Day 5 Flashcards
What ratio indicates fetal lung maturity? What is the proper name for the main component of pulmonary surfactant? (FA15 p600) (FA16 p607) (SU p96) (Phys p468)
L/S >2 is health (<1.5 is predictive of RDS)
Dipalmitoylphosphatidylcholine
Which nutrient deficiency is associated with spooning of the nails (koilonychia)? (H p846)
Sign of hypochromic anemia –> iron deficiency & Plummer-Vinson syndrome
You start a patient on a drug that has been on the market for five years. It has excellent efficacy. However, your patient begins to have an annoying side effect one month after initiation of this drug. She contacts the manufacturer about it, and they, in turn, contact you to gather data on her course while on the drug. In which phase of the clinical trial would this example fall? (FA15 p48) (FA16 p32)
Clinical Trials
Phase I – Small # of healthy volunteers
Trial on normal patients
Phase II – Small # of patients with disease of interest
See if works on diseased patients
Phase III – Large # of patients randomly assigned either to the treatment under investigation or to the best available treatment (or placebo)
Head-to-Head trial with another drug
Phase IV – Postmarketing surveillance of patients after treatment approval
Which bacteria are known for being obligate intracellular bacteria? (FA15 p122) (FA16 p112) (SU
p335-336)
“stay inside cells when it is Really CHilly and COld”
Rickettsia
CHlamydia
COxiella burnetii
What is the equation for determining a drug’s clearance? (FA15 p243) (FA16 p237) (SU p395)
CL = rate of elimination of drug / plasma drug concentration
= Vd x Ke (elimination constant)
= 0.7 x Vd / half-life
The protein derived from what gene serves as a transcription factor for the development and function
of regulatory T cells? (R p784)
FOXP3 Found on the X chromosome Codes for Forkhead Box Protein P3 Important for self-tolerance Absence has been implicated in autoimmune diseases
Where would you expect to find B cells in a lymph node? Where would you find T cells, plasma cells,
and macrophages? (FA15 p198) (FA16 p190) (SU p367, 369) (Phys p427)
B cells – Follicles (cortex)
T cells – Paracortex (region between follicle and medulla)
Plasma cells – Medullary cords
Macrophages – Medullary sinus
What important intracellular proteins are common to both the extrinsic and intrinsic apoptotic
pathways? (FA15 p222) (FA16 p216)
Intrinsic Pathway
- Bcl-2 (anti-apoptotic) - BAX (pro-apoptotic) - BAK (pro-apoptotic)
Extrinsic Pathway
- Fas - FasL
Common proteins to both In & Ex are CASPASES
What is the female homolog to each of the following male structures? (FA15 p568) (FA16 p572) (SU
p197-198)
Corpus spongiosum
Cowper’s glands
(bulbourethral glands)
Prostate
Glans penis
Ventral penile shaft
Scrotum
vestibular bulbs ------------------------------------ Bartholin glands ------------------------------------ urethral and paraurethral glands Skene glands ------------------------------------ Glans clitoris ------------------------------------ Labia minora ------------------------------------ Labia majora ------------------------------------
Which amino acids are necessary for purine synthesis? (FA15 p63) (FA16 p49) (SU p279)
GAG - amino acids necessary for purine synthesis
Glycine
Aspartate
Glutamine
Your 46-year-old male patient is asking your advice on whether to take a daily aspirin. How does taking an aspirin a day prevent platelet aggregation and myocardial infarction? Which two arachidonic acid products affect platelet aggregation? (FA15 p444) (FA16 p446) (SU p243-244)
Irreversibly inhibits COX-1 and COX-2 –> less production of Thromboxane A2 –> less platelet aggregation –> less thrombosis
Thromboxane A2 stimulates platelet aggregation
Prostacyclin (PGI2) inhibits platelet aggregation
What is compartment syndrome, and how is it treated? (SU p242) (COA p540)
Compartment syndrome
Increased pressure within the fascial compartment
Treatment
Fasciotomy
Thiazolidinediones (TZDs) increase expression of one type of GLUT receptors—those in adipose tissue—as one of their antidiabetic actions. Which GLUT receptors would you expect to find on skeletal muscle and fat? (FA15 p314) (FA16 p308) (SU p298)
Insulin-DEPENDENT
GLUT4 - adipose tissue, striated muscle (exercise can also increase GLUT4 expression
Insulin-independent
GLUT1 - RBCs / brain / cornea / placenta
GLUT2 (bidirectional) - beta islet cells / liver / kidney / small intestine
GLUT3 - brain / placenta
GLUT5 (fructose) - spermatocytes / GI tract
Brain uses glucose normally and ketones during starvation
RBCs always use glucose bc they lack mitochondria for aerobic metabolism
"BRICKL" B: brain R: RBCs I: Intestine C: cornea K: kidney L: liver
Which GI ligaments match the following descriptions? (FA15 p344) (FA16 p340)
Separates the greater and lesser sacs
May be cut during surgery to access the lesser sac
2 ligaments that connect the spleen to other structures
Contains the portal triad
Connects liver to the anterior abdominal wall
gastrohepatic ligament (right) gastrosplenic ligament (left) -------------------------------------- Gastrohepatic ligament -------------------------------------- Gastrosplenic ligament Splenorenal ligament -------------------------------------- Hepatoduodenal ligament Portal Triad proper hepatic a. portal v. CBD -------------------------------------- Falciform ligament
An 18-year-old woman has seasonal allergies. She complains that her eyes water and her nose runs constantly during the spring. Which cell type is responsible for her symptoms, and what drug inhibits these cells’ actions? What WBCs descend from the myeloblast (granulocyte) lineage? (FA15 p382-383) (FA16 p378-379) (SU p376)
Mast cells – mediate allergic reaction in local tissues
Cromolyn sodium prevents mast cell degranulation (used for asthma ppx)
Membrane binds with Fc portion of IgE –> crosslinks –> degranulates –> release histamine, heparin, tryptase, eosinophil chemotactic factors
Antihistamines block the downstream effects of histamine
Granulocytes Neutrophils Eosinophils Basophils Mast cells come from a different cell line
In the lower extremity, what are some of the clinical differences between peripheral vascular disease (PVD, also known as peripheral artery disease (PAD)) and deep venous thrombosis (DVT)?
