5/16 Mixed Flashcards
Valproic acid
Used in patients with tonic-clonic seizures and absence seizures
HbS aggregates (sickling) occurs under conditions:
Associated with anoxia: Low pH High levels of 2,3 BPG Low blood volume (dehydration) Oxygen unloading (organs with high metabolic demands promote sickling by extracting more oxygen from the blood
*HbS aggregates in a deoxygenated state
Two allele loci are said to be in linkage disequilibrium when…
A pair of alleles are inherited together in the same gamete (haplotype) more or less often than would be expected given random chance.
Bacillus anthracis
Humans become infected most commonly by exposure through contact with infected animals or animal products (occupational- those who handle livestock)
Preventable adverse event
An injury to a patient due to failure to follow evidence-based best practice guidelines
Major virulence factor of H. influenza type B
Polysaccharide capsule-compose of polymer polyribosylribitol phosphate (PRP)
Protects the bacterium against phagocytosis and complement-mediated lysis by binding factor H (a complement control protein)
Relationship between GFR and serum creatinine
When GFR is normal, relatively large decreases in GFR result in only small increases in serum creatinine
Conversely, when the GFR is significantly decreased, the small decrements in GFR produce relatively large changes in serum creatinine
Every time GFR halves, serum creatinine doubles
MOA of opioids causing upper abdominal pain
Cause contraction of smooth muscle cells in the sphincter of Oddi, leading to spasm and an increase in common bile duct pressures (can cause biliary colic)
Colitis associated carcinoma vs sporadic colorectal carcinoma
Colitis associated carcinoma is more likely to:
- affect younger patients
- progress from flat and non-polypoid dysplasia
- histologically appear mucinous and have signet ring morphology
- develop early p53 mutations and late APC mutations, opposite that of sporadic disease
- Be distributed within the proximal colon
- Be multifocal in nature
Lymph drainage of the testis/scrotum
Lymphatic drainage of the testis is to the para-aortic lymph node (due to its intra-abdominal origin), while lymph drainage from the scrotum goes into the superficial inguinal lymph nodes
Absolute risk reduction
= event rate in the control group - event rate in the treatment group
ERtreatment= # of events in the treatment arm/ number of subjects int he treatment arm
Rb (retinoblastoma) tumor suppressor gene
Encodes a nuclear phosphoprotein that regulates G1 to S checkpoint
Active= hypophosphorylated
Inactive= hyperphosphorylated
Hereditary spherocytosis
AD, Northern european descent
Hemolytic anemia, jaundice, splenomegaly
Increased MCHC, spherocytes on peripheral smear, negative coombs test, increased osmotic fragility on acidifited glycerol lysis test
Complications: pigmented gallstones, aplastic crises from parvovirus B19
Cytoskeleton abnormalities (spectrin and ankyrin)
Which blood vessel has the lowest oxygen content
Coronary sinus- myocardial O2 extraction is very high, cardiac venous blood is the most deoxygenated
Kinesin
Microtubule-associated ATP powered motor protein
Facilitate anterograde transport of neurotransmitter containing secretory vesicles down axons to synaptic terminals`
Communicating hydroceles and indirect inguinal hernias
Caused by incomplete obliteration of the processus vaginalis
Resultant connection between the scrotum and abdominal cavity can allow for fluid leakage (hydrocele) or the passage of abdominal contents (indirect inguinal hernia)
Candidal antigen skin test
Used to determine the presence of cellular or T cell mediated immunity through detection of delayed-type hypersensitivity reaction (IV)
Key cells involved are macrophages, CD4 helper T cells and CD8 cytotoxic T cells
Anergy, or failure to respond to candida antigen testing is typical in patients with SCID
Carotid sinus hypersensitivity
Triggered by pressure on the carotid sinus by a tight shirt collar
The carotid sinus reflex has an afferent limb that arised from the baroreceptors in the carotid sinus and travels to the vagal nucleus and medullary centers via the glossopharyngeal nerve (CN IX); the efferent limb carries parasympathetic impulses via the vagus nerve (CNX)
Optimal site for femoral nerve block
Inguinal crease at the lateral border of the femoral artery
Will anesthetize the skin and muscles of the anterior thigh (eg quadriceps, femur, knee)
Acute intermittent porphyria (AIP)
AD disorder of heme synthesis pathway
Porphobilinogen (PBG) deaminase defiency
Gastrointestinal and neurologic symptoms (abd pain, vomiting, peripheral neuropathy, neuropsych derangements)
Reddish urine that darkens on exposure
Rx: inhibiting ALA synthase (administration of heme and glucose)
Cystic Fibrosis
Produce eccrine sweat with higher than normal concentrations of sodium and chloride
Exposure to high temperature or exercise can lead to hyponatremia due to excessive sodium loss through sweat
Salt supplementation is recommended
Cromolyn and Nedocromil
Mast cell-stabilizing agents
Inhibit mast cell degranulation independent of the triggering stimuli
Less effective than inhaled glucocorticoids and are considered second line for the treatment of allergic rhinitis and bronchial asthma
Topical prostaglandins (Latanoprost)
Increase outflow of aqeous humor via the uveoscleral pathway and are the preferred treatment for open angle glaucoma
Supercondylar humeral fractures
Common pediatric elbow fractures
Often occur after hyperflexion or hyperextension injuries
AnteroLATERAL displacement of the proximal fracture fragment typically cause radial nerve injury > wrist drop and sensory loss over the posterior forearm/dorsolateral hand
AnteroMEDIAL Displacement cause median nerve and brachial artery injury
endometriosis (ectopic endometrium)
Presence of endometrial tissue outside the uterus
Dysmenorrhea, pelvic pain, dyspareunia, infertility
Familial chylomicronemia syndrome
Protein defect: lipoprotein lipase, ApoC-II
Elevated lipoproteins: chylomicrons
Major manifestations: Acute pancreatitis, lipemia retinalis, reuptive skin xanthomas, hepatosplenomegaly
Acute Myelogenous Leukemia (AML)
Very large nucleated cells with scant cytoplasm = blast cells (=ACUTE leukemia)
Linear, purple red inclusions = Auer rods
Pancytopenia
Multifactorial inheritance
Complex process by which numerous genetic and environmental factors interact to determine phenotypic expression
The closer a relative is to the affected person, the more likely the relative is to develop the train
Ex. Spina bifida, cleft lip and palate, diabetes mellitus, coronary artery disease, hypertension
Common peroneal nerve
Most commonly injured leg nerve
Blunt trauma to the lateral aspect of the leg, fibular neck fractures, and external pressure due to prolonged immobility can injure the nerve
“Foot drop” a`nd “steppage gait”
Muscarine
A toxin found in certain mushrooms
Acts as a muscarinic agonist, resulting in increase in parasympathetic nervous system activity
Peripheral vasodilation due to synthesis of NO in endothelial cells, leads to vascular smooth muscle relaxation
