Deck 8 Flashcards
How far down the respiratory tree do ciliated mucosal epithelia go?
Up to the respiratory bronchioles
Will still be present below mucosal glands to cough up any fluid
What chromosomes and genes are abnormal in CML?
9:22 translocation
BCR-ABL gene
Active tyrosine kinase
What does the infraorbital nerve innervate? Where is it?
Goes down infraorbital floor through maxilla
Innervates upper cheek, upper lip, upper gingiva
What are breath sounds and tactile fremitus like when lobar consolidation is present?
INCREASED breath sounds AND tactile fremitus
Both with be decreased in things like pleural effusion or atelectasis
Who gets recurrent neisseria infections?
People with complement deficiencies C5b-C9
What cells secrete what substance to create pus?
Macrophages secrete IL-8 for neutrophil chemotaxis and induces neutrophil phagocytosis
Pus = dead neutrophils
What does the speed of conduction via myelin depend on?
Length constant
Time constant
velocity = length/time
Demyelination INCREASES time constant and DECREASES length constant
What artery lies behind ureter? Which ones lie in front of ureter?
Internal iliac artery behind
Gonadal (uterine) arteries in front (water under the bridge)
Uniform eosinophilic cytoplasm cells with oval/round nuclei in appendix causing abdominal pain. What are they?
Neuroendocrine cells
Carcinoid tumor- mimics appendicitis when found in appendix
Person who gets angioedema randomly. What is cellular deficiency?
C1 inhibitor deficiency. Excessive cleavage of C2-C4 and overproduction of bradykinin**
What cancers is EBV associated with?
nasopharyngeal ca
Burkitt lymphoma
Which antibiotic cannot be taken with SSRIs?
Linezolid –> has MAOI activity so can precipitate serotonin syndrome
What are actions of insulin in skeletal, adipose, liver, and pancreatic tissues?
In skeletal and adipose –> increase glucose uptake
In liver –> decreases glycogenolysis and increases glycogen synthesis
In pancreas decreases glucagon secretion for alpha cells
What antigen is associated with reactive arthritis?
HLA-B27
What is the sensory innervation for anterior and posterior part of tongue?
Anterior = V3 of trigeminal nerve
Posterior is Glossopharyngeal nerve
Chorda tympani = taste for anterior part
What is motor innervation for tongue?
Hypoglossal nerve CN XII
What type of lung disease increases airflow resistance? What type of lung disease increases elastic resistance?
Airflow resistance - obstructive
elastic resistance - restrictive
Does restrictive or obstructive lung disease take rapid shallow breaths?
Restrictive - rapid shallow breaths
Obstructive - slow deep breaths
Which gene is associated with clear cell RCC?
VHL von hippel lindeau
Secrete VEGF and angiogenic growth factors
Tx with anti-VEGF
Treatment for TCA overdose that is causing cardiac arrythmias and lengthening QRS?
Sodium bicarb.
TCAs block Na+ fast channels and cause arrythmias. Give sodium bicarb if signs of ventricular arrythmias and QRS widening occur
Features of TCA overdose?
Anticholinergic symptoms
Resp depression
Tachycardia, arrythmias, lengthening PR/QRS/QT
What is omilizumab?
Anti-IgE binding antibody, inhibits mast cell degranulation
What does stimulation of M3, Alpha2, and BEta2 receptors do to insulin release?
M3 - increases release (sight of smell and food)
B2- increases release
A2- inhibits release
What do the urethral (urogenital) folds become in male and female? Failure to fuse?
IN female- labia majora
In male- underside of penis. Hypospadias if failure to fuse
MOA for LMWH and unfraction heparin?
unfractioned heparin binds antithrombin (increased action against Xa) and thrombin
LMWH binds antithrombin only
What are CYP450 inducers? What do they do to warfarin?
Metabolize warfarin, put people at risk for stroke via thromboembolism- inadequate anticoagulation
Carbamazepine, barbituates, phenytoin, rifampin, St John’s wort*, griseofulvin, modafinil, cyclophosphamide
What are CYP450 inhibitors?
Amiodarone, cimetidine, quinolone, Azoles, clarythromycin, grapefruit juice, isoniazid, ritonavir (protease inhibitor)
What are calcium, phosphorus, and PTH levels in coeliac disease?
Ca and Po low due to vit D deficiency
PTH high
What are bleeding time, PTT, and TT in vWD?
increased PTT (intrinsic due to low VIII) and prolonged bleeding time (test of platelet function)
What is the part of the sarcomere that involves actin binding to structural proteins? What part involves myosin binding to structural proteins?
Z line within the I band for actin
M line within the A band for myosin
What is the definition of a sarcomere?
