4/12 overall Flashcards
macula adherens
-aka?
desmosomes
zona occludens
-aka?
tight junction
tight junction, zona occludens, adherens junction.
-which one relies on calcium?
adherens junction
SSRIs
- name them:
- mnemonic:
Flashbacks paralyze senior citizens.
-Fluoxetine, paroxetine, sertraline, citalopram.
Paget disease of bone
-mechanism?
- Lytic—osteoclasts
- Mixed—osteoclasts + osteoblasts
- Sclerotic—osteoblasts
- Quiescent—minimal osteoclast/osteoblast activity
Paget disease of bone
-serum values? whats inc/dec/normal?
- Ca, PTH, phosphorous = normal.
- inc. ALP.
Paget disease of bone
-presentation:
Hat size can be increased; hearing loss is common due to auditory foramen narrowing.
60 yo man presents w/lytic bone lesion & hearing loss.
-normal lab values except inc. ALP.
Paget’s disease of bone.
Which protein is secreted along w/insulni in 1:1 ratio?
C-peptide
Low serum IgM and normal IgG.
-which disease?
Wiskott Aldrich Syndrome
Which drug class can treat both positive and negative Sxs of schizophrenia?
atypical anti-psychotics.
Typical anti-psychotics
-do they treat positive/neg/both Sxs of schizo?
primarily the positive Sxs.
Atypical anti-psychotics
- name them:
- mnemonic:
“It’s really fuckin ATYPICAL to be CO-Z on the RAQ”
- clozapine
- olanzapine
- ziprasidone
- risperidone
- aripiprazole
- quetiapine
Which atypical antipsychotic can cause agranulocytosis?
-mnemonic?
Must watch clozapine clozely!
MAO inhibitors
- mnemonic:
- name them:
MAO Takes Pride In Shanghai
- Tranylcypromine
- Phenelzine
- Isocarboxazid
- Selegiline (selective MAO-B inhibitor).
“floppy baby”
-what can cause?
Werdnig-Hofman, botulism.
Serotonin syndrome
-most likely caused by combo of which drugs?
MAO inhibitors w/either SSRI or TCA.
-usually dont see it w/SSRI + TCA.
Most common source of metastases to liver?
Colon
Most common source of metastases to bone?
Prostate, breast.
Most common source of metastases to brain?
Lung
hydrops fetalis
-explain the mechanism.
- severe fetal anemia → fetal CHF → massive edema.
- ie. hemolytic disease of Rh+ newborn. Type 2 HSR. Mothers IgG anti-Rb destroys RBCs of newborn in utero. The severe anemia leads to fetal CHF and massive edema = hydrops fetalis.
*can also happen w/parvovirus or any other disease process that destroys fetal RBCs.
Congenital CMV
-Sxs:
Hearing loss, seizures, petechial rash, “blueberry muffin” rash.
hemolytic disease of newborn
-aka?
erythroblastosis fetalis.
Strep pyogenes pharyngitis
-Tx:
beta-lactam.
-penicillin or cephalosporin.
After ELISA & confirming w/western blot, whats the next step in management of suspected HIV pt?
Quantify viral load & get CD4 cell count.
-do this before you start treatment.
What type of bone lesions do prostate mets cause?
-blastic or lytic?
osteoblastic.
damage a nerve that leads to hoarsness - which nerve MUST it be?
recurrent laryngeal.
-not external laryngeal under any circumstances.
Can you damage recurrent laryngeal n. during surgery to have parathyroids removed?
yes.
Which Sxs are common to all congenital infections?
Hepatosplenomegaly, jaundice, thrombocytopenia, and growth retardation (ie. microcephaly).
Acetyl-CoA carboxylase:
- FA synth or oxidation?
- what rxn does it catalyze?
- cofactor?
acetyl-CoA (2C) => malonyl-CoA (3C)
-biotin.
To get a type 4 HSR like contact dermatitis, does that happen after 1 exposure do does it need to be re-exposure?
re-exposure.
Mode of resistance to aminoglycosides?
plasmid-mediated acetylation/adenylation/phosphorylation.
Multiple myeloma
-whats the neoplastic cell and where does it arise?
Monoclonal plasma cell (“fried egg” appearance) cancer that arises in the marrow and produces large amounts of IgG (55%) or IgA (25%).
“Fried egg” appearance on H&E stain.
