March 22 Flashcards
Origin cells of Renal Clear Cell Carcinoma
Proximal rental tubules
What Vitamin do exclusively breast fed babies need supplemented?
Vitamin D !
Also K but they get a K shot at birth
Acute hemolytic transfusion reaction
Type II Hypersensitivity
IgM/IgG bind foreign cells –>
opsonization and phagocytosis or
complement mediated cell lysis
symp: fever, chills, hypotension, dyspnea, chest/back pain, hemoglobinuria (red/brown urine)
12th rib fracture
kidney damage
kidney is immediately deep to 12th ribs
what ribs overlie the spleen
Left 9th, 10th, 11th
Fructose-6-phosphate to ribose-5-phosphate
Transketolase
generates NADPH
NADPH for glutathione antioxidant
NADPH for fatty acid, cholesterol, steroid synthesis
Glucose-6-phosphate dehydrogenase (G6PD also generates NADPH)
Thayer-Martin Media
Contains: vancomycin - inhibits gram + colistin=polymyxin - inhibits gram - nstatin - inhibits fungi trimethoprim - inhibits proteus
grows Neisseria
Areas of the brain for Deep Brain Stimulation for medically intractable Parkinson Symptoms
Subthalamic nucleus
globus pallidus internus
inhibiting there results in thalamo-cortical disinhibition and improved mobility
globus pallidus internus is inhibitory - puts the breaks on
Complication of Measles
days: encephalitis
weeks: acute disseminated encephalomyelitis
years: subacute sclerosing panencephalitis (symp: ataxia, myoclonus, visual problems - biopsy shows RNA virus with hemagglutinin)
Intraabdominal Infections (bugs)
usually polymicrobial
E. coli
B. fragilis
2 most commonly isolated
Aminoglycosides
bacteriocidal inhibition of 30S rRNA
Gentamicin, Neo/Tobra/StreptoMYCIN
good for severe gram - rod infections
ADR: nephrotoxic, ototoxic, neuromuscular blockade, teratogen
resistance: bacterail enzymes that acetylate, phosphorylate, adenylate
Tetracyclines
bacteriostatic inhibition of 30S rRNA
Tetra/doxy/minoCYCLINE
Chlamydia, borrelia burgdorferi, Myco pneumoniae
ADR: teeth and bones in children, photosensitivity, GI distress, ‘teratogen’
resistance: decreased uptake, increased efflux with transport pumps
ADRs of TB Treatment
Rifampin - GI, rash, red/orange fluids
Isoniazid - neurotoxic (give B6), hepatotoxic
Pyrazinamide - hepatotoxic, hyperuricemia
Ethambutol - optic neuropathy
How is CO preserved in chronic aortic regurg
LV hypertrophy and increased LV stroke volume
Pharmacodynamics of Regular Insulin
starts in 30 min
peaks in 2-4 hours
lasts 5-8 hours
Serotonin Syndrome
Triad:
Autonomic Instability (hyperthermia, hypertension, tachycardia) Altered Mental Status (agitation/confusion) Neuromuscular Hypersensitivity (tremor, hyperreflexia, myoclonus)
usually occurs when there is a combo of MAOi + SSRI/SNRI/TCS
Linezolid has MAOi properties, can also do this in the treatment of MRSA
tx: cyproheptadine
Complication of neonatal oxygen supplementation
retinal neovascularization that extends into the vitreous (occurs due to local hyperoxia which upregulates VEGF)
aka retinopathy of prematurity
aka retrolental fibroplasia
retinal detachment and blindness are further complications of the neovascularization
Membranous Glomerulopathy
Nephrotic
glomerular capillary wall thickening without an increase in cellularity
with silver methenamine stain: irregular spikes protruding from GBM (immune complex deposition)
Winters Formula
Used to determine respiratory compensation for metabolic acidosis
Predicted PCO2 = [1.5(HCO3-) + 8] +/- 2
if measured PCO2>Predicted then concomitant respiratory acidosis
if measured PCO2
Cyanide Toxicity
from Nitroprusside infusions
symp: altered mental status, seizures, lactic acidosis, bright red venous blood)
tx: sulfur donors - Sodium Thiosulfate
Sodium Nitrite
Hydroxycobalamin - allows for urinary excretion
Tumor Lysis Syndrome
occurs with rapid destruction of cancers with rapid cell turnover (lymphoma, leukemia, etc)
huge cell lysis –> hyperkalemia and arrhythmia AND hyperurecemia
tx: aggressive hydration, allopurinol, rasburicase (reduces uric acid levels)
Carbamazepine Barbiturates Phenytoin Rifampin Griseofulvin St. John's wort Modafinil Cyclophosphamide
