3/5 Flashcards
P450 inducers?
Rifampin, Carbamazepine Barbiturates, Griseofulvin, chronic alcohol use
P450 inhibitors?
Cimetidine, isoniazid, macrolides, azole antifungals, grapefruit juice
What causes an early diastolic decrescendo murmur?
Aortic regurgitation
Why does administration of amyl nitrite reduce an aortic regurge murmur?
Causes vasodilation, reducing systemic resistance
What causes a systolic ejection murmur that increases with intensity when standing?
Hypertrophic cardiomyopathy (due to a decrease in LV outflow tract size)
What causes a systolic ejection murmur that decreases with intensity when standing?
Aortic stenosis
What type of inheritance is classical galactosemia? What is the defective gene?
AR, defective galactose-1-phosphate uridyltransferase
Common side effects of nitrates (nitroglycerine, isosorbide)?
Headaches and cutaneous flushing
Muscles that Munch (close the jaw)?
Masseter, teMporalis, Medial pterygoid
Lateral pterygoid opens jaw
Divisions of CN V exit the skull due to Standing Room Only, from which foramen?
Opthalmic: Superior orbital fissure
Maxillary: foramen Rotundum
Mandibular: foramen Ovale
What does heparin inhibit?
Factor Xa and thrombin (UFH)
What is lacking in Xeroderma Pigmentosum?
Repair enzyme UV-specific endonuclease
UV radiation causes formation of what type of bonds?
Covalent bonds between adjacent pyrimidine (thymine) NAs
What vitamin deficiency is associated with Isoniazid?
B6, pyridoxine
Supplementation recommended
What is ethosuximide’s MOA in treating absence sz?
Blocks T-type Ca channels that rigger and sustain rhythmical burst discharges in thalamic neurons
Which 3 sz medications act by inhibiting neuronal high-freq firing by reducin the ability of Na channels to recover from inactivation?
Phenytoin
Carbamazepine
Valproic acid
What is the term for the high bone turnover rate seen in hyperPTH?
Osteitis fibrosa cystica
How do nitrites cause poisoning?
Oxidizing ferrous (2+) iron to ferric (3+) iron, forming methemoglobin. Shifts oxygen dissociation curve left. Partial pressure of O2 in blood is normal.
What sugar should be avoided in aldolase B def?
Fructose (which is also in sucrose)
How to characterize the glomerulus in PSGN?
Hypercellular
What are some lab findings in PSGN?
elevated titers of anti-streptococcal ab (anti-streptolysin O, andti-DNase B, anti-cationic proteinase)
Low C3 concentration
Serum cryoglobulins
Serum anti-glomerular basement membrane ab are found in what renal pathology?
Goodpastures RPGN, often with crescent formation on light microscopy
Serum anti-neutrophil cytoplasmic ab are found in what disease?
Granulomatosis with polyangiitis (Wegener’s) RPGN, crescents
What to give for Jimson weed poisoning and atropine overdose?
Physostigmine
Atropine overdose sx mnemonic?
Blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone
(Reverse cholinergic antagonists selective for muscarinic receptors)
What to give for beta blocker overdose?
Glucagon
What is the mechanism for glucagon rescue of beta blocker overdose?
GPCR that increases cAMP, increasing intracellular Ca release during muscle contraction
What infx in HIV pts is like TB, but has marked anemia, HSM, elevated alk phos and LDH, and also grows optimally at 41C?
MAC! Treat with macrolides (clarithro, azithro) +rifabutin or ethambutol
Prophylaxis with macro
What brain tumors show S-100 immunoreactivity?
Schwannomas and melanomas
What brain tumor is described as bizarre looking glial cells with multiple mitotic figures, pseudopalisading necrosis, and abundant neovascularization and hemorrhage?
Glioblastoma (WTF….)
What chronic diseases can lead to hyaline arteriolosclerosis?
NONmalignant HTN, DM
Underlying vessel wall is maintained, but intima is thickened and lumen is narrowed
What type of arteriolosclerosis is produced by malignant HTN?
