Mixed Blocks Notes 7 Flashcards
1
Q
Treatment of Restless Leg Syndrome
A
(1) Limit alcohol, nicotine, caffeine; (2) Dopamine Agonists (eg pramipexole)
2
Q
Restless Leg is common in those with
A
Iron Deficiency, CKD, Diabetes
3
Q
Treatment of Cataplexy
A
Muscarinic Antagonists (narcolepsy)
4
Q
When does the neural tube form
A
Third week of fetal life
5
Q
When do the neuropores close
A
Week Four = Anterior on day 25, Posterior on day 27
6
Q
Tensilon Test
A
Tx of MG pt with Edrophonium (short acting AChEsterase inhibitor); Lack of improvement = cholinergic crisis
7
Q
What mediates rapid decrease in myocardial calcium before relaxation
A
Na/Ca pump sarcolemmal pump; and Ca-ATPase
8
Q
Major immune mechanism against Giardia
A
CD4 and IgA
9
Q
RUQ pain after opiate
A
Biliary colic from contraction of SM cells in sphincter of oddi
10
Q
Mu opioid effects on Histamine, Parietal Cells
A
Increase histamine (don’t use in hypotension); Decr parietal gastric acid secretion
11
Q
Non-caseating granulomas - Crohn’s or Ulcerative colitis
A
Crohn’s
12
Q
Unidirectional enzymes in glycolysis
A
Gluco/Hexokinase, PFK-1, Pyruvate Kinase
13
Q
F-2,6-BP activates what?
A
PFK1 = Glycolysis
14
Q
Insulin vs Glucagon effects on PFK1
A
Insulin –> PFK2 –> F-2,6-BP –> PFK-1 = Glycolysis; Glucagon inactivates PFK-2 via phosphorylation
15
Q
What causes myocardial swelling with ischemia?
A
No ATP to pump Na (Na/K) or Ca (Ca-ATPase) out
16
Q
Mechanism of nitrites in cyanide poisoning
A
Oxidized iron to Fe3+, which binds and sequesters cyanide, preventing it from binding cytochrome a-a3
17
Q
What is used beside nitrites in cyanide poisoining
A
Thiosulfate –> Sulfate binds cyanide
18
Q
Most common cause of aPTT prolongation
A
Lupus anticoagulants
19
Q
Common findings in PCA stroke
A
(1) Contralateral hemianopia; (2) Contralateral parasthesias and numbness [thalamus]
20
Q
Cranial Nerves supplied by PCA
A
III and IV
21
Q
Why gallstones in Crohn’s
A
Can’t resorb bile acids in terminal ileum
22
Q
Rate limiting step in catecholamine synthesis? What blocks this?
A
Tyrosine Hydroxylase - Metyrosine
23
Q
What maintains cardiac output in acute/subacute aortic regurgitation
A
HR temporarily, but mainly increased LV preload
24
Q
Carbamazepine adverse effects
A
(1) BM suppression; (2) Hepatotoxic; (3) SIADH
25
Drugs that cause SIADH
Carbamazepine, Cyclophosphamide, SSRI's
26
Allergic contact dermatitis is due to
Antigen presentation by Langerhans cell --> CD4 response
27
Acanthosis
Incr in spinosum (think psoriasis)
28
Hypergranulosis
Excessive granulation of s granulosum (think lichen planus)
29
Max and min pressures in RV, Pulmonary Artery
4-25 in RV; 9-25 in PA
30
Treatment of PSGN
Loop diuretics and Vasodilators to relieve edema and hypertension
31
Most important prognostic indicator in PSGN
Age
32
Osteoporosis tends to affect what bone
Trabecular - Vertebral bodies, Neck of femure
33
what is characteristic of hyperparathyroidism
Subperiosteal resorption with cystic degeneration
34
Vit D bone loss is characterized by
Excessive unmineralized osteoid
35
Osteopetrosis is characterized by
Persistance of primary, unmineralized spongiosa in medullary canals
36
Drugs that cause seizures
I BItE my tongue - INH, Buproprion, Imipenem, Enflurane
37
Most common sites of intracranial hemorrhage
Deep brain = Basal ganglia, Cerebellar nuclei, Thalamus, Pons
38
Cerebral amyloid angiopathy tends to occur in what areas
Lobar/cortical parenchyma
39
Findings with Pulmonary Silicosis
Nodular densities and eggshell calcifications
40
Pulmonar berylliosis findings
