DIT Q's Flashcards

1
Q

What effect might aminoglycosides have on a developing fetus?

A

Ototoxicity

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2
Q

What birth defect can result from the following agents:

Ace inhibitors

Folate antagonist

Tetracyclines

Lithium

A

Ace inhibitors - renal damage

Folate antagonist - neural tube defects

Tetracyclines - teeth discoloration

Lithium - Ebsteins anomaly

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3
Q

What molecule targets proteins in the ER for lysosomes?

A

Mannose-6-phosphate

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4
Q

What artery supplies…

medullary pyramids and medial lemnisculs in the medulla ?

inferior cerebellar peduncles, nuc ambiguus and lateral STT in teh medulla?

A

medullary pyramids and medial lemnisculs in the medulla ?

Anterior spinal artery

inferior cerebellar peduncles, nuc ambiguus and lateral STT in teh medulla?

PICA

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5
Q

Labs for hepatic cirrhosis?

A

AST > ALT (2:1)

“A Scotch and Tonic”

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6
Q

DDX for erectile dysfunction:

A
  • Hormonal disturbances (low T, hyperprolactinemia)
  • Depression
  • Diabetes
  • Psychological/Psyciatrical (performance anxiety)
  • Medication adverse side effects (beta blockers, SSRIs, neuroleptics, ethanol)
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7
Q

What is type I (alpha) error?

A

Study shows difference between two groups when there is no actual difference

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8
Q

What trace element is important for carbonic anhydrase and lactate dehydrogenase?

A

zinc!

impt also for protein folding

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9
Q

when do we see subluxation of the lenses?

A

Marfan syndrome

homocystinuria

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10
Q

Tuft of hair in the lower back?

A

spina bifida occulta

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11
Q

What occurs at the corto-medullary junction of the thymus?

A

positive and negative selection of T-cells

positively restrict MHC

MHC I - on most nucleated cells

MHC II - only on antigen presenting cells

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12
Q

What is the clinical definition of chornic bronchitis?

A

productive cough for at least 3 months, in at least 2 consecutive years

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13
Q

Local anesthesia:

A

lidocaine and other local anesthetics act by blocking sodium channels, preventing firing

small myelinated fibers blocked first

smaller before large

myelinated before unmyelinated

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14
Q

what meds used in

urge incotinence?

A

Anticholinergic drugs:

oxybutynin

tolterodine

darifenacin

solifenacin

tropsium

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15
Q

different RNAs?

A

prokaryotes only one RNA, makes everything

Eurkaryotes 3 RNAs

RNA I –> rRNA

RNA II –> mRNA

RNA III –> tRNA

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16
Q

which cells do not req insulin?

A

muscles and adipose require glut 4 need insulin

brain, RBC< intestines, cornea, kidney, liver DONT require insulin

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17
Q

Kallman syndrome?

A

sporadic or Xlinked

caused by defective development of GnRH-secreting cells in the hypothalams

men > women

dec FSH, dec LH, low test

fail 2nd sexual characteristics

low sperm counts

associated with anosmia (agensis or hypoplasia of olfactory bulb) and midline facial defects

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18
Q

how can NSAIDs make renal insufficiency worse?

A

Careful using NSAIDs in pt with renal insufficiency

NSAIDS inhibit COX block prostaglandins

recall prostaglandins DILATE, esp afferent arteriole of glolmerulus!! thus if the afferent arteriole of glomerulus is not dilating, you can low renal plasma flow, low GFR

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19
Q

INC infections of S. Aureus and E.coli? What immunity disfunction increases the risk?

A

Chronic granulomatous disease

due to a decrease in the NADPH oxidase deficiency

normally allows phagocytes to create oxygen free radicals and hydrogen periodize to kill bacteria in phagosomes

PREDISPOSES CATALASE POSITIVE bacterial infections

(catalase cat)

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20
Q

Causes of metabolic acidosis with increased anion gap?

