Deck 7 Flashcards
Patient with headaches, HTN, and ruptured cerebral aneurysm. WHat is cardiac defect?
CoA –> Causes hypertension and puts them at risk for ruptured aneurysms
CoA also associated with berry aneurysm formation
What part of ToF determines cyanosis?
RVOT (degree of pulm stenosis determines how much blood is shunted from R-L through VSD)
What happens to CFTR proteins in CF?
Misfolding and failure of glycosylation, followed by proteasome degredation
What does western blot test for?
Specific proteins. They are first separated via gel electrophoresis and then bound to antibodies to be detected
Example: HIV proteins
What does Northern and Southern blot test?
Northern - specific RNA sequences
Southern- specific DNA sequences in an unknown sample
What cells are responsible for Toxic Shock Syndrome?
Macrophages and T cells
T cells interact with MHC II –>
IL 2 from T cells
IL 1 & TNF-alpha from macrophages
What are phases of digestion in stomach and their relation to gastrin?
Cephalic (vagal, and cholinergic mechanisms. Gastric phase –> gastric acid production
Intestinal phase —> protein digestion in duodenum, down-regulates gastrin***
Release YY peptide which inhibit ECL cells from releasing histamine
Which substances inhibit gastric acid secretion?
Prostaglandin, somatostatin, YY peptide
What type of disease causes RPGN? What do you see on light microscopy and on immunoflorescence?
Anti-GBM disease (such as goodpastures)
Antibodies against basement membrane, type IV collagen
LM- crescents
Immunoflorescence- smooth linear deposits
Clinically- nephritic syndrome, crescentic GN
What does granular appearance on immunofluoresence mean?
Membranous nephropathy or PSGN, IgG and C3 deposits
What are baroreceptors in aortic arch vs internal carotids innervated by?
Aortic arch - vagus
Carotids - glossopharyngeal
Where is the AV node located anatomically?
Interatrial septum (tricuspid valve) near opening of coronary sinus
Which organ clears digoxin?
Kidney. Decreased renal function associated with digi toxicity
What cranial nerve pass through jugular foramen?
CN IX, X, XI
Symptoms if jugular foramen compressed?
Loss of gag reflex ipsilateral side,
Loss of accessory muscle use on affected side,
Loss of taste from posterior tongue
Dysphagia
Hoarseness
Uveal deviation toward away from lesion (CNX)
What are labs in hypothyroidism?
TSH increased, T4 decreased, T3 normal
Which antibodies are found in polymyositis?
Muscle enzyme CK
ANA
Anti-Jo (anti-hystidyl-tRNA synthase)
How does polymyositis present?
Middle age, insideous onset of weakness in extremities. Biopsy showing patchy muscle fiber necrosis
Risk associated with polymyositis and dermatomyositis?
Increased risk of adenocarcinoma
dermatomyositis has this risk as well
How to decrease MR murmur?
Decrease afterload
via decreasing systemic vascular resistance
How do you calculate how often a drug needs to be given?
Via the half-life (t 1/2) Time it takes to get to 50% of drug availability
t 1/2 = (0.7 x Vd) / CL
Vd = volume distribution
CL = clearance rate
How many half lives to elimate 50% of drug? 75%?
1 and 2 half lives
So calculate thehalf life and then determine how many hours needed based on number of half lives
Which drugs for BPH decrease prostate size?
5-alpha reductase inhibitors (finasteride, dutasteride) inhibit conversion to DHT
SE of EPO?
Thromboemolic events, HTN
What happens to aorta in tertiary syphilis?
Vasa vasorum gets destroyed
Weakening of adventitia
Aneurysmal dilation of thoracic aorta and aortic root dilation
May see murmur and mediastinal widening
Blue neoplasm under nail- what is it?
Either melanoma or glomangioma (regulates temperature via shunting blood to and from extremities)
What meds do you use for MRSA if patient has vanc allergy?
Dapt or linezolid
MOA daptomycin?
Creates transmembrane channels that cause leakage in cell. Causes depolarization of cell and inhibits DNA and RNA synthesis in bacteria
Inactivated by surfactant –> can’t use to tx pneumonia
SE daptomycin?
Increased CPK levels, myopathy
What type of injuries result in radial nerve damage?
Injury to midshaft of humerus or axilla
What is greatest RF for cervical cancer in HIV?
Immunosuppression
HIV increases expression of E6 and E7 viral oncogenes
What is cause of HUS?
Microangiopathic hemolytic anemia (microthrombi in small vessels)
What are symptoms of HUS?
Hemolytic anemia, thrombocytopenia, AKI
How does oxygen-induced hypercapnia occur in COPD patients?
Main mechanism is V/Q mismatch
O2 dilates pulmonary arteries, so when the arteries dilate in poorly ventilated areas, they become hypoxic
What is function of kinesin?
ATP powered protein that assists microtubules in moving vesicles anterograde toward synaptic nerve terminal
What is overexpressed in GBM? What type of cells proliferate?
Epidermal growth factor receptor- tyrosine-kinase signal transduction system promoting cellularsurvival and proliferation of glial cells (pleuripotent neural stem cells)
Which brachial pouch is absent in Digeorge syndrome?
