Mixed Block Notes 2 for import Flashcards
Laplace’s Law
P=2T/r
Uptake of unconjugated bililrubin occurs via
Organic Anion Transporting Polypeptide (OATP) - passive
Conjugated bilirubin is secreted from hepatocytes via __? This is blocked in __?
MRP2 (active organic anion transporter) - Criggler-Najjar, Rotor
Concentration of Bicarb along Proximal Tubule
Actively reabsorbed due to Carbonic Anhydrase –> Acetazolamide causes excretion
How to differentiate MAC from MTB in HIV patient
MAC has anemia, HSM, incr ALP/LAD due to widespread involvement of RES; Also grows well at 41degC
Prophylaxis and treatment of MAC
Proph with Azithromycin; Tx with Azith + Ethambutol or Rifampin
Absence of ganglion cells in colonic wall causes
affected segment to narrow (can’t relax)
Which parts of GI tract are always involved in Hirschprung
Since NCC’s migrate caudally, rectum always involved
How does metabolism of drug relate to drug-induced lupus?
Slow acetylators more likely (hydralazine, procainamide)
Most liver hydrolysis involve what enzymes
Amidase, Esterase
When is Exenatide used?
(GLP-1) Suboptimal glucose control in patients already on Metformin and Sulfonylureas
Ventricular response to AF is dependent on
Transmission through AV node
What types of viral genomic material can be individually infective?
Positive Linear ssRNA
Interstitial pneumonia in transplant patient
CMV
Treatment of C. diphtheria
Antitoxin –> Penicillin or Erythromycin –> DPT vaccine
Most common cause of death from C diph
Cardiomyopathy
Features of Cutaneous Neurofibromas
Rubbery, Buttonholing
Features of Wiskott-Aldrich
Thrombocytopenic Purpura, Eczema, Recurrent infections
Acute Narrow Angle Glaucoma is often precipitated by
Anticholinergics –> Anterior chamber narrows, obstructing trabecular meshwork
Confirmatory test for calculus cholecystitis
HIDA scan (not ultrasound)
Stool osmotic gap? What increase?
Colonic fermentation products –> Increased when poorly absorbable substances present (lactose)
Nonpolar Aliphatic Hydrophobic AA
VIP GAL - Valine, Isoleucine, Proline, Glycine, Alanine, Leucine
Aromatic Hydrophobic AA
Try Trippin w/ Phenytoin - Tyrosine, Tryptophan, Phenilalanine
Basic/Positive AA’s
Shallow HAL is positive - Hystidine, Arginine, Lysine
Acidic/Negative AA’s
Glutamate, Aspartate
Hydrophilic uncharged AA’s
Come, Take My GAS! - Cysteine, Threonine, Methionine, Glutamine, Asparaine, Serine
When is Arginine essential?
During + nitrogen balance
Non-lactose fermenting, Oxidase negative organism in Sickle Cell Osteomyelitis
Salmonella
Oxidase Positive bugs
Vibrio, Pseudomonas, Campylobacter, Helicobacter, Neisseria, Moraxella, Legionella
Main virulence factor of S aureus in osteomyelitis
Adhesion to collagen
Apo E4 predisposes to
Late-onset familial Alzheimer’s
Hypertrophic CM trait
AD - Beta myosin heavy chain
MOA and use of Dezrazoxane
Iron chelating agent to prevent cardiotoxicity from Anthracyclines
Location of 5-HT3 receptors implicated in chemo n/v
Peripherally in presynaptic nerve terminals of vagus in GI, Centrally in CTZ and Solitary nucleus/tract
Loop diuretics stimulate release of
Prostaglandins –> incr renal BF
Most common benign tumor of breast
Fibroadenoma (<35, often bilateral, cyclinc)
Fibroadenoma histology
Cellular, often myxoid stroma that encircles and sometimes compresses epithelium-lined glandular and cystic spaces
Function of vWF
Platelet adhesion by crosslining GpIb with exposed collagen underneath damaged endothelium
Secondary role of vWF
Carrier protein for factor VIII
Proteins C and S act to inactivate
V and VIII
Thrombin is produced from Prothrombin by
Activated Factor X
Growth Hormone binds to a __ receptor
JAK-STAT
Lecithin-Sphingomyeline Ratio is a marker for
Lung maturity (>1.9 = mature)
Mechanism of methicillin resistance