CYP INDUCERS
Amiodarone Cimetidine Fluoroquinolones (-floxacin) Clarithromycin Azoles Grapefruit Juice Isoniazid Ritonavir
CYP INHIBITORS
Paraaminohippuric Acid (PAH)
~RPF
is filtered from glomerular capillaries into Bowman’s space - FILTRATION: cannot be saturated
So at any given concentration a constant proportion of PAH is filtered
it is also secreted into the PCT - SECRETION: carrier enzyme mediated and can be saturated ex. PAH max secretion is 80mg/min
Vagal maneuver
Carotid Sinus Massage, Valsalva, cold water immersion
Carotid sinus massage
afferent via glossopharyngeal
efferent via vagus nerve –> SA and AV nodes
increases vagal PNS tone –> slowed conduction through AV node and prolonged AV nodal refractory period
terminates supraventricular tachycardia
Central Retinal Artery Occlusion
sudden, painless, permanent monocular blindess
pale retina
cherry red macula (has seperate blood supply)
Glomus tumor
bluish neoplasm underneath the nail bed
glomus body = vasculature and smooth muscle cells that shunt blood flow away from skin surface @ cold to prevent heat loss
thermoregulatory
Pterion
junction of frontal, parietal, temporal, sphenoid bones
fractures here risk laceration of Middle Meningeal Artery –> Epidural Hematoma (lens shaped)
Middle meningeal artery is a branch of the Maxillary Artery
external carotid –> maxillary –> middle meningeal
Splenic artery (origin and branches)
celiac artery –> splenic artery –> (pancreatic, short gastric, Left gastroepiploic) –> spleen organ
gastric tissue supplied by short gastric A. (the fundus of the tummy) is vulnerable to ischemic injury with splenic artery occlusion
Breast Dimpling is a sign of breast carcinoma invasion of the ___?
Suspensory ligament of the breast aka Cooper ligament
Acetyl-CoA regulation of Pyruvate metabolism
Excess Acetyl-CoA (from fatty acid oxidation)
promotes Pyruvate Carboxylase: pyruvate –> OAA –> glucose
inhibits Pyruvate Dehydrogenase: pyrivate –> Acetyl-CoA –> energy!
Acetyl-CoA is pro-gluconeogenesis
Acetyl-CoA is anti-TCA cycle
Golgi Tendon Organ
at the junction of muscle and tendon
detect active muscle contraction (insensitive to passive stretching of muscle)
if too much contraction occurs (too much force on the tendon) –> inhibition of muscle contraction! muscle relaxes to prevent tendon rupture
McCune-Albright syndrome
Mosaicism
constitutive activation of Gs
Precocious puberty, unilateral cafe-au-lait spots, polyostotic fibrous dysplasia (bones look like clouds on xray)
lethal as a germline mutation
survivable due to mosaicism
Kallmann Syndrome
Defective migration of GnRH cells and formation of olfactory bulb
anosmia (poor sniffer)
failure to complete puberty due to decreased GnRH –> decreased FSH and LH
Buprenorphine
partial opioid agonist, binds with high affinity and can prevent/dislodge bound opioids
acts as receptor antagonist in the presence of full opioid agonists
can precipitate withdrawal
used in conjunction with methadone
Methadone
opioid with long half life used to decrease symptoms of withdrawal without giving a ‘high’
Nalaxone
Narcan
can reverse opioid overdose
Naltrexone
long-acting opioid antagonist, prevents relapse
can be used in recovering narcotic addiction or alcoholic
Gram negative rod
lactose fermenting
indole positive
E. coli
Gram negative rod
lactose fermenting
indole negative
Enterobacter cloacae
Topical Vitamin D analogs
Calcipotriene Calcipotriol Calcitriol Tacalcitol
activate Vitamin D receptor which is a nuclear transcription factor –> inhibition of keratinocyte proliferation and stimulation of keratinocyte differentiation
tx for psoriasis
Auer Rods
APML
myeloblasts - large cells with abundant basophilic cytoplasm with auer rods that stain for (myelo)peroxidase
Baclofen
GABA-B agonist
tx for spasticity @ brain and spinal cord disease (MS patients)
Digoxin effects on ANS
increases parasympathetic tone –> inhibition of AV node –> decreased HR
Cromolyn
inhibit mast cell degranulation independent of the stimulus (prevents exocytosis of preformed histamine vesicles)
