March 18 Flashcards
Same alpha subunit as hCG
LH, FSH, TSH
Heteroplasmy
Reason mitochondrial diseases have clinical variability
mixture of genetic material cause mt are always fusing and dividing
Segment of the nephron that is IMPERMEABLE to water (regardless of ADH)
ascending loop of Henle
water flows downhill
Strep pneumo
gram positive lancet shaped diplococci in pairs
alpha hemolytic
optochin sensitive
bile soluble
Traumatic Aortic Rupture
At Aortic Isthmus due to tethering of Ligamentum arteriosum (just past Left subclavian)
Legionella outbreaks
colonization of the water supply
Dermatomyositis is associated with
Malignancy
lung, colorectal, ovarian, non-hodgkin lymphoma
MOA of Tricyclic Antidepressants
block reuptake of NE and 5-HT
tx: depression, OCD, peripheral neuropathy, chronic pain
ADR: Tri-C’s Convulsions, Coa, Cardiotoxicity, anticholingeric, alpha-1 block –> postural hypotension
OD tx: sodium bicarb to prevent arrhythmia
Tumor Stage and Grade
Stage > Grade for prognosis
stage: local tissue invasion, LN involvement, metastasis
grade: cellular description (well differentiated –> anaplastic)
Rate Control
AV nodal blocking drugs
beta blockers
calcium channel blockers
good for tx of Paroxysmal Atrial Fibrillation
Rhythm Control
Antiarrhythmics (sotalol, flecainide, amiodarone)
Class III Antiarrhythmics
Potassium Channel Blockers
A - amiodarone (pulm fibrosis, thyroid)
I - ibutilide
D - dofetilide
S - sotalol
prolong repolarization in cardiac myocytes
prolong AP duration, prolong QT interval
tx: A fib, A flutter, ventricular tachy
ADR: torsades do pointes -> V fib
Intracellular electrolyte derangements in CF
increased Cl- causes increased Na+ and water
Why is Ca++ elevated in sarcoidosis
activation of macrophages –> increased 1-alpha-hydroxylase activity in macrophages –> PTH independent production of 1,25-dihydrovitaminD –> increased intestinal absorption of Ca++
MOA Liver injury in HBV
HBsAg and HBcAg are loaded into MHC-I of infected hepatocytes –> CD8+ T-cells –> destruction of hepatocytes
HBV does not have a cytopathic effect.
Work of breathing in Restrictive vs Obstructive Pulmonary disease
Restrictive (Pulmonary Fibrosis) - least work with high RR and low TV - fast and shallow breaths - stiff lungs are hard to distend
Obstructive (asthma, COPD) - least work with low RR and high TV - slow deep breaths
Histology of Chronic Lung Transplant Rejection
aka Bronchiolitis obliterans
lymphocytic inflammation and destruction of the small airways (bronchioles) –> fibrinopurulent exudate and granulation tissue –> fibrosis and scarring
Histology of Acute Lung Transplant Rejection
perivascular and interstitial mononuclear cell infiltrate
Hypertensive Emergency
end-organ damage, papilledema, encephalopathy (altered mental status), acute kidney injury (increased Cr)
tx: Fenoldopam - D1 receptor agonist –> increased cAMP –> vasodilation!!
decreased systemic blood pressure
increased renal perfusion –> increased urine output
Familial chylomicronemia
Familial hypertriglyceridemia due to LPL deficiency
plasma looks milky, forms creamy supernatant, lipemia retinalis (milky appearing retinal vasculature)
risk of Acute Pancreatitis!
