Miscellaneous Flashcards
What is the amino acid precursor of Heme?
Glycine
Glycine -(B6)> Porphyrin -> Heme
What is the amino acid precursor of Histamine?
Histidine
Histidine -(B6)>Histamine
What is the amino acid precursor of NAD+/NADP+?
Tryptophan
Tryptophan -(B6)> Niacin -> NAD+/NADP+
What is the amino acid precursor of Melatonin?
Tryptophan
Tryptophan -> Serotonin -> Melatonin
What is the amino acid precursor of GABA?
Glutamate
Glutamate -(B6)> GABA
What is the amino acid precursor of Glutathione?
Glutamate
Glutamate -> Glutathione
From the spinothalamic tract & dorsal columns: Pain, temp, touch, pressure and proprioception to primary somatosensory cortex
Ventral Posteriolateral Nucelus (VPL thalamus)
What is the amino acid precursor of Epinephrine
Phenylalanine
Phenylalanine -(BH4)> Tyrosine -(BH4)> Dopa -(B6)> Dopamine -(Vit C)> Norepinephrine -(SAM)> Epinephrine
From the trigeminal & gustatory tracts: Face sensation & taste to primary somatosensory cortex
Ventral Posteriomedial Nucleus (VPM thalamus)
What vitamin has the name Thiamine?
Vitamin B1
“The Rich Never Pan Pyrite-Filled Creeks”
From the optic tract: Vision to calcarine sulcus (occipital lobe)
Lateral Geniculate Nucleus (LGN thalamus)
What vitamin has the name retinol/retinal?
Vitamin A
From the superior olive and inferior colliculus of tectum: Hearing to the auditory cortex of the temporal lobe
Medial Geniculate Nucleus (MGN thalamus)
What vitamin has the name Pantothenic Acid?
Vitamin B5
“The Rich Never Pan Pyrite-Filled Creeks”
From basal ganglia: Motor to motor cortex and premotor cortex
Ventral Lateral Nucleus (VL thalamus)
What vitamin has the name Pyridoxine?
Vitamin B6
“The Rich Never Pan Pyrite-Filled Creeks”
What vitamin has the name alpha-tocopherol?
Vitamin E
What vitamin has the name Folic acid?
Vitamin B9
“The Rich Never Pan Pyrite-Filled Creeks”
What vitamin has the name Niacin?
Vitamin B3
“The Rich Never Pan Pyrite-Filled Creeks”
What vitamin has the name Riboflavin?
Vitamin B2
“The Rich Never Pan Pyrite-Filled Creeks”
What vitamin has the name Ascorbic Acid?
Vitamin C
What vitamin has the name Cobalamin?
Vitamin B12
“The Rich Never Pan Pyrite-Filled Creeks”
What drug can lead to a deficiency in B6 as well as B3?
Isoniazid
- What disease is caused by niacin deficiency?
- What are the symptoms?
- Pellagra
- Dermatitis, Diarrhea, & Dementia
What is the amino acid tryptophan a precursor of
- Niacin
- NAD/NADP
- Serotonin
- Melatonin
What is the role of pantothenic acid in metabolism?
Pantothenic acid (vitamin B5) is a component of Acetyl-CoA which functions in the transfer of acyl groups
What is the metabolic role of biotin
Biotin (B7) is an apoenzyme in carboxylation reactions
“Buy-a-tin of CO2”
What 4 GI problems are associated with Down Syndrome?
- Duodenal atresia
- Hirschsprung disease
- Annular pancreas
- Celiac disease
What are the indications for Metronidazole?
“GET GAP on the Metro”
- Giardia
- Entamoeba
- Trichomonas
- Garderella vaginalis
- Anaerobic bacteria
- Pylori (H. pylori)
What are 2 important adverse effects of metronidazole?
- It causes a disulfuram reaction with alcohol consumption
- Teratogenic
Which nerve(s) innervate the diaphragm?
“C3, C4, C5 keeps the diaphragm alive”
Innervation of the diaphragm is by the phrenic nerve (composed of Cranial nerves 3, 4, and 5)
- What medium is used to culture mycobacterium?
- How long does it take to culture?
- Lowenstein-Jensen Agar
- Takes 2-4 weeks
What is the treatment for Mycobacterium Leprae?
Rifampin, Clofazimine, and Dapsone (Dapsone may exacerbate G6PD deficiency)
What is the only agent used as solo prophylaxis in TB?
Isoniazid
What is the treatment for latent TB?
Isoniazid for 6-9 months
- What antibiotic is used for prevention of Mycobacterium avium-intracellulare (MAI)?
- When should prophylaxis begin?
- How do you treat an MAI infection?
- Azithromycin or Clarithromycin
- CD4 < 50
- Clarithromycin + Ethambutol
What drugs are known for causing drug-induced lupus?