Oligodendroglia, plasma cell (MM), seminoma & dysgerminoma.
Ribavirin
-tox:
Hemolytic anemia. Severe teratogen.
Can dopamine cross BBB?
No, but L-DOPA can.
Epidural hematoma
-where does it form?
forms btwn the outer and inner dural layers.
Which brain hematoma leads to CN 3 palsy & why?
Leads to uncal hernation which can cause CN III palsy.
Sotalol & ibutilide
- what are they?
- tox?
K channel blockers (class III) -torsades de pointes.
Odds Ratio: formula
(a/c)/(b/d)
ab
cd
aspirin poisoning
-how long til the metabolic acidosis kicks in?
2-3 hours.
Aortic arch baroreceptors
- what do they respond to?
- does that inc or dec. AP firing rate?
- responds only to INC. in BP.
- vagus n to solitary nucleus.
carotid sinus
- what do they respond to?
- does that inc or dec. AP firing rate?
- responds to inc or dec. in BP.
- CN9 to solitary nucleus.
*Hypotension => dec. AP firing.
- vasculature has resting sympathetic tone, the baroreceptors put the brakes on it.
- so when BP drops, the brakes are released.
beta-thal
-mechanism?
Point mutations in splice sites and promoter sequences => dec. β-globin synthesis.
*alpha-thal there are gene deletions. Not so in beta-thal. In beta-thal it fucks up the mRNA step.
beta-thal
-is it a mutation resulting in a defective beta-globin protein?
NO
- due to mutations that result in defective txn, processing, or translation of beta-globin mRNA.
- ie. abnormal splicing.
Conn syndrome & hyperaldo.
-what will serum sodium be?
- NORMAL due to aldo escape via ANP/BNP.
- do not be tricked into saying hypernatremia bc excess aldo resorbs more Na!
Baby crawls
-how old?
8 months
Baby stands
-how old?
10 months
Baby pincer grasp
-how old?
10 months
baby says mama/dada
-how old?
10 months
baby uses fork/spoon
-how old?
20 months
Cubes stacked
-formula to know how old the baby is:
number = age (yr) × 3
b-HCG
-marker for what?
- Hydatidiform moles and Choriocarcinomas (Gestational trophoblastic disease).
- testicular cancer.
What marker used to monitor ovarian cancer progression?
CA-125
Alkylating agents most commonly lead to what types of cancer?
Leukemia/lymphoma
Erythropoietin = paraneoplastic hormone of which cancers?
Renal cell carcinoma, thymoma, hemangioblastoma, hepatocellular carcinoma, leiomyoma, pheochromocytoma.
Psammoma bodies seen in which diseases?
-mnemonic?
PSaMMoma bodies are seen in:
- Papillary carcinoma of thyroid
- Serous papillary cystadenocarcinoma of ovary
- Meningioma
- Mesothelioma
duloxetine
-what is it?
SNRI
3 Cs of TCA toxicity:
Convulsions, Coma, Cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia.
Which TCA has fewer anti-cholinergic s/e and is good for elderly?
-mnemonic:
nortriptyline
-Use nortriptyline so the old people wont “tryp”.
Inc. creatinine level for pt taking meds for GERD.
-why?
H2 blockers (cimetidine & ranitidnie) can dec. renal excretion of creatinine.
Male pt taking meds for peptic ulcer develops breasts.
-how?
cimetidine (H2 blocker) has anti-androgen effects.
*its a P450 inhibitor and steroid synth enzymes = P450 enzymes.
PPIs
-what type of inhibitors are they?
Irreversible inhibitors.
PPIs
-tox:
P450 inhibitors
-Increased risk of C. difficile infection, pneumonia. Hip fractures, dec. serum Mg2+ with long-term use.
Pt is on PPIs, what will gastrin level be?
- PPIs can also inc. gastrin prod 2-4 fold b/c they inc. pH of stomach. A low pH in stomach is what has neg. feedback on gastric production.
- Omeprazole associated w/hypergastrinemia.
antacid use
-can cause hypo/hyperkalemia?
hypokalemia
Metoclopramide
- mech:
- use:
- tox:
- D2 receptor antagonist.
- Diabetic and post-surgery gastroparesis, antiemetic.
- parkinsonian effects, has drug effect w/digoxin & diabetic agents.