no increased risk for CAD
Nicotinic Receptors
Ligand gated ION channels
activation (perhaps with ACh at neuromuscular junction) allows:
Na and Ca to flow IN
K+ to flow OUT
Most common cardiac anomaly in Down Syndrome
complete atrioventricular canal defect
failure of endocardail cushion fusion –> ostium primum ASD + VSD + single AV valve
RNA Pol I location and function
Nucleolus for rRNA
Negative Skewed Distribution Curve
bulk is shifted to right
mean
Positive Skewed Distribution Curve
bulk is shifted left
mode
Croup
Laryngotracheitis
Paramyxoviridae - parainfluenza virus
barking cough and stridor
PFTs for COPD
TLC: increased
FEV/FVC: decreased
FVC: decreased
RV: increased
overinflated, can’t move air very well
Wolff-Parkinson-White
AV conduction tract bypassing AV node - AV accessory pathway
short PR
Wide QRS
delta wave- broad upstroke of QRS
Class IA antiarrhythmics
Quinidine, Procainamide, disopyramide
Block Na - decrease height of phase 0
Block K - prolong AP @ phase 3
depress phase 0 depolarization
Lactase Deficiency
aka Lactose Intolerance
osmotic diarrhea
decreased stool pH
increased stool osmolality
increased breath hydrogen content
Attachment of Posterior Cruciate Ligament
PCL attaches at medial epicondyle of femur –> intercondylar area
PCL is Posterior to ACL
Attachment of Anterior Cruciate Ligament
ACL attaches at lateral epicondyl of femur –> intercondylar area
ACL is Anterior to PCL
Innervation of Anterior 2/3 of tongue
Taste = Chorda Tympani of Facial CN VII Sensation = Mandibular of Trigeminal CN V3 Motor = hypoglossal CN XII
Innervation of Posterior 1/3 of tongue
Taste = Glossopharyngeal CN IX Sensation = Glossopharyngeal CN IX Motor = Hypoglossal CN XII
Causes of High Renin and High Aldo
in HTN with low K
Secondary HyperAldo
renin-secreting tumor (JG tumor)
diuretics
malignant HTN
Causes of Low Renin and High Aldo
in HTN with low K
Primary HyperAldo
Aldo producing tumor
adrenal hyperplasia
Causes of Low Renin and Low Aldo
in HTN with low K
Non-Aldo causes
congenital adrenal hyperplasia
Cushing syndrome
exogenous mineralocorticoids
Acute dystonic reaction
ADR of D2 antagonists
Haloperidol, fluphenazine
Causes of Polyhydramnios
Esophageal/Duodenal/Intestinal Atresia
Anencephaly (increased risk with anti-epileptics)
impaired fetal swallowing
OR
increased fetal urination due to uncontrolled GDM, parvovirus infection
Causes of Oligohydramnios
Renal agenesis, ARPKD
impaired fetal urination
POTTER sequence Pulm Hypoplasia Oligohydramnios Twisted Face Twisted Skin Extremity defects Renal Failure (in utero)
Aortic Regurg
Widened pulse pressure
–> head bobbing
diastolic murmur heard at left sternal boarder
Hydrocephalus ex-vacuo
Hydrocephalus (enlargement of the ventricles) due to neuronal loss
seen in patients with Neurodegenerative disease (AIDs dementia)
Markers of Precursor B-cells
CD19
CD10
TdT - all lymphs
Markers of Precursor T-cells
CD1
CD2
CD5
TdT - all lymphs
MAOi
Selegiline, Phenelzine, Tranylcypromine
irreversibly bind MAO and prevent breakdown of amine neurotransmitters (NE, 5-HT, DA)
wait 2 weeks for MAO regeneration before starting SSRI
must avoid Tyramine containing foods - Wine and Cheese - for else HTN crisis
de Quervain thyroiditis
Subacute Granulomatous Thyroiditis
painful enlargement of the thyroid following acute viral illness
causes transient hyperthyroid (weeks) followed by hypothyroid (months) –> full resolution
biopsy: lymphocytic infiltrate with macrophages and multinucleated giant cells
Thiazolidinedione
pioglitazone
improves insulin sensitivity
enters nucleus and binds PPAR-gamma + RXR (retinoid X receptor) –> altered gene transcription
increased Fatty Acid uptake
Increased adiponectin (secreted by fat tissue, increases insulin sensitivity and fatty acid oxidation)
Increased insulin sensitivity (@muscle and liver)
decreased TNF-alpha
