April 13 Flashcards
Occurs when the ventral and dorsal parts of the pancreas fail to fuse at 8 wks–generally asymptomatic, but may cause chronic abdominal pain and/or pancreatitis?
Pancreas divisum
What is telomerase?
An RNA-dependent DNA polymerase that adds DNA to 3’ ends of chromosomes to avoid loss of genetic material with every duplication
–long telomeres are seen on stem cells and short on mature cells–myocardial cells, neurons, pancreatic B-cells
Within in the lungs, binding of O2 to Hb drives _____ and ____ from Hb (haldane effect). Within peripheral tissue, binding of ____ and ____ facilitate O2 unloading from Hb (Bohr effect).
CO2 and H+
What is the key tumor marker for Choriocarcinoma, which can occur secondary to complete mole?
B-hCG
Why should SSRIs and MAO inhibitors be administered together?
Potential for serotonin syndrome–excessive serotonin in the synaptic cleft due to decreased reuptake and decreased degradation
How do tumor cells become resistant to anticancer drugs?
P-glycoprotein ATP-dependent transport
–Actively removes chemo drugs from the cell–especially hydrophobic ones like the anthracyclines
What is the presentation for Femoral (L2-L4) nerve injury and how can this occur?
Pelvic fracture or compression from hematoma/abscess
Sensory loss over anterior and medial thigh
Difficulty with stairs
Frequent falling secondary to knee buckling
Patellar reflex diminished
Decreased thigh flexion and leg extension
How does Right sided colon cancer present?
Ascending colon
Exophytic mass
Iron deficiency anemia
Weight loss
How does Left sided colon cancer present?
Descending colon and rectosigmoid colon
Infiltrating mass
Partial obstruction
Colicky pain
Hematochezia
Cardiac ischemia causes intracellular accumulation of what?
Ca
Na
No ATP available for ATPase
Causes cell and mitochondrial swelling due to accumulation of H2O
ETOH induced hepatic steatosis is caused by what?
Decreased free fatty acid oxidation secondary to excess NADH production by the 2 major ETOH enzymes–Alcohol dehydrogenase and aldehyde dehydrogenase
What are the non-pharmacological treatments for insomnia?
Sleep hygiene–Environment and what you do before bed
Stimulus control–eliminating stimuli in bedroom and only going to be when sleepy
Relaxation
Sleep restriction
CBT
What is Hawthorne effect?
Change of behavior as a result of awareness of it being studied
What class I of anti arrhythmics prolong AP duration, which shorten AP and which ones have no effect on AP duration?
Class IA– Prolong AP duration–prolong depolarization with K channel activity
Class IB–Shorten AP duration
Class IC–No change in AP duration
What is the cause of Lesch-Nyhan syndrome and what is unregulated because of the deficiency?
Defective purine salvage due to absent HGPRT
- Hyperuricemia
- Gout
- Pissed off
- Retardation
- Dystonia
Increased PRPP amindotransferase to supply sufficient purine nucleotides due to increased uric acid production and demand for de novo purine synthesis
Damage to what area of the brain will cause “pie in the sky” upper quadratic anopia?
Temporal lobe lesion
How is RPF calculated?
RBF x (1-HCT)
FF= GFR/ RPF
What is the suprachiasmatic nuclei of the hypothalamus responsible for?
Circadian rhythm
Pineal gland function
What is the lateral nuclei of the hypothalamus for?
Hunger
What is the ventromedial area of the hypothalamus for?
Satiety–stimulated by leptin
What is the anterior hypothalamus for?
Cooling—A/C is for cooling
What is the posterior hypothalamus for?
Heating
A penetrating wound to the left sternal border at the 4th intercostal space is most likely to penetrate through what part of the heart?
Right ventricle–makes up most of the anterior surface of the heart
Chronic granulomatous disease pts are susceptible to catalase-positive organisms. Name these…
Cats Need PLACESS to Belch their Hairballs
Nocardia Pseudomonas Listeria Aspergillus Candida E. coli Staphylococci Serratia B. cepacia H. pylori
Genetic defect in NADPH oxidase
What is the origin of melanocytes?
Neural crest
Prolonged, untreated obstructive sleep apnea can result in what?
Pulmonary HTN and right sided HF
What can change in order to compensate for right sided HF and increased central venous pressure, in order to prevent edema?
Lymphatic drainage can increase which will compensate for the increased CVP and prevent edema–However CVP can increase to a point where lymphatic drainage can’t keep up–edema ensues
What can be given to decrease ETOH cravings and what is the MOA?
Naltrexone –blocks mu-opioid receptors —blocks the reward and reinforcing effects of ETOH
Disulfiram–inhibits aldehyde dehydrogenase and cause adverse side effects when ETOH is consumed
–so this is used to get them to stop drinking the shit
Transmural inflammation and fibrinoid necrosis of the arteries is associated with what disease and what is commonly seen in pts with this disease?
Polyarteritis nodosa
Commonly associated with HepB
What is the principal stabilizing force for secondary structure of proteins?
Hydrogen bonds
- -a-helix
- -b-sheets
Post-partum bleeding that can not be controlled in a G2P2 who underwent C-section in first delivery and V-back for second?
Placenta accreta/increta/percreta
to muscle/in muscle/through muscle
Child with palpable purpura on buttocks/legs, arthralgias and abdominal pain that occur shortly after URI?
