mixed deck 04/13 Flashcards
Cricothyrotomy
- place the tube between the cricoid and the thyroid cartialages and requires an incision through the following structures:
1. skin
2. superficial cervical fascia (including subcutaenous fat and platysma muscle)
3. investing and pretracheal layers of the deep cervical fascia
4. cricothyroid membrane
Ethambutol
-treatment for M. tuberculosis and atypical mycobacterial infections
side effects:
-decreased visual acuity, central scotoma, and or color-blindness (reversible)
Fenoldopam
- the only intravenous agent that improved renal perfusion while it lowers blood pressure
- it is a benazepine derivative of DA but it is SELECTIVE D1-receptor agonist (so no effect on alpha or beta)
- recall DA –> AC–> cAMP–> vasodilation in arterial beds especially RENAL, MESENTERIC, and CORONARY beds.
- decrease in systemic vascular resistance (lowers BP)
- improve renal perfusion
scarlett fever rash
- after 1-2 days rash appears on the neck, armpits and groin that subsequently generalizes to the rest of the body.
- the rash begins as scarlet spots or blotches, giving a boiled lobster appearence
- as the rash progresses and becomes more widespread, it begins to resemble a sunburn with goose pimples “sand paper rash”
- the cheeks commonly appear flushes, giving the area around the mouth a pale appearence in comparison (circumoral pallor)
- towards the end of the first week, desquamation begins and is most pronounced in the armpits, groin, and tips of the fingers and toes
cleft lip
-when the maxillary prominences fail to properly fuse with the intermaxiallary segments (formed by the fusion of two medial nasal promineses) during early development.
cleft palate
results when the palatine shelves of the maxillary prominence fail to properly fuse with one another or with the primary palate
Pure red cell aplasia (PRCA)
- a rare form of marrow failure characterized by severe hypoplasia of marrow erythroid elements in the setting of nromal granulopoiesis and thrombopoiesis.
- inhibition of erythropoietic precursors and progenitors by IgG autoantibodies or cytotoxic T lymphocytes
- assoc with immune system disease such as thymomas and lymphocytic leukemias.
- also assoc with parvovirus B19 infection.
Mucormycosis:
mucur, rhizopus, absidia
-they form broad, nonseptate hyphae that branch at wide often 90 degreen angles (mold only)
- assoc with diabetic ketoacidosis and underlying immunosupression (transplant, leukemia etc)
- facial and periorbital pain, headache, and purulent nasal discharge. The fungi proliferates in the walls of blood vessels and causes necrosis of the corresponding tissue –> black eschar may be seen on the palate or nasal turbinates
Hyperplastic arteriolosclerosis
- in renal arterioles can result from and perpetuate malignant HTN. The pathological lesion is an onion-like concentric thickening of arteriolar walls in the renal vasculature and elsewhere.
- the stenosis decreases the glomerular perfusion and GFR, thus activating the renin-angiotensin-aldosterone system – viscious cycle
Acute viral hepatitis
- low grade fever, anorexia, nasuea, dark colored urine, and RUQ tenderness
- diffuse balooning degernation (hepatocyte swelling), mononucelar cell infiltrates and councilman bodies (eosinophilic apoptotic hepatocytes) are seen histologically).
motion sickness treatment
- the muscarnin M1 and histamic H1 pathways are sitmulation resulting in nausea and vomiting of motion sickeness
- meclizine, dimenhydrinate are first generation antihistaminic drugs
side effects of antimuscarinics: blurry vision, dry mouth, palpitations, urinary retention and constipation.
lower border of the lung is located how many intercoastal spaces above the respective pleural border?
two intercoastal spaces.
-thoracentesis therefor should be performed betwen 5th and 7th ribs along the midclavicular line, the 7th and 9th ribs along the mid axillary line and the 9th and 11th ribs along the paravertebral line
Lower bord of the right pleura is at what rib for
midclavicular line
midxillary line
paravertebral line
midclaviular: 7th rib
midaxxilary: upper border of 10th rib
paravertebral line: 12th rib
the lower border of the pleura of the left lung is at what rib for the
midclavicular, midaxillary and paravertebral lines?
midclavicular: 7th rib
midaxillary: lower border of the 10th rib
paravertebral line: 12 rib
remember the lung is isually located two intercoastal spaces above the respective pleural border
methadone
- heorin addiciton
- mu receptor
- long acting
isoniazid is structurally similiar to pyridoxine (vitamin B6)
- this antibiotic increases the urinary excretion of pyridoxine
- competes for vitamin B6-binding sites, leading to defective synthesis of neurotransmitters like GABA
- isoniazid-induced neuropathy can usally be preventd with pyridoxine supplementation
Tumor cells
human multidrug resistant gene MDR1
the protype product of this gene is P-glycoprotein, a transmembrane protein that functions as an ATP-dependant efflux pump
-in tumor cels, this ATP-poweed transmembrane pump protein actively removes chemotherapeutic agents, particularly hydrophobic agents like antracyclines
Cytochrome P450 monooxygenanses
- present in hepatic microsomes and the ER of other tissues
- metabolizes steroids, alcohol, toxins and other forein substances by rendering them soluble and easer to excrete
- hoever metabolic processing also converts pro-carcinogens into carcinogens –> mutations
- ex of a carcinogen for lung cancer is benz (o)pyrene
oral metronidazone can cause disulfaram like effects when combined with
alcohol
- it is used to treat giardiasis, trichomonas vaginitis and bacterial vaginosis
first-dose hypotension can be a potential limiting factor when initiating ACE inhibitors
predisposing risk :
-hyponatremia, hypovolemia secondary to diuretics, low baseline blood pressure, high renin or aldosterone levels, renal impairment and heart failure. examples thiazide and loop diuretics
Charcot-bouchard pseudoaneurysms
assoct. HTN
Location: small arteries that perfuse the basal ganglia and internal capsule
size: <1mm
Result of rupture: intracerepbral hemorrhage in the areas of basal ganglia, internal capsule,thalamus and pons
symptoms of rupture:
sudden onset of focal deficits
Glucagonomas
- rare pancreatic tumors
- necrolytic migratory erythema, an elevated erythematous rash typically affecting the groin area
- hyperglycemia, stomatitis, cheilosis and abdominal pain
osler-weber-rendu syndrom
- hereditary hemorrhagic telangiectasia
- autosomal domiant condition marked by the presence of telangiectasias in the skin as well as the mucous membranes of the lips, ornasopharynx, respiratory tracts, GI tract, and urinary tract.
