mixed deck 04/21

Question 1

overuse of diuretics can lead to contraction alkalosis

Answer 1

overuse of diuretics or any other causes of volume loss lead to compensatory increase in aldosterone production. aldosterone causes retention of sodium and water and a loss of potassium and hydrogen ions by the kidneys.

• this causes a contraction metabolic alkalosis
• typical lab findings will be a high pH, a high HCO3 and a high pCO2

Question 2

panic attack episodes

Answer 2

hyperventilation

• decreases the pc02 and causes a respiratory alkalosis
• acute condition so no metabolic compensatory

Question 3

Petazocine and butorphanol are unique in that they are PARTIAL mu opiod receptor agonists. but

Answer 3

when used in combination with morphine or other opiods, they can competitively inhibit mu receptors and product antagonisist effects reducing opiod analgesic effects, this can lead patients to withdrawal symptoms

Question 4

C. trachomatis is an intracellular pathogen that has a cell wall, but the cell wall is unique in that

Answer 4

it lacks peptidoglycan!!!

so b-lactam drugs are no use! and (cephalosporins, penicillins)

instead use macrolide like azithromycin or tetracylcines
note ureaplasma urealyticum also lacks a cell wall

Question 5

Amphoterible B binds to ergosterol of fungal cell membranes to excert its antifungal effects, however it can bind what to some degree?

Answer 5

cholesterol
this is what causes the toxicity to human tissues

ex) nephrotoxicirt, hypoklemia, hypomagnesiemia, anemia, thrombophlebetis at site of injection, acute infusion related reactions like fever, chills, rigors and hypotension

Question 6

azoles inhibit or induce CP450?

Answer 6

inhibit!

fluconazole, itraconazole

Question 7

griseofulvin used for dermatophytes only binds to

Answer 7

microtubular proteins as the mechanism of action

Question 8

inferior MI –> RCA , which perfuses the AV and SA node, this can lead to bradycardia.
to treat the bradycardia, use atropine an anticholinergic which will decrease the vagal tone. Watch out for sideeffectsL

Answer 8

CNS: sedation
EYE: mydriasis (dilated pupils), cycloplegia (paralysis of accommodation). Recall there are M3 for ciliary muscle and constrictor pupillage which do accomodation and constriction respectively.
-this can lead to a narrowing of the anterior chamber angle and diminished outflow aqueous humor –> angle-closure glaucoma
heart: tach
secretions: decrease
bladder: detruser relaxation, delays voiding
bronchi: bronchodilation

Question 9

what anticholinergic which can cause CNS sedation can be used for motion sickness?

Answer 9

scopolamine

Question 10

What anticholinergic which works on CNS sedation is used for Parkinsons disease?

Answer 10

Benztropine

Question 11

what anticholinergic, specifically an antimuscarin can be used for bronchodilation?

Answer 11

ipratropium

Question 12

H1 receptor antagonist diphenyhydramine can be used for allergic rhinitis, but dont forget it has

Answer 12

anticholinergic effects too of muscarinic receptors –> decreased secretions. Decreased sweat gland secretions can result in fever and compensatory cuteneous vasodilation
-inhibition of pupillary constrictor and ciliary muscles

Question 13

Staph foreign body infections?

S.epidermis!!!

Answer 13

• release an extracellular polysacchidre matric that encases the bacteria!
• BIO FILM!

Question 14

Which organisms can make biofilms?

Answer 14

staph epidermidis
step mutans and step sanguinis (viridins)
pseudomonas aeruginosa
nontypable hemophilus influenza

Question 15

examples of encapsulated bacteria?