- Isoniazid
- Hydralazine
- Procainamide
What is an important side effect of ethambutol?
Optic neuropathy: Red/Green color blindness (reversible)
What diseases might have Bells palsy as a complication?
“my Lovely belle Had An STD”
- Lyme disease
- Herpes Zoster
- AIDS
- Sarcoidosis
- Tumors
- Diabetes
Myasthenia Gravis is associated with abnormalities of what organ
Thymus: Most cases of Myasthenia Gravis are associated with a Thymoma or Thymic hyperplasia
Name the Class Ia antiarrhythmics
“Double Quarter-Pounder”
- Dysapyramide
- Quinidine
- Procainamide
Name the Class Ib antiarrhythmics
“Lettuce, Tomato, Mayo, Pickle”
- Lidocaine
- Tocainide
- Mexiletine
- Phenytoin
Name the Class Ic antiarrhythmics
“Fries Please”
- Flecainide
- Propafenone
If a patient has hypertension, bradycardia and respiratory depression, what should you strongly consider in your differential?
Increased intracranial pressure (IE hemorrhage etc.)
This is the Cushing reaction: Increased intracranial pressure constricts arterioles -> cerebral ishemia and reflex sympathetic increase in perfusion pressure (hypertension) -> increased stretch -> reflex baroreceptor induced bradycardia
What drugs cause gynecomastia?
“Some Drugs Create Awesome Knockers”
- Spironolactone
- Digoxin
- Cimetidine
- Alcohol
- Ketoconazole
What drugs cause drug-induced lupus
“SHIPP”
- Sulfasalazine
- Hydralazine
- Isoniazid
- Procainamide
- Phenytoin
What is the mechanism of action of Sulfonamides?
They are folic acid inhibitors (bacteriostatic): PABA antimetabolites inhibit dihydropteroate synthetase
What is the mechanism of action of Trimethoprim?
Folic acid inhibitor: Inhibits bacterial dihydrofolate reductase
What drugs have photosensitivity reactions?
“SAT for a Photo”
- Sulfonamides
- Amiodarone
- Tetracyclines
What drugs should be avoided in patients with an allergy to sulfa?
- Celecoxib
- Furosemide
- Thiazides
- Probenecid
- TMP-SMX
- Sulfsalazine
- Sulfonylureas
- Acetazolamide
What drugs can cause Stevens-Johnson syndrome?
- Penicillins
- Sulfa drugs
- Seizure drugs (Ethosuximide, Lamotrigine, Carbamazepine, Phenobarbital, Phenytoin)
- Allopurinol
What are the clinical uses for TMP-SMX?
- UTIs
- Shigella and Salmonella infections
- MRSA
- Prophylaxis for pneumocystis jirovecii pneumonia
What bacteriocidal drug fits this description: Reduced by bacterial proteins to a reactive intermediate that inactivates bacterial ribosomes. Indication in UTI cystitis (not pyelonephritis) by E. Coli or S. Saprophyticus (Not Proteus)
Nitrofurantoin
- On what medium do you culture H. influenzae?
- What factors does it require?
“Mom goes to the Five and Dime store to buy Chocolate”
- Chocolate agar
- Factors V and X
What organism grows on Lenstein-Jensen agar?
M. Tuberculosis
What color do lactose-fermenting enteric bacterial colonies appear when grown on MacConkey’s agar?
Pink colonies
What is MacConkey’s agar?
- Agar containing bile salts and crystal violet (Inhibits the growth of Gram (+)s)
- Also contains lactose and neutral red (lactose-fermenters form pink colonies)
On what medium do you culture E. Coli?
Eosin-Methylene blue agar
On what medium do you culture fungi?
Sabouraud’s agar
What bacteria fits this description, what can infection with it cause, and how do you treat it?
- Gram (-) cocci
- No polysaccharide capsule
- No maltose fermentation
- No vaccine
N. gonorrhoeae
Can cause
- Gonorrhea
- Septic arthritis
- Conjunctivitis
- Pelvic inflammatory disease
- Fitz-Hugh-Curtis (a rare complication of pelvic inflammatory disease)
Treatment
- Ceftriaxone
- Erythromycin is used topically on the eyes of neonates to prevent eye infection at birth that may cause blindness
What bacteria fits this description, what can infection with it cause, and how do you treat it?
- Gram (-) cocci
- Polysaccharide capsule
- Maltose fermenter
- Vaccine but not for type B
N. Meningitidis
Can cause
- Meningococcemia
- Meningitis
- Waterhouse-Friderichsen
Treatment
- Ceftriaxone
- Rifampin is used for prophylaxis
- What do you do next if you suspect a kid has epiglotitis?
- What bacteria can cause epiglotitis especially in kids?
- Is there a vaccine?