A

MUD PILES

Methanol

Uremia

Diabetic ketoacidosis

Propylene glycol

Iron tables / Isoniazid

Lactic acidosis

Ethylene glycol

Salicylates (aspirins)

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21
Q

Attributable Risk

A

Attributable riks = difference between exposed and unexposed groups, porportion of diease caused by exposure

2X2

AR = (A / A+B) - (C / C+D)

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22
Q

leuprolide

A

GnRH agonist

binds to GnRH r in anterior pituitary –> not pulsatile! –> downregulation of receptors –> suppression of release of LH and FSH and reduced testosterone production –> helps slow the growth of prostate CA

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23
Q

Urea cycle enzyme deficiencies?

A

Ornithine transcarbamylase deficiency:

INC ammonia levels within the first days of life

X linked recessive

–> INC orotic acid in blood and urine (part of purine synthesis)

dec BUN, symptoms of hyperammonemia (neurological deficits)

Hyperammonemia: tremor, slurred speech, comnolence, vomiting, cerebral edema, blurred vision

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24
Q

Brachial cleft cyst vs thyroglossal duct cyst?

A

Branchia cleft cyst @ lateral neck, does NOT move with swallowing

Thyroglossal duct @ midline, MOVES with swallowing

remnant is foramen cecum

thyroid diverticulum arises form the flor of the primitive pharnyx and descents to the beck at foramen cecum –> thyroid remains connects to tongue by thyroglossal duct (if persists!!); if duct persist it becoems the pyramidal lobe of thyroid