Pouch III (Inferior parthyroid gland, thymus) And IV (superior PTH, ultimobrachial body)
What does the 1-4 branchial pouch become?
1st - auditory canal
2nd - palatine tonsil
3rd - inferior PTH, thymus
4th - Superior PTH, ultimobrachial body
What is pathogenesis of Turner syndrome? WHich gene is affected?
Pathogenic SHOX gene
Meiotic non-disjunction in meosis II
45X or 46XX with mosaicism
What are clinical features of Thrombotic Thrombocytopenic Purpura (TTP?)
Hemolytic anemia with schistocytes
Thrombocyotpenia, increased bleeding time, normal PT/PTT
Microangiopathies
What is pathogenesis behind TTP? WHat is Tx?
Decreased ADAMTS13 level –> uncleaved vWF –> more platelet trapping & activation
Tx = plasma exchange
glucocorticoids, retuximab
What is equation for minute ventilation and alveolar ventilation?
Minute ventilation = tidal volume(L)/ breaths per min
Alveolar ventilation = (tidal volume - dead space)/ breaths per min
Where dead space = ventilated but poorly perfused areas
Equation for physiologic dead space?
Physiologic dead space = tidal volume x (PaCO2- expired CO2/PaCO2)
What is cutoff level for triglycerides causing acute pancreatitis?
> 1000mg/dL
Where is the vomiting center located? What drugs are used as first line from GI irritation to treat nausea/vomiting?
Medullary vomiting center
5_HT3 receptor antagonists- ondasteron
GI causes include traveller’s diarrhea, infections, chemotherapy, distension
Which anti-nausea medications are used for vestibular nausea? Migraines?
Anticholinergics and antihistamines
Migraines - anti-dopaminergics
What is H2PO4- urine level in DKA patient?
Raised. It acts as a buffer for H+, allows kidney to excrete more H+ via H2PO4- and NH4+ without raising urinary pH
What antipsychotics are highest risk for causing metabolic syndrome?
Olanzapine
Clozapine
Get fasting glucose and lipid levels
What determines risk for UTI in hospital?
Duration of catheter insertion
Remove when no longer indicated
Which nerve is affected in MS when one eye fails to react to light?
CN II (optic nerve, sensory info toward EDW nucleus)
What do kegel exercises do?
Strengthen levator ani and help control urethral hypermobility
Which hormones are released from hypothalamus?
TRH, VIP, dopamine
How do antipsychotics cause galactorrhea and amenorrhea? Which path is blocked?
Inhibit dopamine, which normally inhibits prolactin. Hyperprolactinemia —> inhibition of GnRH
Blocks tubuloinfundibular (mesolimbic) path
Where is Edinger-Westfall nucleus located?
Midbrain
Light from CN II –> pretectal nucleus —> EDW –> ciliary body —> pupillary sphincter
What is D-xylose? What can it test for?
Monosaccaride like glucose/galactose. It tests for direct absoprtion through brush border (coeliac). WIll be normal in pancreatic insufficiency but abnormal in coeliac
What type of arthritis can occur with reactive arthritis?
Ank spond, HLA B27 +, seronegative, sarcroilitis**
What are functions of angiotensin II?
Stim aldosterone ( more Na+ reabsorption), vasoconstriction, vasoconstriction of efferent arteriole to maintain GFR
ACE/ARBs will inhibit above effects- BP control
How do Betablockers lower BP?
Inhibit renin production, block B1 receptors in JG cells
How do aminoglycosides work?
Bind 30s subunit of ribosome - causes genetic code misreading*
Gentamycin. Often used to treat endocarditis from enterococci
Boy with bone tumor mets to lungs. Cells are small round, with clear cytoplasm. What is it?
Ewing sarcoma
What type of cells result in Ewing sarcoma?
Mesenchymal stem cells
Patches of necrosis and hemorrhage, fibrous septae
Why prescribe primaquine?
They have action against latent hypnozoites from P vivax and ovale. Inhibit relapse.
How does topical capsiasin treat post-herpetic neuralgia?
Deletes substance P and defunctionalization of pain fibers
What surface proteins are absent in PNH?
CD 55 and CD59 (Anti-MAC complex)
Aplastic anemia, pancytopenia
PIGA gene mutation
What chemokines cause COX2 secretion?
IL-1 and TNF-alpha
What is venous pressure in RA, RV, and pulmonary arteries?
RA - 1-6mmHg
RV - 25mmHg sys 5mmHG dias
Pulmonary artery - 25mmHg sys, 6-12mmHg dia (sudden rise in diastolic because of pulmonary capillary backpressure and pressing against LA)
What type of tumor is associated with cytokeratins?
Epithelial
WHat is Trastazumab?
Monoclonal antibody against HER2r
What does HER2 code for?
Oncogene encoding for transmembrane glycoprotein with intrinsic tyrosine kinase activity. Accelerates cell proliferation
What ischemic changes do you see after ischemic stroke at 1 day, 2 days, 1 week, and 2 weeks?
1 day- red neurons (eosinophilic cytopasm, loss of Niisl substance)
2 days - Neutrophils
3-7 days: macorphages and microglea
2 weeks; reactive gliosis and neovascularization, liquefactive necrosis
>2 weeks glial scar
