Fourth Evaluation Flashcards
Advanced mitral stenosis
Can lead to severe pulmonary hypertension and right sided heart failure
-Dilatation of the right ventricle and pulmonary regurgitation secondarily can occur
-right sided S3/S4 can arise
Mitral Stenosis
-A2-OS interval is inversely correlated with mean diastolic left atrial pressure
-Diastolic rumble and pre-systolic accentuation due to left atrial contraction
Carbamazepine
- Leads to exaggerated response to ADH
- ADH is released from posterior pituitary (neuropophysis:- axons radiate from neuron cell bodies in hypothalamus)
ADH packaging
Begins in supraoptic nuclei
(Oxytocin in paraventricular)
-Translated into proteins, packed into neurosecretory vesicles and travel via anterograde axonal transport to posterior pituitary in association with intra vesicular proteins- neurophysins
Hepatitis A virus infection
-Subclinical or silent
-“Anicteric” usually involves no jaundice in kids
-Can be self limited- malaise/anorexia/vomiting
Has no chronic phase or asymptomatic viral carrier state
DNA Damage
Damage
- Depurination of DNA/base excision repair
- Thymine dimer forms (UV)
- Breaks in chain and oxidative damage (ionizing)
- Cross-linkage/intercalation/alkylation
- Nitrates meal leads to deamination of cytosine, adenine and guanine to form uracil, xanthine and hypoxanthine
DNA repair
In base alteration is repaired Base Excision Repair
- Glycosylase:- recognize and cleave
- Empty sugar-phosphate site called a basic site or apurinic-apyrimidinic (AP)
- Endonuclease then cleaves 5’ end of the AP site
- Lyase completes AP removal, removing sugar phosphate group
- DNA polymerase gills the gap with right sugar-phosphate
FF = GFR/RPF
How do you determine the GFR
GFR is calculated by creatinine clearance, inulin clearance or Starling
RPF is calculated by clearance of PAH
Clearance:- urine conc*urine flow rate/plasma concentration
Isotretinoin (Accutane)
- all trans retinoic acid (tretinoin)
- a derivative of vitamin A
- Used to treat to severe acne
Issues seen with levodopa used alone
-what about with carbidopa added
-Postural hypotension and hot flashes
(result from peripheral conversion of levodopa to dopamine, a peripheral decarboxylase inhibitor like carbidopa prevent this)
-Nausea and vomitting if used alone
-Even with combination with carbidopa, you see anxiety, agititation, insomnia,
Atropine poisoning e.g. Jimson Weed or Gardener’s Mydriasis.
-Physostigmine, a cholinesterase inhibitor used to treat
Blind as a bat, mad as a hatter, red as a beef, hot as a hare, dry as a bone, bowel/bladder lose their tone and the heart runs alone
left gastric artery
- follows lesser curvature of the stomach
- Most gastric ulcers arise here too
- Hence can cause gastric bleeding
Anal fissure
- Longitudinal tear in mucosa of distal anal canal distal to the dentate line (posterior midline)
- Posterior anal canal is relatively poorly perfused
- Anal fissures are associated with low-fiber diets and consitipation
- Severe tearing pain associated with the passage of bowel movements
Liver specific enzyme, that facilitates triglyceride breakdown products
- Lipase breaks down triglyceride to fatty acid (beta oxidation/ketogenesis) and glycerol
- Glycerol kinase in liver, converts glycerol to glycerate3phosphate
- G-3-P is converted to DHAP (derive energy from glycolysis, and gluconeogenesis from glucose)
B-aminoproponitrile
-Found in peas
Caises angiolathyrism
-Changes elasticity
-Mimics myxomatous degeneration seen in patients with Marfans
-Inhibits lysyl oxidase, an enzyme responsible for cross linking elastin fibers and collagen fibers
