Deck 3 Flashcards
Difference between class 1 and class 2 HLA proteins?
Class 1 (B): expressed in all nucleated cells and present to CD8 T lymphs. Class II (DR, DP, DQ): expressed by antigen presenting cells (Mx, dendritic cells) and present to CD4 Th
Examples of class 1 HLA?
HLA B27- PAIR = seronegative spondyloarthropathies (because of absence of rheumatoid factor ie IgM against IgG)
What is buspirone used for?
GAD- not panic disorder because of slow onset of action (1-2 weeks); no sedation, addiction, good with alcohol; “I’m always anxious the BUS will be ON time”
What things happen in herniation from temporal lobe lesions?
Uncal hernation: Transtentorial herniation of uncus -> ipsilateral 3rd nerve palsy (fixed dilated pupil) and compression of cerebral peduncles (corticospinal tract injury with hemiplegia)
What things happen in central herniation?
Abducens palsy
Which polymerase has 5’- 3’ exonuclease activity?
Only DNA polymerase 1 (in addition to having 5-3 polymerase, and 3-5 exonuclease activity)- remove primer and fix damaged sequences
What is MOA of opiates on pre and post synaptic cells
Bind mu receptor- Pre = closure of voltage gated Ca channels (reduced Ca influx / neurotrans release from presynaptic); Post = mu binds K channels and hyperpolarization from K efflux
What drugs inhibit renin release?
Bblockers- block stimulation of beta-1 receptors located on juxtaglomerular cells
What effect does dropping Co2 have in brain?
Vasoconstriction
Jaundice, pruritis, dark urine, light stools, B symptoms, indicative of what?
Adeno of head of pancreas blocking bile duct
How does ribavirin work? What is it used for?
Hep C and RSV: nucleoside antimetabolite that interferes with duplication of viral genetic material
Cheyne stokes breathing seen in what?
CHF
What antiarrythmics prolong cardiac cycle (QT interval)? Which one doesn’t cause Torsades?
Class 1A, III; Amiodarone doesn’t cause torsades
What three main vessels supply blood to GI?
Celiac trunk, SMA, IMA
What meds for hypoPTH patient with hypocalcemia?
Calcitriol (active vit D)- Calcidiol has to be converted by PTH
Symptoms of neuroleptic malignant syndrome?
Diffuse muscle rigidity, high fever, autonomic instability (BP, tachy), altered sensorium, high CK (rhabdo)
What causes NMS? Tx?
From antipsychotics (block dopamine); Give dantrolene or bromocriptine (dopamine antagonist)
Which SERM is used for Tx of breast cancer? For osteoporosis?
BC = tamoxifen; Osteoporosis = Raloxifene (antagonist action in breast/ uterus)
Difference between type 1 and type 2 error?
Type 1: conclude there’s a difference when there isn’t. Type 2: conclude no difference when there is
What accounts for adverse effects of Fabry’s?
Deficiency of a-galactosidase- breaks down Gp3 or ceramide trihexidase; This accumulates in vascular smooth muscle cells, glomerular cells, cardiac myocytes, DRG and autonomic ganglion
What medications dilate coronary arteries and can cause coronary steal syndrome?
Adenosine and dipyridamole
What does IF microscopy show in PSGN?
Granular deposits of IgG, IgM, and C3 in mesangial and basement membranes
Which amino acids are exclusively ketogenic?
Lysine, leucine
Symptoms of pyruvate dehydrogenase deficiency? Why?
Lactic acidosis, neuro deficits; Pyruvate can’t become Acetyl coA- build up of pyruvate shunts to lactate –> Lactic acidosis
The liver converts D2,3 to 25,hydroxyvitamin D with 25-hydroxylase- what converts to 1,25-dihydroxy?
Kidney- with 1-a-hydroxylase (stimulated by PTH, decreased by Ca)
What makes you think adrenal crisis? What Tx?
Severe hypotension, shock, abd pain, vomiting, weakness, fever-Hx of autoimmune endocrinopathies, weight loss, hyperpigmentation (addison); Tx: fluids with glucocorticoid supplementation (hydrocortisone, dexamethasone)
What activates/ inactivates 6-mercaptopurine? What precautions should you take?
Activated by HGPRT, inactivated by xanthine oxidase (and thiopurine methyltransferase). PRECAUTION: reduce 6-MP dose if giving allopurinol! (XO inhibitor)
What medication raises HDL and cause trigger gout? What other SE?
Niacin- reduces clearance of HDL; decreases renal excretion of uric acid. Other SE: flushing, hyperglycemia, hepatotoxicity
What receptors does dopamine stimulate? What effect on heart/ kidneys?
D1 receptors in kidney = Incr GFR, renal BF, Na excretion. B1 in heart = Incr contractility, SBP, HR (***At higher doses can stimulate a1)
How does diphenoxylate help with diarrhea?
opioid - mu receptors in GI and slows motility (to discourage abuse- combined with atropine)
What medication can reduce craving of alcohol? Target?
Naltrexone- blocks mu-opioid receptor
What genes encode DNA transcription factors important in segmental development of embryo (along cranio-caudal axis)?
Homeobox or Hox genes
What are the segmented viruses that can undergo antigenic shift?
Orthomyxovirus, Reovirus, bunyavirus, arenavirus
What is the role of ubiquitin?
Tag that attaches to protein and marks them for destruction (by proteasome)
What does VIP do (a VIPoma)? What counters it?
Stimulates pancreatic bicarb and Cl, and incr cAMP of intestinal epithelium causing loss of Na, Cl, and water => secretory diarrhea. VIPoma: watery diarrhea, hypokalemia, achlorhydria.
What inhibits VIP?
Somatostatin (octreotide) inhibits VIP
What does octreotide inhibit?
Decreases production of VIP, gastrin, glucagon, CCK
How can you diagnose anti-phospholipid syndrome?
SLE, prolonged PTT, history of thrombosis, spontaneous abortions, falso positive syphilis tests
Symptoms of pineal gland mass?
Obstrucive hydrocephalus (papilloedema, HA, vomiting) and Parinaud syndrome (limited upward gaze from compression of tectum)
What lab is elevated in pineal tumor??
B-HCG: most commonly germinomas
