Deck 2 Flashcards
What is MOA for interaction between GTN and phosphodiestrase inhibitors (sildenafil, vardenafil, tadalafil)?
GTN nitrates cause NO creation, smooth muscle relaxation and increase cGMP. cGMP is metabolized by phosphodiestrase
What is xeroderma pigmentosum? Pathogenesis?
Xeroderma pigmentosum
Excessive sensitivity to sunlight, freckles and ulcers
UV rays –>thymine dimers –> defective nucleotide exision repair (lack of UV specific endonuclease that excises damaged DNA)
Which polio vaccine causes most robust IgA response?
Live attenuated oral (Sabin)
Pathogenesis of hyper-IgM syndrome?
Defective CD40 (B cells) binding CD40L (T cells) so no class switching
Patients will have opportunistic infections
What causes acanthosis nigrans in DM?
Free fatty acids cause insulin resistance
Increase hepatic gluconeogenesis
Impair insulin-dependent glucose uptake
Which electrolytes are abundant inside vs outside cell?
K in cell
Na, Cl, Ca all extracellular
Which kidney cells increase potassium reabsorption in hypokalemia?
Alpha intercalcated cells
Which kidney cells increase K secretion in hyperkalemia?
Principal cells in collecting duct
What promotes increased K+ excretion?
High extracellular K+, increased aldosterone, alkalosis (promotes K entry into principal and alphaintercalcated cells), increased tubular flow (high sodium, volume expansion)
How does sarcoidosis cause hypercalcemia?
Activated macrophages express PTH independent conversaion of 1-alpha-hydroxylase, leading to increased conversion of vit D to 1,25 dihydrocalciferol
Which medication should you give acutely to people with contraindicated NSAIDs in gout?
What are SE of it?
Colchecine
N/v, diarrhea, abdo pain (disrupts microtubule formation in GI cells)
Impaired leukocyte migration and phagocytosis
What is Abetalipoproteinemia?
Autosomal recessive disease - can’t synthesize ApolipoproteinB. Foamy cytoplasm of enterocytes.
Malabsoprtion, greasy stools, abdominal distension
Low plasma triglycerides, cholesterol, VLDLs, and apoB. Poor lipid absorption
Caused by MTP gene mutation
RBCs show acanthocytes (thorny appearance) and neurological abnormalities
Where is SA node anatomically?
RA near superior vena cava
Where is AV node anatomically?
RA near tricuspid valve
Where should thoracocentesis be performed in front, middle and back?
Midclavicular 6-8 ribs
Midaxillary 8-10
Posterior 10-12
Anything below these risks penetrating abdominal structures
Where do nerve, artery, and vein lie between ribs?
On the lower border of the rib
Always perform thoracocentesis on the upper border
What drug class is scopolamine?
Antimucarinics (anticholingergis)
Motion sickness
What drug class is Diphenhydramine, meclizine, and promethazine?
Antihistamines
Motion sickness and hyperemesis gravidarum
What drug class is prochloperazine and metclopramide?
Dopamine receptor antagonists
Chemotherapy induced emesis
What drug class is ondasteron and granisetron?
Serotonin 5-HT3 receptor antagonists
Chemotherapy induced emesis
What class of drug is aprepitant and posaprepitant?
Neurokinin 1 (NK1) receptor antagonist
Chemotherapy induced emesis
What areas of the brain are involved in vomiting?
Area postrema (floor of 4th entircle) NTS (Medulla)
What receptors are involved in vomiting?
H1, 5-HT3, D2, M1, NK1,
What agent should be used in pregnant women with DVT?
LMWH (enoxaparin) heparin doesn’t cross placenta
What is found on histology for histoplasma infection?
Granulomas, macrophages with intracellular oval yeast
What are short acting post parandial insulins?
Aspart, lispro, glulisine
What are long acting insulins?
Detemir, glargine
Baby with bloody stools, abdominal distention, and air in bowel wall. What is it?
nec enterocolitis
What pharyngeal arches are innerved by what nerves?
Arch 1 - CN V
Arch 2- CN VII
Arch 3 CN IX
Arch 4 & 6 CN X
What does the 1st pharyngeal arch become?
Muscles of mastication, Zygoma, Incus, Malleus, maxillary bone, mandible
What does 2nd pharyngeal arch become?
Muscles of facial expression, Stapes, styloid, lesser horn of hyoid
What is Treacher-Collins syndrome?
Abnormal development of 1st and 2nd pharyngeal arches. Craniofacial abnormalities, airway compromise, absent middle ear bones
What are symptoms of atypical depression?
Mood reactivity, rejection sensitivty, increased sleep and appetite, leaden paralysis
What meds are used to treat atypical depression?
MAOIs (phenelzine)
When to use MAOIs in depression?
Treatment resistant depression or atypical features of MDD
What causes hematuria and elevated urine pH?
Struvite stones
What receptors dialate pupil?
Alpha 1 agonists
Which receptors relax uterus?
B2 agonists such as terbutaline and ritodrine (used as tocolysis)
What drugs cause tosades de pointes? MOA?
Prolong QT interval
Class IA and III antiarrhythmics (sotalol, quinidine)
antipsychotics (haloperidol)
Antibiotics (macrolides, quinolones)
What are clinical manifestations of primary ciliary diskynesia?
Infertility- sperm motility impaired
Chronic sinusitis, bronciectesis
situs inversus
What causes hemibalism?
Damage to subthalamic nucleus (part of basal ganglia), usually from lacunar stroke due to HTN or diabetes
What part of brain mediates satiety?
Ventromedial hypothalamic nuclei. Damage leads to hyperphagia and obeisity
What part of hypothalamus mediates hunger?
Lateral hypothalamic nuclei
