May 23 Flashcards
which step of the citric acid cycle requires thiamine
conversion of a-ketoglutarate to succinyl CoA by a-ketoglutarate dehydrogenase complex (also requires NAD+, both of which are degreased in alcohol intox)
why must you be care when administering glucose to alcoholics
they are often thiamine deficient which can then lead to Wernicke encephalopathy due to the increased thiamine demand (acute confusion, opthalmoplegia and ataxia)
which disorder is characterized by a sphingomyelinase deficiency and what are its charateristics
Niemann-pick
causes hepatosplenomegaly, neurologic regression (neurodegeneration), and macular cherry-red spots
how do you diagnosis Kawasaki disease?
fever for more than 5 days plus 4 of the following:
- bilateral non-exudative conjunctival injection
- cervical lymphadenopathy
- mucositis (erythema of the palatine mucosa, fissured erythematous lips, strawberry tongue)
- extremity changes: edema of the hands and feet, erythma of the palms and soles, desquamation of the fingertips
- rash: polymorphous usually urticarial on the extremities and spreads to the trunk
what is a serious complication of kawasaki disease
coronary artery aneurysm due to coronary artery inflammation
what is the most effective type of drug for hypertriglyceridemia and what is its MOA
fibrates - activate PPAR-a which decreases VLDL synthesis
which receptors does NE activate
a1- vasoconstriction (Gq)
a2 - decreased NE and insulin secretions (Gi)
B1 - increases cardiac contractility (Gs)
what is the protein defect in familial chylomicronemia syndrome (type 1), what lipoprotein is elevated in the serum and what is the main manifestation
lipoprotein lipase and ApoC-II are defective causing increased chylomicrons and causing recurrent acute pancreatitis in childhood
what histopathology is characteristic of a mesothelioma?
epithelioid tumor cells with numerous long slender microvilli and abundant tonofilaments
which structures does the 3rd aortic arch give rise to and which nerve is it associated with
common carotid artery and prox internal carotid artery and its associated with the glossopharyngeal nerve (CN IX)
which aortic arch gives rise to the true aortic arch and what else does it form and what nerve is it associated with
4th arch also gives rise to the subclavian arteries and is associated with the superior laryngeal branch of the vagus nerve
which aortic arch forms the pulmonary arteries
6th (also forms the ductus arteriosus) associated with the recurrent laryngeal branch of the vagus
which electrophoresis method should be used to detect if a gene is being expressed
Northern block to detect mRNA
what type of sample is analyzed in a southern blot
DNA
what type of sample is analyzed in a western block
protein
what type of sample is analyzed in a southwestern block
DNA-bound protein
what type of sample is analyzed in a northern blot
mRNA
how do you treat a TCA overdose
Sodium bicarbonate (works by increasing serum pH and extracellular sodium alleviating fast sodium channel blockade)
how does a TCA overdose present
QT-prolongation, mental status change, seizures, prolonged QRS duration, ventricular arrhythmias, and anticholinergic findings
what causes a jejunal/ileum atrisia in utero
vascular occlusion in utero (terminal ileum ends up spiraled around an ileocolic vessels causing an “apple-peel” apearence
what test is used to confirm malabsorption
stool test with Sudan III stain (identifies unabsorbed fat)
what is diphenoxylate and loperamide used for and what is their MOA
its an opioid anti-diarrheal drug, that binds mu opiate receptors in the gut to slow motility
what 3 factors are the best measures of liver function
serum albumin levels, bilirubin levels, and prothrombin time These are the best prognostic indicators in pts with cirrhosis. (AST and ALT measure liver injury)
which gastric layer are the parietal cells located
in the upper glandular layer (below the epithelium) of the body and fundus
what gastric layer are the chief cells located? and what do they secrete
the deep glandular layer - they secrete pepsinogen `
describe how astrocytes are affected by hepatic encephalopathy
ammonia in the blood is taken up by the astrocytes and used to turn glutamate into glutamine, that is normally transferred to the neurons which convert it back to glutamate. The excess ammonia increases glutamine synthesis in the astrocyte which increases the intracellular osmolarity causing swelling and impaired glutamine release which decreases the amount of glutamine available to the neurons and disrupts excitatory neurotransmission
if someone drinks pesticides/insecticides what are the common symptoms and what is the treatment
symptoms: garlic breath, vomiting, watery diarrhea, QTc prolongation
tx: Dimercaprol or DMSA (this is arsenic poisoning)
what is the common tumor marker for hepatocellular carcinoma
Alpha fetoprotein
what is the common tumor marker for pancreatic carcinoma
CA-19.9
what is the common tumor marker for colorectal cancer
CEA - Carcinoembryonic antigen
what location of colon cancer is more likely to present as iron deficiency anemia
right sided/ ascending colon
which location of colon cancer is more likely to present as obstruction
left sided (rectosigmoid)
H. pylori is most commonly found in what part of the stomach and is most likely to cause ulcers where
antrum / prepyloric area - ulcers are most likely in the duodenum
what is heparins antidote
Protamine (binds heparin to form an inactive complex)
what is schizoaffective disorder
major depressive or manic episode concurrent with symptoms of schizophrenia/ Lifetime history of delusions or hallucinations for > 2 weeks in the absence of major depressive or manic episodes. mood symptoms are present for majority of illness, not due to substances or other medical conditions
where are the 3 leads placed in a biventricular pacemaker
right atrium, left ventricle, and the atrioventricular groove (stimulates left ventricle)
which symptoms of Graves disease are not seen in other causes of hyperthyroidism
infiltrative dermopathy (pretibial myxedema), exophthalmos, periorbital edema, and eye movement limitations
which nerve innervates the deltoid
axillary nerve
How does axillary nerve damage occur and typically present
typically occurs from shoulder trauma, and presents with sensory loss over the lateral shoulder and weakness on shoulder abduction (due to denervation of the deltoid muscle)
where would a stroke occur to cause pure hemisensory loss
ventral posterior thalamus (VPL and VPM)
what are the symptoms and exam findings for fibromyalgia
widespread musculoskeletal pain, fatigue, impaired attention and concentration, psychiatric disturbances, symptoms lasting > 3 months.
exam findings: multiple tender pints at characteristic locations, absence of joint or muscle inflammation
what does mullerian inhibiting factor dO
causes regression of the paramesonephric (mullerian) ducts that normally give rise to the internal genitalia in the female fetus
what are typical symptoms of Gaucher disease
bone pain, abdominal distension due to hepatosplenomegaly, easy bleeding and bruising, pallor and fatigue due to pancytopenia