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25
clozapine major side effect
Cauess agranulocytosis needs to monitor WBC weekly!!
26
anteiror shoulder dislocation vs a posterior shoulder dislocation?
ant dislocation: external rotation, slight abduction axillary artery, axillary nerve scenarios - blow to the arm while abducted, externally rotated and extended PE- prominent acromion process (if thin, loss of normal roundness of the shoulder, appears more angular Posterior dislocation: internal rotation, adduction, unable to externally rotate the arm unusual to have any neurovascular compromise scenario - seizure, electrocution PE: bulge in the posterior shoulder area, anterior aspect of the shoulder is relatively flat
27
cyclosporine:
Use: immuno supp for transplat, psoriasis MOA: binds to cyclophilin --\> inhibits calcineurin normally calcineurin activates nuclear factor of activated T-cells cytoplasmic (NFATc), which upregulated IL-2 (impt for T cell growth and differentiation) --\> inhibition of T-cell growth, activation and differentiation
28
central pontine myelinolysis:
when sodium is corrected too quickly (such as in SIADH) could cause: diplopia, dysarthria, paralysis, locked-in syndrome (pt alert and awkae up unable to move)
29
pericarditis casues?
idiopathic, coxackivirus a/b, tb, uremia, lupus, scleroderma, radioation of the chest, acute RF, dressler syndrome, cancer mets
30
Sx of fat-soluble vitamin deficiencies:
A: night blindness, dry skin D: rickets, osteomalacia, hypocalcemium, tetany E: fragile RBC, muscle weakness, demyelination of CNS K: coagulation factor defects, osteoporosis, CAD
31
Meckles arches:
Meckles - 1st brachial arch CN V2 and V3 Mesoderm - muscles and arteries Neural crest - bones and cartilage
32
mean, median, mode relationship in normal, positive and left skewed graphs
normal mean = mode = median positive - shifted to the left, tail to the mean \> median \> mode negative- shift to the right, tail to the left mode \> median \> mean
33
problems with mercury during pregnancy?
brain damage
34
rate order: zero vs first
zero order elimination = constant amt of drug eliminated per unit of time - linear graph - amt metabolized stays constant regardless of concentration first order elimination = a constant fraction of the drug is metabolized per unit time - curved
35
what artery supplies distal colon vs proximal 2/3 of colon? what structures are they derived from?
proximal 2/3: SMA from midgut distal 1/3: IMA from hindgut
36
status epilepticus acute vs prophylaxis
acute - stop seizure: benzos once it has stopped, treat with anti-convulsant for further seizures: phenytoin first line
37
Treatment of asthmas ...
**chronic asthma** - fluticasone, budesonide (corticosteroids) **acute exacerbations** - albuterol, levalbuterol (b2 agonist) **narrow therapeutic index, drug of last resort** - theophylline **blocks conversion of arachidonic acid to leukotriene** - Zileuton **inhibits mast cell release of mediators, used for prophylaxis only** - cromolyn **inhaled treatment that blocks muscarinic receptors** - ipratropium, tiotropium **inhaled _long_-actin B2 agonist** - **_salme_**terol **blocks leukotriene receptors** - montelukast, zafirlukast
38
hyperaldosteronism treatment and side effects
spironolactone, eplerone hyperkalemia, spironolactone (adrogen antagonist --\> gynecomastia in men, progesteron agonist --\> menstrual irregularities in women)
39
neomycin
aminoglycoside prevent bac from syn proteins by binding to the 30s subunit of the bac ribsomomes inhibitng formation of the initiation complex **toxicities: nephrotoxic, ototoxic, teratogenic**
40
fluamide vs finasteride?
Flutamide: for prostate CA; competitive testosterone receptor inhibitor Finasteride BPH, male pattern baldness inhibits 5 alpha reductase (T --\> DHT)
41
bone injured when falling on an outstretch hand?
scaphoid bone is the most commonly injuryed
42
PCP intoxication
psychomotor agitation, impulsiveness, psychosis, belligerence, homicidality, aggression/violence, fever, tachy \*verticle and horizontal nystagmus\*
43
interferon gamma
Th1 secreted stimulates macrophages and inhibits T2 helper cells
44
benzo's vs barbiturates?
