April 1 - Cardio, Psych, Derm Flashcards
Embryologic development of venous system
Three systems during development
1. Umbilical veins: connnect to placenta; degenerate
2. Vitelline veins: drain yolk sac; become portal system, including SMA, etc
3. Cardinal veins: become systemic circulation
In fetus, all drain to the sinus venosus (primitive part of heart)
Wolff-Parkinson-White syndrome: EKG findings, pathophys, complications
EKG: short PR interval (QRS comes right after P wave), delta wave (early activation of ventricle via bypass tract)
Pathophys: extra bypass tract that can conduct in both directions between atria and ventricles. Sets up for AV re-entrant tachycardia in which loop occurs through bypass tract and AV node
Complication: A fib can be life threatening because can conduct to ventricles through bypass tract. Need to avoid meds that slow AV node conduction as they increase flow through bypass tract
Myocardial ischemia: timing and effects
ATP decreases and results in loss of contractility within 60s of total myocardial ischemia.
Ischemis less thatn 30 mins reversible but with prolonged myocardial dysfunction for a few days after restarting blood flow
Ischemia longer than 30 mins results in large decrease in ATP with loss of cell homeostasis and irreversble injury
Risk factors for aortic dissection
HTN is single number one risk factor
NO synthase
Converts arginine + NADPH + O2 to NO
Brachiocephalic vein
External jugular drains scalp and lateral face to R subclavian vein. R subclavian vein drains arm and dumps to brachiocephalic.
IJV drains brain, neck, face and dump into brachiocephalic.
R lymphatic duct also drains to brachiocephalic
Other condition associated with congenital QT prolongation
Sensorineural deafness
Phenoxybenzamine
Irreversible alpha1 and alpha2 antagonist used to treat pheochromocytoma
Phentolamine
Reversible competitive alpha antagonist used to catecholamine induced HTN crisis
Fenoldopam
Peripheral D1 agonist that causes vasodilation, esp of renal artery, leading to diuresis and natriuresis.
Cilostazol
Decreases platelet activation and causes direct arterial vasodilation. Used in PAD
Segmented viruses
Orthomyxoviruses, reoviruses, bunyaviruses, arenaviruses
Burkitt lymphoma translocation
t(8;14) c myc and IgH
Calcineurin inhibitors; names, MOA, ADRs
Names: cyclosporine and tacrolimus
MOA: inhibit calcineurin, preventing activation of NFAT and production of I-2
Use: Autoimmune disease and transplants
ADRs: DDIs through CYP metabolism. Nephrotoxicity (constricts renal vessels) leading to HTN. Increased uric acid, hyperglycemia. Cyclosporine also causes gingival hyperplasia and hirsutism
Sirolumus: MOA, ADRs
Also called rapamycin
MOA: Inhibits mTOR, decreasing response to IL-2, decreasing B and T cell proliferation
ADRs: marrow suppression, hyperlipidemia, hyperglycemia
Methotrexate: MOA, ADRs
MOA: Inhibits dihydrofolate reductase. Prevents conversion of dUMP to dTMP, which requires THF.
ADRs: myelosuppression that is reversible with leucovorin/folinic acid. Stomatitis/mucositis. Abnormal LFTs
Cyclophosphamide: MOA, use, ADRs
MOA: alkylating agent that causes cross linking of DNA, inhibiting DNA replication
ADRs: myelosuppression, hemorrhagic cystitis (decreased with hydration and mesna), SIADH
Use: vasculitis, glomerulonephritis, chemo
Infliximab: MOA, use, ADRs
MOA: anti-TNF monoclonal
Use: RA and Crohns disease
ADR: can reactivate TB
Etanercept: MOA
Decoy receptor for TNF alpha
Linezolid: use and ADR
Antibiotic that treats resistant gram positive bugs. Has MAOI activity and can precipitate serotonin syndrome in someone on SSRI
Alcoholism pharmacotherapy
- Disulfiram
- Naltrexone: blocks rewarding/reinforcing effects of alcohol and decreases cravings, only one that can be initiated while still drinking
- Acamprosate: modulates glutamate transmission at NMDA receptor
Fluphenazine
High potency first gen antipsychotic, similar to haloperidol
Thioridazine
Low potency first gen antipsychotic, similar to chlorpromazine
TCAD- how cause arrhythmias
Cause QT prolongation and QRS widening at high dose by blocking Na+ channels. Leads to arrhythmias
Transferance vs displacement
Transference: Shifting of emotions or desires associatied with person from PAST to person in PRESENT
Displacement: Expressing unacceptable feelings meant for someone else in present life to someone safer
Akathisia
Extrapyramidal side effect. Restlessness, inability to sit still, occurs days to weeks after starting antipsychotic.
Tourette disorder diag criteria and treatment
Both multiple motor and 1+ vocal tic (grunting, throat clearing, yelling, etc). Lasts over a year and onset before age 18
Treatment: antipsychotics, alpha agonists, behavioral therapy
Schizophreniform vs schizophrenia
Phreniform: 1-6mos
Phrenia: over 6 mos
Narcolepsy diag test
Low hypocretin-1 in CSF
Chronic lymphedema complication
Angiosarcoma 10 yrs later
Bullous pemphigoid vs pemphigus vulgaris
Bullous pemphigoid: ABs against hemidesmosomes
Pemphigus vulgaris: ABs against desmosomes
Intraductal papilloma
Most common cause of bloody nipple discharge. Papillary cells around fibrovascular core.
Fibrocystic change
Diffuse small cysts +/- metaplasia. Cyclic breast pain
Fibroadenoma
Small firm mobile mass. Proliferation of stroma and ducts. Stroma can compress ducts to slits.
Perineal body
Separates urogenital and anal triangles. Midline epidiotomy goes to it
Tuberous sclerosis
Auto dom. Renal angiomyolipomas, brain hamartomas, cardiac rhabdomyomas, ash leaf patches
Alkaptonuria
Tyrosine metabolism disorder (Can’t convert tyrosine to fumarate). Deficient homogentisic acid dioxygenase. Black color to urine, black pigment on collagen, arthropathy in adulthood
Malformation
Intrinsic cell or tissue defect leads to chain of downstream effects.
Deformation
Caused by extrnisic mechanical forces
Disrupation
Breakdown of previously normal tissue
Theophylline intoxication
Seizures, tachyarrhthmia