Serotonin & dopamine in CTZ
-are they pro or anti vomit?
pro-vomit
-thats why serotonin antagonist (ondansetron) and dopamine antagonist (metoclopramide) are anti-emetics.
aprepitant
-what is it?
anti-emetic.
-NK1 receptor antagonist. Blocks neausea from pain.
How does inc. progesterone lead to gallstones?
Progesterone:
- reduces gallbladder emptying
- reduces bile acid secretion
- gallbladder hypomotility can lead to gallstones
Can you see cholesterol gallstones on CXR?
Usually no bc they are radiolucent.
-sometimes have some calcification so can see them a little.
Brown pigment stones
- which bugs can cause it?
- use of which enzyme and build up of what?
- E.coli, Ascaris lumbercoides, clonorchis sinensis.
- beta-glucoronidase
- unconjugated bili.
How would biliary colic present w/o pain?
in a diabetic w/peripheral neuropathies.
rare primary infection of gallbladder - which bug?
CMV
Branches of celiac trunk:
-common hepatic, splenic, left gastric.
periventricular plaques in brain
-what disease?
MS
Which cellular compartment responsible for adding mannose-6-phosphate to proteins for trafficking to lysosomes.
cis golgi.
Which drugs can cause pulm. fibrosis?
-mnemonic?
Breathing Air Badly from Medications.
-Bleomycin, Amiodarone, Busulfan, Methotrexate.
Bleomycin
- mech?
- use?
- tox:
Induces free radical formation, which causes breaks in DNA strands.
-Testicular cancer, Hodgkin lymphoma.
-Pulmonary fibrosis, skin changes, mucositis. Minimal
myelosuppression.
Trastuzumab (Herceptin)
- tox:
- mnemonic:
“HEARTceptin” damages the HEART.
-Cardiotoxicity
Bleomycin
-which phase does it act in?
G2
Doxorubicin (Adriamycin), daunorubicin
- mech:
- tox:
- tox mnemonic:
Generate free radicals & Intercalate in DNA.
- dilated cardiomyopathy, myelosuppression, alopecia.
- “rub” = “ruby red” = cardiotox.
Doxorubicin (Adriamycin), daunorubicin
-what do you give to prevent the cardiotox?
Dexrazoxane
Busulfan
- mech:
- use:
- cross links DNA.
- CML & ablate pt’s bone marrow before bone marrow transplantation.
Busulfan
-tox:
Severe myelosuppression (in almost all cases), pulmonary fibrosis, hyperpigmentation.
anti-jo1
-which disease?
dermatomyositis & polymyositis.
Which beta-lactam can cause seizure?
carbapenems.
Hirschsprung disease
-associated w/what disease?
Down syndrome
Hypoglossus nerve.
-innervates all tongue muscles except ____ which is innervated by ____.
-inn. all intrinsic tongue muscles except palatoglossus which is inn. by CN 10.
CN 9
-whats the only muscle it innervates?
stylopharyngeus.
recurrent laryngeal n. innervates all muscles of
larynx except the _____ which is innervated by ___,
- cricothyroid.
- The cricothyroid is inn. by the external branch of the superior laryngeal nerve.
SLE
- nephritic syndrome:
- nephrotic syndrome:
- Nephritic—diffuse proliferative glomerulonephritis.
- Nephrotic—membranous glomerulonephritis.
*both will end in “itis” bc theyre both immune complex mediated.
SLE skin/msk Tx:
hydroxychloroquine
SLE lupus nephritis Tx:
cyclophosphamide + glucocorticoids.
Proton pump in stomach:
-H & what other ion?
H/K ATPase.
Do lithium and sodium compete for resorption?
No, lithium follows Na as its being resorbed.
Does diabetes insipidus cause hypo or hypernatremia?
Cause hypernatremia bc you’re pissing out so much volume that renin/aldo kicks in and saves a bunch of sodium.
Which drug can be used for choriocarcinoma & ectopic pregnancy?
MTX
-can be abortifacent.
Which drug can be used for choriocarcinoma & ectopic pregnancy?
MTX
-can be abortifacient.
proinsulin polypeptide precursor is cleaved into what products?
insulin + c-peptide (both are secreted).
What do the cells involved in MEN syndromes have in common?
they are all neural crest origin!
Infected w/diphtheria, whats the most important treatment?
The antitoxin (passive immunization). -the antibiotics & DPT vaccine come secondary.
*this is true for all toxin mediated bugs.
