NE, Epi, melanin, thyroxine
What is the antidote for serotonin syndrome?
Cyproheptadine, first gen histamine antagonist with nonspecific 5HT-R anatgonism
Slowly growing jaw mass in setting of oral trauma, that drains yellow pus through the skin = what bug?
Actinomyces
Normal gram+ oral flora
Tx: penicillin and debridement
Borrelia burgdorferi causes what disease?
Lyme disease
Pasteurella multocida is associated with what type of injury?
Animal (usually cat) bites
What is the disease and cutaneous lesion associated with Rickettsia?
Rocky Mtn Spotted Fever, with palmoplantar erythematous macules that migrate centrally
What 2 drugs are given to diabetics to decrease progression of diabetic nephropathy?
ACE-I and ARB
Lisinopril