second line therapy for asthma
polyribosylribitol phosphate
PRP
component and virulence factor of Haemophilus influenae type b capsule
Hib is the most common cause of epiglottitis (fever, stridor, dyspnea)
Paradoxical embolism
originate in the systemic circuit –> intracardiac shunt –> arterial circulation –> stroke
intracardiac shunts:
patent foramen ovale
ASD - wide fixed splitting S2 (no change with inspiration
VSD
wide splitting S2 that does not change with respiration
Atrial Septal Defect
Diastolic decrescendo murmur that decreases with nitrates
aortic regurg - gets better with decreased afterload
ejection systolic murmur that increases on standing
hypertrophic cardiomyopathy (worsens due to increased LV outflow tract obstruction)
ejection systolic murmur that decreases with standing
aortic stenosis
pre-systolic murmur that disappears with atrial fibrillation
mitral or tricuspid valve stenosis
last systolic crescendo murmur with midsystolic click
mitral valve prolapse
Botulinum toxin
inhibits ACh release from the presynaptic nerve - blockade can be overcome via facilitation
nicotinic blockade: flaccid paralysis (diplopia, dysphagia)
muscarinic blockade: dry mouth (hot as a hare, red as a beet, dry as a bone, etc)
3 D’s: Diplopia, Dysphagia, Dysphonia
tx: antitoxin
Reactive Arthritis
Urethritis, Conjunctivitis, Arthritis
can’t pee, can’t see, can’t climb a tree
associated with HLA-B27
from infections with Chlamydia, Salmonella, Shigella, Yersinia, Campylobacter, Clostridium difficile
Myotonic Dystrophy
trinucleotide repeat disease (CTG)
myotonia (sustained muscle contraction)
muscle weakness and atrophy (esp Type 1 fibers)
cataracts
frontal balding and gonadal atrophy
Atypical depression
leaden paralysis - arms/legs feel heavy
mood reactivity - feel better with positive events
rejection sensitivity - hypersensitive to criticism
Treatment for Atypical Depression (and treatment-resistant depression)
MAOi: Phenelzine, Selegiline, Tranylcypromine
inhibit MAO deamination of 5-HT, NE, DA
ADR: serotonin syndrome, HTN crisis
Latissimus dorsi
Innervation: Thoracodorsal N.
Actions: extension, adduction, medial rotation humerus
CREST syndrome
Calcinosis - Ca deposition in soft tissue
Raynaud
Esophageal dysmotility
Sclerodactyly - thickening and tightening of skin @ fingers and toes
Telangiectasia
pulmonary arterial hypertension –> cor pulmonale
anti-centromere antibodies
Treatment for Bipolar Disorder
Lithium Valproate Quetiapine Carbamazepine Lamotrigine - good for depression prevention
Diastolic Heart Failure
Normal LV Ejection Fraction
Normal LV End-Diastolic Volume
Increased LV filling pressure
impaired relaxation: ischemic/fibrotic myocardia
ventricular wall stiffness: amyloid deposition, hypertrophy
Necrotizing Enterocolitis
‘thin curvilinear areas of lucency that parallel the bowel wall lumen’
areas of lucency are gas
occurs in preterm infants
anti-inflammatory that does NOT impair platelet aggregation
Celecoxib - COX 2 selective
Secretin
S cells duodenum –> increased pancreatic secretion of bicarb by pancreatic duct cells
released in response to high H+ in the duodenum
ADR of mannitol
can cause pulmonary edema
Ureter is immediately anterior to
internal iliac artery
Ureter is immediately posterior to
gonadal vessels
Friedreich Ataxia
kyphoscoliosis
high plantar arch
degeneration of the spinocerebellar tract and lateral corticospinal
hypertrophic cardiomyopathy and congestive heart failure
trinucleotide repeat (GAA) of frataxin gene Chr9
Frat bro thats always staggering and falling but has a sweet big heart
Frataxin Staggering gait frequent falls diabetes hypertrophic cardiomyopathy
gliosis
astrocytes
LH
FSH
LH –> Leydig –> Testosterone
FSH –> Sertoli –> inhibin B and ABG
Hemolytic Uremic Syndrome
microthrombi in small blood vessels
after infection with E. coli O157:H7 or Shigella
as RBCs bind O2 they release
Haldane effect
H+ and CO2
S1-S2
tie you shoe
achilles
L3-L4
kick the door
patellar
C5-C6
pick up sticks
biceps
C7-C8
lay them straight
triceps
