Fast Facts Flashcards
Brain structure responsible for extraocular movements during REM?
PPRF, paramedian pontine reticular formation
Name teratogens
ACE inhibitors (renal) Valproate (neural tube) Phenytoin (cleft palate, heart defects) Lithium (Ebstein anamoly) Tetracycline (discolored teeth) Warfarin (hemorrhage, abortion -- use heparin!) Excessive Vitamin A (abortion)
Which parts of the hypothalamus regulates ANS?
anterior = para posterior = symp
Bells Palsy vs. Stroke
Bells involves the forehead
Muscles of mastication
Masseter, temporalis, medial and lateral pterygoid
Horner Syndrome symptoms
Ptosis, miosis, and anhidrosis
Thyroglossal duct cyst presentation
- midline neck mass
- asymptomatic
- ## moves with swallowing
Elevated ESR associated with…
infection, inflammation, neoplasm, RA, temporal artertits, osteomyolitis, polymyalgia rheumatica
Tiotropium used for
COPD (inhaled anticholinergic)
Competitive vs noncompetitive inhibitor
Competitive: binds active site, can be diluted out
Noncompetitive: binds elsewhere, renders inactive, irreversible
Km =?
[S] at 1/2 Vmax
related to affinity, not quantity
How can you increase Vmax?
By increasing the number of enzymes
Therapeutic Index = ?
LD50/ED50
higher is safer
low TI = seizure drugs, lithium, digoxin, warfirin
Vd = ?
D/C
iv drug/concentration of drug in plasma
CL = ?
rate of elimination/plasma concentration = (0.7)Vd/half life = K*Vd
LD = ?
Css * Vd
MD = ?
Css * CL
Half-life %
1 = 50% 2 = 75% 3 = 87.5% 4 = 94%
Efficacy = ?
max effect a drug can produce
Potency = ?
amount of drug required to produce an effect of a given intensity
Partial agonists impact on efficacy and potency?
Decreases efficacy (Vmax) Potency is independent
Agonist + noncompetitive antagonist impact on Vmax
Decreases Vmax
Agonist + competative antagonist impact on potency
Decreases potency (increases Km)
Layers of the epidermis
stratum… corneum, lucidum, granulosaum, spinosum, and basalis
4 molds that are considered dermatophytes?
trichophytin, microsporum, epidermophytin, malasezia furfur
boot-shaped heart
right ventricular hypertrophy
continuous machine-like murmur
patent ductus areteriosis
tendon xanthomas
familial hypercholesterolimia
cafe-au-lait spots
neurofibromatosis type 1
tuft of hair on lower back
spina bifida occulta
Found in SW U.S. - fungus
coccidioides immitis
Found in Mississippi and Ohio River basins - fungus
histoplasma capsulatum
San Joaquin Valley Fever
coccioides immitis
Rural Latin America - fungus
paracoccidioides brasiliensis
Plant thorns - fungus
sporothrix schenckii
Found east of Mississippi River - fungus
blastomyces dermatitidis
bird and bat droppings
histoplasma capsulatum
mold form contains barrel-shaped arthroconidia and associated with dust storms
coccidioides immitis
broad-based budding of yeast
blastomyces dermatitidis
Multiplebuddings of yeast form - captain’s wheel
paracoccidioides brasiliensis
causes diaper rash
candida
45 degree branching, septate hyphae, opportunistic mold
aspergillis fumigatus
irregular, nonseptate hyphae, wide angle branching
mucor or rhizor
Know for causing pneumonia in AIDS patients
pneumocystis jirovecii
Cause of meningitis in AIDS patients
cryptococcus neoformans
Infections associated with birds
Chlamydophila psittaci, histoplasma capsulatum, cryptococcus neoformans, H5N1 influenca virus, west nile virus
prophylaxis for cryptococcus in AIDS pts?
fluconazole
PCP prophylaxis in AIDS patients
trimethoprim-sulfa
sporothrix schenckii treatment
oral potassium iodide and itraconazole
oral candidiasis treatment
nystatin and fluconazole
systemic candidiasis treatment
amphotericin B
criteria for major depressive disorder
2 or more weeks of anhedonia and/or depressed mood plus 5/9 of the following:
Sleep disturbance, Interest decreased, Guilt, Energy decreased, Concentration problems, Appetite changes, Psychomotor retardation, and Suicidal ideation
clinical presentation suggestive of lymphoma
- painless lymphadenopathy
- B symptoms: wt loss, night sweats, fever
What histological changes occur in a smoker’s trachea
columnar to squamous metaplasia
Most common leukemia in children
ALL
Most common leukemia in adults in the US
CLL
characteristic auer rods in leukemia
AML
more than 20% blasts in the marrow (leukemia)
ALL or AML
Less than 5% blasts and more mature cells (leukemia)
CLL or CML
PAS (+) acute leukemia
ALL
Always positive for the Philadelphia chromosome (t 9;22)
CML
Acute leukemia positive for peroxidase
AML
Solid sheets of lymphoblasts in the marrow
ALL
Always associated with BCR-ABL genes
CML
Atypical depression
hypersomnia, hyperphagia, mood reactivity, and hypersensitiveity to depression
(Treat with SSRIs)
Dysthymia
milder depression >2 years
Buproprion
atypical, inhibits NE and D2 reuptake
works well with 5H-T
lowers seizure threshold, stimulant, no sexual side effects
used for smoking cessation
Mirtazipine
atypical antidepressant, alpha 2 antagonist
increases NE release and 5H-T (like SNRI)
SE = antihistamine effects (dry mouth, sedation, weight gain)
Trazadone
used for insomnia and depression
inhibits 5H-T reuptake
can be added to SSRI or SNRI
SE = priapism (“trazaBONE”) and sedation
smoker, heavy drinker, new cough and flu-like symptoms, gram stain shows no organisms, but silver stain of sputum shows GNR. DX?