Decreased Leptin
Thrombotic Thrombocytopenic Purpura
decreased ADAMTS13 –> vWF multimers –> microvascular thrombi (platelet rich) = impaired vWF cleavage
hemolytic anemia with schistocytes
thrombocytopenia (increased bleed time with normal PT and PTT)
+/-
renal failure / acute kidney injury
neurologic symptoms like sensory loss
Reported measure of case-control study
Exposure Odds Ratio
ex. people with Dz and people without Dz vs exposure and non-exposure
Reported measure of cohort study and clinical trials
Median Survival
those receiving treatment vs placebo
Reported measure of cross-sectional study
Prevalence odds ratio
prevalence of disease in different populations
Inheritance of NF-1
single gene autosomal dominant
NF-1 on Chr17
Antioxidant enzymes
Superoxide Dismutase
Glutathione peroxidase
Catalase
get rid of ROS –> water + O2
ROS cause lipid peroxidation, protein damage, DNA breaks
Acute Epiglottitis
due to Hib infection (Haemophilus influenza type b)
dysphagia, drooling, fever, cherry red epiglottis
Extrinsic Pathway of Apoptosis
FasL binds Fas receptor (CD95)
-or-
TNF-alpha binds TNF
–> activation of caspase 8 and 10
occurs in negative selection in thymus
Intrinsic Pathway of Apoptosis
Bcl-2 - antiapoptotic
BAX and BAK - proapoptotic
Bcl-2 binds cytochromeC, preventing apoptosis
p53 activates BAX/BAK - proapoptotic
low Bcl-2 allows cytochrome C to bind APAF-1 –> activation of Caspase 9 –> apoptosis
Potassium Iodide
given to prevent uptake of radioactive iodine @ thyroid
ex. radiation exposure
MAO capsaicin
depletion of Substance P –> decreased nociception!
Shigella
Gram negative rod
Lactose non-fermentor = white colonies on MacConkey agar
Oxidase negative
no H2S production on TSI agar = not black colonies
mucosal invasion is pathogenic mechanism - invades via M cells –> spreads laterally to epithelial cells
watery –> bloody and mucus stools
Shiga Toxin - inactivates 60S rRNA
tx: ampicillin or TMP-SMX
Lesion causing Right Homonymous Hemianopia
Left Optic Tract (between optic chiasma and LGN)
cannot see things on the right side
Decreased leukocyte alkaline phosphatase
CML
t(9:22) = BCR-ABL
Cells that perform glycolysis and only sometimes produce ATP?
RBCs
can do glycolysis to produce ATP
-or-
skip ATP production to produce 2,3-BPG - allows for increased O2 delivery to tissues
increased 2,3-BPG with RIGHT shift
Wide Fixed splitting of S2 regardless of inspiration
ASD
can result in Eisenmenger syndrome - irreversible changes to pulmonary vessels
Secreted with neurophysins
ADH and oxytocin
Effects of Nitrates
vascular smooth muscle relaxation (veno>arterial)
reduced preload = decreased LV end-diastolic pressure and volume
reduced afterload due to arterial vasodilation
MOA Verapamil and Diltiazem
Block Ca Channels
slow phase 4 depolarization @ SA and AV nodes
treatment for paroxysmal supraventricular tachycardia
Screening for THF-alpha inhibitors
Must be evaluated for latent TB
TNF-alpha allows cell-mediated immunity - keeps latent TB in check
infliximab, etanercept
Phentolamine
alpha-1 blocker
counteracts NE vasoconstriction, like if a pt is getting NE infusion and infusion site turns pale
ADR of Methotrexate
oral and GI ulcers hair loss pancytopenia hepatotoxicity (hepatitis, fibrosis, cirrhosis) pulmonary fibrosis
rescue with leucovorin!
MOA Diabetic Neuropathy
diabetic microangiopathy (due to endoneural arteriole hyalinization) –> nerve ischemia
aka vessels undergo non-enzymatic glycosylation –> narrowing and hyalinization
PrP
causes Prion Dz in beta-pleated sheet conformation
see spongiform transformation of gray matter on biopsy
Nerve carrying Pleuritic Chest Pain
Phrenic
innervates Parietal Pleura @ mediastinum and diaphragm
Primary TB
lower lobe
calcified LN
small fibrosis
Ghon complex
Secondary TB
cavitary lesion in the Upper Lobe
-aka-
apical cavitary lesion
