5/9 Mixed Flashcards
Acute rejection of endomyocardial biopsy (cardiac transplant rejection)
Dense infiltrate of mononuclear cells, usually composed primarily of T lymphocytes
Primarily cell-mediated
Autosomal recessive inheritance (if both parents are carriers)
25% chance of inheriting 2 normal alleles (AA)
50% chance of inheriting one normal and one mutant allele (Aa or aA)
25% chance of inheriting 2 mutant alleles
75% chance of inheriting one or more mutant alleles
Treatment of Bulimia nervosa
SSRI (fluoxetine)
Nutritional rehab
Cognitive-behavioral therapy
Bacteroides
Gram negative anaeroic rods
Produce B lactamase
Rx: piperacillin-tazobactam
Class III antiarrhythmic drugs (amiodarone, sotalol, dofetilide)
Block K channels, inhibit the outward K currents during phase 3 of cardiac action potential, prolonging repolarization and total action potential duration
Location of the AV node
Endocardial surface of the right atrium, near the insertion of the septal leaflet of the tricuspid valve and the orifice of the coronary sinus
Radiofrequency ablation of AV node
Parvovirus B19 infection
Nonspecific viral syndrome
erythema infectiosum (fifth disease) in children
Acute arthropathy in adults
Precipiating factors to hepatic encephalopathy
Drugs (sedatives, narcotics)
Hypovolemia (diarrhea, vomiting)
Excessive nitrogen load (GI bleeding, constipation)
Metabolic disturbances (hypokalemia, metabolic alkalosis, hypoglycemia)
Infections (pneumonia, urinary tract infection, spontaneous bacterial peritonitis)
Portosystemic shunting
Rx hepatic encephalopathy
Lower blood ammonia levels
Oral administration of disaccharide (lactulose)
Converts absorbable ammonia into nonabsorbable ammonium ions, trapping ammonia in the stool and increasing nitrogen excretion
Fourth heart sound (S4)
Atrial gallop sound (before S1)
Heard immediately after atrial contraction phase as blood is forced into a stiff ventricle
Dermatomyositis as a paraneoplastic syndrome
(can occur alone or as pn syndrom)
Most commonly associated cancers include ovarian, lung, colorectal, non-Hodgkin lymphoma
Final common pathway for HCL section
H/K ATPase proton pump on parietal cells
Stimulated by Ach, histamine, gastrin
Proton pump inhibitors= lansoprazole, omeprazole
Bacterial vaginosis
Grayish-white vaginal discharge with "fishy" odor Overgrowth of gardnerella vaginalis, an anaerobic gram-variable rod Clue cells (squamous epithelial cells covered with bacterial organisms) seen on wet mount microscopy or cytology
Beta-endorphin
Endogenous opioid peptide that is derived from proopiomelanocortin (POMC)
POMC= polypeptide percursor that goes through enzymatic cleavage and modification to produce beta-endorphins, ACTH, MSH
Primary anti-ischemic effect of nitrates
Systemic vasodilation with a decrease in left ventricular end-diastolic volume/wall stress, results in decreased myocardial oxygen demand
Drug induced lupus erythematosus
Abrupt onset: fever, fatigue, arthralgia, arthritis, rash, serositis
Predilection for slow acetylators
Anti-histone antibodies
Implicated drugs: procainamide, hydralazine, isoniazid, minocycline, TNF-a inhibitors (etanercept)
MI scar
Type I collagen
Also seen in: dermis, bone, tendons, ligmanets, dentin, cornea, blood vessels, scar tissue
Leukotriene B4
Stimulates chemotaxis of neutrophils to sites of inflammation
Other important chemotactic agents include 5-HETE (leukotriene precursor), complement component C5a, and IL-8
Osteocytes remain connected to each other by
Gap junctions
Trendelenburg gait
Hip drops down as the ipsilateral foot is lifted off the ground
Observed when there is injury to the contralateral superior gluteal nerve
Injections to the superomedial quadrant of the buttock have a high probability of injuring the superior gluteal nerve
Obstructive sleep apnea
Due to neuromuscular weakness of the oropharnyx
Rx: Electrical stimulation of the hypoglossal nerve increases the diameter of the oropharyngeal airway and decreases the frequency of apneic events
Epistaxis
Commonly caused by irritation of the highly vascular mucosa at the anterior nasal septum
Anterior nasal septum contains the Kiesselbach plexus
The anterior ethmoidal, sphenopalatine, and superior labial arteries anastomose in this region
Dubin-Johnson Syndrome
Benign AR disorder characterized by defective hepatic excretion of bilirubin glucuronides due to a mutation in the canalicular membrane transport protein
Episodes of jaundice, otherwise asymtomatic
Grossly, the liver appears black due to impaired excretion of EPI metabolites, which histologically appear as dense pigments within lysosomes
Selective proteinuria
Albumin loss with minimal loss of more bulky proteins (such as IgG and macroglobulin)
Crossover study
Subjects are randomly allocated to a sequence of 2 or more treatments given consecutively. A washout (no treatment) period is often added between treatment intervals to limit the confounding effects of prior treatment.
Highest osmolarity in the nephron
At the bottom of the loop of Henle
Postpartum Ovarian Vein Thrombosis
Persistent fever after delivery, localized abdominal/flank pain, no response to ABX
Left ovarian vein drains into the left renal vein and the right ovarian vein drains directly into the IVC
Most thrombosis is right sided
Neural tube defects
Failure of fusion of neural tube during 4th week of fetal development
Occurs in the region of the neuropores
If neuropore does not fuse, opening exists between the neural tube and the ambiotic cavitiy
AFP, achetylcholinesterase appear in the amniotic fluid (due to CSF leakage)= prenatal dx of NTDs
Hepatic abscess
Undeveloped countries: Entamoeba hisolytica
Developed countries: bacterial infection (ex. Staph aureus via hematogenous seeding of the liver)
Enteric bacteria (E. coli, Klebsiella, enterococci) can cause hepatic abscesses by ascending the biliary tract (ascending cholangitis), portal vein pyemia, or direct invasion from an adjacent area (cholecystitis).
Giant Cell Arteritis
Cell-mediated immunity is primary mechanism
Production of cytokines, in particular Interleukin-6 is an important driver of this process and closely correlates with severity of symptoms
Rx: Monoclonal Ab against IL-6 (tocilizumab)
B-blockers lower BP via 2 mechanisms:
Reducing myocardial contractility and heart rate
Decreasing renin release by the kidney
Trimethoprim (in bacteria)
Methotrexate (in human cells)
Pyrimethamine (in some protozoa)
All prevent the reduction of folic acid to tetrahydrofolate (THF) by inhibiting dihydrofolate reductase (DHFR)
Clostridium tetani
Prevents release of inhibitory neurotransmitters glycine and gamma-aminobutyric acid (GABA)
Rx for cerebral vascular spasm following SAH
Calcium channel blockers, specifically Nimodipine
What should be assessed prior to initiation of metformin therapy?
Renal function by serum creatinine measurement
Increased risk of lactic acidosis
Nitrate Administration
Must provide nitrate-free interval every day in pts using long acting nitrates to avoid the development of tolerance