Alterations in PBP2a (also affects cephalosporins)
Immunity to reinfection by influenza is mediated by
Circulating antibodies against Hemagluttinin
Tumor originating from collecting duct cells
Renal Oncocytoma
Transitional cell tumors of pelvis are often what morphology
Papillary
Niacin-induced flushing is mediated by
Prostaglandins
___ reduces pain by decreasing level of substance p in PNS
Capsaicin
Clinical uses of Valproate
Anticonvulsant (absence, myoclonic, grand mal) AND mood stabilizer (acute mania, bipolar)
Anticonvulsants used as mood stabilizers in bipolar
Valproate, Carbamazepine, Lamotrigene
Carbamazepine indications
Trigeminal Neuralgia, Manic episodes, Partial and generalized seizures
MOA and use of Olanzapine
second gen antipsychotic
QT interval reflects
Myocyte AP duration
Two congenital syndromes that cause QT prolongation
- Jervell Lange-Nielson (AR, neurosensory deafness); 2. Romano-Ward (AD, no deafness)
Mutations affecting cardiac cell cytoskeletal proteins or mitochondrial enzymes of ox phos are though to cause
Genetic Dilated CM’s
Mutations of calcium-binding SR protein might underly
Arrhythmogenic RV Cardiomyopathy –> Progressive fibrofatty replacement of RV
Extramedullary hematopoesis is most frequently associated with
Chronic Hemolytic Anemias (eg beta thal)
Pentazocine
Opioid narcotic designed to produce analgesia with little to no abuse potential (weak antagonist at mu)
Short-acting benzos
ATOM - Alprazolam, Triazolam, Oxazepam, Midazolam
Long-acting benzos
Choose Carefully Due to Falls - Chlordiazepoxide, Chlorazepate, Diazepam, Flurazpam
Malabsorption, Diarrhea, PAS-positive granules in intestinal macrophages
WHIPPLES DISEASE - Tropheryma whippelii
Recurrent infections with Strep pneumo, H flu, and Moraxella indicate
Humoral immunodeficiency
Pneumocystis and chronic mucocutaneous candidiasis indicate
T cell deficiency
Immotile cilia syndrome presents in newborn period with
Respiratory distress –> Recurrent Otitis Media, Bronchitis, Sinusitis (opprotunistic infections like PCP unusual)
Agammaglobulinemia means susceptible to
Extracellular, encapsulated bacteria
Exchange of viral dna in coinfection by non-segmented viruses
Recombination
Viral phenotypic mixing
Coinfection leads to one virus with nucleocapsid protein from another
AE’s of TZD’s
Weight gain, edema, CHF
Damage to the Caudate is associated with
Transient hemiparesis and frontal lobe symptoms such as inattentiveness, abulia, forgetfulness
Compression fracture in elderly woman –> Calcium and PTH?
Normal
Driver of respiratory function in COPD vs normal
pO2 in COPD vs pCO2 normally –> Supplementary O2 in COPD will lead to respiratory suppression and coma
Main toxin of C perf
Lecithinase (phopholipase C, alpha toxin)
Insular cortex is associated with
Integrating body states w/ emotions (limbic); ANS control; Conscious experience of visceral sensations
Damage to internal vs external Globus Pallidus
Internal –> Excessive movement; External –> Decreased
Role of D arm of tRNA
Dihydrouracil residues –> Helps facilitate correct tRNA recognition by proper Aminoacyl tRNA synthetase
Role of T arm of tRNA
Binding tRNA to ribosomes
Only RNA that contains thymidine
T RNA
NE to Epinephrine requires
SAM - PNMT enzyme
BH4 is required for synthesis of
Tyrosine, DOPA, Serotonin, Prolactin
Winter’s Formula
PaCO2 = (1.5*HCO3) + 8 +/- 2
Media for growing V cholerae
Alkaline - extremely acid sensitive organism
Mechanism of hepatocyte damage in Hep B
CD8 response to viral antigens on cell surface
Regulatory HIV genes required for replication
Tat, Rev
Structural HIV genes
Gag, Pol, Env
Products of Gag, Pol, Env genes in HIV
Gag - p24, p7; Pol - RT, Integrase, Protease; Env - gp120, gp41
Function of HIV nef gene? Rev? Tat?