Resembles sarcoidosis (nodular infiltrates, enlarged lymph nodes, non-caseating granulomas), but is not strongly associated with pleural plaques or effusions
41
Findings in coal worker's pneumoconiosis
Multiple discrete nodules most prominent in upper lung zones
42
X ray of hypersensitivity pneumonitis due to inhalation of organic dust
Diffuse nodular interstitial infiltrates
43
Granulomatous destruction of liver bile ducts
Primary biliary cirrhosis
44
Intrahepatic hydatid cysts
Echinococcus
45
Mechanism of gingival hyperplasia with phenytoin
PDGF
46
Phenytoin toxicity mainly effects
Cerebellum and vestibular system --> Ataxia, Nystagmus
47
Systolic ejection murmur that increases with standing? Decreases with standing?
Hypertrophic CM - increases; Valvular aortic stenosis - decreases
48
Wide splitting of S1 accentuated by inspiration
Delayed closure of tricuspid = Complete right bundle branch block or tricuspid stenosis
49
Carboxylation of glutamate residues
Vitamin K
50
Erythropoeisis and peripheral blood smeal in Acute Intermittent Porphyria
Erythropoeisis and peripheral blood smear normal
51
Opiates used for diarrhea
Loperamide, Diphenoxylate
52
Pathogens most responsible for post-flu pneumonia
Pneumococcus, S aureus, H flu
53
Mycobacterium kanasaii symptoms
Pulmonary tuberculosis-like symptoms
54
High intracellular NADH in setting of hypoglycemia
Fuel other than glucose is being metabolized
55
High NADH/NAD+ ratio
Pyruvate to lactate and OAA to malate => Inhibits gluconeogenesis
56
What antibody is rarely seen in drug-induced Lupus
Anti-dsDNA (look for anti-histone)
57
Range for microalbuminuria
30-300 ug/mg creatinine
58
MOA of Adenosine in Supraventricular Tachy
Slows conduction thru AV node by hyperpolarizing the nodal pacemaker and conducting cells
59
All inhalational anesthetics, except what, are respiratory depressants
NO
60
Inhalational anesthetics preferred in pts with asthma
Halothane, Sevofluorane - Bronchodilation properties
61
Inhalational anesthetic effects on hepatic, renal, and cerebral BF
Decr hepatic; Incr cerebral; Decr GFR and RPF
62
Main side effects of bile acid binding resins
HyperTG (incr VLDL and TG synthesis), GI upset, Malabsorption, Gallstones
63
First line treatment of hypertriglyceridemia
Fibrates - decr hepatic synthesis
64
Clinical manifestations of schistosomiasis result from
Th2-mediated granulomatous response directed against eggs (with eos and mac's)
65
Periportal Pipestem Fibrosis
Hepatic schistosomiasis
66
Echinococcus reservoir
Dog
67
Diphyllobothrium latum comes from
Freshwater fish
68
2,3-BPG only binds to
Deoxyhemoglobin
69
Why doesn't HbF bind 2,3-BPG as well
Serine residues instead of histidine
70
HbC
Glutamic acid --> Lysine = Mild, chronic hemolytic anemia
71
Directly responsible for intimal thickening in athersclerosis
Smooth muscle cells (NOT FIBROBLASTS)
72
Treatment with Menotropin and hCG
Menotropin is human menopausal gonadotropin and acts like FSH; hCG acts like LH surge
73
Hepatolenticular degeneration
(GP and Putamen) Wilson's disease --> Wing-beating tremor, Psychosis
74
Burning or stabbing sensation in one half of body
Thalamic syndrome
75
Mechanism of Dermatitis Herpetiformis
Cross reaction of anti-Gliadin ab's with Reticulin in epidermal basement membrane
76
Cerebral amyloid angiopathy vs hypertensive hemorrhage
Lower mortality rate, More benign clinical course than hypertensive hemorrhage
77
Hematuria and proteinuria in subacute BE
Immune complex deposition
78
Bacteriostatic antibiotic that inhibits binding of aminoacyl-tRNA to 30S subunit
Tetracyclines
79
What is upregulated after statins lower total serum cholesterol
LDL receptor
80
LCAT vs CETP
