Lessons Learned Flashcards by Kat Elsener

Normal age-related cardiac changes

Decreased L ventricle chamber size
Sigmoid-shaped ventricular septum
Increased interstitial connective tissue
Lipofuscin pigment w/in macrophages

Decreased compliance of aorta & proximal major branches may lead to isolated systolic HTN

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Compare the endogenous opioids

Mu- endorphins, morphine

Delta- enkephalins, DPDE

Kappa- dynorphins, ketazocine

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Holiday Heart syndrome

Atrial fibrillation induced by binge drinking

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Describe the 3 types of GABA receptors

GABAa- found in the brain; ion channel; causes Cl- influx when stimulated

GABAb- found in brain; G-Protein; causes K+ efflux, decreases Ca2+ influx, and inhibits adenylyl cyclase when stimulated

GABAc- found in retina; ion channel; causes Cl- influx when stimulated

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Deficiency of which vitamin mimics Friedriech ataxia?

Vitamin E (posterior column & spinocerebellar tract demyelination)

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Dysphagia + recent travel to South America

Think Chagas disease!

Trypanosoma cruzi, spread by Rediviid bugs

Tx: Nifurtimox

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What conditions precipitate gallstones?

Elevated cholesterol/bilirubin
Decreased bile salts
Gallbladder stasis

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Dysphagia + koilonychia

Iron deficiency anemia

Think Plummer-Vinson Syndrome + spoon nails

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Mutation responsible for achondroplasia

Fibroblast Growth Factor Receptor 3 (FGFR 3)

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Hepatocytes with ground-glass appearance

Hepatitis B

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Stewart-Treves Syndrome

Cutaneous angiosarcoma in the context of chronic lymphedema

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IgA nephropathy vs Acute Poststreptococcal glomerulonephritis

Both nephritic syndromes

IgA Nephropathy (Berger’s disease)- related to Henoch-Schonlein disease

Presents days after infection
Normal complement levels

Acute poststreptococcal glomerulonephritis

Develops weeks after infection
Low complement levels

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Key players in Type IV hypersensitivity reactions

Macrophages, CD4+, CD8+, & natural killer cells

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Compare homocysteinuria vs Marfans

Homocysteinuria- AR; downward lens dislocation; tight joints; mental retardation; heart uninvolved

Marfans- AD; upward lens dislocation; loose joints; normal intellect; aortic incompentence may occur

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Supplement isoniazid treatment with:

Vit B6 (pyridoxine)

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Orotic aciduria

Inability to convert orotic acid to UMP (de novo pyrimidine synthesis pathway) due to defect in EITHER orotic acid phosphoribosyltransferase OR orotidine 5’-phosphate decarboxylase

Autosomal recessive

Findings: increased orotic acid in urine, megaloblastic anemia (unimproved w/ B12 or folic acid), failure to thrive. NO HYPERAMMONEMIA (contrast w/ OTC deficiency)

Tx: Oral uridine administration (converts to UMP, which provides feedback inhibition to CPS II :. decreasing orotic acid production)

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Ideal agent to treat hypertension plus osteoperosis

Hydrochlorothiazide (increases reabsorption of Ca in distal convoluted tubules)

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Key mediator of septic shock

TNF-alpha

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Councilman body

Eosinophilic globule indicative of hepatocyte apoptosis

Seen in acute viral hepatitis, yellow fever

Hormone that causes hypercalcemia in squamous cell carcinoma

Parathyroid hormone related peptide (PTHrP)

Causes Humoral Hypercalcemia of Malignancy

Effect of competitive vs noncompetitive inhibitors on Vmax & Km

Vmax- proportional to enzyme concentration
Km- affinity of enzyme for substrate

Competitive inhibitors increase Km; Vmax is unchanged; decreases potency

Noncompetitive inhibitors decrease Vmax but Km is unchanged; decreases efficacy

Monosaccharides –> Disaccarides

Glucose + glucose = maltose

Glucose + fructose = sucrose

Glucose + galactose = lactose

Treatment for pheochromocytoma

Phenoxybenzamine- non selective α-blocker

Hypocalcemia + shortened 4/5th digits

Albright’s hereditary osteodystrophy

Pseudohypoparathyroidism

Therapeutic use of interferons

Glycoproteins synthesized by virus-infected cells block replication of DNA & RNA viuses Use: IFN-alpha: chronic hep B & C, Kaposi's sarcoma IFN-beta: MS IFN-gamma: NADPH oxidase deficiency Toxicity: neutropenia

