April 12 Flashcards
What is associated with polyhydramnios?
Impaired fetal swallowing
- Esophageal/duodenal atresia
- Anencephaly
Increased fetal urination
-High fetal cardiac output
What is the purpose of administering H. influenzae serotype B–Hib vaccine that is conjugated to a carrier protein?
Protein conjugation causes a T-cell mediated immune response leading to long term immunity through production of B-lymphocytes
How is bioavailability of an oral drug calculated?
(AUC oral x IV dose) / (AUC x oral dose)
Damage to the sub thalamic nucleus, most often by lacunar strokes, will cause what symptoms?
Contralateral hemiballism
–due to decreased excitation of the globus pallidus –reducing inhibition of the thalamus
What drains into the superficial inguinal lymph nodes?
Anal canal–below pectinate line
Skin below umbilicus
Scrotum
Vulva
Elevated level of ______ confirms diagnosis of menopause.
FSH
–loss of negative feedback on FAH due to decreased estrogen
Order of cardiac tissue conduction velocity?
Purkinje system
Atrial muscle
Ventricular muscle
AV node
“Park AT VENTure AVenue
tRNA is a small noncoding form of RNA that contains chemically modified bases–dihydrouridine, ribothymidine, pseudouridine–tRNA has a ____ sequence at the 3’ OH end that is used as a recognition sequence by______.
CCA
Proteins
–Serves as the amino acid binding site
persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and actions or one’s environment?
Depersonalization/derealization disorder
What systemic mycoses is associated with granulomatous inflammation?
Blastomycosis
What is the treatment for Acute intermittent porphyria and what does this affect?
Glucose and heme–which inhibit ALA synthase
–reduces the toxic metabolites–d-ALA and porphobilinogen
The presence of what maker in hepB infection greatly increases the chances of vertical transmission of the virus from mother to fetus?
HBeAg
–Good indicator of high infectivity
What is the MOA of tetrodotoxin and what is its source?
Binds fast voltage-gated Na+ channels in cardiac and nerve tissue–preventing depolarization
Source–pufferfish
Sym: Nausea, diarrhea, paresthesia, weakness, dizziness, loss of reflexes
Aplastic anemia is characterized by what triad and what is increased with this disorder?
Decreased Hb
Thrombocytopenia
Absent hematopoietic cells in bone marrow–fatty infiltration–dry bone marrow tap
Increased EPO production by the kidneys
Characterized by agencies of cerebellar vermis with cystic enlargement of the 4th ventricle and is associated with noncommunicating hydrocephalus and spina bifida?
Dandy-walker syndrome
What defect is often seen in xeroderma pigmentosum?
Nucleotide excision repair defect–UV specific endonuclease—which is responsible for recognizing the thymine dimer and excising the DNA with these defects
Newborn with anion-gap metabolic acidosis, ketosis and hypoglycemia along with increased propionic acid is most likely to have a defect in what enzyme?
Propionyl CoA carboxylase
- -responsible for conversion of propionyl-CoA to methylmalonyl-CoA
- -Involved in the metabolism of odd-chain fatty acids, branched-chanin amino acids, methionine, and threonine
What polymerase is found in prokaryotic cells only and has 5’-3’ exonuclease activity?
DNA polymerase I
–Removes RNA primer created by RNA primes and repair damaged DNA sequences
What type of channel is the CFTR channel involved in CF?
ATP-gated Cl- channel that secretes Cl- in lungs and GI tract, and reabsorbs Cl- in sweat glands
What is the inheritance pattern of PKU, which presents with intellectual disability, gait or postural abnormality, eczema, and musty body odor?
Autosomal recessive
Damage to the lateral geniculate nucleus will cause impairment of what?
Ipsilateral eye
Collections of squamous cell debris that form a round, pearly mass behind the tympanic membrane in the inner ear?
Cholesteatoma–can lead to conductive hearing loss by eroding ossicles, mastoid air cells
A lesion to what part of the thalamus can lead to hyperphagia and obesity?
Ventromedial nucleus–controls satiety and monitors blood sugar levels
What is seen with primary hyperaldosteronism?
Increased aldosterone Decreased renin HTN Hypernatremia Hypokalemia Metabolic alkalosis--increased HCO3-
Desmopressin can be used for the tx of hemophilia A–what does it do?
Increases the amount of circulating factor VIII
Complete or partial methylmalonyl-CoA mutase will cause what and how will it present?
Organic acidemia–presents in newborn as lethargy, vomiting, and tachypnea —-increased methylmoalonic acid and propionic acid
Ketotic hypoglycemia
Hypoammonemia
metabolic acidosis
What is pituitary apoplexy and how does it present?
Sudden hemorrhage of pituitary gland–often in the presence of an existing pituitary adenoma
Sudden onset severe headache, visual impairment–bitemporal hemianopia, and features of hypopituitarism
What embryonic structure gives rise to the superior vena cava?