Henoch-Schonlein purpura–Vasculitis secondary to IgA immune complex deposition
Tendency for certain alleles at 2 linked loci to occur together more or less often than expected by chance?
Linkage disequilibrium
- -Measured in a population and often caries in different populations
- -Can occur even if the genes are on different chromosomes
What is the role of Kinesin?
Anterograde to microtubule— (-)–> (+)
–Involved in slow axoplasmic transport in neurons
Anterograde transport of intracellular vesicles and organelles toward to + end of microtubule–rapidly growing end
snRNPs are important components of _______, which are used for splicing of pre-mRNA.
Spliceosomes
–Spinal muscular atrophy is infantile disorder resulting from defect in snRNPs leading to flaccid paralysis due to LMN damage in the anterior horn of the spinal cord
How does homocystinuria present and what is used for tx?
All forms result in excess homocysteine
Findings:
- Increased homocysteine in urine
- intellectual disability
- osteoporosis
- marfanoid habitus
- kyphosis
- lens subluxation
- thrombosis
- Atherosclerosis–stroke/MI
Tx: Increased cysteine, B12, B6
What is the difference btw repression and suppression?
Repression is involuntarily withholding an idea or feeling from conscious awareness–Immature defense
Suppression is intentionally withholding an idea or feeling from conscious awareness–temporary and mature defense
What artery runs anterior to the 3rd portion of the duodenum?
SMA
Adult brain tumor that Central areas of necrosis and hemorrhage with surrounding pseudopalisading tumor cells?
Glioblastoma multiforme
What class of diuretics improves mortality in HF pts?
Spironolactone and eplerenone
- -Mineralocorticoid receptor antagonists
- -block the binding of aldosterone to receptors and block the deleterious of aldosterone on the heart–causing regression of myocardial fibrosis and improvements in ventricular remodeling
What is the MOA of the bisphosphonates?
Pyrophosphate analogs–bind hydroxyapatite in bone–> inhibiting osteoclast activity
What bacteria is catalase-negative, gram + cocci that can grow in hypertonic solution and can cause endocarditis after GU instrumentation/cath?
Enterococcus
What cells are involved when ALL presents with mediastinal mass?
T-lymphocytes
Pt will present with difficulty swallowing
What is the primary virulence factor of Strep pneumonae that prevents phagocytosis?
Polysaccaride capsule
What are the clinical clues for spinal metastasis?
Constant pain Not relieved by rest or analgesics Worst at night Not responsive to positional changes Older age
What are the lab values seen with renal osteodystrophy?
Secondary hyperparathyroidism
- Low Ca–due to decreased intestinal absorption (decreased 1,25 vit D)
- High serum Phosphorus
- Increased PTH and ALP
Most common cause of CF?
Mutation to the deltaF508—impairs the posttranslational processing of CFTR—resulting in shunting of the CFTR toward proteasome with complete absence of the protein in the apical membrane of the affected epithelial cell
Elevated sweat chloride
Biotin (Vit B7) is a cofactor for what 3 carboxylation enzymes?
Pyruvate carboxylase–Pyruvate to oxaloacetate
Acetyl-CoA carboxylase–Acetyl-CoA to malonyl-CoA
Propionyl-CoA carboxylase–Propionyl-CoA to methylmalonyl-CoA
What 3 cytokines mediate systemic inflammatory response and stimulate hepatic secretion of acute-phase proteins?
IL-1, IL-6 and TNF-a
Causes an increase in ESR–nonspecific marker of inflammation –high levels of fibrinogen
Anesthetics with high tissue solubility are characterized by what?
Large arteriovenous concentration gradients and slower onset of action
Objects that get stuck in the piriform recess can cause damage to what nerve which will affect what?
Internal laryngeal nerve–affecting the cough reflex
What is hibernating myocardium?
refers to the presence of LV systolic dysfunction due to reduced coronary blood flow at rest that is partially or completely reversible by coronary revascularization
What drug inhibits intestinal brush border absorption of cholesterol in the small intestine?
Ezetimibe
Pts with HIV often experience reactivation of latent EBV, which puts them at risk for the development of what?
Increased incidence of EBV induced lymphoproliferative disorders –lymphomas like burkitts
Burkitt lymphoma involves what translocation and overexpression of what?
8;14 translocation with overexpression of c-MYC oncogene
How does McCune-Albright syndrome present and what causes it?
Presents with unilateral cafe-au-lait spots, polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities
–onset of secondary sex characteristics before age 8
Due to mutation affecting G-protein signaling–only survivable if mosaicism
Crescent formation is diagnostic for rapidly progressive GN. What do crescents consist of?
Glomerular parietal cells
Monocytes
Macrophages
Abundant fibrin
What does squatting due for pts with tetrology of fallot?
Increases systemic vascular resistance and decreases left-right shunting
—increasing pulmonary blood flow and increasing oxygenation
What is the most common malignancy associated with asbestos exposure?
Bronchogenic carcinoma THEN mesothelioma
Sepsis can cause what type of pulmonary problems in older individuals?
Acute respiratory distress syndrome–sepsis causes cytokine release, which provoke an inflammatory response and increase neutrophils–leads to capillary damage and leakage of protein and fluid into the alveolar space
Pancreatitis can also cause ARDS–alveoli become lined with waxy hyaline membranes