(H p2066, 2170)
PVD/PAD Atherosclerosis of the peripheral arteries Claudication Decreased/absent peripheral pulses Foot may be cool to the touch Skin can become pale/shiny/hairless
DVT
Blood clot in a peripheral vein
Leg is warm (not cool)
Increased calf circumference
Moses sign (calf tenderness with compression)
Homan sign (calf pain with dorsiflexion of the ankle)
You have a patient who is experiencing progressive difficulty with swallowing liquids and solid food. Subsequently, the patient undergoes a barium swallow that reveals stenosis of the lower esophageal sphincter. What is the diagnosis associated with this barium swallow finding? What are some common causes of this diagnosis? (FA15 p357) (FA16 p354)
Achalasia Loss of Auerbach plexus Secondary to Chagas disease (T cruzi) Amyloidosis Sarcoidosis Extraesophageal malignancy CREST
A 66-year-old man currently taking warfarin for atrial fibrillation is instructed to avoid food products that contain vitamin K in order to optimize anticoagulation. For what coagulation factors is vitamin K necessary? (FA15 p94) (FA16 p82) (SU p270)
Factor II, VII, IX, X
Proteins C & S
A 22-year-old man suffers a stabbing injury to the chest. He has lost a lot of blood, and you are concerned that his cardiac output is low. What are the two equations for cardiac output?
(FA15 p272) (FA16 p266) (SU p68)
CO = SV x HR
CO = rate of O2 consumption / (arterial O2 content - venous O2 content)
A 5-year-old boy is treated with mebendazole for a pinworm infection. Mebendazole acts on microtubules to inhibit the pinworms. What other medications act on microtubules? What syndrome demonstrates a defect in microtubule polymerization? (FA15 p74, 215) (FA16 p60, 209)
"Microtubles Get Constructed Very Poorly" M: mebendazole (antihelminthic) G: Griseofulvin (antifungal) C: colchicine (antigout) V: vincristine/vinblastine (anticancer) P: placlitaxel (anticancer)
Chediak-Higashi syndrome Macrophage microtubules do not polymerize properly Recurrent pyogenic infections Peripheral neuropathy Partial albinism
An adult trauma patient begins to experience shortness of breath on day 3 of his hospital stay. The patient had an open reduction internal fixation of a right femur fracture. You are concerned the patient’s shortness of breath might be attributed to an embolus. What type of embolus is this patient at risk of getting? What are the different types of emboli? (FA15 p609) (FA16 p617) (SU p103)
Fat embolism
FAT BAT
Fat emboli (hypoxemia, neurologic abnormalities, petechial rash) Air emboli Thrombus Bacterial Amniotic (can lead to DIC) Tumor
How can a skull fracture at the base of the brain lead to pulsating exophthalmos (protrusion of the eye)? (H p237)
Skull fx –> Torn ICA in cavernous sinus –> increase BP in sinus –>
blood fills ophthalmic vein and orbital tissue –> exophthalmos (which pulses)
What is the site of action of each of the following diuretics? (FA15 p552) (FA16 p556) (SU p148, 164)
Thiazide diuretics- Loop diuretics- Carbonic anhydrase inhibitors- Osmotic diuretics- Potassium-sparing diuretics-
early Distal Convoluted Tubules -------------------------------------- Ascending loop of Henle -------------------------------------- Acetazolamide Proximal tubules -------------------------------------- Mannitol Proximal tubules Descending loop of Henle Collecting duct -------------------------------------- coritcal collecting tubules
In patients with a prolactinoma, what pharmacologic agent can be used to inhibit the release of
prolactin? In normal physiology, how is prolactin secretion regulated? (FA15 p316) (FA16 p310)
(SU p170, 184)
Bromocriptine (dopamine agonist)
regulated by dopamine
Prolactin – secreted by Anterior Pituitary
– inhibited by dopamine from hypothalamus
– INCREASED by TRH / pregnancy / OCPs / estrogen
– STIMULATED by anti-psychotics
– Prolactin inhibits its own secretion by increasing dopamine production and release from the hypothalamus