Legionella pneumophila (Legionnaire’s dz)
temporal arteritis – symptoms and lab for dx?
unilateral headache, jaw claudication, blindness/impaired vision
lab = increased sed rate or temporal artery biopsy
30 yo woman presents with low grade fever and a rash that worsen with sun exposure, and widespread edema. Dx and labs?
Lupus
ANA
SSRIs
inhibit 5-HT reuptake (longer in synapse)
depression, anxiety, bulimia, OCD, PTSD
take 1 month to start working
fluoxetine, cirtriline, etc.
SE = sexual dysfunction, serotonin syndrome (avoid SSRI, SNRI, MAOIs, Kava kava, St. John’s Wort, Tryptophan, cocaine, amphetamines) [hyperthermia, hyperclonus, HTN, THR, flushing, diarrhea, anxiety, delirium] – mental status, ANS instability, and neuromuscular abnormalities –> treat with cooling and benzos
SNRIs
Inhibit 5H-T and NE reuptake
venlofaxaine, duloxitine (- diabetic neuropathy and fibromyalgia)
depression and anxiety
SE = increase in BP, nausea, sedation
TCAs
blocks reuptake of NE and 5HT
“-triptylines,” “-ipramines,” and “-doxapin”
alpha blocking sx, anticholinergic symptoms
SE = sedation, hypotension, dizzy, (hot as a hare, dry as a bone,) lower seizure threshold
overdose= convusions, coma, cardiotox, resp depression, hyperpyrexia, confusion, hallucination (RX with sodium bicarb for urinary excretion.)
MAOIs
hinders enzyme that breaks down dopamine and NE
phenylziene, isocarboxazid, tranylcypromine, selegine (Parkinsons)
SE= hypertensive crisis (with tyramine ingestion from foods –increase in BP -> hemorrhage, arrhythmia, stroke,) tachy, arrythmia, serotonin synd. (CV collapse, hyperthermia, muscle rigidity)
buproprion
inhibits NE and D2 reuptake
works well with 5-HT
lowers seizure threshold, stimulant, no sexual SE
used in smoking cessation
mirtazipine
alpha2 antagonist
increases NE release and 5HT (like SNRI)
SE = antihistamine effects (dry mouth, sedation, weight gain.)
trazadone
trazaBONE (SE = priapism and sedation)
used for insomnia
inhibits 5hT reuprtake
can add to SSRI or SNRI
Hypothyroidism
Sx: wt gain, wold intolerance, feel tired, skin/hair changes, constipation, lower voice, menorrhagia, slowed mental/physical, slow return phase in reflexes
levothyroxine - synthetic T4 analog
triiodothronine - T3, more unpredictable
T4 converted to T3 in body
Cretinism
hypothyroidism in fetus/infant
causes=iodine-deficient diet, thyroid-related enzyme deficiency, thyroid developmental defect, thyroid doesnt descend, transfer of antibodies form mom
sx= impaired physical growth, enlarged tongue, mental retardation, enlarged abdomen
Hashimotos’s
autoimmune thyroiditis
painless goiter
dense infiltrates of lymphocytes into thyroid (dx=antithyroglobulin or antithyroid peroxidase atb)
5:1 females, increases with ages
HLA-DR5 and HLA-B5
can have transient hyperthyroidism when cells spill T4
increased risk of Bcell lymphoma
Subacute (de Quervan) Thyroiditis
hyper --> hypo painful goiter HLA-B35 females 3:1 recent viral infection causes it
Thyroid Surgery Complications
recurrent laryngeal nerve injury (hoarseness)
parathyroid glands
Struma Ovarii
thyroid hormone-secreting teratoma
Somatostatin’s clinical uses
diarrhea and splanchnic circulation (cirrhosis)
pituitary excess: acromegaly, TSH-secreting tumor, ACTH-secreting tumor
GI endocrine excess: carcinoid syndrome, zollinger ellison syndrome, VIPoma, glucagonoma, insulinoma
Propylthiouracil
blocks addition of iodine to tyrosine groups on the thyroglobulin –> decreses the synthesis of thyroid hormone
SE = rash, agranulcytosis, aplastic anemia
most common thyroid cancer
papillary carcinoma
cold intolerance
hypothyroidism
enlarged thyroid cells with ground glass nuclei
papillary cancer of the thyroid