**Benzo** increases the **FREQUENCY** of GABAa receptor Cl- channel opening **Barbiturates** increases the **DURATION** of GABAa receptor Cl- channel opening --\> CNS depressive effects, respiratory (hypovent), CV depression (bradycardia) NOT a good mixture with alcohol
45
Decompression sickness
when divers come up too quickly nitrogen gas forms bubbles in the blood joint and muscle pain, neurologic sx (dizziness, syncope, paralysis), the chokes (sob, PE, death -- occlusion in the lung) could use carbonic anhydrase inhibitors (acetozolamide)
46
Clinical presentation: resting tremor, postural instability, mask like facies antiviral drug?
parkinsonisms amantadine - causes increase release of dopamine
47
which anti-cancer drugs are responsible for restrictive lung disease
bleomycin -- induces free radicals methotrexate busofin?
48
ACUTE medical treatment for esophageal varices
octreotide
49
antidote for digoxin tox?
digoxin immune Fab fragments (digiFab) - too expensive most of the time give nl potassium and magnesium, give lidocaine for any arrhythmias...
50
What is related with a hydatiform mole?
2% of complete moles are associated with **choriocarcinoma** **tumor marker: b-hCG** (make sure it goes down!)
51
incomplete paramesonephric ducts could lead to what clinical presentation?
-\> bicornate uterus, which a women could present with frequent miscarriages fallopian, uterus, upper portion of the vagina aka: mullerian ducts
52
Crescent shaped hemorrhage?
Subdural hematoma bridging veins
53
Test for hereditary spherocytosis?
Hereditary sperhocytosis is a defect in RBC cytoskeleton proteins such as spectrin, band 3, pallidin, ankyrin Test: osmotic fragility test, or flow cytometry keep putting RBC in increasing osmotic fluids, which are more fragile Findings: microcytic, round with no central pallor, increase RDW, INC MCH spleen --\> extravascular hemolysis negative coombs tests Splenomegaly, gallstones, aplastic crises with stress
54
nucleosome
8 histoproteins in nucleosome core with DNA surrounded around lots of + charged dna around (lysine, arginine) Histone H1 ties nucleosomes together
55
Visual blackout G-force?
Visual black out occurs at 4-6 Gs because G forces pulling blood down to the abdomen and legs and not enough going to the brain
56
Dorsal root ganglia
neural crest derived from ectoderm
57
Complements:
Which.. Opsonizes: C3b Neutrophil chemotaxis: C5a MAC: C5b, C6 -C9
58
blood supply of the adrenals
superior adrenal artery arises from teh inferior phrenic artery middle adrenal artery arises from the aorta inferior adrenal artery arises from the renal artery
59
Frequent neisseria infections?
C5-C9 deficiency
60
frequent pyogenic respiratory tract infections?
C3 H. influ
61
paroxysmal nocturnal hemoglobinuria
CD55, CD59, prevents the complement from attacking RBCs K activating factor DAF
62
increased frequency of type III hypersensitivity
C3 deficiency (ie - glomerular nephritis)
63
ACTH --\> cushing syndrome -- small cell lung CA PTH- related peptide --\> hypercalcemia -- squamous cell lung CA Erythropoietin --\> polycythemia -- renal cell CA, hemangioblastoma, HCC, pheochromocytoma ADH --\> SIADH -- small cell lung CA, intracranial neoplasms
64
Homan's sign?
Pain in the calf upon dorsiflexion Possible DVT
65
Why do we see osmotic damage to some cells in diabetic pt?
glucose --\> sorbitol via aldose reductase --\> fructose via sorbitol dehydorgenase Schwann cells, retina and kidneys don't have sorbitol dehydrogenase; so the aldose reductase coverts glucose to sorbitol which then acts as an osmotic agent --\> damage
66
type II B error
study that shows no error when in fact there is error
67
risk factors for osteosarcoma?
Bone infarcts, radiation, paget disease of hte bone, familial retinoblastoma, male sex, ages 10-20 yrs
68
cotton wool spots in the retina
chronic HTN diabetic retinopathy aids lupus temporal arteritis wegnere glume poly adeno.
69
anovulation
elevated cortisol, central --\> cushing syndrome amenorrhea + hirstuism + obsesity --\> PCOS
70
T3 and T4 production
TSH stimulation causes the uptake of iodine with a I/Na+ cotransporter... Iodine then gets exported into the colloid, there it undergoes oxidation into I- by periodixase and then organification, with the addition of thyroglobulin --\> MIT or DIT then condensation into T3 and T4 boud to TG...released into the blood stream after the proteolytic removal of TG (recycled) Active = T3 Most that is made is actually T4 but converted in the periphery
