Block 4 Flashcards
Diastolic heart sound heard shortly after the second heart sound
S3 gallop, usually present in decompensated heart failure.
Heard when the patient lies in left lateral decubitus position.
Dense interstitial mononuclear infiltrates in kidney
Acute cellular rejection, occurs <6 months after transplant, especially in pts who stopped immunosuppressant
Pralidoxime
Anti cholinergic used in organophosphate poisoning, better than atropine because it can act on both muscarinic and nicotinic receptors
Persistent tachypnea leads to
Respiratory muscle fatigue
Pigment gallstones
Composed of Ca+2 salts of unconjugated bilirubin are comparatively soft and are dark brown to black.
- brown pigment stones typically arise secondary to bacterial (E.coli)or helminthic infrction (ascaris lumbricoides), infection to billiary tract, which results in the release of “beta-glucuronidase” by injured hepatocytes and bacteria.
IL-12 role
If antigen is presented by a Macrophage(MAC), MAC will produce IL-12 that stimulate the differentiation into TH1 subset.
What is D-xylose
Monosaccharide that is absorbed directly without the action of pancreatic enzymes and can be used to test for brush border absorptive function independent of pancreatic function.
- it can be decreased with bacterial overgrowth of small intestine
Interscalene nerve block
is regional anesthesia technique used for procedures involving the shoulder and upper arm. This is done injecting anesthesia to the scalene triangle–> blocking Brachial plexus roots and trunks.
Important side effect :-> it causes transient ipsilateral diaphrgamatic paralysis in nearly all patients.(this method shouldn’t be done in COPD and contralateral phrenic nerve dysfunction )
Degradation of polysaccharide to monosaccharide requires?>
Pancreatic amylase
beta-glucuronidase in gallstones
It leads to brown pigmented soft stones. Arises from infection to biliary tract,. It hydrolyzes bilirubin glucuronides and increases the amount of unconjugated billirubin.
Monosaccharide transport in small intestine
Sodium dependent cotransporter or facilitated diffusion
Intrapleural pressure fall during inspiration is derived from
Diaphragm contraction
Naive TH0 cells differentaiton
TH0–> TH1 : it need IL-12 and IFN-¥
TH) –> TH2 : it needs IL-4, IL-5
Amyl nitrite inhalation effect on heart
Leads to vasodilation, resulting in transient decrease in venous return and BP.
What are chromaffin cells
Postganglionic sympathetic neurons derived from neural crest cells that receive sympathetic input (neuroendocrine cells)
A1 receptor is what G protein class
q-class–>Gq->phospolipase C-> acts on PIP2–> produces DAG and IP3 –> IP3 –> increase smooth muscle contraction by increasing calcium
Trapezius muscle is innervated by
Accessory nerve (CNXI), also sternocleidomastoid.
Lipoatrophy ,
Drugs that causes it
Refers to loss of subcutaneous fat, especially from face
Common side effect of stavudine and zidovudine (RT inhibitors)
Chronic renal allograft rejection - pathogenesis
- it begins with graft endothelial damage mediated by low grade cellular and humoral immune responses directed against alloantigens.
- this results in obliterative fibrous intimal thickening and scattered mononuclear infiltration of the surrounding tissues.
- consequent renal ischemia and chronic inflammation causes shrinkage of renal parenchyma with tubular atrophy and interstitial fibrosis.
Myasthenia gravis, treated with AChE inhibitors exacerbation
- myasthenia crisis: under treatment (low dose)- responsive to edrophonium
- cholinergic crisis: over treatment (high dose)-irresponsive to edrophonium
Lactobacilli is
Present in the vagina, its a gram positive bacteria.
S3 sound
Ventricular gallop sound, after S2, heard during rapid passive filling of ventricles in diastole. Due to sudden cessation of filling as ventricular reaches its elastic limit.
- its best heard with the bell of stethoscope over the cardiac apex while the patient is in left lateral decubitus. Listening at end expiration makes the sound even more audible by decreasing lung volume and bringing the heart closer to chest wall
Common hepatic artery branches
- Proper hepatic
- Gastrodudenal
- Right gastric artery
Chromaffin cells in the adrenal medulla are stimulated by
Acetylcholine ,released by sympathetic preganglionic neurons and secrete catecholamine (80% E and 20% NE) into blood stream.
Lidocaine side effects
- neurological signs such as tremor, drowiness, and changes in the mental status, although it can lead to generalized seziures
Differences between TH1 and TH2
TH1 is responsible for cell mediated response, it activates MAC and CT-cells. It secretes IL-2, IFN-¥, and lymphotoxin ß, and result in cytotoxic immune response. TH2 is responsible for humoral mediated respones, it activates B cells and promotes class switching, it secretes IL-5, IL-4, 10, and 13. Its results end in secretion of antibodies.