LCAT catalyzes esterification of cholesterol (nascent HDL to mature HDL); CETP transfers cholesterol to other lipoprotein particles
81
Endocrine hormones that increase cAMP
FLAT ChAMP CGC - FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2), MSH, PTH, Calcitonin, GHRH, Glucagon
82
Hormones that increase cGMP
ANP, BNP, NO (EDRF)
83
Endocrine Hormones that increase IP3
GOAT HAG - GnRH, Oxytocin, ADH (V1), TRH, H1, AgII, Gastrin
84
Intrinstic tyrosine kinase receptors
Insulin, IGF-1, FGF, PDGF, EGF
85
Receptor-associated tyrosin kinase
PIGGLET - Prolactin, Immunomodulators (Cytokines, IFN), GH, G-CSF, EPO, Thrombopoetin - Acidophils and Cytokins
86
Resistant to Ampicillin but sensitive to Ceftriaxone
Beta-Lactamase production
87
Meniere's disease
Triad of vertigo, sensorineural hearing loss, tinnitus --> Incr production and/or decr excretion of endolymph
88
Blastomycosis on chest x ray
Mimics TB --> Granulomatous nodules
89
Systolic ejectin in aortic stenosis
Decr, because it takes longer for valve to open
90
Most common cause of pyridoxine deficiency
INH
91
First line for malignant otitis externa
Fluoroquinolone
92
Renal and lungs masses --> Improvement after removing renal mass
RCC --> Tx with IL_2
93
Central Venous Pressure and what tend to correlated
Pulmonary capillary wedge (at least in septic shock?)
94
Normal CVP and PCWP
CVP 2-8; PCWP 2-15
95
Effects of Ia, b, and c on AP conduction conduction velocity
Ia slows, Ib no effect, Ic slows
96
Effects of Ia, b, and c on AP duration
Ia prolongs, Ib shortens, Ic minimal effect
97
Predominant actions of Class II antiarrhythmics
Slow sinus node discharge rate, Slow AV node conduction and prolong refractoriness
98
Predominant effects of Class III antiarrhythmics
Prolong AP duration; No effect on conduction velocity
99
Predominant effects of Class IV antiarrhythmics
Slow sinus node discharge rate; Slow AV node conduction and prolong refractoriness
100
MOA of Adenosine
A1 receptors --> Activates K channels --> incr K conductance --> transient conduction delay thru AV node
101
Digoxin effects on AP duration and QT interval
Decr APD, Shorten QT interval
102
C3a stimulates
Histamine release --> Permeability, Dilation
103
Platelet Activating Factor causes
Platelet agg, Vasoconstriction, Bronchoconstriction, Incr leukocyte adhesion to endothelium
104
Hyperplastic polyps are composed of
Well-differentiated mucosal cells that form glands and crypts
105
Hamartomatous polyps are composed of
Mucosal glands, Smooth muscle, CT
106
Inflammatory polyps are seen in
UC, Crohn's --> Regenerating intsetinal mucosa
107
Lymphoid polyps are found in
children
108
4 Non-neoplastic polys
Hyperplastic, Hamartomatous, Inflammatory, Lymphoid
109
Symptoms of Diffuse Esophageal Spasm
Dysphagia and Chest pain
110
Phosphoglucomutase
Glucose 1 6 phosphate
111
Carnitine deficiency
Impairs FA transport into mitochondria, restricting ketone body formation
112
Skeletal Muscle Carnitine def symptoms
Myoglobinemia, Weakness after exercise, Elevated muscle TG's, Hypoketonemia
113
Medium Chain Acyl-CoA DH deficiency
Hypglycemia, Hypoketonemia
114
Tryptophan is a precursor for
Nicotinic Acid, Serotonin, Melatonin
115
Clinical manifestations of Hartnup disease are primarily due to
Tryptophan malabsorption --> Niacin deficiency
116
Symptoms of Hartnup
Most children asymptomatic --> Can have pellagra-like rashes, photosensitivity, ataxia
117
Urinary excretion of what AA's is normal in Hartnup
Proline, Hydroxyproline, Arginine
118
Thiamine use by the body is maximal in states of
Accelerated carb metabolism
119
Pyridoxine def results in
