5 Flashcards
Improved survival (decompensated systolic heart failure)
ACE Inhibitors, ARBs, aldosterone antagonists (spironolactone, eplerenone) and Beta blockers (carvedilol, metoprolol)
Beta blockade in decompensated HF helps by:
Note used in stable HF
1) decreasing afterload (decreases circulating levels of vasoactive hormones (NE, renin, endothelin).
2) slow ventricular rate (decrease cardiac work)
Mayer-Rokintansky-Kuster-Hauser (MRKH) syndrome (aka Mullerian aplasia or vaginal agenesis)
Variable uterine development and no upper vagina (short vagina)
Short vagina, normal ovaries secreting estrogen–>regular secondary sexual characteristics, hypoplastic or absent uterus = primary amenorrhea (can’t menstruate)
Mullerian aplasia
All females with Mullerian defects should undergo what?
Renal ultrasound (50% will have coexisting urologic anomaly) Ex: unilateral renal agenesis
Kallman syndrome occurs due to?
decreased synthesis of GnRH in the hypothalamus (hypogonadotropic hypogonadism)
47 XXX
- Tall
- Decreased IQ (minor)
- Physically normal including sex development
Huntingtons Disease
loss of neurons in the caudate and putamen
Damage to the nucleus ambiguous of the medulla
produces myoclonus
Lesions of subthalamic nucleus or lacunar infarcts in that area lead to
hemiballism (flinging movements of contralateral extremities)
FGF gene (apical ectodermal ridge)
lengthen limbs
sonic hedgehog
holoprosencephaly
Encode DNA-binding transcription factors that play an important role in the segmental organization of the embryo along the cranio-caudal axis
Homeobox- HOX genes
Homebox-Hox gene disruptions
skeletal abnormalities and improper positioned limbs and appendages
Colchicine decreases NEUTROPHIL migration and phagocytosis by interfering with ______
microtubule formation.
Colchicine also decreases tyrosine phosphorylation–> decreased neutrophil activation
Irreversible gynecomastia and testicular atrophy due to increased __________ levels due to anabolic steroid abuse
androstenedione
Testicular germ cells tumors (firm rapidly growing testicular mass) can cause ________ do to excessive B-hCG
gynecomastia
Uremia and High creatine in Chronic renal insufficiency. High uremia is toxic to
your balls
Haloperidol induced gynecomastia =
increased prolactin
Alcoholic liver cirrhosis gynecomastia=
Impaired hepatic degradation of estrogen and ethanols direct inhibition of testosterone production
Originates on the anterior aspect of the sacrum and occupies most of the space in the greater sciatic foramen. Inserts on greater trochanter of the femur
Piriformis (sciatic nerve runs below)
Piriformis action
- Externally rotate the thigh when extended
- abduct the thigh when flexed
Piriformis syndrome
Pain tingling and numbness in the buttocks and along the nerve distribution due to hypertrophy or muscle injury compressing the sciatic nerve in the foramen
Smallest of 3 gluteal muscles; works with gluteus medius to stabalize the hip and abduct the thigh when the limb is extended
gluteus minimus
Passes through the greater sciatic foramen and is involved in external hip rotation
piriformis muscle
Patient with FH of sudden death, recurrent syncope, and ion channel defect
congenital long QT
LQT 1 and LQT 2 are due to
mutations in K+ channel that contribute to the outward-rectifying potassium current
Recurrent palpitations, syncope, seizures, or sudden cardiac death
Torsades de pointes
Two most common mutations in in hypertrophic cardiomyopathy (AD)
1) myosin-binding protein C gene
2) cardiac beta-myosin heavy chain gene
Secondary Infection with a different viral serotype can cause a more sever illness, possibly due to antibody-dependent enhancement of the infection, enhanced immune complex formation, and/or accelerated T-lymphocyte response
DHF (Dengue hemorrhagic fever)
-increased capillary permeability
Lesion on lateral foot
LAD in both popliteal and inguinal
Lesion on medial foot
LAD in inguinal
Receive lymph drainage from:
- Lower extremity
- scrotum (not testes)
- perineum
- Anterior ab wall (inferior to umbilicus)
- butt
- skin of penis (except glans)
superficial inguinal lymph node
Non-motile, unencapsulated, gram-positive rods. Found in clumps (chinese characters) or joined in V or Y shape chains.
Cytoplasm contains metachromic granules that stain with aniline dyes (meth blue)
Corynebacterium diphtheriae (classic 2-subunit AB exotoxin)
Most common cause of calcium kidney stones
Idiopathic hypercalciuria
Toxin used in torticollus and cosmetic hoes
Clostridium botulinum toxin B (inhibits presynaptic release of Ach)
Selective vasodilators used to cause coronary steal in people too fat to exercise stress test
Adenosine and dipyridamole
coincides with atrial contraction and is produced by the resultant onrush of blood striking a stiff left ventricle
S4 (low frequency)
S4 is associated with
Restrictive cardiomyopathy and left ventricular hypertrophy
Serotonin receptor blockade
appetite stimulation and weight gain
surface marker for monocyte-macrophage cell linage
CD 14
Multi-chain complex T-cell marker
CD 7
How does NaHCO3 (sodium bicarb) reverse TCA overdose
1) increase serum pH–> favors neutral form of drug–> cant bind Na channels
2) Also increases extracellular sodium to help overcome competitive rapid (fast) sodium channel blockade induced by TCAs
Neurophysin II point mutation –> abnormal folding at ER and removal from ER along with bound vasopressin=
Autosomal Dominant Hereditary Hypothalmic diabetes insipidus
Hamartomatous polyps (disorganized mucosal glands, smooth muscle, connective tissue)
Peutz-Jeghers syndrome or juvenile polyposis
bleeding and intussusception
Hyperplastic (well differentiated mucosal cells that form glands and crypts)
NOT DYSPLASTIC and usually asymptomatic
Villous adenomas
can secrete large quantities watery mucus leading to secretory diarrhea, hypovolemia, and electrolyte abnormalities
Stimulation of detrusor muscle contraction and internal urethral spincter relaxation
Parasympathetic (S2-S4)
MS urge incontinence due to loss of CNS inhibition of detrusor contraction.
as disease progresses bladder can become atonic leading to overflow incontinence
The presence of colloid containing microfollicles suggest a benign
follicular adenoma
What does the hindgut give rise to?
Distal third of transverse colon, descending and sigmoid colon, rectum, and upper part of anal canal
Cyclosporine extensively metabolized by liver and GI tract
CYP3A isoenzymes
Furocoumarins (inhibit CYP)
found in grapefruit juice
Collections of SQUAMOUS CELL debris that form a round pearly mass behind the tympanic membrane in the middle ear
Cholesteatomas (can be congenital or may occur as an acquired primary lesion or following infection, trauma, or surgery of the middle ear)
Cholesteatomas can cause _______ via production of lytic enzymes that often erode through the auditory ossicles
Conductive hearing loss
Envelope glycoprotein sequences also contain a hypervariable region prone to frequent genetic mutation
HEP C virus
Does the QRS complex duration increase or decrease during exercise?
decrease slightly (do to faster cardiac conduction via increased HR)
Use-dependence: sodium blocking effects intensify as heart rate increases due to less time between action potentials for medication to dissociate from the receptor
Class 1C (slowest class 1 agents to dissociate from sodium channel)
Weird use of tamoxifen (selective estrogen receptor modulator)
prevent gynecomastia
Increased estrogen to androgen ratio increase risk for gynecomastia. Histo?
Ductal epithelial hyperplasia surrounded by dense stromal fibrosis
Crohns
Th1 (IL-2, INF-Y, TNF)
