Day 6 June 26 Flashcards
Which drug to use in someone with osteoporisis and family history of breast cancer?
Raloxifine
Raloxifene MOA
SERM - strong ANTagonist activity in breast, with AGONIST activity on bone
Tamoxifen MOA
ANTAGonist in breast, AGONIST on bone AND uterus
Would you use tamoxifen for osteoporosis? Why?
No - it has agonist activity on uterus, not appropriate for treatment of osteoporosis
microscopic pathologic changes in Alzheimer’s disease?
neurofibrillary tangles and extracellular amyloid-beta plaques
how does a tissue specimen appear in an ectopic pregnancy?
Decidualized endometrium - dilated, coiled endometrial glands and vasculared edematous stroma
how does a molar pregnancy tissue appear ?
Chorionic villi with avascular edematous stroma
Virulence factor of N. gonorrhea?
pili - attach to mucosal surfaces
Why is it difficult to form immunity against N. gonorrhea?
N. gonorrhea undergoes antigenic variation. At any one time, only one pilus gene is expressed. They also undergo recombination with other to produce new antigenic types of pili.
Hydatidiform moles are at risk for transformation to what?
Malignant transformation to trophoblastic neoplasm
Which type of Hydatidiform mole is associated with extremely high B-hcg levels?
Complete mole
S/E of extremely high B-hcg?
Hyperemesis gravidarum
Preeclampsia
Hyperthyroidism
Theca-lutein cysts
Which type o Hydatidiform mole have fetal tissue?
The partial mole.
Complete moles have NO fetal tissue.
What is the karyotype found in the Hydatidiform moles?
Complete mole - XY or XX
Partial mole - XXY or XXX
does a complete mole have maternal or paternal DNA?
paternal only
immunohistochemistry of Hydatidiform moles?
Complete- p57-negative
Partial - p57 positive
which type of Hydatidiform mole is associated with a greatest risk neoplastic transformation to trophoblastic cancer?
Complete (15-30%)
How do you monitior for neoplastic transformation after removal of Hydatidiform moles?
Monitor H-BCG - a level that rises or plateaus is a red flag
alpha fetal protein is a marker of WHICH types of tumour?
Yolk sac tumours in the ovaries or testes
what is increased in the blood of someone with sickle cell disease?
Bilirubin and LDH (due to intra and extravascular hemolysis of red blood cells)
what is decreased in the blood of someone with sickle cell disease?
haptoglobin -this protein binds bilirubin in the blood to prevent tubular kidney damage
what does pulsus paradoxicus refer to?
an exaggerated drop (>10) in systolic pressure during inspiration
how can you detect pulsus parodoxicus when using a blood pressure cuff?
You inflate the cuff above systolic pressure and gradually deflate it. The first sounds you hear will be the systolic pressure. If you only hear it on expiration and the pressure at which you hear it on inspiration is >10mgg difference, then it is pulsus paradoxicus.
How does pericardial effusion cause pulsus paradoxicus?
Normally during inspiration there is increased venous return to the right heart, and so it expands into the pericardium. If there is pericardial restriction, then it is forced to expand into the left ventricle, decrease the amount of filling in the left ventricle and thus the stroke volume, leading to a decreased systolic pressture on inspiration.
Where are M2 receptors found?
Heart
What effect does M2 agonist have?
Relaxes heart, decreasing contraction and HR
Where are M1 receptors found?
Brainf
What are M1 receptors important for?
Memory formation and cognitive functioning (inhibition leads to confusion)
Where are M3 receptors found?
Peripheral vasculature, lung, bladder, eyes, GI system, skin
How does M3 agonism effect peripheral vasculature?