Anemia, Peripheral neuropathy, Dermatitis
120
Tocopherol deficiency
Vitamin E = Myelopathy and neuro
121
How do Listeria and Shigella survive intracellularly
Escape from phagosome into cytosol
122
How does MTB survive intracellularly
Blocks fusion of phagosome with lysosome, Inhibits phagolysosome acidification
123
Immune response to Listeria
IFNg, TNFb, IL-12 --> Cell mediated response --> macrophage killing
124
Gram negative rod that grows at 4 degrees
Listeria
125
Uricosuric drugs
Probenecid, Sulfinpyrazone
126
Xanthine oxidase inhibitor safer than allopurinol
Febuxostat
127
Most common manifestation of CMV in HIV
Retinitis
128
Epispadias results from
Faulty positioning of genital tubercle in fifth week of gestation
129
Virus that aquires lipid envelope form nucleus
Herpes family
130
Blockade of what receptor inhibits gluconeogenesis, glycogenolysis, and lipolysis
B2
131
Main effect of nitrates in treating angina
Reduce preload --> reduce LV volume
132
Herniation causing CN III neuropathy
Uncal
133
Most common cause of Abetalipoproteinemia
LOF mutation in Microsomal TG Transfer Protein (MTP) --> Normally folds apoB and transfers lipids into chylomicros or VLDL
134
Polyol pathway impairment occurs in tissues that
Do not rely on insulin for glucose transport (lens, peripheral nerves, kidney, blood vessels)
135
Elevated galactitol
Galactosemia --> Cataracts
136
Cross linking of proteins by glycosylation products in vessels facilitates
Inflammatory cell invasion, Deposition of LDL --> Atheroscerlosis
137
Skeletal findings in hyperparathyroidism
Cortical (compact) bone in appedicular skeletal --> Subperiosteal erosions, Salt-and-pepper skull, Osteolytic cysts (osteitis fibrosa cystica)
138
Disorganized lamellar bone structure in mosaic pattern
Paget's
139
Osteoid matrix accumulation around trabeculae
Vit D deficiency - Excessive unmineralized osteoid with widened osteoid seams
140
Persistence of primary spongiosa in medullary cavity with no mature trabeculae
Osteopetrosis --> Accumulation of woven bone, diffuse skeletal thickening
141
Trabecular thinning with fewer interconnections
Osteoporosis
142
How do erythrocytes utilize NADPH
Maintain Glutathione in reduced state by glutathione reductase
143
What is a Heinz body
Denatured Hb from oxidative stress
144
As opposed to serotonin syndrome, NMS is characterized by
Absence of myoclonus and presence of rigidity
145
Keratoderma blennorhagicum commonly associated with
Reactive Arthritis
146
Mechanism of Pertussis toxin
Disinhibits AC via Gi ADP ribosylation --> incr cAMP --> Incr histamine sensitivity and phagocyte dysfunction
147
Direct tissue effects of GH
(1) Insulin resistance; (2) Fat utilization; (3) Protein synthesis
148
Indirect tissue effects of GH
IGF-1 by liver --> Growth of bone, cartilage, soft tissue
149
GH vs IGF-1 receptor
GH is JAK-STAT; IGF-1 is specific receptor TK
150
Main sites of digestion and absorption of dietary lipids
Duodenum --> Jejunum
151
How does diet affect calcium stones
Low calcium diet actually increases risk; High protein and Na diet increases risk
152
What is recommended for patients with calcium stones who have hyperoxaluria
Pyridoxine --> Decreases endogenous oxalate production
153
Vitelline vs Cardinal veins
Vitelline form portal; Cardinal form caval
154
PG's that mediate protection of gastric mucosa
PGI2 and PGE2
155
Salicylism
Vertigo, Tinnitus, Hearing loss
156
Classic Legionnaires presentation
Very high fever in smoker + diarrhea, confusion, cough
157
Coccidiomycosis in immunocompetent
Usually asymptomatic
158
Conversion of NE to Epi occurs where? Stimulated by?
