Deck 5 Flashcards
What is the extrapyramidal side effects of antipsychotics?
Q.id 510: akathisia, tardive dyskinesia
What happens in cleft lip? Cleft palate?
Cleft lip: failure of fusion of maxillary prominence with intermaxillary segment during 5-6th week. Cleft palate: failure of fusion of palatine shelves/ primary palate
What is the principle site for NE synthesis in brain?
Locus ceruleus: paired pigmented nucleus in post rostral pons & lateral floor of 4th ventricle; involved in mood, arousal, sleep-wake states, cognition, autonomic function; pathogenesis in anxiety disorders
What effect do glucocorticoids have on liver? Peripherally?
stimulate gluconeogenesis; peripherally oppose insulin actions and promote catabolism; net effect = hyperglycemia
How can crohns cause gallstones?
Bile salts aren’t reabsorbed/ recycled in terminal ileum => hyperconcentrated cholesterol
What macrolide does not have P-450 effect?
Azithromycin
What is the clinical triad of congenital rubella?
Congenital cataracts (white pupils), sensory-neural deafness, and PDA
What does heparin do?
LMWH: binds antithrombin III that binds Xa - stops it from converting prothrombin to thrombin; Unfractioned binds both Xa and thrombin
What does IL-2 do?
T cells! Stimulates growth of CD4 and CD8 T cells and B cells; activates NK and monocytes. Anti tumor because of T cell + NK
What compound is decreased in narcolepsy?
Hypocretin-1 (orexin-A) and Hypocretin-2 (orexin-B). Produced in lateral hypothalamus - promote wakefulness and inhibit REM
What general anesthetic can cause acute hepatitis?
Halothanes (“anes”): metabolized by P-450 and can are converted to toxic metabolites damaging or causing immune damage to liver; 2 days - 3 weeks post-exposure
What are the actions of ANP?
Peripheral vasodilation, natriuresis, diuresis = kidneys (dilates afferent arteriole, limits sodium reabsorption, inhibits renin), adrenal (restricts aldosterone), blood vessels (vasodilation, capillary leak)
What inhibits ANP?
Neprilysin = metalloprotease that also inhibits bradykinin, glucagon, enkephalins
What does CO poisoning change/ not change?
Decreases fraction of hemoglobin available for O2 binding-> decr O2 carrying capacity & O2 content of blood; does not change PaO2 (amount of O2 dissolved in plasma)
Where and what are symptoms of conus medullaris syndrome?
L2: Flaccid paralysis of bladder & rectum, impotence, saddle (S3-5) anesthesia, maybe weakness of leg; From herniated disk, tumors, spinal fractures
Where and what are symptoms of cauda equina syndrome?
Anywhere in cauda equina: S2-4 = lower back pain radiating to leg, saddle anesthesia, loss of anocutaneous reflex w/ plantar flexion weakness, bowel and bladder dysfunction (S3-5), loss of ankle jerk reflex with plantar flexion weakness
How can you reduce the risk of ovarian cancer?
oral contraceptives, multiparity, breastfeeding. HPV vaccine does NOT reduce risk (only cervical, vaginal, vulvar)
Where’s Guyons canal? What nerve? What injury?
Hook of hamate. Ulnar nerve. Fall on outstretched arm
What are symptoms of acute & chronic vitamin A toxicity?
Acute = nausea, vomiting, vertigo, blurred vision; Chronic = alopecia, dry skin, hyperlipidemia, hepatotoxicity, hepatoSM, visual difficulties, papilloedema (pseudotumor cerebri)
What is an aschoff body?
Mycoardial granuloma (interstitial fibrosis with lymphs/ macros + multinucleated giant cells) found in acute rheumatic fever- myocarditis; Will be replaced by fibrous scar leading to chronic mitral stenosis
Production of PTH-related protein occurs with what cancer?
Most commonly with squamous cell carcinoma of lung, head, and neck causing incr osteoclast activity and incr Ca
Why increased calcium in granuloma disorders (sarcoid, tuberc)?
Macrophages in granuloma express 1-alpha-hydroxylase, which increases 1,25-dihydroxyvitamin D synthesis -> incr GI absorption of Ca
A mutation in what causes polycythemia vera? What else can this cause?
JAK2 (cytoplasmic non-receptor tyrosine kinase) = causes constitutive activation of kinase domain….. Also implicated in essential thrombocytopenia, primary myelofibrosis, etc
Where are long fatty chains (and some branched chain fatty acids) broken down?
Peroxisomes- special beta oxidation or alpha oxidation; Peroxisomal disease = hypotonia, seizures, hepatomegaly, retardation,
What medications are given in to prevent ischemic stroke in patients with TIA?
blood pressure control, statins, low-dose aspirin
Characteristics of VSD in newborn? When are they detected?
Loud, blowing holocystolic murmur at mid to lower left sternal border; not detectable at birth but 4-10 days post; LARGE = heart failure, failure to thrive, diaphoresis with eating, Eisenmenger syndrome
What cells are affected in HIV-associated dementia?
Inflammatory activation of microglial cells: HIV infected monocytes cross BBB to become mx + microglial form microglial nodules;
What are features/ structures affected in HIV-associated dementia?
Features of subcortical dementia (attention/ working/ memory problems, executive function, processing) and affect subcortical/ deep gray matter structures
What is immediate Tx of diphtheria?
Administration of 1. Diphtheria antitoxin (passive immunity: inactivates circulating exotoxin but can’t for toxin that has already gained access to cardiac & neural cells) 2. Penicillin or erythromycin (prevents release of new exotoxin) 3. DPT vaccine (active immunization prevents further)
Difference between 1st gen / 2nd gen antihistamines?
1st gen (diphenhydramine, chlorpheniramine, promethazine, hydroxyzine, “ine”, “ate”, etc) cross BBB and cause sedation- DON’T USE IN ELDERLY; 2nd Gen = less sedation
What medications cause fat redistribution (lipoatrophy, central deposition)?
HAART = Lipoatrophy is loss of fat from face, extremities, butt w/ nucleoside reverse transcriptase inhibitor/ protease; Central fat dep = HIV Tx regimen
Why squat in tetra of fallot?
Increase SVR and route blood into lungs
What ratio indicates lung maturity?
Lecithin (phophatidylcholine): sphingomyelin; First is in surfactant - second is in membrane. Equal until 30 weeks and 2:1 by 35 weeks
LAD: inheritence? Deficiency in what? Characteristics?
Auto recessive; absence of CD18 antigen necessary for integrins; recurrent skin/mucosa infections (staph, gram - rods), late separation of umbilical cord, leukocytosis, impaired wound healing, lack of purulence or pus
Classic symptoms of primary hyperPTH?
Bones, stones, moans = bone pain, renal stones, GI groans (peptic ulcer), psych overtones. However, usually asymptomatic
What are most important substances for autoregulation in coronary blood flow?
NO & adenosine (product of ATP acts as vasodilatory element)
Defect in marfans?
Fibrillin-1: large extracellular glycoprotein that surrounds elastin to form microfibrils in large blood vessels, periosteum, suspensory ligaments of the lens
What is unique about telomerase?
Made up of telomerase reverse transcriptase (TERT) (RNA dependent DNA polymerase) and RNA component (TERC) that is RNA template; adds TTAGGG sequences to telomeres; long telomerases in stem cells
What hormone increases bicarb secretion?
Secretin from S cells in duodenum - causes to secrete bicarb rich, Cl- poor fluid
Spliceosomes cut at what intron sequences?
GU at 5’ and AG at 3’