71
zollinger ellision syndrome
gastrinoma, gastrin secreting tumor stimulates the release of acid into the stomach does not respond to PPIs duodenism or pancreas
72
peptic ulcers (ZE) + kidney stones + hypogonadism??
MEN 1! recall MEN 1 is: parathyroid, pituitary and pancreatic involvement
73
PCOS
1. adnrogen excess 2. polycystic ovaries 3. anovluation or oligoovualation clomiphene = estrogen antagonist, blocking normal feedback --\> increasing release of LH and FSH --\> induces ovulation
74
when is consent NOT required by the patient
1. emergency situations 2. pt lacks decision making capacity --\> can't make consent thus power of attorney or spouce 3. waiver giving conset to other
75
Amiodarone... what needs to be measured
PFTs, LFTs, TFTs Pulmonary fibrosis, hepatotox, thyroid dysfunction (hypo or hyper) corneal deposits, neuro probs, constipation, photsensitivity, blue gray skin discoloration since amiodarone is about 40% iodine by weight
76
when is a fetus most susceptible to teratogens??
Embryonic perio weeks 3-8, when organs are formed!
77
How is the body affected if stayed in space for too long?
DEC all of the following: blood volume, RBC, muscle strength and work capacity, maximum cardiac output LOSS of CALCIUM and PHOSPHATE from the bones --\> loss of bone mass
78
what is the most common gynecologic neoplasm?
leiomyoma = firboids common smooth muslce bundles in different dirrections - whorled pattern benign
79
polycythemia vera
myeloproliferative disorder bone marrow is making too many RBC not cancerous, benign inc plasma volume, inc red cell mass, normal O2 and decrease erythropoietin
80
treatment for vWd?
Desmopressin - synthetic analog of ADH releases vWF stored in endothelium recall that AVP - factor 8, vWD, and pressor
81
N-acetylcystein
- inhaled to lose mucus plugs - orally for acetominophen overdose - orally prophylaxis ad IV contrast induced nephropathy
82
granuloma annulare?
asympto (no itching, burning..) no-scaly, slightly erythematous annular plaque irregular, well-defined edges thick, rope-like border (different from ring worm etc..) small --\> grows out usually localized to the wrist, ankles,dorsal surfaces of hands/feet
83
Kallmann syndrome
clinical pres: hypogonadims (due to decreased synthesis of GnRH in the hypothalamus), anosmia, lack of secondary sexual characteristics
84
flow of blood into and out of the thyroid gland:
arterial supply: external carotid ---\> superior thyroid artery Thyrocervical trunk --\> inferior thyroid artery Venous: superior, middle and inferior thyroid vein
85
First degree AV block
first degree = prolongation of the PR interval \> 200 msec (.2 sec) \>5 little boxes or 1 big box asymptomatic
86
Pericarditis clinical presentation
Chest pain, that is sharp and pleuritic, worse with inspiration and relieved by sitting up and leaning forward DEC capacity of the right ventricle, fluid backs up --\> **JVD** w/constrictive pericarditis --\> **kussmaul sign** = JVD with inspiration (normally inspiration decrease intrathoracic pressure so that blood from the superior vena cava flows to the right atrium and ventricle -- but constriction of the heart by constrictiv pericarditis could prevent this thus --\> JVD **Friction rub** doesnt coincide with any specifc part of the cardiac cycle EKG - **diffuse ST elevation and diffuse PR depression**
87
Guaifenesin
Expectorant—thins respiratory secretions; does not suppress cough reflex Stimulates the VAGUS NERVE to generate low viscosity secretion in the bronchial tree NOT a cough suppresant
88
Encapsulated bacteria: what test is used to detect? What meds are used?
**SHiNE SKiS** **S**trep pneumo **H**. influ type B **N**. meningitidis **E. C**oli **S**almonella **K**lebsiella pneumo **S**trep grou B Encapsualted bacteria are **opsonized** and then cleared by the spleen -- their capsules serve as an antiphagocytic virulence factor asplenics have a DEC opsonizing ability and thus incerased risk for severe infections \*\*give vaccines for: S. pneumo, H. influ and N. meningitis\*\* capsule + protein conjugate serves as an antigen in vaccines Test: add serum that contains anticapsular antibodies -- look for the **QUELLUNG** reaction [capsule appears to swell in response to the antibodies-- *_quellung/swellung_*]
89