Nef - Downregulate CD4 and MHC 1; Rev - Transport of unspliced viral transcripts out of nucleus; Tat - Protein that transcriptionally activates other viral genes
Features of Colitis-associated CRC vs sporadic
(1) younger; (2) Flat or non-polypoid dysplastic precursor; (3) Mucinous and/or signet ring morphology; (4) early p53 and late APC - opposite of sporadic; (5) proximal colon; (6) Multifocal
MOA of Varenicline
Partial agonist at nicotinic ACh receptor
Pentamidine is used for
Prophylaxis and tx of PCP
Nifurtimox is used for
Chagas treatment
Normal alveolar pO2
104 mmHg (if higher, poor perfusion)
When is O2 equilibration diffusion-limited
Emphysema, Fibrosis, Very high blood flow (ie exercise)
A, I, and H bands
A is thick myofilament, I is Actin only, H is Myosin only
Pharmacodynamic Drug Antagonism
Drug can antagonize or prevent effect of another drug or endogenous substance
Pharmacokinetic drug interaction
eg CYP inducers
Treatment of recurrent C diff colitis
Fidaxomicin
MOA of Fidaxomicin
Inhibits sigma subunit of RNA polymerase; Less effect on normal flora; Poor oral
Most common cystic fibrosis mutation and result
dF508 –> Impaired post-translational processing and results in proteasome degradation
AA’s with three titratable protons
Acidics, Basics, CT = Glutamate, Aspartate, Histidine, Arginine, Lysine, Cysteine, Tyrosine
Salicylate acid base disorder
(1) Rapid respiratory depression causing alkalosis; (2) A few hours later metabolic acidosis
Effect of ANP on kidney, Adrenals, BVs
Dilates afferent arterioles, Inhbitis Na reabsorption, Restrict aldosterone secretion, cGMP-mediated veno- and arteriodilation
Type of MI usually associated with Bradycardia
Inferior - SA/AV nodal branch block
ANS drug that can cause Glaucoma
Atropine –> Midriasis –> Narrowing of anterior chamber
Anti-mitochondrial Ab’s
Primary biliary cirrhosis
Anti-Smith Ab’s
Anti-snRNP = Specific for SLE
Rapid atrophy and shrinkage of liver on autopsy
Halone-induced liver failure
Shortest half life pro-coagulant factor
Factor VII (PT)
What enzyme produces urea in Urea cycle
Arginase (Arginine –> Urea + Ornithine)
Excessive amounts of Orotic acid are usually found in
OTC deficiency, Citrullinemia, Arginosuccinate aciduria
Low levels of C1 esterase inhibitor
Hereditary Angioedema
Mechanisms of C1 esterase inhibitor
Inhibit C1 –> Activated C1; Inactivates Kallikrein (which converts Kininogen to Bradykinin)
16S rRNA function
Component of 30S subunit –> Expresses sequence complementary to Shine-Dalgarno in all prokaryotic mRNA
23S rRNA function
Peptidyltransferase - Peptide bond formation
Pontiac Fever
Legionella –> Acute, flu-like, self-limited disease
Features of Legionnaire’s Disease
Recent expsoure to contaminated water, Pneumonia, High Fever; Sometimes GI, Relative bradycardia, neurologic
Most common lab finding in Legionnaire’s
Hyponatremia
Bilateral ACA occlusion
LE motor, Behavioral (abulia), Urinary incontinence
Spread of H flu vs N meningitidis to meninges
H flu uses lymphatics, N men is hematogenous, Both from Pharynx
MOA of Organophosphates
AChE inhibitors
Bromoacetylcholine MOA
Inhibits Choline Acetyltransferase
Nicotininc receptor antagonists
Pancuronium, Tubocurarine
Hemicholinium MOA
Choline import into presynaptic terminal
Train of Four seen in Non-depolarizing blockade
eg Tubocurarine - Slanted within group, Group increases each 4
Train of Four seen in Depolarizing blockade
Equal within group, Group increases each four (phase 1) –> Resembles slanting of non-depolarizing in phase 2
Neostigimine in Phase 1 vs 2 of Succinylcholine NMB
Augments blockade in Phase 1, Reverses it in Phase 2
Duration of Succinylcholine action depends on
Diffusion out of NMJ and metabolism by plasma cholinesterase
Nitrate with best bioavailability
Isosobide Mononitrate
Hep B Window Period
Time lag betwee HBsAg disappearing and Anti-HBs appearing
Most specific marker for diagnosis fo acute Hep B
Anti-HBc IgM –> Present in window period
Vitamin E deficiency manifestations
Neuromuscular disease (myopathy, ataxia, pigmented retinopathy, dorsal column) and Hemolytic anemia
Vitamin E primarily serves to
Protect fatty acids from oxidation –> Neurons and erythrocytes most susceptible
Vitamin C excess
Nausea, Abdominal pain, Diarrhea, Stones
Physostigmine vs Neostigmine and Edrophonium
Neostigimine and Edrophonium are Quaternary Amines and can’t cross BBB
Tarry stool and fatigue are seen with what CT agents
Alkylating agents (upper GI bleed)
Abdominal pain and jaundice may be seen with what CT agent
Mercaptopurine (cholestasis and hepatitis)
Flagellate skin discoloration is seen with what CT agent
Bleomycin (along with pulmonary fibrosis)
Nitroblue Tetrazolium testing
Properly functioning PMNs produce ROS that reduce yellow NBT to dark blue formazan that precipitates within the cells
DHR flow testing
NADPH oxidase shows decr fluorescence
NBT and DHR testing in MPO deficiency
Normal
Pyruvate kinase deficiency is a common cause of
Chronic Hemolytic Anemia
Ortner Syndrome
Mitral Stenosis –> LA enlargement –> Impingement on Recurrent Laryngeal N
Location of Glut-2
Regulation of Insulin Release –> Hepatocytes, Beta cells, Renal tubular cells, Small intestine
Location of Glut-3
Placenta, Neurons
What is commonly found regarding uterus on vaginal vaginal examination in Endometriosis
Nodularity of uterosacral ligaments, Fixed retroversion of uterus
Ectopic endometrial tissue secretes
PG’s –> Interfere with ovulation and tubal function –> Infertility
Adenomyosis
Presence of endometrial glands w/in uterin myometrium (presents with bleeding, painful menses, and enlarged uterus unlike endometriosis)
When to give Ribavirin with RSV?