- Make the child comfortable because if you do something to upset the child, his/her airway might close
- Haemophilus influenzae
- Yes, H. influenzae has been largely irradicated by the vaccine
What bacteria fits this description, what can infection with it cause, and how do you treat it?
- Small Gram (-) coccoid rod
- Most invasive diseases are caused by the capuslar type B subtype
- Produces an IgA protease
Haemophilus influenzae
Can cause
- Epiglotitis
- Meningitis
- Otitis media
- Pneumonia
Treatment
- Ceftriaxone
- Rifampin is used for prophylaxis
What bacteria fits this description, what can infection with it cause, and how do you treat it?
- Gram (-) rod
- Silver stain
- Faculative intracellular organism
Legionella pneumophila
Can cause
- Severe pneumonia
- Fever
- GI and CNS symptoms
Treatment
- Macrolides
- Quinolones
On what medium do you grow Legionella pneumophila?
“French legionnaire with his silver helmet, sitting around a campfire (charcoal) with his iron dagger. This guy ain’t no sissy”
Charcoal yeast extract cultures with iron and cysteine
What bacteria fits this description, what can infection with it cause, and how do you treat it?
- Causes blue-green pigment
- Produces endotoxin that causes fever/shock
- Produces exotoxin A that inactivates elongation factor-2
Pseudomonas aeruginosa
Can cause
- Pneumonia (especially in Cysitc fibrosis)
- Sepsis
- External otitis
- UTI
- Drug/Diabetes-induced Osteomyelitis
Treatment
Aminoglycoside (Gentamycin) + extended-spectrum penicillin (Piperacillin or Ticarcillin)
What is the treatment for H. Pylori
Triple therapy
Clarithromycin + PPI + Amoxicillin or Metronidazole
Name the killed virus vaccines
“RIP Always”
- Rabies vaccine
- Influenza (Injectable)vaccine
- Salk (Injectable) Polio vaccine
- Hepatitis A vaccine
What 4 infectious diseases cause a rash on the palms and soles?
- Rocky Mountain Spotted Fever (Rickettsia rickettsii)
- Hand, Foot, and Mouth Disease (Coxsackie A virus)
- Syphyllis (Treponema pallidum)
- Meningicoccus: N. meningitidis)
Patient presents with fever, severe musculoskeletal pain, and retro-orbital pain/headache. Blood test reveals thrombocytopenia and Tourniquet test reveals excess petechiae (aka a positive test). What is the diagnosis?
Dengue fever caused by the Arbovirus, Dengue, a member of the Flavivirus family.
Which RNA viruses are more common in winter months?
- Influenza (Orthomyxovirus)
- Rotavirus (Reovirus)
- RSV (Paramyxovirus)
Which RNA viruses are more common in summer months?
- Poliovirus (Picornavirus)
- Coxsackievirus (Picornavirus)
- Echovirus (Picornavirus)
- West Nile virus (Flavivirus)
What are the X-linked diseases?
“Fabry’s tale: Duke the Muscular Hunter Brutally Lysed the Albino Gopher without being aWAre it was a Fragile Hemophiliac!”
- Fabry disease
- Duchenne muscular dystrophy
- Hunter syndrome
- Bruton agammglobulinemia
- Lesch-Nyhan syndrome
- Ocular albinism
- G6PD deficiency
- Wiskott-Aldrich syndrome
- Fragile-X syndrome
- Hemophilia A and B
What is the classic triad of congenital Rubella?
- Congenital cataracts (White pupils)
- Sensorineural hearing loss
- Patent ductus arteriosus
Sensory corpuscle that senses pain and temperature
Free nerve endings
- C - Slow, unmyelinated fibers
- A-delta - Fast, Myelinated fibers
Sensory corpuscle that senses Dynamic, fine/light touch and position sense. It is large, myelinated and adapts quickly, and is located on hairless (Glabrous) skin
Meissner’s corpuscle
Sensory corpuscle that senses vibration and pressure. It is large and myelinated, and is located in deep layers of the skin, ligaments, and joints
Pacinian corpuscles
Sensory corpuscle that senses pressure, deep static touch (eg shapes, edges), position sense. It is large, myelinated and adapts slowly and is located in hair follicles
Merkel’s disk
Are these lab findings indicative of Down Syndrome, Edward syndrome or Patau syndrome:
- Decreased AFP
- Increased beta-hCG
- Decreased Estriol
- Increased Estrone
Down Syndrome
Are these lab findings indicative of Down Syndrome, Edward syndrome or Patau syndrome:
- Decreased AFP
- Decreased beta-hCG
- Decreased Estriol
- Normal Inhibin A
Edward syndrome
Are these lab findings indicative of Down Syndrome, Edward syndrome or Patau syndrome:
- Decreased free beta-hCG
- Decreased PAPP-A
- Increased nuchal translucency
Patau syndrom