Z line to Z line
With myosin being the thick part, actin being thin
What do you see on Prussian blue stain of myocardium in people with hemochromatosis? WHy are women symptomatic later in life?
Brown pigment and dilated heart
Menstrual cycle helps relieve iron load
What substances are released from mast cells and basophils in anaphylaxis?
Histamine and tryptase (specific to mast cells)
What is the stimulus for mast cell degranulation?
IgE receptor aggregation and cross-linking of antigens
What does ALP signify?
Osteoblast activity
What are serum markers of osteoblast activity?
ALP and N-terminal propeptide of type 1 procollagen (PINP) from collagen fibrils
What does hypoxemia with hypercapnia and normal A-a gradient mean?
Alveolar hypoventilation is occuring- obesity, neuromuscular disordrs, high altitude (low inspired O2)
What does it mean if pt is hypoxic with elevated A-a gradient?
R-L shunt, pulm edema, V/Q mismatch, impaired diffusion ILD)
Where does secretin come from? What does secretin stimulate?
Duodenal cells release secretin in response to H+. Secretin stimulates release of HCO3- from pancreas
Cl- secretion decreases as HCO3- increases
What are common causes of polyhydraminos?
Increased urination - high cardiac output, maternal hemorrhage, parvovirus infection
Decreased swallowing - GI, duodenal, or esophageal atresia, anencephaly**
Maternal diabetes and multiple gestation
What symptoms does damage to the vermis, cerebellar hemispheres, and fluconodular lobe cause?
vermis - truncal ataxia
hemispheres- limb dysmetria, past pointing and intention tremor
flucclonodular lobe- vertigo and nystagmus
What tissue does direct hernias penetrate?
Transversalis fascia
What structures are anterior and posterior to esophagus in midsection?
Anterior- LA
posterior - descending aorta
Where are neurophysins (post-translational hormone processing), oxytocin, and ADH secreted from?
Posterior pituitary**
They are SYNTHESIZED in hypothalamus
What does a wide, fixed S2 mean?
ASD present
WHat happens if ASD is left untreated?
Normally ASD causes L-R shunt
Pulm artery hypertrophy occurs
Eventually reversal of shunt to R-L occurs (Eisemenger syndrome) and clubbing and cyanosis can occur
What does AR do to diastolic pressure?
lowers it. Wide pulse pressure
Collapsing pulses (waterhammer) are signs
SE of amphotericin B?
Nephrotoxicity* Increased permiability in distal tubule causing hypokalemia and hypomagnesemia
Hypokalemia, weakness and arrhythmias
What are ECG changes with hypokalemia?
Flat T waves, ST depression, U waves
What are symptoms of lead poisoning?
SOB, microcytic anemia, pallor, anemia with basophilic stippling, abdo pain, constipation*, peripheral neurop
Normal ferritin and iron stores
Inhibits heme synthesis pathway
What is seen on urinalysis, light microscopy, and serum levels with PSGN?
Urinalysis- RBC casts
Anti-streptococcal antibodies, Low C3**
Light microscopy- enlarged hypercellular glomeruli
HOw do alcohols and chlorhexidine kill bacteria?
Disrupt cell membrane
Which cleaning agents are active against spores?
Iodine
Hydrogen peroxide
What is antidote for benzo overdose?
Flumazenil - bind as antagonist to GABA-a sites to block action of benzos
What is antidote for SSRI overdose?
Cyroheptidine
Antidote for Anticholinergic overdose?
Physiostigmine
Antidote for opiod overdose?
Naloxone
Which antiarrhythmic drugs prolong QT interval?
Class III (K blockers)
Which antiarrhythmic drug will prolong QT interval without risk of tosades de pointes?
Amiodarone
WHat do nitrates do to heart?
Decrease preload and end diastolic pressure
Mainly vasodilate venous system with moderate affect on arterioles (so they also decrease afterload)
What type of pericarditis do people with SLE get?
Fibrinous pericarditis
Causes triphasic friction rub
What does raburicase do?
Increases conversion of uric acid into water soluble metabolites (allantoin, excreted in urine)
How does carbon tetrahydrochloride cause hepatocyte damage?
Creation of free radicals
CYP450 inducer - lipid degredation and lipid peroxidation with H202
“fatty change and hepatocyte necrosis”
Equation to determine whether an autosomal recessive trait (such as CF) will pass on to child if both parents are carriers?
(1/4 from mother) x (probability within race for mother) x (1/4 from father) x (probability within race for father)
What causes AS in older adults?
Aortic calcification
Fibroblasts become osteoblast like cells depositing bone matrix on valves and progressive causing calcification