Confirmed, severe RSV at risk for dz progression (immunodeficiency, prematurity, cardiopulmonary disease)
Mechanism of Shiga-like toxin
AB - A subunit prevents binding of tRNA to 60S ribosomal subunit
Bactrim is drug of choice for
Pneumocystis jiro, Toxoplasma, Nocardia
Hyoscyamine
Anti-muscarinic to counteract AChEi in Myasthenia Gravis
Side effects of Thiazide Diuretics
Hyper Glycemia Lipidemia Uricemia Calcemia
Medication-induced fat redistribution
Corticosteroids, HAART (Protease inhibitors)
Chronic Eosinophilic Bronchitis in asthmatics involves
Bronchial wall infiltration by numerous activated eosinophils in response to IL-5 by allergen-activated TH2 cells
Class 3 Anti-arrhythmics
Amiodarone, Ibutilide, Dofetilide, Sotalol
Which vitamin supplement should be given to child with Measles
Vitamin A - Reduces time to recovery from pneumonia and diarrhea, as well as risk of death
Which HIV drug to give to pregnant women
Zidovudine
Protein secondary structure is due to
Hydrogen bonds (Tertiary due to ionic bonds, hydrophobic interactions, hydrogen bonds, and disulfide bonds)
E coli aquired ability to form pili via
Conjugation
Strep pneumo aquired capsule via
Transformation
Function of Thyroid Peroxidase
Oxidize inorganic iodide to organic iodine; Formation of monoiodotyrosine and diiodotyrosin; Coupling of these to iodotyrosines
Lab studies in HUS
Only bleeding time elevated
Bacitracin MOA
Prevents mucopeptide transfer into growing cell wall
Trimpethroprin, Methotrexate, and __ inhibit DHFR
Pyrimethamine
Important Bactrim AE’s
Hyperkalemia, Megaloblastic Anemia
Serotonin Syndrome effects
HARM - Hyperthermia, ANS instability, Rigidity, Myoclonus
Drugs that precipitate Serotonin Syndrome
TTYL - Tramadol, Triptans, trYcyclics, Linezolid
Features of Myotonic Dystrophy
Frontal balding, Gonadal atrophy, Arrhythmia (My toupe, my testicles, my ticker); sustained grip, type 1 fiber loss
Most important signalers in Coronary autoregulation
Adenosine, NO
What causes NO release in coronaries
Pulsatile stretch, Flow shear stress
What subtype not stimulated by NE
Beta 2
Skeletal Muscle Depolarization –>
L-type channel-RyR mechanical coupling (no significant flux of Ca across L-type Ca channel) –> RyR1 opening –> Binds Troponin C
Cardiac Muscle Depolarization –>
L-type Ca influx on PM –> RyR2 opening
Smooth Muscle Depolarization –>
v-gated L type Ca influx –> Calmodulin (no troponin) –> Myosin light chain kinase –> P-lation of myosin
Nonselective beta blocker with a1 blocking activity
Labetolol
Systemic sequelae with Diphtheria
Myocarditis, Heart Failure, Neurotoxicity
EKG leads for LAD
V1-V3
Type 3 collagen is found in
Granulation tissue, Skin, Lungs, Blood vessels
Bell vs Diaphragm
Bell = Low freq; Diaphragm = High
S3 on end expiration
More audible, Heart closer to chest wall
Localized amyloidosis confined to cardiac atria
ANP-derived (elderly)
Prolyl Hydroxylase –>
Proline on Procollagen –> Stable triple helix
Lysyl Hydroxylase –>
Stronger
Bepridil
CCB - Second line anti-anginal drug
Loud P2 =
Pulmonary hypertension
Kussmaul =
Paradoxical rise in JVP during inspiration
Don’t use DPH-CCB with
Acute Coronary Syndrome (reflex tachycardia)
Digoxin toxicity
Hyperkalemia, Vision, N/V/D
Afib with RVR: tx –>
CCBs, BBs, then Digoxin second line
Lidocaine is for what arrhythmias
Ventricular, not Atrial
Mechanism of Fibrates
Peroxismal Proliferator-Activated Receptor Alpha –> LPL activity increase –> Decr TB, Raise HDL
How do assess severity of Mitral Regurg
Presence of S3 gallop