March 17 Flashcards
IL-4
B-cell switch to IgE
IL-5
B-cell switch to IgA
ADR of Lithium
Hypothyroid
DI
Tremor
Ebstein Anomaly (congential cardiac defect)
ADR of Digoxin
Neuro: color vision changes, weakness, confusion, fatigue
GI: nausea, vomiting, abd pain
Cardiac: arrhythmia! (any kind, esp ventricular)
precipitated by: hypokalemia, hypovolemia, renal failure
Burkitt Lymphoma
t(8:14)
8 = c-Myc - overexpression, oncogene promotes tumor growth
African type - jaw mass
sporadic - abdominal/pelvic mass
starry sky appearance on histology
Strep Viridans
synthesizes dextrans from sucrose
allows adhesion at Fibrin-Platelet aggregates
adheres to pre-existing valvular lesions –> endocarditis
Galactosemia
galactose-1-phosphate uridyl transferase deficiency is most common
inability to convert Galactose-1-phosphate –> glucose-1-phosphate
symp: jaundice, vomiting, hepatomegaly, E. coli sepsis, cataracts, hemolytic anemia
INH-induced Neuropathy
due to competition with and deficiency of Pyridoxine B6
defective synthesis of GABA and increased urinary loss of B6
Angiogenesis (2 substances)
VEGF (vascular endothelial growth factor)
FGF-2 (fibroblast growth factor-2)
IL-1 and IFN-gamma are pro-inflammatory cytokines that can increase VEGF to indirectly promote angiogenesis
Cord Factor in mycobacterium
Virulence factor!
mycobacteria without cord factor are not pathogenic
actions: inactivates neutrophils, damages mitochondria, induces release of TNF
causes TB to grow in ‘thick rope-like cords in a twisted serpentine pattern”
mRNA detection
Northern Blot
assess gene expression
Müllerian aplasia
aplasia = defective development or congenital absence
variable uterine development with a short vagina/no upper vagina
Cardiac Tamponade
pericardial effusion
Beck triad: hypotension, elevated JVP, muffled heart sounds
decreased systolic pulse pressure during inspiration due to increased venous return to RV which compresses LV
Chancroid
Haemophilus ducreyi
multiple deep painful ulcers with gray.yellow exudate at base
inguinal LAD
Cranial nerve effected by parotid gland tumor?
Facial Nerve CNVII courses through the parotid gland
can cause facial droop (CN VII = muscles of facial expression)
Influenced by disease PREVALENCE
positive and negative predictive value
NOT: sensitivity, specificity, nor likelihood ratio
Obturator Nerve
L2-L4
thigh adduction
injury @ pelvic surgery
Femoral Nerve
L2-L4
flexion of thigh, extension of leg
sensory over medial leg, knee
injury @ iliopsoas (hematoma or abscess)
Common Peroneal Nerve
L4-S2
foot eversion, doriflexion, toe extension
sensory over lateral lower leg and dorsum
injury @ fibular neck fracture
Tibial Nerve
L4-S3
foot inversion, plantar flexion, toe flexion
sensory of soles of feet
injury @ knee trauma
Superior Gluteal
L4-S1
stabilizes pelvis
injury @ upper medial gluteal (injection)
Trendelenburg gait - contralateral hip drops and patient leans towards side of lesion
Gallstones
Cholesterol?
Bile Acids?
Phosphatidylcholine?
cholesterol UP
bile acids DOWN
phosphatidylcholine DOWN
bile is supersaturated with cholesterol and precipitates out :(
Carotid Sinus Innervation
Afferent - glossopharyngeal nerve CN IX
Efferent - vagus nerve CN X
pressure @ carotid sinus –> increase in PNS and decrease in SNS –> bradycardia, hypotension and even syncope (carotid sinus hypersensitivity)
Pt with mono-like illness but negative heterophile antibody test?
