March 13 Flashcards
Why is edema NOT seen in mild/moderate Right Heart Failure?
RHF causes:
Increased central venous pressure
Increased interstitial pressure
Increased lymphatic drainage!
ultimately lymphatic drainage is overwhelmed and edema is apparent
Acute Promyelocytic Leukemia
APML t(15:17)
15=PML gene
17=RARa gene (retinoic acid receptor alpha)
tx: all-trans retinoic acid, forces promyelocyte differentiation
symp: anemia, bruising, mucosal bleeding, recurrent infections
smear: promyelocytes with auer rods
Conus Medullaris Syndrome
Lesion at L2 (effects L2-S5)
impotence
flaccid paralysis of rectum and bladder
saddle anesthesia (S3,4,5)
causes: disc herniation, tumor, spinal fracture
Wheal and Flare lesion (bee sting)
Type I hypersensitivity
1) IgM –> IgE class switching
2) Fc of IgE binds mast cell and basophils
3) cross linking of bound IgE
4) degranulation - Histamine Release! (leukotrienes, prostaglandins)
vasodilation and increased vascular permeability
Gerstmann Syndrome
Lesion at Dominant Parietal Cortex
symp: agraphia, acalculia, finger agnosia
Preeclampsia
Gestational Hypertension > 140/90 after 20 weeks
-and-
Proteinuria
due to abnormal placentation, lack of invasion of maternal arteries by trophoblasts
HELLP Syndrome (pregnancy)
Hemolysis
Elevated Liver enzymes
Low Platelets
smear shows schistocytes
Fibrillin-1
Mutated in Marfan Syndrome
large extracellular glycoprotein that forms a sheath around elastin
abundant at:
large vessels (aortic dissection)
zonular fibers of lens (subluxation)
periosteum
FBN1 gene at Chr15
Marfan Syndrome
AD mutation of FBN1 gene at Chr15 - fibrillin deficit
Tall, thin, long fingers (arachnodactyly), hypermobile joints, pectus excavatum
dissecting aortic aneurysm
floppy mitral valve
subluxation of lens (up and out)
small nuclear ribonuclearproteins (snRNPs)
Form Spliceosome
removes introns
Spinal Muscular Atrophy
mutation in SMN1 gene - defective snRNPs –> defective spliceosome
symp: flaccid paralysis due to degeneration of anterior horn, motor delays, decreased DTRs
What amino acid is essential in PKU patients?
Tyrosine
(lack phenylalanine hydroxylase which converts phenylalanine –> tyrosine)
symp: musty odor, light pigmentation, developmental delay, seizures
restrict phenylalanine from diet!
Tyrosine derivatives
Catecholamines norepinephrine epinephrine dopamine melanin
Failure of spiraling at cardiac development
Transposition of Great Vessels
incompatible with life unless PDA or patent foramen ovale occurs too
What serum substances increase with SIBO (small intestine bacterial overgrowth)
Folate
Vit K
(deficiency in B12, D, A, E, and iron)
Ecological Study
study of POPULATIONS
ex. study of VitD intake and MS in multiple cities at same latitude
Broca Aphasia
Comprehension - Intact
Speech - Non-fluent
Repetition - Impaired
Broca Broken Boca - frustrating
Wernicke Aphasia
Speech - Fluent
Comprehension - Impaired
Repetition - Impaired
Wernicke is Wordy but makes no sense - gobledegook
Hepcidin
Acute Phase Reactant
synthesized and released by hepatic parenchymal cells
increased with high iron load and inflammation
decreased with hypoxia and increased EPO
binds ferroportin –> degredation = decreased Fe absorption from gut
increases iron release from macrophages
responsible for anemia of chronic disease
Communicating Hydrocele
Patent processus vaginalis allows peritoneal fluid to accumulate in Tunica Vaginalis
transluminating scrotum in newborn
Medical (non-surgical) Management of Gallstones?
Hydrophilic Bile Acid supplementation
ex. ursodeoxycholic acid
improve cholesterol solubility and help dissolve the stones
Rabies Virus
ssRNA with bullet shaped capsule
binds Nicotinic ACh receptors and travels retrograde
flu-like prodrome
agitation, fever, photophobia, hydrophobia, dysphagia, hypersalivation
Where is rRNA transcribed?
Nucleolus - primary function!
Toxic Shock Syndrome
caused by Toxic Shock Syndrome Toxin from Staph aureus
macrophages present toxin to T-cells –> widespread T-cell activation
T-cells release: IL-2
Macrophages release: TNF-alpha, IL-1
causes capillary leakage, sepsis, fever,
symp: altered mental status, sunburn-like rash, decreased BP, sepsis
HBV Hepatocellular Carcinoma
likely caused by viral genome integration into host genome –> neoplastic changes
How are extended spectrum beta-lactamases acquired?
plasmids!
treatment with carbapenems (imipenem)
Where is the Sinoatrial (SA) node?
Right Atrium near the opening of the SVC
Phenoxybenzamine
noncompetitive alpha-adrenergic antagonist
tx for pheochromocytoma
Treatment for Restless Leg Syndrome?
Dopamine agonists
pramipexole, ropinirole
Amlodipine
Dihydropyridine Calcium Channel Blocker (-dipines)
causes vasodilation
tx: HTN
side fx: peripheral edema, flushing, HA, dizziness
dilation of precapillary arterioles causes edema
ACEi and ARD cause dilation of postcapillar venuoles and prevent peripheral edema
Incretin Effect
GLP1 and GIP
increased insulin release with some loading dose of glucose when taken orally instead of IV
