Deck 13 Flashcards
What areas are most affected by aspiration pneumonia?`
Supine = post right upper/ superior right lower; Standing = basilar (right)
What is milrinone? Why is it used for systolic HF?
PDE-3 inhibitor»_space; incr cAMP: Cardiac = incr inotropy; smooth muscle = vasodilation
What is the process of infective endocarditis?
Disruption of endocardial surface > adherence of platelets/fibrin (sterile fibrin/platelet nidus)»_space; microorganisms colonize
What helps distinguish alcoholic pancreatitis vs other causes?
Macrocytosis
Histo for acute tubular necrosis?
Flattened epithelial cells, loss of brush border, necrosis, denudation of BM, MUDDY BROWN CASTS
What sections of kidney are most susceptible to ischemic injury?
Proximal tubule (straight portion), thick ascending loop: participate in active transport and have high O2 demand
Who can get hydrocephalus ex-vacuo?
AIDS dementia, AZ: cortical atrophy > expansion of ventricles w normal CSF pressure
What do you give in life-threatening warfarin toxicity?
FFP: restores all clotting factors (II, VI, IX, X & proteins)
What is cryoprecipitate used for?
Factor VIII, XIII, vWF, fibrinogen
What conditions could give you ataxia, loss of position/ vibration, loss of deep tendon reflex…?
Vitamin E deficiency, Friedrich ataxia, Vit B12- Qid 671
How do each of psoriasis Tx work: topical Vit D, cyclosporine, etanercept, MTX? (Qid 8569)
Vit D = vit d receptor is nuclear TF that inhibits keratinocyte prolif; Cyclo = inhibits NFAT (inhibiting IL-2); Etanercept = Binds TNF-a; MTX = inhibits purine & thimidylic acid synthesis in rapidly proliferating skin epithelial cells
What causes bronze diabetes?
Hemochromatosis
What is mechanism of fibrinolytics (alteplase)?
binds fibrin in clot and converts entrapped plasminogen to plasmin
What does primary HSV-1 result in?
Herpetic gingivostomatitis; usually come in to doctors for dehydration
Where is the renal vein in relation to renal artery?
Crosses anterior to aorta and renal arteries
What is the sweat like in CF? Why?
Hypertonic w high sodium/ Cl: CFTR usually reabsorbs chloride and Na/ H2O follow in ducts of eccrine glands»_space; risk of hyponatremia (give salt supplementation to infants)
Episodic HA, tachycardia, diaphoresis…?
Pheo
In coronary artery disease, what else should be given if can’t take aspirin?
Clopidogrel: blocks ADP receptors and prevents aggregation; just as effective as aspirin
Pancytopenia w/o splenomegaly…?
Aplastic anemia (dry tap w hypocellular marrow, fat & stromal cells)! Also B12/ folinic, acute leukemia, myelodysplastic syndrome
What is characteristics biochemical feature of Huntingtons?
Loss of GABA (containing neurons)
How and where does shigella get into intestinal cells?
Invade M cells as base of villi within a Peyer Patch via endocytosis
What regulates transition from G1 > S? How does it regulate?
RB protein: active when hypophosphorylated; cell stimulation by growth factor > Activation of cyclin D, cyclin E, CD4 & 6»_space; hyperphosph RB is inactivated & releases E2F transcription factor»_space; pass through checkpoint
Why is hypernatremia & edema rarely seen in primary hyperaldosteronism?
Aldosterone escape: Aldo increases intravascular volume»_space; incr RBF»_space; increased Na excretion & limited net sodium retention
What do antibodies against phospholipase a2 receptor cause in kidney?
Membranous nephropathy
What virus causes aplastic crisis in sickle cell patients?
Parvovirus
What organism has polyribosylribitol phosphate (PRP) as virulence factor?
H. flu: part of polysaccharide capsule - protects against phagocytosis and complement by binding factor H (control protein that prevents complement on host cells_
What can chronic lymphedema cause? Ie. 10 years after women has breast cancer removal…?
Lymphangiosarcoma
Cause of prolonged PTT & BT?
vWD
What causes the maldevelopment of thymus/ parathyroid gland in Di George?
Defective neural crest migration into derivatives of 3rd and 4th pharyngeal pouches
Recurrent respiratory infections caused by Pseudomonas, diarrhea, failure to thrive.? Tx?
Cystic fibrosis; Pancreatic lipase supplementation will help with nutrient absorption - Qid 808
What causes heparin induced thrombocytopenia? Tx?
HIT = thrombosis from antibodies to heparin and platelet factor IV; stop heparin and give direct thrombin inhibitors (argatroban, lepirudin, hirudin)
Which areas of brain cause parkinsons? Where do you target for deep brain stimulation?
Excessive stimulation of globus pallidus internus by subthalamic nucleus»_space; excessive inhibition of thalamus; Target Gpi or sTn
Vasculitis of lower leg/ arm associated with tobacco?
Buergers disease: can extend into surrounding arteries, nerves, veins; Tx: smoking cessation
Fever, rash, renal problems weeks after starting medications? What kind of reaction?
Acute interstitial nephritis (interstitial edema & leukocyte infiltration); IgE-mediated hypersensitivity or cell-mediated (type IV) reaction depending on drug? Qid 835
Patient with osteolytic lesions, precocious puberty, café-au-lait spots? What is mechanism?
McCune Albright syndrome; Mosaic somatic mutation during embryogenesis of stimulatory a subunit of G protein: constituitive activation of Gs pathway > gain of function in cells: melanocytes (café-au-lait macules), early puberty, activation of osteoclasts
In healing process, what cytokines control fibroblast proliferation & function?
TGF-b (stimulates connective tissue remodeling); also platelet derived growth factor
What expresses 1-a-hydroxylase in sarcoidosis and other granulomatous disorders?
Activated macrophages
Which hypothalamic nuclei is responsible for jet lag and circadian rhythms?
Suprachiasmatic (remember that it takes stimuli from retina)»_space; sends stimuli to other nuclei to regulate temp, cortisol, melatonin
What intracellular/ extracellular processing occurs with collagen synthesis?
Intracellular = cleave signal sequence > hydroxylation of Pro/lys > glycosylation > assemble triple helix; Extracellular = terminal peptides cleaved (N/ C peptidases) > collagen molecules spontaneously assemble > covalent crosslinks by lysyl oxidase
What condition from defect in collagen synthesis?
Ehler-Danlos: defect from procollagen peptidases (cleaves terminal ends extracellularly
Signs of tuberous sclerosis?
Auto dom: hamartomas, facial angiofibromas, angiomyolipoma, ash-leaf patches, rhabdomyomas (cardiac), mitral regurg
Foamy macrophages in intestinal mucosa with rod shaped bacilli, PAS positive,diastase-resistant granules?
Whipple disease: middle aged caucasians with malabsorption, diarrhea, weightloss
Which would you give post-MI with COPD?
Metoprolol (cardioselective if COPD)
How can you get bradykinin-associated angioedema?
C1 inhibitor deficiency; symptoms = facial swelling (no urticaria), laryngeal edema, GI problems- Qid 11667