CMV! especially in immunocompetent patients
Atropine Overdose
give physostigmine
crosses CNS to relieve all symptoms (dry as a bone, red as a beet, mad as a hatter, hot as a hare)
Terbinafine MOA
inhibits squalene epoxidase –> cannot produce Ergosterol
Timolol ophthalmic drops MOA
decreases aqueous humor production by ciliary epithelium
acetazolamide does this too
Drugs that increase outflow of aqueous humor
muscarinic agonists: pilocarpine, carbachol - increase outflow at trabecular
prostaglandin agonists = PGF2alpha - latanoprost, travoprost
Drugs that decrease aqueous humor production
timolol
acetazolamide
MOA IFN-alpha and IFN-beta
secreted in response to viral infection
decrease/stop protein synthesis of infected and nearby cells (autocrine/paracrine)
Results of defective ApoE3 and ApoE4
decreased clearance of chylomicrons and VLDL –> elevated cholesterol and TGs
eruptive palmar xanthomas (yellow nodules/papules) and premature atherosclerosis
Chronic Alcoholic Pancreatitis
abdominal pain, chronic diarrhea, weight loss due to exocrine insufficiency and malabsorption
xray shows calcifications in the apigastric area
Dietary Energy
Protein - 4cal/1g
Carbs - 4cal/1g
Fats - 9cal/1g
Ethanol - 7cal/1g
Anaplastic Features
loss of cell polarity pleomorphism - high variation in cell size and shape high N:C ratio lots of mitotic figures giant multinucleated cells
Effect of Nitrite Exposure
converts Fe2+ hemoglobin –> Fe3+ methemoglobin
Methemoglobin cannot carry oxygen, causes dusky skin discoloration
decreases oxygen carrying capacity, oxygen content, and bound fraction of oxygen
partial pressure of oxygen (oxygen dissolved in the plasma, regardless of hemoglobin content/status) remains normal
Contra-indication for fibrate therapy?
gallstones!
fibrates inhibit bile acid synthesis –> decreased cholesterol solubility –> increase precipitation of cholesterol and gall stone formation
Lesch-Nyhan
X-linked Recessive deficit in HGPRT (decreased purine salvage)
see increased PRPP (phosphoribosyl pyrophosphate amidotransferase) due to increased de-novo purine synthesis
symp: dystonia, developmental delay, self-mutilation, hyperuricemia, ‘orange sand BM’
Uric acid precipitation
collecting ducts due to low urine pH
uric acid precipitates in an acidic environment
tx - urine alkalinization - acetazolamide
Hemolytic disease of the newborn
erythroblastosis fetalis
destruction of fetal RBCs by maternal IgG due to Rh incompatibility
positive direct Coombs test (autoimmune hemolysis) anemia jaundice hydrops fetalis (massive edema) extramedullary hematopoiesis
COPD and Respiratory Drive
Chronic hypercapnia –> blunted PaCO2 response
decreased PaO2 becomes the main respiratory drive; detected by the carotid and aortic bodies
PaCO2 detected by central chemoreceptors in the medulla by decreased pH in the CSF
Superior Orbital Fissue
carries: Occulomotor Nerve (CN III) Trochlear Nerve (CN IV) Ophthalmic Nerve (CN V1) Abducens Nerve (CN VI) Superior ophthalmic vein
lesion here would cause loss of corneal blink reflex and inability to adduct eye
alpha unit of hCG is similar to
LH
also FSH
Staph aureus food poisoning
due to ingestion of lots of preformed exotoxin from picnic/potluck mayo containing foods
rapid onset (<6hrs) nausea, vom, abd cramps
also poultry, egg, meat, tuna, and dairy foods
Hypophosphorylated Rb protein
prevention of G1/S cell cycle transition
Urodynamic changes in MS
bladder hypertonia and poor distensibility due to loss of inhibition
urge incontinence and OAB aka spastic bladder
IgA nephropathy
painless hematuria 5-7 days post URI
deposition of IgA complexes in the mesangium
LM - mesangial hypercellularity
IF - IgA in the mesangium
Henoch-Schönlein purpura if extra-renal symptoms: abd pain, arthralgia, palpable purpura
Short acting insulins
Lispro
Aspart
Glulisine
peak in 0.5-3hours
given just pre-meal
MOA of hydroxyurea in HbS patients
increases hemoglobin F synthesis
MOA unknown :D
First Generation H1 blockers
hydroxyzine, promethazine, chlorpheniramine, diphenhydramine
sedative and contraindicated in older patients due to fall risk
tx: allergy, motion sickness, sleep aid
Newer H1 blockers
Loratadine, cetirizine, fexofenadine
non sedating and good for the treatment of allergy!
Tx for anaerobic pneumonia (due to aspiration)
Clindamycin!
