Block 29 Flashcards
Guidelines for preventing cardiovascular events after MI
- the best treatment for prevention of cardiovascular events are HMG-Coa reductase inhibitors (statins) as those and always used as first line (even if HDL is low and LDL is normal).
- fibrates are inferior to statins in reducing cardiovascular evens and are primarily used to prevent pancreatitis in pts with very high TAG levels.
- niacin used usually in patients failed to benefit from both above
- ezetemibe usually used in patients having high LDL despite statin use.
Which enzyme uses needs FAD in krebs cycle
Succinate dehydroginease (from succinate to fumurate)
Riboflavin deficiency
- stomatitis
- chelitis
- glossitis
- seborrheic dermatitis
- eye changes
- anemia
Good pasture syndrome
- nephritic syndrome
- renal biopsy shows linear deposits of immunoglobulins along the glomelular basment membrane which composed from IgG and C3
- type of RPGN in which cresentic GN occurs.
- pulmonary hemorrhage may be present as collagen type IV also present in the alveoli.
Selective IgA deficiency
Usually assymptomatic, recurrent sinopulmonary or GI infection
- autoimmune disease (celiac disease may be present)
- anaphylaxis during transfusion (due to presence of IgA - foreign to body)
- diagnosed with low or absent IgA with normal IgG , IgM
Fetal circulation
Oxygenated blood from placenta is delivered to the fetus via the umbilical vein, thus the umbilical vein have the highest O2 content on fetal circulation (ligamentum teres).
-then to the liver —> ductus venosus —> IVC —> right heart —> foramen ovale—> left heart.
Enzymes that uses NAD
- Isocitrate dehydrogenease
- A ketoglutarate dehydorgease
- Malate dehydorgeanse
- Pyruvate dehydrognease
G6PD deficiency
X-linked disorder mostly affects males.
- in erythrocytes G6PD is essential for maintaining adequate NADPH concentration (necessary to prevent oxidative stress)
- this syndrome is augmented under the infleuence of certain drugs (bactrim, dapsone, antimalarias, sulfinamides-trimethoprim ..) or other oxidant such as fava beans.
Nucleosomes structural subunits
- within the nucleus are composed of DNA wrapped around a core of histone proteins.
- there are five major histones H1, H2A,H2B,H3 and H4. Each histone core is made up of 8 histone proteins (2 of each H2a,b, H3 and H4) .
- H1 is located outside the histone core, it binds to the linker segment of DNA that lie between nucleosome and facilitate packaging of nucleosomes into more compact structures.
Effect of lung volume on alveolar and extraalveolar vessels
- Increased lung volume causes alveolar expansion and lengthwise streching of the interstitial alveolar blood vessels. This increases their length and recudes its diamter resulting in increased alveolar vessel resistance
- Decreased lung volume during expiration causes the extralveolar arteries and vein to become narrowed due to decreasd radial traction from adjacent tissues and compression by the positive intrathoracic pressure. This leads to increase in extraalveolar vessel resistance.
- PVR is calculated as a sum of alveolar and extralveolar resistance ats these vessels lie in series with each other.
- the highest PVR is present in inspiration and lowest in expiration.
GLUT 2
Glucose enters the beta cells via GLUT 2 and undergoes oxidative metabolism through glycolysis and citric acid cycle generating ATP.
- ATP binds to the regulatory subunit of ATP-sensetive K+ channel.
- K+ channels normally opened at rest and maintain membrane polarization allowing outward movement of potasium from the beta cells, but when ATP binds to it channels close.
- high ATP/ADP ration leads to decreased K+ efflux and membrane depolarization. This result in the openeing of Ca+ channels —> insulin release.
Cutaneous innervation of the ear
The majority of external ear recieves cutaneous innervation from the great auricular nerve(C2-C3), lesser occipital(C2-C3) nerve and auricotemporal nerve(CN V3)
Most of the external auditory canal including the external portion of tympanic nerve is innervated by the mandibular nerve .
-however the posterior part of the external auditory cana as well as the concavity and posterior eminentia of the concha is innervated by small auricular branch of vagus nerve ( if otoscope speculum is inserted patient may develop vasovagal syncope)
SVC like syndrome with only one side affected means obstruction is present in
Brachiocephalic veins
ARDS
- diffuse injury to the pulmonary microvascular endothelium and alveolar epithelium resulting in increased pulmonary capillary permability with leaky alvelocapillary membrane
- this result on noncardiogenic pulmonary edema with normal capillary wedge pressure. (Usually elevated PCWP is more suggestive of cardiogenic pulmonary edema).
- acute pancreatitis is highly associated with this syndrome.
- cytokines such as TNF-å, IL-1, IL-6 and IL-8 begins to circulate in response to the infection causing activation of pulmonary epithelium.-> provokes inflammatory response -> capillary damage and leakage of protein and fluid into alveolar space.
- most cases of ARDS occurs after 24 hours of inciting risk factor.
Vibrio cholera
Oxidase positive , gram negative comma shaped organism able to grow in water and high alkaline selective media.
- cases can be isolated or with small outbreaks.
- fluid replacement is the mainstay of managment
- it leads to watery diarrhea
- pathogens typically causes dirrhea by producing cholera toxin (V. Cholera doesnt invade intestinal epethelium ).
- cholera toxin activated adenylate cycase 00> increased cAMP
- enhanced chloride efflux and decreased sodium reabsorption, and massive watery diarrhea.
- toxin also induces mucin ejection by goblet cells.
- rice water stool.
- no leukocytes or erythrocytes are present in stools.
