Deck 8 Flashcards
Describe infantil beri beri
2-3 months- fulminant cardiac syndrome w cardiomegaly, tachycardia, cyanosis, dyspnea, vomiting
Describe adult beri beri?
Dry = peripheral neuropathy of distal extrem w/ sensory + motor; Wet = additional cardiac involvement
What deficiency causes beri beri?
Thiamine
Which vitamin is important for complex I & II (ECT) and TCA? How?
Riboflavin (B2); Qid 1807; Can get modified into FMN (complex I) and FAD (complex II & TCA)
Which enzyme in TCA needs riboflavin?
Succinate dehydrogenase (succinate > fumarate)
What’s the effect of IgA protease?
Prevents adherence to mucosa»_space; increased mucosal colonization
Characteristics of disseminated gonorrheal infection?
Triad of arthritis, dermatitis, tenosynovitis in sexually active women
What is the most common cardiac defect in turners? How would it sound?
Bicuspid aortic valve: early systolic, high frequency click heard over right second interspace
In what conditions is mitral valve prolapse common?
CT disorders: Marfan, Ehler-Danlos
Cause of elderly man w dysphagia, foul breath, food regurgitation?
Zenkers diverticulum: mucosal outpouching through area of muscle weakness in wall of hypopharynx
Treatment with statins increases what?
LDL receptor density: hepatocytes increase surface expression of LDL receptors to increase uptake of circulating LDL
What causes red man syndrome? Mechanism?
Vanco: Histamine release due to non-IgE mediated mast cell degranulation
Triglyceride med with cutaneous flushing and warmth? How can you prevent?
Niacin: mediated by release of prostaglandins; aspirin can reduce if given 30-60 minutes prior
What vitamin deficiency can occur in sickle cell or other hemolytic diseases?
Folic acid: increased erythrocyte turnover
What does the EBV glycoprotein bind to?
CD21 = cellular receptor for C3d complement component, present on B cells & nasopharyngeal epthelial cells
What medical therapy can be given to help with cholesterol gallstones?
Bile acid supplements: solubilize cholesterol
What are treatments for PCOS?
Weight loss, oral contraceptives (minimize endomet prolif, prevent pregnancy, reduce androgenic symptoms), estrogen receptor modulation (if they want to get pregnant)
What is first line in essential tremor?
Propanolol: non-selective B blocker
Kid with myopathy with activity, cardiomyopathy, hypoketotic hypoglycemia…?
Primary carnitine deficiency
Most common symptom of meckel diverticulum? What else?
Spontaneous, painless lower GI bleeding; ; also intussusception = colicky abd pain and “currant jelly” stools
What is 99m-Tc-pertechnetate scan used for?
Affinity for parietal cells- finds ectopic gastric mucosa (Meckels)
Distal duodenal ulcer…? How can secretin be used to confirm?
ZE gastronoma; Secretin = released from duodenum to incr pancreatic bicarb and decr gastrin -> in gastrinomas it stimulates gastrin release b/c abnormal adenylate cyclase
Where is iron absorbed?
Duodenum and proximal jejunum
What tests are abnormal for extrinsic pathway? What clotting factors?
PeT: extrinsic - II, V, VII, X
What tests are abnormal for instrinsic? What clotting factors?
PiTT: Intrisic - II, V, VIII, IX, X, XI, XII
What tests are abnormal in hemophilia?
PTT; normal PT, BT, platelet
Infant with malabsorption low triglyceride, cholesterol, VLDLs?
Abetaliproteinemia- can’t make apoB forming proteins
What RBC abnormality in abetalipoproteinemia?
Acanthocytes: Deficient fat-soluble vitamins (can’t absorb) and abnormal membranes w thorny projections Qid: 327
Most common causes of SAH?
Saccular (berry) aneurism: usually at circle of willis- anterior communicating…. Associated with Ehlers-Danlos & autosomal dominant PKD
What drugs improve survival in decompensated HF?
BBs, ACEI, ARBS, Aldo antagonist
What processes maintain blood sugar in fasting?
Glycogenolysis (predominates first 12-18 hours) & gluconeogenesis (>18 hours)
What is Romberg test used for?
Proprioception: positive test = sensory (dorsal column/ peripheral nerves) ataxia vs. cerebellar
In what conditions is Romberg test positive?
B12 & syphilis (tabes dorsalis)
Most common vasculitide in kids? What causes it?
Henoch-Schonlein purpura: caused by circulating IgA complexes (type III sensitivity) - complexes in small vessels and kidneys; suspect in kids 3-10 with palpable purpura, hematuria, GI; self-limiting so Tx is supportive
What autoantibodies are most specific for RA?
Anti-CCP (cyclic citrullinated peptides); Tissue arginine is converted to citrulline in inflammation; diagnosed through ELISA. RF is present in 10% healthy & 30% SLE
Where does most cutaneous lymph from umbilicus - feet, external genitalia (scrotum), anus go to?
Superficial inguinal lymph nodes
Lymph from testes goes to where?
Para-aortic (retroperitoneal)
Lymph from glans penis & cutaneous posterior calf goes to where?
Deep inguinal
What causes dilation of coronary sinus?
(drains into R atrium) so R sided pressure -> pulmonary hypertension
What cells make AMH?
Sertoli cells