Drugs related to Drug-Induced Lupus Erythematosus
SLE-like syndrome
Drugs that are metabolized by N0acetylation in the liver
Isoniazid
Procainamide
Hydralazine
(also:Phenytoin, Sulfa drugs)
Hydralazine
increases cGMP in smooth muscle –> vasodilation arterioles>veins (reduces afterload)
given with beta-blockers to prevent reflex tachy
MOA External beam radiotherapy
causes dsDNA breaks
Manifestation of Hyperestrinism in Liver Cirrhosis
gynecomastia
testicular atrophy
decreased body hair
spider angiomata (estrogen is arteriolar dilator)
Osteodystrophy
long-term complication of chronic renal disease
derangements in Ca and Phos –> increased PTH –> osteopenia and osteomalacia
Site of obstruction in fetal unilateral hydronephrosis
Ureteropelvic junction
Most common cause of viral meningitis?
Enteroviruses (coxackievirus A, poliovirus, echovirus)
aka aseptic meningitis
Atrial Natriuretic Peptide
Kidney: dilates afferent arteriole –> increased GFR –> increased urinary output
AND inhibits renin secretion
Adrenal Gland: decreases aldosterone secretion
Blood Vessels: relaxes smooth muscle –> vasodilates
ANP broken down by neprilysin
Resistance in Parallel
1/Rtotal = 1/R1 + 1/R2 ..etc
Prophylaxis for HIV CD4 < 200
TMP-SMX or dapsone for PCP pneumonia and toxo ghondi
Prophylaxis for HIV CD4 < 50
Azithromycin + Rifambutin for MAC
Glossopharyngeal Nerve CN IX
Sensory: tympanic membrane, tonsils, and posterior 2/3 of tongue (taste and touch) and gag reflex
Motor: stylopharyngeus
carotid body and carotid sinus
Aortic Arch Derivatives
1 2 3 4 6
1 = maxillary "maximal is first" 2 = stapedial (stapedial is second) 3 = Common Carotid (and prox internal carotid) 4 = aortic arch and prox R. subclavian 6 = pulmonary arteries and ductus arteriosus
How are viral proteins prepared for presentation on MHC-I
via ubiquitin ligase –> ubiquitin protease
Anterolateral humeral fracture (distal)
radial nerve injury
Anteromedial humeral fracture (distal)
median nerve injury
brachial artery injury
Fragile X syndrome
FMR1 gene on X chromosome
long, narrow face
prominent forehead and chin
large testes
hyperlaxity of joints of the hand
developmental delay (speech and motor) ADHD, anxiety, autism spectrum
Nerve injured during thyroidectomy
external branch of superior laryngeal - innervates cricothyroid muscle
runs with superior thyroid artery and vein
Response to High Altitude
decreased PO2 –> decreased PaO2
increased ventilation –> decreased PaCO2
decreased PaCO2 –> respiratory alkalosis
respiratory alk –> increased pH
increased RR, increased EPO, increased 2,3 BPG, increased renal excretion of HCO3-
Class III Antiarrhythmics
Decreased function of voltage gated potassium channels in cardiac myocytes
prolonged QT and prolonged action potential duration
can degenerate into torsades de pointes or v. fib
ex. Amiodarone, Ibutilide, Sotalol
Central Obesity and Pulmonary Function
Restrictive Lung Dz
Decreased: FEV, FVC, ERV, TLC
unchanged: RV
Fructose 2,6-bisphosphate
Activates PFK1 –> increased glycolysis
inhibits gluconeogenesis
Aminoglycosides
Inhibit @ 30S –> bacteriCIDAL
good for gram negative rods (esp Pesudomonas)
ARDs: nephrotoxic, ototoxic, teratogen, tendon rupture
(-mycin/micin) - gentamicin, neomycin, tobramycin
ADR of Tamoxifen
Endometrial hyperplasia and carcinoma
Hot Flashes
VTE (venous thromboembolism)
MOA Benzodiazepines
increase FREQUENCY of Cl- channel opening
“I want benzos all the time”
MOA Barbiturates
increase DURATION of Cl- channel opening
barbitDURates
Rivaroxaban
Factor Xa inhibitor
rivaroXaban also apiXaban
Direct thrombin IIa inhibitors
Dabigatran, argatrobam, bivalirubin
Wright-Giemsa stain
used to visualize reticulocytes, picks up rRNA
Age-Related Macular Degeneration
gradual vision loss due to chronic oxidative damage
grayish discoloration of the macula with areas of adjacent hemorrhage
Tx: VEGF inhibitors (bevacizumab, ranibizumab)
Meconium ileus
Cystic Fibrosis
obstructs at ileum
Acute vs Chronic Pericarditis
Acute
friction rub
Chronic
friction rub
3rd heart sound
pulsus paradoxus - drop in systolic >10 on inspiration
kussmaul sign - increased JVP with inspiration
increase venous return with inspiration