April 9 Flashcards
What is release from steroli cells that allow for male differentiation?
MIF–Mullerian inhibiting factor–causes mullerian duct to involute–stopping formation of female internal genitals
- -Defective steroli cells in male fetus will result in male and female internal genitalia
- –Leydig cells secrete testosterone which allows wolffian ducts to develop into male internal genitalia
Midshaft fracture of the humerous can result in damage to what nerve and what artery?
Radial nerve–C5-T1–wrist drop
Deep brachial artery
What heart defect is associated with head bobbing?
Aortic regurgitation
Wide pulse pressure results in bounding femoral and carotid pulses with abrupt collapse
What is Bosentan used for and with is its MOA?
Used for Pulmonary HTN
–Competitively antagonizes Endothelin-1 receptors–decreasing pulmonary vascular resistance
a-Amanitin, found in Amanita phalloides–mushroom inhibits what?
RNA polymerase II–which makes mRNA
–Causes severe hepatotoxicity
A humoral response with antibodies directed against _______ is the most important source of protection against influenza.
Hemagglutinin
Dopamine is dose dependent, having different effects with increased dosing, what are these effects?
Low doses–Stimulate D1 on renal and mesenteric vasculature –resulting in vasodilation and increased blood flow to these areas
Higher dose–stimulates B1-adrengeric receptors in the heart and increase contractility
Even higher dose–stimulates a1-adrengeric causing vasoconstriction
What disease presents with dermatitis (necrolytic migratory erythema), diabetes, DVT, declining weight, depression and normocytic normochromic anemia?
NME–elevated, painful and pruritic rash typically affecting the face, groin, and extremities–crusting and scaling with bronze-colored indurations
Glucagonoma–tumor of pancreatic a-cells causing overproduction of glucagon
Tx: octreotide, surgery
What is the MOA of opioid analgesics, such as morphine, fentanyl, codeine, loperamide, methadone?
Act as agonists at opioid receptors to modulate synaptic transmission
- Open K+ channels, close Ca2+ channels–> Decreases synaptic transmission
- -Inhibition of release of ACh, NE, 5-HT, glutamate, substance P
Fructose intolerance is a hereditary deficiency of aldolase B causing fructose-1-phosphate accumulation–causing inhibition of glycogenolysis and gluconeogenesis –sym: hypoglycemia, jaundice, cirrhosis and vomiting. What should be avoided in the diet of these pts?
Fructose and sucrose (glucose + fructose) intake
What lymphoid neoplasm is seen mostly in adult males and causes marrow fibrosis resulting in a “dry tap” on aspiration of the bone marrow?
Hairy cell leukemia–Mature B-cell tumor
Pts usually present with massive splenomegaly
What part of the bronchial tree has the most amount of resistance and which has the least?
Most–med sized bronchi
Least–terminal bronchioles–due to large # in parallel
Anterior nose bleeds are most likely caused by damage to what structure located where?
Kiesselbach plexus–located in anterior segment of the nasal septum
What is the most common cause of meningitis in adults?
Strep pneumoniae
What adverse effects are seen with the 1st generation antihistamines?
Sedation
Antimuscarinic–blockage of ACh
anti-a-adrenergic —hypotension and postural dizziness
What is the cause of Osteogenesis imperfecta?
Caused by a variety of gene defects–most commonly COL1A1 and COL1A2—decreased production of otherwise normal type I collagen–leads to impairment of bone matrix formation
What ligament is torn with radial head subluxation–nursemaids elbow?
Annular ligament tear from its periosteal attachment at radial neck
Seen in children due to sudden pulling of arm
Propranolol is given with hyperthyroidism, what 2 functions does it have?
Reduce HR and anxiety/agitation
Also inhibits iodothyronine deiodinase–reducing the peripheral conversion of T4–> T3
–reduces thyroid hormone action on peripheral tissue
What is the surface marker for macrophages?
CD14
Phosphoribosyl Pyrophosphate synthetase enzyme (PRPP) excess can cause gout, what is the mechanism?
PRPP–responsible for purine synthesis pathway–> more purine synthesis=more purine degradation–> hyperuricemia–> gout
Which aortic arch derivative makes up the proximal part of the pulmonary arteries and ductus arteriosus?
6th arch
4th– Left Aortic arch and proximal part of right subclavian
3rd–Common carotid and proximal part of internal carotid artery
2nd–Stapedial artery and hyoid artery
1st–Part of maxillary artery –branch of external carotid
What is produced by S. sanguinis allowing it to cause endocarditis?
Dextrans–bind to fibrin-platelet aggregates on damaged heart valves
What is the cause of Hartnup disease?
Autosomal recessive deficiency of neutral amino acid (tryptophan) transporters in proximal renal tubular cells and on enterocytes
–results in neutral aminoaciduria and decreased absorption from the gut–decreased tryptophan for conversion to niacin–> pellagra-like symptoms
What meds should be avoided in the elderly for treatment of insomnia?
Benzodiazepines
Antihistamines
Sedating antidepressants
Use–Ramelteon–Melatonin agonist–few side effects
Where does parvo B19 replicate?
In the erythrocyte precursors of the bone marrow
What occurs in respiratory and gastric glands in CF pts compared to sweat glands?
Respiratory and gastric–Impaired CFTR results in reduced lumen secretion of Cl- and increased luminal absorption of Na+ and H2O
Sweat glands–CFTR mutation results in production of hypertonic sweat with high chloride content
Pt has elevated Alkaline phosphatase, what enzyme can be used to differentiate liver vs bone origin?
gamma-glutamyl transpeptidase –found in various liver and biliary disease but NOT in bone disease
–associated with ETOH use
Disorder of increased HCT that may present with intense itching after hot shower and is associated with V617F JAK2 mutation?
Polycythemia vera
–Increased RBCs, WBCs, Platelets