Answer 15

streptococcus pneumoniae
haemophilus influenza type B
Neisseria meningitidis

Question 16

antiphospholipid antibody syndrome immune hypercoagulability

Answer 16

-antiphospholipid antibodies (lupus anticoagulant/or anticardiolipid antibodies)
venous thromboembolism, arterial thromboembolism, or frequent fetal loss.
-prolongue aPTT

Question 17

Paraneoplastic syndromes occur due to tumor cells producing substances that frequently induce an autoimmune reaction and cause damage and deferenation of healthy organs and tissues

Answer 17

• examples are lambert-eaton myasthenic syndrome

- paraneoplastic cerebellar degeneration

Question 18

localized amyloidosis (confined to a single specific organs)

Answer 18

cardiac atria: atrial natriuretic peptide (senile)
thyroid gland: calcitonin (medullary carcinoma)
pancreatic islets: islet amyloid protein (amylin)
cerebrum/cerbral blood vessels: B-amyloid protein (alzheimers)
pituitary gland: prolactin

Immune globulin light chains cause multi-organ amyloid deposition in primary systemic amyloidosis

Question 19

hyperparakeratosis

Answer 19

describes the retention of nuclei in the stratum corneum, which signals incomplete keratinization

Question 20

hypergranulosis

Answer 20

describes excessive granulation in the startum granulosum of the epidermis and is seen in conditions such as lichen planus

Question 21

the major histologic finding in patients with contact dermatitis

Answer 21

spongiosis
epidermal accumulation of edematous fluid in the intercellular spaces
-delayed hypersensitivity langerhand cells MHC II to CD4 T helped cells, to bring T cells in

Question 22

eczematous dermatitis

Answer 22

erythematous, paulovesicular, weeping, encrusted lesions that may evolve into thickened, scaly plaques
-atopic dermatitis, drug related eczematous dermatitis, photo-eczematous dermatitis, primary irritant dermatitis

Question 23

anaplastic tumor characteristics

Answer 23

• loss of polarity, complete disruption of normal architecture
• nucleo pleomorphism and cellular plemorphism (shapes and sizes)
• high N:C ration, that are often deep staining (hyper chromatic) with abundant, coarsely-clumped chromatin and large nucleoli
• mitotic figures
• giant multinucleated tumor cells

Question 24

Bronchial epithelial cells can produce keratin pearls after a phenotypic switch from columnar epithelium to squamous epithelium.

Answer 24

this is metaplasia

Question 25

pneumonia

Answer 25

bronchopneumnia - patchy inflammation of a number of lobules

interstitial: inflammatory infiltrate is confied to alveolar walls
lobar: inflammatory process involves an entire lung lobe

Question 26

Lobar pneumonia typically follows 4 stages

Answer 26

congestion (first 24 hours)

• lobe is red, heavy, boggy
• histo vascular dilation, alveolar exudate contains mostly bacteria

red hepatization (2-3days)

• love is red, firm ( liver-like consistency)
• histo, alveolar excudate contains erythrocytes, neutrophils and fibrin

gray hepatization (4-6days)

• gray-brown firm lobe (pale and firm)
• histo: RBC disintegrate, alveolar exudate contains neutrophils and fibrin

resolution:
lobe restoration of normal architecture
histo enzymatic digestion of exudate

Question 27

internal juglar vein

Answer 27

drains the brain and superficialface and neck

Question 28

external jugular vein

Answer 28

drains the scalp and portions of the lateral face

Question 29

the subclvian vein is a continuation of the axillary vein

Answer 29

both drain blood from the upper extremity

Question 30

SVC syndrom

Answer 30

-SVC is obstructed, which would have hface, neck, chest and both arms would be involved

Question 31

the brachicephalic vein drains the ipsilateral external jugular vein and subclavian veins

Answer 31

-this would cause a one side SVC syndrome

Question 32

the right brachiocephalic vein also drains the right lymphatic duct-drians the lymph from the right upper extremity, the right face and neck and the right hemithorax and the right upper quadrant of the abdomen

Answer 32

the left lymph is from left thoracic duct does the rest of the body

Question 33

Gram-negative sepis is due to release of endotoxin LPS from bacterial cell walls. LPS is heat stable, and has three regions O antigen, core pollysacharide and lipid A

Answer 33

Lipid A is the toxic component
-it causes activation of macrophages leading to the widespread release of IL-1 and TNF alpha, which cause the signs and symptoms of septic shock, fever, hypotension, diarrhea, oliguria and vascular compromise and finally DIC

Question 34

mulluscum contagiosum is caused by sexually transmitted poxvirus

Answer 34

DS and linear DNA

-characterized by white, umbilicated papules on the penis, vulva or groin