Feb 19th Kaplan Flashcards
What is ferritin?
Binds iron with in the cells
What is transferrin?
Transfers iron in the serum
Where is transferrin made and what causes it to increase in synthesis?
In the liver and its synthesis is increased when ferritin is low
Thus high ferritin leads to decrease in the production of transferrin
What is Total biding capacity and what does it show?
How much transferrin is in the serum to bind iron
- thus synonymous with transferrin levels
what is Percent transferrin saturation?
Amount of iron bound to transferrin
Where are common places for excess iron to accumulate?
Pancreas Spleen Skin Liver Heart pituitary Joints
What tumor results in loss of vertical eye movements?
Pinealoma
What is central pontine myelinosis?
Demyelination primarily of the pons due to prolonged hyponatremia followed by rapid correction
Are steroids hormones produced on demand or stored in vesicles?
Produced on demand
- they are lipophilic thus can move quickly across membrane so no need to make them before
What sort of hormones are produced and stored in vesicles?
Protein hormones which are lipiphopic which means they need more time to get signal across cell membrane
Celiac has antibodies produced against which protein?
Gliadin
Which HLA typing is Celiac disease associated with?
HLA- DQ2 and DQ8
What are the common findings in celiac disease?
- IgA anti tissue transglutaminase
- Anti-endomysial
- Anti-deamindated gliadin peptides
- Reticulin IgA
Does a pt with celiac disease present with bone pain? why?
They can
- Auto-ab’s against osteoprotegerin which causes in activation of osteoclasts via RANK-ligand
What is another name for osteoprotegerin?
Osteoclastogenesis inhibitory factor
What is dermatitis herpetiformis?
Itchy red vesicular rash found predominantly on the extensors
What is the pathogenesis of dermatitis herpetiformis?
subepidermal deposition of IgA and Anti-transflutaminases
- May also find neutrophils
What is the mnemonic for sensitivity ruling out?
Dogs have SENSITIVE SNouts
- SN- Sensitivity
- Rules out
- Like a D-dimer
What does the mnemonic SPPIN stand for?
Specificity rules IN
Who commonly presents with s. aureus scalded skin syndrome?
Infants–> especially around umbilicus
children
Adults with renal insufficiency
What is seen on physical exam in SSSS?
Positive Nikolsky sign of blisters
Sloughing of upper layers of epidermis
Erythema
What is the cause and what is targeted in SSSS?
Exotoxin from S. Aureus
- Targets desmosomes at the layer between the granulosum and corneum.
Where do SJS and TEN target on the skin layer?
Epidermal and dermal junction
What does hypercapnia cause in terms of vessels?
Vasodilation
- increase systemic and pulmonary resistance
- thus increased afterload
Pt presents with increased anion gap metabolic acidosis? She is on metformin. What is the cause of the acidosis?
Lactic acid
- especially in renal insufficient patients
What is cyclobenzaprine?
Centrally acting Skeletal muscle relaxant
- spasmolytic
What are the AE’s of Cyclobenzaprine?
Anticholinergic affects
What muscle controls contraction if the bladder?
Detrusor
What are oxybutin and tolterodine used for?
M3 antagonists which are used for urge incontinence
- leads to smooth muscle relaxation of bladder and ureters
What is Menetrier disease?
Gastric hyperplasia of mucosa–> leads to hypertrophied regae
- increased proliferation of mucous producing cells
pt presents with Menetrier disease, what is lost in fecal matter?
protein
- increased mucous cells causes parietal cell atrophy and decreased H+ which leads to decreased breakdown of proteins
- malaborption downstream
What cytokine is overproduced in Menetriers disease
TGF-a
What is first line treatment for schizophrenia?
Atypical antipsychotics
- Risperidone
What else can be used to treat schizophrenia?
Antipsychotics (neuroleptics)
- high potency
- low potency
What is Torticollis?
involuntary twisting of the neck with neck pain and abnormal head posture
What drugs are commonly associated with Toricollis?
High potency antipsychotics
- Haloperidol
- Fluphenazine
- Trifluoperazine
What is the mnemonics for high potency antipsychotics?
Try to fly high
- Trifluoperazine
- Haloperidol
- Fluphenazine
What are some other common side affects of high potency antipsychotics?
More EPS symptoms and less non-neurological symptoms
How about low potency antipsychotics what are their sxs compared to high potency?
We need more of them to act
- thus more non-neuro sxs
- less EPS sxs
What is the mnemonic for low potency antipsychotics?
Cheating Thieves are low
- Chlorpromazine
- Thioridazine
What are EPS symptoms?
Extra-pyramidal sxs
- acute dystonia
- Akathisias
- Parkinsonian syndromes
- Tarditive dyskinesias (irreversible)
what can one give to treat the reversible EPS sxs?
Benztropine
Diphenhydramine
Benzos
What are the non-neuro sxs associated with taking typical antipsychotics?
Muscarinic
Alpha1
Histamine
How many pts with mumps present with bilateral parotitis? Orchitis
90% and 40 respectively
Where are some common locations for tophus?
External ear
Olecranon bursa
Achilles
how do you treat acute gouty arthirtis?
NSAID’s
Indomethacin
Steroids
Colchicine
Increased AFP (amniotic and maternal) and Ache (amniotic) lead to what type of defect and when?
Day 27
- Meningocele or Meningomyelocele
- NOT bifida
What is normal range of ejection fraction?
55-75%
What is the systemic response to hypoxia in terms of vessels?
vasodilation
- allows for increase return of venous blood to heart
- Constrictions small vessels and arterioles
Does gastrin weaken or strengthen the stomach lining?
Strengthen
- causes increase in cell division in the proliferation zone