Hypnotic w/ lower risk of dependence

Nonbenzodiazepine hypnotics Zolpidem, Zaleplon, Eszopiclone Act via BZI receptor; reversed by flumazenil Toxicity: ataxia, HA, confusion; short duration due to rapid metabolism by liver enzymes

Kussmaul Sign

Paradoxical rise in JVP w/ inspiration Indicative of constrictive pericarditis

Elevated 14-3-3 protein in CSF

Creutzfeldt-Jakob disease

Branched chain amino acids

Isoleucine Leucine Valine

Unique components of smooth muscle contraction

Calmodulin (bound by Ca to activate MLCK) Myosin light-chain kinase --> Myosin P + actin --> CONTRACTION *Nitric oxide increases cGMP :. inhibits MLCK Myosin light-chain phosphatase --> Myosin + actin --> RELAXATION

Hepcidin

Central regulator of iron hemostasis (binds ferroportin to prevent intestinal absorption of iron & to prevent macrophage release of ferritin) Acute phase reactant synthesized by hepatocytes

Malignant hyperthermia

AD sensitivity to inhaled anesthetics Defective ryanodine receptor on sarcoplasmic reticulum releases excessive Ca into mm cytoplasm --> elevated ATP reuptake in SR Tx: Dantrolene

Fanconi syndrome vs Fanconi anemia

Fanconi anemia: genetic defect in DNA repair --> AML, bone marrow failure; congenital defects (short stature, abnormalities of skin/arms/head/eyes/kidneys/ears), developmental disabilities Fanconi syndrome: disease of proximal tubules where glucose, amino acids, uric acid, phosphate, & bicarb pass into urine instead of being reabsorbed; causes proximal renal tubular acidosis

Profound hypochlorhydria + increased serum gastrin

Pernicious- anemia induced atrophic gastritis

Methods to reduce risk of tumor lysis syndrome

Aggressive hydration Rasburicase (recominant urate oxidase; converts uric acid to allantoin for excretion) Allopurinol TLS: oncologic emergency during chemo where rapid cell turnover leads to massive release of intracellular ions (potassium, phosphorous)

Weil's Disease

Infection w/ leptospira interrogans --> jaundice, azotemia, fever, hemorrhage, & anemia

ITP vs TTP

Both decrease platelet count, decrease platelet survival, & increase bleeding time ITP- Defect in anti-GpIIb/IIIa antibodies --> peripheral platelet destruction Labs show increased megakaryocytes TTP- Deficiency of ADAMTS 13 (vWF metalloprotease) --> decreased degradation of vWF multimers Labs: schistocytes, elevated LDH Pentad of symptoms: neurological symptoms, renal symptoms, fever, thrombocytopenia, & microangiopathic hemolytic anemia

Name the hepatitis viruses

HAV- RNA picornavirus HBV- DNA Hepadnavirus HCV- RNA flavivirus HDV- RNA delta virus HEV- RNA hepevirus

Serotonergic neurons are found in. . .

the RAPHE NUCLEUS in the brainstem

Which parts of the kidney are most susceptible to hypoxia?

Proximal tubules & thick ascending limb of loop of Henle (both located in outer medulla)

Renal pathology associated w/ sickle cell disease

Papillary necrosis

Reactions involving biotin

Biotin = B7 Used as a cofactor for carboxylation enzymes (add 1-C group) 1- Pyruvate carboxylase: Pyruvate (3C) --> oxaloacetate (4C) 2- Acetyl CoA carboxylase: Acetyl CoA (2C) --> malonyl CoA (3C) 3- Proprionyl CoA carboxylase: Propionyl-CoA (3C) --> methylmalonyl-CoA (4C)

B6 is needed to synthesize:

cystathionine, heme, niacin, & GABA (B6 is converted to pyridoxal phosphate, which is also used in transamination, decarboxylation, & glycogen phosphorylase)

Atypical cells seen during EBV infection

Reactive cytotoxic T cells *They hug the RBCs!

Which part of the lymph node isn't well developed in DiGeorge Syndrome?

Paracortex

Defect in xeroderma pigmentosum

UV-specific endonuclease