Adrenal medulla by PNMT - Stimulated by Cortisol (incr PMNT gene expression)
159
COMT converts epi and NE to
Metanephrine and Normetanephrine
160
SGLT2 inhibitors
Canagliflozin, Dapaglifozin
161
AE's of SGLT2 inhibitors
Urinary tract and Genital mycotic infections; Symptomatic hypotension
162
What should be assessed before starting SGLT2 inhibitors
Renal function
163
Which anti-diabetic requires LFT's
Thiaxolidinediones
164
Soft, breathy voice =
Vocal cord dysfunction
165
Acid-base abnormality in ATN
Retention of H and anions --> high anion gap metabolic acidosis
166
Recovery phase of ATN
Profuse diuresis, HypoK/Mg/PO4/Ca
167
Triptan MOA
5-HT 1b/d agonists --> Inhibit vasoactive peptides, promote vasoconstriction, block pain pathways
168
Bupropion MOA
DA, NE reuptake inhibitor
169
Migraine prophylaxis
TCAs, SNRI's, BB's, Valproate, Topiramate
170
What cholesterol meds increase bile acid synthesis
Binding resins; Fibrates
171
First and second line treatment of AF with RVR
CCBs/BB's, then Digoxin
172
Delayed afterdepolarizations
Occur in states of hyperexcitability (eg high intracellular Ca or high catecholamine states) - How digoxin can lead to Vtach
173
Signs of Uncal (transtentorial) herniation
CNIII, Contralateral or ipsilateral hemiparesis (crus cerebri), Contralateral homonymous hemianopsia with macular sparing (PCA)
174
Subfalcine herniation sign
ACA compression
175
Duret hemorrhage
Caudal displacement of brainstem --> Rupture of paramedian basilar artery branches --> Duret
176
Ingestion of what can cause myxomatous degeneration
Sweet peas --> Angiolathyrism
177
Incr murmur in HOCM
Decrease preload or afterload --> Decr LVEDV and increase outflow obstruction
178
Bile salt deconjugation
Colonic bacteria in small intestine --> Steatorrhea due to failure of miscelle formation
179
Final product of FA oxidation that enters CAC
Succinyl CoA (from methlymalonyl CoA)
180
Lab findings in SLE
Hemolytic anemia, Thrombocytopenia, Leukopenia, Hypocomplementemia
181
Cause of anemia and thrombocytopenia in SLE
Type II hypersensitivity
182
Fibrous intimal thickening with endocardial plaques limited to right heart
Carcinoid heart disease --> Pulmonic stenosis, Restrictive cardiomyopathy
183
How to grow H flu in sheeps blood agar
S aureus --> X factor released by hemolysis, V factor secreted by s aureus
184
Fat embolism syndrome is characterized by
pulmonary insufficiency, diffuse neuro impairment, thrombocytopenia, anemia