-> NO synthesis and relaxation
How does M3 agonism effect the lungs?
bronchoCONSTRICTION
How does M3 agonism effect the bladder?
increased Ca and SM CONTRACTION
How does M3 agonism effect the GI system?
increased peristalsis
How does M3 agonism effect the eyes?
causes sphinctor muscle contraction ->miosis
How does M3 agonism effect the skin?
increased sweat production
What is muscarine?
a toxic found in some mushrooms, which acts on the M3 receptors and M2 receptors
Leads to decreased heart rate, shock, etc.
osteoporosis caused by excess PTH primarily affects which areas in the bone?
Corticol bone leads to subperisteol erosions (as compared to osteoporosis, which has trabecular thinning)
How does bone appear in osteoporosis?
trabecular thinning
Milirone MOA
PDE-3 inhibitor -leads to decreased breakdown of caMP
How is milirone useful in heart failure ?
In the heart, this increase Ca results in more actin-myosin-troponin action and thus increased inotrophy
In the smooth muscle, this activates PKA which increases SR uptake of Ca, leading to vasodilation
what type of drug is fluoxetine?
SSRI
what drugs are used to treat PAINFUL diabetic neuropathy ?
SNRI’s
TCA’s
Gabapentinoids
what type of drug is amitriptyline?
TCA
how does amitriptyline help treat painful neuropathy?
it inhibits volate gated Na channels in sensory nerves, , blocks NMDA receptors in the spinal cord and alters NE signalling in the brain
what type of drug is ciprofloxacin?
Fluoroquinalone
What should not be taken with fluoroquinalones?
Cations (ca, iron, aluminum, magnesium)
Antacids may decrease the bioavailability of which antibiotics?
Fluoroquinolones and tetracyclines, since antacids contain cations
Which type of cell is important in preventing superfical candida infections? (oral/esophageal, cutaneous, vulvovaginitis)?
T cells
Which type of cell is important for defending against hematogenous spread of candidiasis? (disseminated candida - endocarditis, candidemia)
Neutrophils
Pseudohyphae-producing yeast that cannot form germ tubes?
Candida
patients with a gastrin-secreting pancreatic tumour (zollinger-ellison syndrome) should be assessed for what?
Signs of MEN1 syndrome/family history of MEN1
What cancers arise in MEN1?
Primary hyperparathyroidism
Pancreatic tumours
Pituitary tumours
What cancers arise in MEN2A?
Primary hyperparathyroidism
Pheochromocytoma
Medullary thyroid cancer
What cancers arise in MEN2B?
Medullary thyroid cancer
Pheochromocytoma
Mucosal neuromas / marfanoid habitus
What. isthe main toxin of C. perfringens?
lecithinase - cleaves phospholipids leading to cell lysis
Is sotalol a beta blocker?
Yes and its an antiarrhythmic
What adverse cardiac effect is sotalol associated with?
QT prolongation and torsades de points
what will be seen on muscle biopsy of someone with a mitochondrial myopathy on gomore trichome stain?
splotchy red appearance (from mitochondria accumulating under the sarcolemma)
pembrolizumab MOA?
Monoclonal antibodies that blocks program death ligand 1 (PD-L1) on cancer cells, making them more susceptible to cytotoxic t cells
what is program death ligand 1 (PD-L1)?
a molecule that is upregulated by cancer cells -it binds to the receptor on cytotoxic t cells and suppresses their ability to induce cell death
how does bone marrow change as you get older?
Higher quantity of fat and a reduced overall mass
-decreased progenitor cell diversity and response to cytokine stimulants
in which part of the nephron do thiazide diuretics work?
distal convoluted tubule
thiazides MOA
block NaCl uptake in DCT
thiazides can be used to treat which type of kidney stones and why?
calcium kidneys stones - the decreased Na uptake into the tubular cell increases Ca Na exchange on the basolateral membrane, leading to increased Ca uptake (Decreased Ca secretion)
MOA of loop diuretics?
block Na Cl K uptake transporer in ascending loop of henle
where do K sparing diuretics work?
collecting duct - inhibit the effects of aldosterone
which nerve runs right behind the right atrium?
right phrenic nerve
pathophys of goodpasture syndrome?
autoantibodies are produced against glomerular basement membrane