Drug induced lupus erythematous
-new onset lupus symptoms
-ANA and Anti-histone antibodies (specific) (>95% of cases)
Exposure to:->
1. Hydralazine
2. Procainamide
3. Isoniazid
4. Minocycline
5. Quinidine
Primary infection with HSV-1 results in
Gingiovomastitis .
- peak age for primary infection is 6 months - 5 years.
- prodromal symptoms (fever, malaise, chills )–> after 1 week.
- painful vesicles, extensive covering the lips and gingiva, may include the palate and tongue.
- pain often result in dehydration
Pyruvate kinase(PK) enzyme
- Pyruvate kinase is a glycolytic pathway enzyme that converts phosphoenolpyruvate to pyruvate–> generation of ATP.
- Allosteric stimulation of PK by F1,6bis, stimulate glycolysis.
- RBC, which have no mitochondria rely on lactate as main metabolite for glycolysis.
Latent infection
During latent infection no virus is produced and no clinical course occurs
Exocrine pancreas deficiency
The exocrine pancreas has significant secretory reserve and >90% of glandular tissue must be destroyed before a patient will develop clinical malabsorption.
Hyper-acute kidney rejection
- vascular fibrinoid necrosis
- neutrophil infiltration of arterioles, glomeruli, and peritubular capillaries.
- occurs within minutes to hours after donor-recipient vascular anastamosis.
clonorchis sinensis
This is a helmenthic infection, liver fluke, common cause of pigmented stone formation in east Asia, and can have long asymptomatic period before inducing a symptom
Adrenal medulla on histology
Chromaffin cells with a deeply basophilic cytoplasm
Target cells are seen in
ß-thalassemia
Diastolic ventricular compliance
Conditions that decrease ventricular compliance are LVH, hypertrophic cardiomyopathy, and infiltrative disorder.
Its unaffected by EDV.(as crystalloid infusion in hypovolemic shock)
Platysma is innervated by
Facial nerve, cervical branch
How is bacterial overgrowth in small intestine is diagnosed
Decreased absorption of D-xylose
Slow virus infection
Months to years
Example is measles in CNS–> subacute sclerosing panencephalitis
Decreased amounts of glyocgen in epithelial cells of vagina
Postmenopausal , or lactating women
atrophic vaginitis
Sodium bicarbonate therapy can be used in
- widened QRS interval or ventricular arrythmia, in case of drug intoxication (TCA especially, and slicylates)
- naHCO3 –> increase PH –> favors non-ionized form of the drug. Making it less accessible to bind to sodium channels.
- it also increases extracellular sodium concentration which helps overcome competitive rapid sodium channel blockade.
PPI side effects
Hypomagnesemia and increased risk for osteoporosis
Chronic renal allograft rejection
- gradual deterioration in graft function that occurs at least 3 months post transplant
- characterized by worsening hypertension, progressive rise in serum creatinine and proteinuria, with normal urinary sediment.
Biofilm producing bacteria
Biofilms functions as a barrier to antibiotic penetration and interferes with host defenses, including opsinization, neutrophils migration and even T lymphocyte activation.
These bacteria include:
1. S.epedrmidis (in prosthetic devices and Iv catheters)
2. S.mutans, S.sanguinis (dental plaques)
3. P.aeruginosa (CF pneumonia, contact lenses)
4. Viridans (endocarditis)
5. Non typable H.infleuenza(otitis media)
Intracellular infection are cleared by
Cell mediated immunity: cytotoxic T cell which is stimulated by TH1 cell which in turn stimulated by IL-12 and IFN-¥
Verapamil side effects
-negative inotropy, constipation and gingival hyperplasia
ß-HCG is detectable in serum after
6-7 days of fertilization .
ß-hCG is detectable in serum at <5 IU/L.
Burr cells and helmet cells are seen in
Traumatic hemolysis which can result either from microangiopathic hemolytic anemia or mechanical damage (prosthetic valve).
Coffe ground emesis
Peptic ulcer
Edrophonium is used in
Its an chilnergic agonist from the family of antochilnesterase, its used to diagnose mythsenia gravis.
Heme degredation
Heme is converted to biliverdin by heme oxygenase, then biliverdin to unconjugated billirubin by biliveridin reductase.
Abortive viral infection
Infection in which virus enters cells but cant successfully produce infective virus–> isn’t capable of making the disease
S.epidermidis most important virulence mechanism
Synthesis of an extracellular polysaccharide matrix.
(Once attachment occurs, the bacteria multiply and communicate with one another to induce the synthesis of an extracellular polysaccharide, that encases the bacteria)
It usually associated with foreign body infections (eg. catheters) because its ability to form biofilm.
Paroxysmal narrow QRS complex, supra-ventricular tachycardia
Wolf Parkinson white (WPW)
WPW pathogenesis
Pre excitation syndrome
In pts with WPW, when there is no re-entrant tachycardia–> normal sinus impulses reach the ventricles first via accessory pathway and shortely afterword via AV node. (Accessory pathway –> pre-excites the ventricles ahead of normal conduction pathway –> hence the term “pre-excitation syndrome”. The result is shortned PR interval (often <0.12 seconds) with and early upslope (delta-wave) at the start of each QRS complex. The QRS complex is wider that normal as a result of delta wave.