Right common cardinal vein and right anterior cardinal vein
Intravascular hemolytic anemia is characterized by…
Schistocytes
Decreased serum haptoglobin
Increased LDH and bilirubin
What is the DOC for absence seizures?
Ethosuximide–sucks to have silent (absence) seizures
Also can use valproic acid
Small intestinal bacterial overgrowth (SIBO) can be seen in pts who have undergone gastric bypass surgery. What substances are expected to be decreased and which ones increased?
Decreased
- B12
- A, D, E
- Iron
Increased–due to increased bacteria producing these
- Folate
- Vit K
What is the role of hepcidin and where is it synthesized?
Decrease Iron absorption and decrease iron release from macrophages
Synthesized in the liver and is present with increased Fe levels and inflammatory conditions
What does Ca bind in a muscle contraction?
Troponin
What are the 3 capsular polysaccharide vaccines?
S. pneumonae
N. meningitidis
H. influenzae
A crescendo-decrescendo systolic murmur is characteristic of what?
Aortic or pulmonic stenosis
Holosystolic, high-pitched “blowing murmur” that is best heard at the apex and radiates toward axilla is indicative of what?
Mitral regurgitation
–commonly caused by Rheumatic fever
Small papillary tumor within lactiferous ducts that is the most common cause of nipple discharge–serous or bloody and shows papillary cells with fibrovascular core?
Intraductal papilloma
What is produced by Neisseria species, S. pneumonae, and H. influenzae that allows these bacteria to adhere to mucosal surfaces?
IgA protease which cleaves IgA at the hinge region
Low birth weight is associated with intraventricular hemorrhage, where is the source of bleeding?
Germinal matrix
What is the MOA of Phencyclidine (PCP) and how does intoxication present?
N-methyl-D-Aspartate (NMDA) receptor antagonist
Violence, impulsivity, psychomotor agitation, vertical nystagmus, tachycardia, HTN, analgesia, psychosis, delirium, seizures
What are complications of a neonate seen with diabetes during pregnancy?
Premature delivery Fetal macrosomia Congenital malformations -Neural tube defects -Cardiovascular anomalies -Caudal regression syndrome Respiratory distress Transient hypoglycemia Polycythemia and hyperviscosity
A hernia that occurs medial to the inferior epigastric vessel is due to what?
Weakness of transversalis fascia
- -Direct inguinal hernia–protrudes through the inguinal (Hesselbach) triangle
- -usually seen in older men
What disorder presents in 14-16 yo female who is fully developed with secondary sex characteristics, but presents with primary amenorrhea and what is seen on pelvic exam?
Mullerian agenesis–Mayer-Rokitansky-Kuster-Hauser syndrome
PV–short vaginal canal with rudimentary uterus
Mullerian duct is responsible for development of:
- Fallopian tubes
- Uterus
- Upper vagina
What is the tx for Essential tremor?
Propranolol
Primidone
High-frequency tremor with sustained posture–worsened with movement or when anxious
Pt often self-medicate with ETOH
What is the cause of Ehlers-Danlos syndrome?
Deficiency in procollagen peptidase–N-terminal propeptide removal–impaired crosslinking
What is responsible for keloid formation?
Increased transforming growth factor-B which is responsible for fibroblast migration, proliferation and connective tissue synthesis
Electrical stimulation to what nerve will decrease the frequency of apneic events in pts with obstructive sleep apnea?
Hypoglossal
What type of secretion do sweat and salivary glands have?
Merocrine–cells secrete via exocytosis
What type of secretion do mammary glands have?
Apocrine–cells secrete via membrane bound vesicles
Sebaceous glands and meibomian glands have what type of secretion?
Holocrine–cells lyse and release everything–zits
What diuretics are associated with ototoxicity?
Loops–Furosemide
What autoantibodies are present with polymyositis and how does it present?
+ ANA
+ anti-Jo-1—Anti-Histidyl-tRNA synthetase
Increased CK
Progressive symmetric proximal muscle weakness
Characterized by endomysial inflammation with CD8+ T cells –with patchy necrosis
Increasing difficultly climbing stairs, getting up from chair, carrying heavy objects
What is given for chemo induced vomiting that blocks neurokinin 1 in the area pastrema?
Aprepitant
Fosaprepitant
What is given for cyanide poisoning?
Nitrite–MetHb–binds CN
Thiosulfate–thiocyanate–excreted in urine
Hydroxocobalamin–cyanocobalamin–excreted in urine
What disease presents in younger child as cardiac and skeletal muscle cells unable to generate ATP from fatty acids and the liver is unable to synthesize ketone bodies (acetoacetate) when blood sugar is low?
Systemic primary carnitine deficiency–inherited defect in transport of LCFAs into the mitochondria–> toxic accumulation
Weakness
Hypotonia
Hypoketotic hypoglycemia