- rupture may cause epistaxis, GI beeding or hematuria
meconium ileus
- the intraoperative finding of an inspissated green mass suggests that the distal ileum has been obstructed by dehrdrated meconium.
- abnormalities in Cl, Na, water transport by the ductal epithelium of the intestinal mucous glands cause isotonic dehydration of the lumen contents
Rb tumor supressor gene is located on chromosome 13g14
Rb protein is active when hypophosphorylate in its active state is prevents cell cycle to proceed
-inactive state is hyperphophoylated, this allows the cell cycle to proceed through thr g1-S checkpoint.
benign prostatic hyperpasia leads to intermittent bladder outlet obstruction and overflow incontience.
- Urinary retntion results in increased pressure into the UT and resultant reflux nephropathy. Ultimately, hydronephrosis and renal interstitial atrophy and scarring ensue.
- the condition should be promptly treated, as prolonged obstruction can cause permanent damage and chronic renal failure.
Renal papillary necrosis, which can be caused by a number of systemic conditions associated with ischemia
- sickle cell disease or trait —> sicklying causes obstruction of small kidney vessles
- analgesic nephropathy – decrease prostaglandin syntheiss, inhibit renal blood flow
- DM - non-enzymatic gylcosylation causes changes in vascular walls, leading to compromised renal vasculature
- acute pyelonephritis and UT obstruction –> edematous interstitium of the pyelonephritic kidney compresses the medullary vasculature, thus predisposing the patient to ischemia.
Vagus nerve on the lung
- vagus nerve efferent activity on bronchial smooth muscle is constriction (recall B2 sympathetic causes dilation)
- this is mediated by M3 receptors
- M3 receptors of mucous glands in the bronchial submucusa increase secretions
- thus increased vagal stimulation increases bronchoconstriction and secretion leading to incease airflow resistance and therefor increase work of breathing
Creutzfeldt-jakob disease
prion protein PrP is normally found in neurons and has an alpha helical structure
- if the a-helix is converted to a b-pleated sheet then the protein cannot be broken-down
- accumulates in gray matter
- the gray matter undergoes spongiform change
- vacuoles form within the cytoplasm of neurons and neutrophils
- later they grow bigger and form cysts
Integrins
-are a family of transmembrane protein receptors that interact with the extracellular matrix by binding to collagen, fibronectin and laminin.
25-30% of individuals have colonization of staph and or MRSA where?
-nasopharynx
anterior nares
alpha -1- receptor affects on eyes
pupillary dilator mucle contracts whichs caused dilation of the pupil (mydriasis)
ex) ophtalmic preparation of phenylephrine
Beta 2 agonist acitivity of uterine contractions
- agonist leads to uterine relaxation, an effect called tocolysis, which is used in obstetrics to defer premature labor.
ex) ritodrine and terbutaline
Macrolides inhbit CP450
- erythromycin
- clarithromycin
but not azithromycin
-so drugs that are normally metabolized by the liver will last longer is used in conjunction with a marcrolides
examples are statins
Nonnucleoside reverse transcriptase inhibitors NNRT
nevirapine, efavirenz, delavirdine
-antriretroviral drugs do not require activation via intracellular phophorylation
etoposide
- chemotherapeutic agent that inhibits the sealing activity of topoisomerase II
- treatment will cause chromosomal breaks to accumulate in divide cells –>cell death
both hep B and C increase risk for HCC
butttt hep B virus integrates its DNA into the host genome, thereby elevating the risk of HCC
Urine discharge from the umbilicus
-the urachus is a remnant of the allantois that connects the bladder with the yolk sac during fetal development. Failure of the urachus to obliterate by birth results in patent urachus
Fatty streaks
- earlierst lesion of atherosclerosis and are present in all individuals after age of 10
- they are composed of intimal, lipid filled foam cells, derived from macrophages and SMC that have engulfed lipoproteins
chronic cholestasis from viliary obstruction
-cause fat soluble vitamin malabsorption
like vitamin A deficiency
frequency sounds low and high heard best at?
- low frequency sound is best detected at the apex of the cochlear near the helicotrema
- high freqency sound is best detected at the base of the cochlear near the oval and round windows