Cytoskeleton abnormalities anemia
- herditery spherocytosis
- elliptocytosis
- stomatocytosis
Iipodystrophy
It redistribution of fat from extremities to the trunk. Medication induced body fat redistribution s a common side effect of HAART (HIV-drugs). It results from 2 processes , wasting of fat from face and extremities and deposition of fat in trunk and viscera.
Tzanck smear shows
Multinucleated giant cells
Splenomegaly due to undegraded metabolite accumulation
Niemann pick disease and gaucher disease
Alveolar hyperventilation signs
- Acute dyspnea, hypocapnia and hypoxemia.
- Arterial paCO2 is the main indicator for total alveolar ventilation.
- It can occur due to V/P mismatch that causes decreased O2 and CO2 exchange (PE or pneumonia).
- the resultant hypoxemia stimulates peripheral chemoreceptors and increase the respiratory drive above normal values.–> hyperventilation.
Mysthenia gravis signs and symptoms
- fluctuating weakness over the course of the day
- ptosis
- diplopia
- fatiguable chewing, dysphagia
ß-agonist acts on what receptor
G-stimulatory –> increase cAMP
Deep inguinal ring and superfacial inguinal ring
Deep inguinal ring is formed by the transvalis fascia
Superficial inguinal ring is formed by the external oblique apounerosis.
Prior to fertilization oocyte is arrested in
Meiosis II metaphase
And before puberty arrested in prophase meiosis I
Tensilon test
Infusion of short acting AcHE inhibitors such as edrophonium, increases neuromuscular transmission and can provide temporary improvement in symptoms. This is done in mysthenia gravis
Ondines curse
Impairment of respiratory control centers in brainstem can result in decreased frequency and/or amplitude of involuntary respiration . Voulntary breathing would be unaffected .
WPW , re-enterant pathway
In case of tachyarrythmia , the wide QRS complex converts into narrow QRS because the accessory pathway no longer preexcites the ventricles but instead forms a re-enterant circuit back to atria.
ß-hCG is detectable in urine at
14 days after fetillization
Gallstones- cholesterol stones
They are formed when the ability of bile salt to solubillize cholesterol is overwhelmed by high concentration of cholesterol in bile
They are yellow to pale gray and hard
Reactivation of HSV leads to
Herpes labialis
Adenosine
Chest burning, flushing and transient hypotension
Infective endocarditis –> circulating immune complexes can lead to
Deposition in spleen –> splenomegaly
And deposition in kidney
Mitochondrial myopathy
- inabillity to use oxidative phosphorylation (mitochondrial defect)
- myopathy, lactic acidosis, nervous system dysfunction.
- muscle biopsy shows ragged red fibers.
Pyruvate kinase deficiency
PK, is the second most common congenital hemolytic anemia
- it results in insuffecient ATP –> water and K+ losses –> defective membrane architecture –> echinocytes –> hemolysis.
- reticuloendothelial cells in the splenic red pulp are involved in the removal of damaged RBC,–> increase activity in PK deficiency –> red pulp hyperplasia –> splenomegaly.
Crescent formation in glomerulus
Typically seen in:
- anti-GBM
- ANCA associated disease
- immune complex mediated glomerulonephritis.
Passive splenic congestion occurs in
Portal hypertension , splenic vein thrombosis , and congestive heart failure
In case of hypovolemic shock managment
Rapid infusion of blood and crystalloid such as saline–> intravascular volume and ventricular preload increase rapidly –> the increase in preload stretches the myocardium and increase the end diastolic sarcomere length –> increase SV and CO
Neuroleptic malignant syndrome
Malignant FEVER: F: fever E:encephalopathy V: unstable VVitals E: increased Enzymes R: Rigidity (muscle)(lead pipe)
MS incidence
Its incidence in increased in people with certain HLA types
Envirnomental factors also important as its more common in tempreture latitudes. (More common in USA,canada, and northern europe)
Clinical features of tricylic antidepressant overdose
- CNS:mental status changes, seziures, respiratory depression
- CVS:sinus tachycardia,hypotension,prolonged QT interval
- anti-cholinergic: dry mouth, blurred vision, dilated pupils ,urinary retention, flushing and hyperthermia
Candida vaginitis
Gram + lactobacilli comprises a major part of the normal vaginal flora and exist in balance with other colonizers at normal vaginal PH of 3.8-4.5, changes in the vaginal flora can lead to overgrowth of candida. This changes results usually from : - antibiotic use -high estrogen -systemic corticosteroid therapy -uncontrolled diabetes -any other cuase of immunusupression
shrinkage of renal parenchyma with tubular atrophy and interstitial fibrosis.
chronic renal graft
