March 29 Flashcards
Anti arrhythmic that can cause 2nd degree AV block
diltiazem and verapamil
also cause constipation, bradycardia
Polycythemia vera
intense itching after hot shower, facial plethora (reddish complexion), splenomegaly
increased: RBCs, WBCs, Platelets
JAK2 mutation –>
JAK is an cytoplasmic receptor tyrosine kinase; EPO receptor signal transduction –> JAK2 –> clonal proliferation of myeloid cells
Cytoplasmic tyrosine kinase
aka non-receptor tyrosine kinase
JAK2/STAT
implicated in polycythemia vera, primary myelofibrosis, myeloproliferative disorders
prolactin, IL-2, IL-6, IFN, GH, EPO
Intrinsic receptor tyrosine kinases
receptors for insulin, insulin-like growth factor, and epidermal growth factor (EGFR)
think growth factors: IGF-1, FGF, PDGF, EGFR
Glucagonoma
rare pancreatic alpha cell tumor
causes DM and necrolytic migratory erythema
necrolytic migratory erythema - painful and pruritic rash @ face/groin/extremities
“crusting and scaling at the borders with central areas of brownish induration” + superficial necrolysis
VIPoma
WDHA
Watery Diarrhea Hypokalemia Achlorhydria
Dog Bite
Pasteurella multocida
gram negative cocobacillus
mouse smell on culture
mouse-like odor = indole+
cellulitits at site of bite
Fight Bite (human)
Eikenella corrodens
Cat Bite
Pasteurella multocida (cellulitis) Bartonella henselae (lymphangitis)
Autosomal Dominant Polycystic Kidney Disease
85% due to mutation PKD1 @ Chr16
15% due to mutation PKD2 @ Chr4
associated with berry aneurysm (–> subarachnoid hemorrhage), mitral valve prolapse, hepatic cysts
tx: ACEi or ARB
most common cause of bacterial meningitis in adults
Strep pneumo
Transtentorial aka Uncal Herniation
ipsilateral mass lesion (hemorrhage or brain tumor) esp @ temporal lobe
first sign is impingement on CN III –> fixed dilated pupil (ipsilateral) + ptosis + down and out gaze
Hereditary Orotic Aciduria
defect in uridine 5’-monophosphate synthase –> elevated orotic acid levels - defect in pyrimidine synthesis
delayed developmental milestones and megaloblastic anemia
Uridine supplementation
Ligamentum Flavum
thickening can cause central spinal stenosis and compression of nerve roots –> pain/numbness/paresthesia
located between cord and spinus processes
posterior rostral pons at the lateral floor of the fourth ventricle
locus ceruleus
produces norepinephrine
Rifampin
inhibits DNA dependent RNA polymerase
hippocampus and cerebral arterioles with patchy red deposits that turn green under polarized light
Alzheimers
beta amyloid plaques
Crohns
mediated by Th1 –> granulomatous inflammation
hyperemic and edematous bowel, cobblestone appearance, non-caseating granuloma, transmural inflammatory infiltrate
risk of kidney stone due to hyperoxaluria
Risk Factors for Nephrolithiasis
Low fluids Low Calcium High Oxalate (spinach) High ProteinHigh Sodium High Fructose
Gout –> hyperuricosuria
Crohns –> hyperoxaluria
hyperPTH –> hypercalciuria
low urinary citrate (chronic metabolic acidosis like diarrhea)
Myocardial hibernation
chronic myocardial ischemia causes decreased metabolic rate and function of myocardium
@ reperfusion/revascularization the hibernating myocardium improves contractility and LV function!
Fluphenazine
DA antagonist
treatment for Tourette syndrome
tics are often temporarily suppressible and often preceded by an urge to make movement/noise
extrapyramidal side fx
Diverticula
True vs False
Traction vs Pulsion
True = all layers Mucosa-Submucosa-Muscularis-Serosa (Meckel’s)
False = Psuedo - no muscularis (Zenker’s)
Pulsion are caused by increased intraluminal pressure @straining for BM
Most adult diverticulum are false and pulsion
TB treatment that must be activated by mycobacterial catalase peroxidase
INH
activated by intracellular catalase peroxidase - mechanism of resistance
Halothane hepatitis
acute hepatitis post-op due to halogenated inhaled anesthetics like desflurane
elevated AST, ALT and bilirubin + centrilobular necrosis
D-alanine-D-alanine
structurally similar to penicillin
what vancomycin binds to
Ree-Sternberg cells
CD15+ and CD30+
Hodgkin lymphoma
peak in 20y/os and 60y/os
B-cell lymphoma
associated with EBV infection
Opioid OD
miosis, decreased RR, decreased HR, decreased BP, decreased bowel sounds
give naloxone
“watershed” area of kidney
proximal tubules
ischemia –> acute tubular necrosis (increased serum Cr and BUN but normal ratio)
straight portion of proximal tubule and thick ascending limb of Henle are most susceptible to hypoxia b/c they have active (ATP) transport of ions = increased O2 demands
Muddy brown casts
Acute Tubular Necrosis (most often due to cardiogenic shock)
Erosion vs Ulcer
Erosion stays in mucosa and muscularis mucosa
ulcers go deeper: mucosa-muscularis mucosa-submucosa and even muscularis propria
Placental abruption
seperation of placenta from uterus while baby is still in utero –> DIC
DIC of pregnancy mediated by tissue factor (from placental injury) –> activation of coag cascade
Familial hypocalciruic hypercalcemia
autosomal dominant disorder to Calcium-sensing receptors (which are transmembrane GPCR) - high serum calcium required to activate defective calcium sensors - raised set point of calcium induced regulation (inhibition) of PTH
Fenoldopam
D1 agonist
for HTN crisis
vasodilator (esp at coronary, pheripheral, renal, splanchnic)
promotes natriuresis
NNRTIs
Efavirenz
Nevirapine (CYP inducer)
Delavirdine
Integrase Inhibitors
-TEGRAVIRs
Dolutegravir
Elvitegravir
Penetration Inhibitors
Enfuviritide
binds GP41
Attachment Inhibitors
Maraviroc
binds CCR5
Hormone Sensitive Lipase
converts TG
- -> glycerol –> gluconeogenesis –> glucose
- -> free fatty acid –> lipolysis –> ketones
Aortic Dissection
severe retrosternal chest pain that radiates to the back
inciting event: tear in aortic intima
HTN is primary risk factor
HTN ==> medial hypertrophy –> reduced blood flow –> medial degeneration –> aortic enlargement and increased wall stiffness –> increased wall stress –> tear –> dissection
Paroxysmal nocturnal hemoglobinuria
mutated PIGA gene –> decreased GPI –> decreased surface proteins:
CD55 = DAF (decay accelerating factor) CD59 = MAC inhibitory protein
without these you get too much complement-mediated hemolysis
symp: hemolytic anemia, hemoglobinuria, thrombosis (hepatic, portal cerebral veins), pancytopenia
hemosiderosis - iron deposition in the kidney due to chromic hemolysis –> PCT dysfunction
Schiller-Duval body
yolk sac tumors
resemble glomeruli
congenital hypothyroidism
generally due to thyroid dysgenesis (agenesis, hypoplasia, ectopy)
symp: lethargy, poor feeding, constipation, hypotonia, umbilical hernia, protruding tongue, large fontanelle
Hemochromatosis
Autosomal recessive, abnormally high iron uptake
liver disease, hepatomegaly, abd pain, hyperpigmentation
“bronze diabetes” = DM, pigment cirrhosis, and hepatomegaly