Hyperplastic arteriolosclerosis
Homogenous, onion-like, concentric thickening of arteriole walls
Heavy cigarette smokers can get calf, foot, or hand intermittent claudication, superficial nodular phlebitis, and cold sensitivity have what disease?
Thromboangiitis obliterans (Buerger’s disease)
Significant risk factor for mesothelioma?
Asbestos (insulation, ship building, mining)
Toxic shock syndrome is mostly from what bug?
Staph aureus
Toxic shock syndrome activates what immune cells?
Macrophages and T cells
What are some histological markers of eczema?
Intraepidermal vesicles, superficial epidermal hyperkeratosis (scales), epidermal hyperplasia (acanthosis), chronic inflammatory infiltrate
What are the only 2 purely ketogenic AAs?
Lysine and Leucine
What is more distal, airway epithelial cilia, or goblet cells?
Cilia, present throughout the respiratory bronchioles. Goblet cells end in the bronchi.
Is excess neutrophil elastase activity in alveoli associated with panacinar or centriacinar emphysema?
Panacinar, more common in lower lung fields due to higher perfusion. Can be due to alpha1antitrypsin deficiency.
Is smoking associated with panacinar or centriacinar emphysema?
Centriacinar, with greater upper lobe distribution due to destructive proteases released by macrophages/neutrophils
Is alpha 1 antitrypsin deficiency associated with panacinar or centriacinar emphysema?
Panacinar
What molecules/hormones increase gastric acid secretion? (3 things)
Histamine, ACh, gastrin
What molecule inhibits gastric acid secretion?
PGE2
What syndrome causes excess gastrin secretion?
Zollinger-Ellison syndrome
vWF protects what clotting factor from degradation?
Factor VIII, so vWF deficiency can cause a prolonged bleeding time and PTT, with a normal platelet count.
In what disorder do you see an isolated PTT prolongation? What medication?
Hemophilia A (X linked disorder caused by factor VIII deficiency)
Heparin (antithrombin associated inhibition of factors II and X)
What do you see on PT, PTT, platelet count, and bleeding time with uremic platelet dysfunction?
Normal PT, PTT, platelet count
Increased bleeding time
Acute extrapyramidal symptoms are related to which neurotransmitter?
D2
Which Staph species is associated with foreign bodies?
Staph epidermidis (forms biofilm)
It is coagulase neg, part of normal skin flora
Which Staph species has protein A?
Staph Aureus (protein A binds to Fc region of Ig, inhibiting opsonization and phagocytosis)
What are the 3 phases in Paget disease of bone?
- Osteolytic (osteoclast dominant from excessive RANK signaling and NK-kB activation)
- Mixed (osteoclast/osteoblast) with abnormal new bone
- Osteosclerotic (osteoblast dominant forming dense hypovascular mosaic pattern of lamellar bone with prominent cement lines)
Aqueous humor is produced by what cells?
Ciliary epithelial cells
What type of medications precipitate narrow angle glaucoma?
Anticholinergics, more acute presenting with h/a and eye pain
What drugs decreases secretion of aqueous humor? From where?
Timolol (nonselective beta blockers)
Acetalzolamide (carbonic anhydrase inhibitor)
Decrease secretion by ciliary epithelial cells
What drugs increase outflow of aqueous humor?
Prostaglandin F2a (latanoprost, unoprostone, travoprost) Cholinomimetics (pilocarpine, carbachol)
What is the first line tx for Enterobiasis (dx by scotch tape test)
Albendazole
Virus that causes Mono?
EBV
Causes of mononucleosis-like sx?
CMV, toxo
Which cholesterol drugs increase risk for gallstones?
Fibrates and bile acid binding resins (cholestyramine, colestipol, colesevelam)
What does an intimal tear precede?
Aortic dissection
What does an intimal streak precede?
AAA
What to give for Succinylcholine slow metabolisers?
neostigmine