carpal bones
some loves try positions that they can't handle @ proximal radial side: scaphoid, lunate, triquetrum, pisiform @ distal radial side: trapeziume, trapezoid, capitate, hamate
90
why do we NOT want to use
diphenhydramine -- antihistamine but also anticholinergic side effects which could make elderly indviduals delirious and confused, urinary retention (also bad for BPH!) NOT for chronic insomnia -- helps people fall asleep (side effect of sedation) BUT it disrupts normal sleep architecture
91
CD4? CD8?
CD4 = T helper cells CD8 = cytotoxic T cells -- bind to target cells and induce apoptosis (neoplastic cells, virally infected cells + cells from transplant donor)
92
What breast pathology best describes the following...
msot common breast tumor in women under 25? fibroadenoma Most common breast mass in postmenopausal women? invasive ductal CA most commob breast mass in premenopausal women? fibrocystic change of the breast most common form of breast cancer? invasive ductal CA
93
what are the positive and negative symptoms of schizophrenia
Positive delusions, hallucinations, disorganized speech, disorganied or catatonic behavior Negative: flat affect, social withdrawl, lack of motivation, lack of speech/thought
94
femorath sheath
deep to inguinal ligament, find: artery, vein and lymph NOT the nerve! femoral line palapate the nervous pulse --\> palpate the femoral artery and insert the needle medial to the artery
95
kluver bucy
bilateral amygdala / temporal lobe HSV1 esp hypersexuality, disinhibited behavior, hyperorality
96
too many transfusions could be bad because...
iron overload --\> hemosiderosis/hemochromatosis iron is hard to remove from the body
97
Cheyne-stokes respiration
repeating cycles of apnea, hypercapnia followed by compensatory phase of hyperventilation and hypocapnia due do diminished sensitivity to medullary center caused by drug overdose, cerebral atherosclerosis, cerebral lesions and prolong circulation time from heart failure
98
what is the function of the following APO proteins
Apo A-I --\> activates LCAT (necessary for the maturation of HDL) APO B-48 --\> mediates chylomicro secretion from enterocytes APO B-100 --\> binds LDL R (from the liver) APO C-II --\> removes FFA from lipid particles APO E (on all lipoprotein particles) --\> mediates extra/remnant uptake; related to numerous disorders including **Alz Dz**
99
Neostigmine
Reverse neuromuscular blockade Ileus Bladder atony
100
Physostigmine
atropine overdose or overdose of other anti-muscarinic drugs
101
Edrophonium
aka Tensilon diagnosis of myasthenia gravis
102
pyridostigmine
treat myasthenia gravis
103
echothiphate
treat open-angle glaucoma
104
donepezil, rivastigmine, galatamine
treat Alz Dz
105
clavulanic acid, sulbactam, tazobactam
used in combo with penicilins to degrade penicilinase/b-lactamse produced by bacteria that break down the penicilin structure and preven the abx from working apporpriately.
106
warfarin overdose/antidote? heparin overdose/antidote?
Warfarin: vitamin K, fresh frozen plasma heparin: protamine sulfate
107
vitamin D activation
1. LIVER --\> 25-OH vitamin D (calcidiol) 2. KIDNEY --\> 1,25 (OH)2 vitamin D (calcitriol) \*ACTIVE\*
108
How do the following drugs affect the blood pressure? phnoxybenzamine, epinephrine, phenylephrine
**phenoxybenzamine**: irreversible alpha blocker **Epinephrine**: alpha and beta agonist --\> stimluate beta2 on vascular smooth muscle and casue peripheral vasodilation --\> pressure will drop **Phenylephrine**: rev alpha agonist --\>pure alpha and not induce B2 mediated vasodilation thus will vasoconstrict AC--\> alpha constrict BD --\> beta dilate
109
Serotonin Syndrome
TOO MUCH SEROTONIN ie) MAO + SSRI SX: tremor, hyperreflexia, muscle, rigidity/clonus, hyperthermia, diaphoresis, flushed skin, agitation, seizures, cardiovascular collapse * STOP drug, give BENZO + supportive care* * if this fails --\> give, **cyproheptadine [blocks serotonin R]***
110
common carotid and jugular vein?
BTW sternocleidomastoid muscle you'll find the cartoid artery and jugular --\>common carotid is medial the internal jugular
111
how do you know that surfactant is at its appropriate level in a fetus?
