5/11 Flashcards
Fanconi is a defect in…
reabsorption in PCT of kidney
Bartter syndrome
aut rec defect in thick ascending loop of Henle
similar to loop diuretics
hypokalemia, metabolic alkalosis
Gitelman syndrome
aut rec defect of NaCl in DCT
hypokalemia, metabolic alkalosis
Liddle syndrome
Aut dom gain of function mutation: increase Na reabsorption in collecting tubules
presents like hyperaldosteronism- met alkalosis, hypertension, hypokalemia
treat- amilioride
sydrome of apparent mineralocorticoid excess
hereditary def of 11beta-hydroxysteroid dehydrogenase (cant convert cortisol to cortisone)
excess cortisol stimulates MR–> hypertension, hypokalemia
or eating too much licorice
renal tubular acidosis (RTA) type 1
DISTAL: defect in alpha interacalated cells to secrete H+–> no new HCO3 generated
urine pH > 5.5, hypokalemia, risk for Ca stones
causes: amphotericin B, congenital anomalies, analgesic nephropathy
RTA 2
PROXIMAL: defect in PCT HCO3 reabsorption
urine pH<5.5; hypokalemia; risk for rickets
causes: Fanconi, CA inhibitors
RTA type 4
hypoaldosteronism–> HYPERKALEMIC –> less NH3 synthesis in PCT –> less NH4 excretion
urine pH<5.5
causes:
- less aldosterone made: diabetic hyporeninism, ACEI, ARBs, NSAIDs, heparin, cyclosporine, adrenal insuff
- aldosterone resistance (K sparing diuretics, TMP/SMX)
uremia
increase in BUN
nausea, anorexia pericarditis asterixis encephalopathy platelet dysfunction
which drugs can cause acute interstitial nephritis
diuretics nsaids penicillins, cephalopsporins PPIs rifampin
renal papillary necrosis associations
sickle cell
acute pyelonephritis
analgesics (NSAIDs)
DM
SAAD
what is the type of junction in endothelial BBB?
tight junctions
cryptococcus neoformans enters via which route?
respiratory
asbestos on imaging
pleural thickening with calcification
posterolateral midlung zone (6-9th rib)
pleural effusions can occur
how does fragile x mutation inactivate the gene?
once you get over 200 CGG repeats, the gene FMR1 becomes hypermethylated, silencing the gene
Ghon complex
lower lobe lung lesion + ipsilateral hilar adenopathy (calcified lymph node)
seen in primary TB- initial infection
Bloom syndrome
aut rec BLM mutation- defective helicase
growth retardation, facial anomalies, photosensitivity, immunodeficiency
JAK kinase is a receptor for
GH, prolactin
cytokines
insulin activation pathway
1) tyrosine kinase receptor
2) phosphorylate IRS
3) IRS then stimulates two pathways:
- RAS/MAP kinase (cell growth, DNA synthesis)
- PI3K (protein phosphatase)- glycogen, lipid, protein synthesis
where on the antibody is the site for complement attachment (C1)
the higher Fc region (above phagocytic attachment site)
anesthesia’s effect on brain
decrease vascular resistance (increase cerebral blood flow)
can lead to increased intracranial pressure
which anesthetics are preferred in asthmatics
halothane and sevaflurane- bronchodilation
since other anesthetics suppress mucociliary clearance–> atelctasis
inhaled anesthetics on kidney
decrease GFR
increase vascular resistance
decrease RPF
what is the intrapleural pressure at FRC?
-5 cm H20
what disease is silicosis associated with and why?
TB
silicosis impairs macrophages
tibial nerve injury
from injury to popliteal fossa
problem with foot inversion, plantar flexion, and toe felxion
problem with sensory stimulation of plantar side of foot
which muscle most affected in rotator cuff injury
supraspinatus
impingement between acromion and humeral head
symptoms of radial injury in the supinator canal
weakness on finger/thumb extension (finger drop)
cause: repetitive pronation/supination movements
extensor muscles and cutaneous stimulation fine because that would need a more proximal injury
bacteria that produce dextrans from sucrose
strep viridans
Afferent and efferent limbs of the carotid sinus baroreceptor
afferent- Hering branch of CN IX to the medulla
efferent- CN X
symptoms of Meckel’s diverticulum
painless GI bleeding
possible intrussception- colicky pain and currant jelly stools
which drugs can help post-op urinary retention
muscarinic agonist (eg. bethenacol)
alpha one antagonist
ACE effect on bradykinin
ACE usually degrades bradykinin
so ACEI leads to increased bradykinin
bicuspid aortic valve complication
aortic stenosis around age 50
where in the lungs does TB reactive
upper lobe bear apex
where in the nephon is water reabsorbed the most?
proximal tubule (regardless of hydration status)
patients with MS develop which type of incontinence?
first: urge incontinence- detrusor overactivity from lack of CNS inhibition
later- bladder becomes dilated and atonic- leading to overflow incontinence
which agents help treat urge incontinence
muscarinic antagonist
how does kidney try to compensate metabolic acidosis?
- increase HCO3 reabs.
- increase H+ secretion
- excrete buffers (HPO4, NH3) to combine with H+ to form H2PO4 and NH4
Is PAH secreted or reabsorbed?
secreted, not reasborbed
3 phases of acute tubular necrosis
- initiation- 36 hours- ischemic or toxic injury
- maintenance- 1-2 weeks- tube damage- oliguria, metabolic acidosis, hyperkalemia; necrosis and casts; decrease GFR
- recovery- re-epithelization of tubules- GFR recovers, casts clear
recurrent pneumonia, absent vas deferens, digital clubbing. Think…
cystic fibrosis
what are sources of NAD+?
niacin, tryptophan
in hardy-weinberg, for a really rare aut rec disorder, what is p in the probability of being a carrier (2pq)?
p=1
what can help prevent wrong-site surgery?
independent verification of site by 2 health care workers
wet vs dry age-related macular degeneration
dry: gradual vision loss from chronic oxidative damage leading to subretinal inflammation and bm thickening- drusen deposits
progressive thickening–> hyoxia–> VEGF–>
wet: acute vision loss with metamorphopsia (distortion of straight lines). greyish-green subretina.
valproate teratogen anomaly
neural tube defect (meningocele…)
what causes annular pancreas
abnormal migration of the ventral pancreatic bud
what can happen when baby goes down canal with genital warts?
HPV can infect other stratified squamous epithelium, like true vocal cords- weak cry, stridor, hoarse
can acquire respiratory papillomatosis
what can precipitate thiamine def/wernicke encephalopathy
glucose infusion
because thiamine is a cofactor for one of the enzymes in glucose metabolism
what should be a clue that the maculopapular rash on the immigrant is rubella and not measles?
postauricular/occipital LAD
rubella rash also faster?
myotonic dystrophy
aut dom CTG trinucleotide repeat disease for myotonia-protein kinase gene
mostly affects type 1 fibers
symptoms: slow relaxation of muscle (hard to loosen grip after handshake), cataracts, balding, gonadal atrophy
hypertensive crisis pathology
onion-like concentric thickening- hyperplastic arteriolosclerosis
hypothyroid myopathy
muscle pain, cramps and weakness of proximal muscles
delayed tendon reflexes
other symptoms of hypothyroidism present
ELEVATED CK