lecithin:Sphingomyelin ratio \>2:1 for lung maturity proper name: dipalmitoylphosphatidylcholine
112
spooning of the nails vs clubbing of the nails:
spooning = Koilonychia --\> indicative of iron deficiency clubbing of the nails --\> oxygen deprivation/hypoxemia
113
what are the phases of making drugs?
phase 1: assesses the safety of the drug on normal patients phase 2: determines if the drug actually works on dz patients phase 3: head to head trial with another drug phase 4: post-marketing surveillance trial of pt after approval
114
obligate intracellualr bacteria?
Rickettsia chamydia coxiella burnetti
115
drug clearance?
**CL = 0.7xVd/ half life**
116
FOX P3??
Found on the X chromosome Codes for Forkhead Box Protein P3 Regulatory T cells -- impt for self-tolerance absence/mutation has been implicated in AI dz, lethal immune dysregulation, polyendocrinopathy, exocrinopathy, and X-linked I PEX syndrome
117
Where are the following found in a lymph node? B cells, Tcells, macrophages
118
amino acids necessary for purine synthesis?
glycine, aspartate and glutamine
119
What are langerhan cells? What characteristic finding would you see on electron microscopy of a dendritic cell with Langerhans cell histiocytosis?
Birbeck granule "tennis rackets" or rod shape Collective group of **proliferative disorders of dendritic (Langerhans) cells**. Presents in a child as **lytic bone lesions** and **skin rash** or as **recurrent otitis media with a mass involving the mastoid bone**. Cells are _functionally immature_ and *_do not effectively stimulate primary T cells via antigen presentation_* Cells express **S-100 (mesodermal origin)** and **CD1a**.
120
Lung cancer mets?
liver, bones, adrenal glands, brain
121
Lithium teratocenicity:
**Ebstein anomaly** *_Tricupsid leaflets displaced inferiorly_* *_RV hypoplasia_* *_Tricuspid regurgitation or stenosis_* Other anti-psychotic meds that are also teratogenic: **Carbamazepine** [neural tube defects, craniofacial defects, IUGR, developmental dealy, hypoplastic fingernails] Valporate -- inhibit folate absoprtion, neural tube defects **Aripiprazole/risperidone** are not technically teratogenic but can cause extrapyramidal symptoms in the newoborn
122
Name the glycogen storage disease:
Severe hypoglycemia with elevated lactate: Von Gierke (type I) hypoglycemia without elevated blood lactate: Cori (type III) cardiomegaly: pompe *[trashes the pump]* **M**yoglobinuria associated w/exercise: **M**cArdle disease (type V)
123
organophosphate poisoning?
inhibits the AChe --\> increasing the ACh in the synaptic cleft symptopms: **DUMBBELSS**
124
what is normal pulmonary artery pressure?
NL: 8-20 mmHg Pulmonary HTN \>25 mmHg
125
conditions associated with oligohydramions? Polyhydraminos?
**Oligo** - less amniotic that nl associated with: placental insufficiency, bilateral renal agenesis, posterior urethral valves / decrease fluid production **POTTER** sequence: bilateral renal agenesis --\>olighydramnios --\> congenital abnormalities P- pulm hypoplasia O- oligohydraminos T- twisted skin T - twisted face E-extremity/limb deformities **Poly**- excess amniotic fluids - esophageal or duodenal atresia, anecephaly, maternal diabetes
126
what are the phases of drug metabolism? What part of metabolism of drugs do elderly people lose first?
**Phase 1 reactions** - elderly pop loses first! includes - oxidation, reduction, hydrolysis **\*\*P450\*\*** **Phase 2:** conjucation reaction
127
essential amino acids:
**PVT TIM HALL** phenyalanine Valine Threonine Tryptophan Isoleucine methionine Histidine Arginine (only in children) Leucine Lysine
128
insomnia
melatonin antihistamies (diphenhydramine) Trazadone TCAs - amitriptyline (heart arrythmia) Long acting bezos - addicting (temazepam, lorazepam) Zolpidem/ambien Zaleplon eszopiclone/lunesta ramelteon
129
What arises from...
bulbus cordis: right ventricle and outflow tracts of left and right ventricle left horn of sinus venous: coronary sinus Primitive atrium - fibrous (trabeculated) portions of the left and right atria Truncus arteriosus - ascending aorta and the pulmonary trunk Primitive ventricle- fibrous (trabeculated) portions of the left and right ventricles Right horn of sinus venous - smooth part of the right atrium Right common and anterior cardinal veins - SVC
130