Mon June 29 Flashcards
how may ethylene glycol lead to kidney damage?
ethylene glycol is metabolized to glycolic acid and oxalic acid.
- Glycolic acid causes direct tubular cytotoxicity
- oxalate precipitates and causes tubular obstruction
pyruvate carboxylase function?
Converts pyruvate to oxaloacetate for gluconeogenesis
What deposits in Henoch-Schlonlein purpura?
IgA and C3 deposition
what is amlodipine?
Ca channel blocker
What is diltiazem?
Ca channel blocker
does bicarb increase with vomiting?
yes - you have loss of H which is used to produce the buffer H2CO3, resulting in a relative increase in HCO3-
The dehydratio also leads to impaired HCO3- excretion
how does potassium contribute to the increased bicarb that occurs with metabolic alkalosis?
hypokalemia from loss of vomiting results in more uptake of H, as it is exchanged for K
(K goes extracellular for H which goes intracellular)
what is choroidal nevus?
an eye freckle
is choroidal nevus genetic?
NO
which pathway is responsible for crude touch?
spinothalamic
what fungus appears as sphagetti and meatballs on KOH prep?
malessezia
the dose of local anesthetic to achieve adequate anesthesia is higher in….
infected tissue - increased acidity at infected sites renders the anesthetic to its charged form, which does not cross the cell membranes
morphine is predominantly cleared in the. …
whereas fentanyl and hydromorphone are primarily cleared…
kidneys
in the liver
what is eplerenone?
a mineralocorticoid blocker that has less anti-androgenic effects than spironolactone
what do tRNA molecules have at their 3’ end? (the acceptor stem)?
a CCA tail -used for other molecules to recognize them
buproprion MOA
inhibits reuptake of NE and dopamine
buproprion A/E?
seizures
who is buproprion contraindicated in ?
those with seizure disorders and eating disorder (electrolyte imbalances increase risk for seizures)
which radiation-related skin changes may be present acutely post radiation (within 3 months?)
apoptosis and epidermal edema
erythema, desquamation
pigment changes and loss of skin appendages (hair, glands)
which radiation-related skin changes may be present in the late stage post radiation (over 3 months?)
- Fibrosis - from homogenization of dermal collagen (due to fibroblast activation by TGF-B released from dying cells)
- vascular damage -> chronic hypoxia and ulceration
- abnormal microvasculature (telangiectasias)
which organisms form pink colones on macconkey agar?
organisms that ferment lactose (E coli, Klebsiella, Enterobacter)
what is the major virulence factor of E coli that cause neonatal meningitis?
K1 capsular antigen
When do you start prophylaxis for pneumocystitis jiroveci?
CD4 <200
When do you start prophylaxis for toxoplasmosis gondii?
CD4<100
When do you start prophylaxis for M avium?
CD4< 50
Uterine fundus abnormalities result from…
failed lateral fusion of the paramesonephric ducts
Failure of the involution of the paramesonephric ducts would result in what?
a longitudinal uterine septum
what does heteroplasmy mean?
it refers to having different mitochondrial genomes within a single cell (each cell has 100s of mitochondria)
dysthmia AKA
persistant depressive disorder
how does persistant depressive disorder differ from major depressive disorder?
its a chronic form of depression that lasts for years but is less severe than MDD
diagnosis criteria of MDD vs persistant depressive disordeR?
MDD - 5 criteria met for at least 2 weeks with severely impaired functioning
Persistant depressive disorder - 3 criteria met, lasts for at least 2 years, milder impairment in functioning
which enzyme is absent in Gauchers disease?
lysosomal beta-glucocerebrosidase
what accumulates in Gauchers disease?
glucocerebrosidase
how do you treat Gauchers disease?
recombinant glucocerebrosidase
how do you administer recombinant glucocerebrosidase?
IV
-its a polypeptide (peptide drugs undergo extensive cleavage in the stomach and duodenem, and also arent effectively absorbed across the intestine)
recombinant glucocerebrosidase MOA?
binds to mannose-6-phosphate receptor on the cell, and gets endocytosed into lysosomes where it degrades accumulated glucocerebrosidase
presentation of Gauchers diseasE?
hepatosplenomegaly, bone pain, pancytopenia (from accumulation of lipid laden macrophages)
how does infusion of excess normal saline lead to non anion gap metabolic acidosis?
the excess chloride causes bicarb to shift inside of cells -> decreased blood pH
Also the increase blood volume causes the kidneys to secrete Na, increasing urinary Na
what repeats in huntingtons disease?
CAG
In huntingtons disease, there is atrophy of. ..
the caudate nucleus
what causes hemiballismus?
decreased activity in the subthalamic nucleus
which 2 factors are important for osteoclast differentiation?
M-CSF (macrophage colony stimulating factor)
receptor for activated nuclear factor kappa-b ligand (RANKL)
what will the osteoclasts look like in pagets disease?
Osteoclast multinucleated giant cells have up to 100 nuclei (opposed to the normal 2-5)
what causes juvenile pagets disease ?
OPG loss of function mutations (the decoy receptor for RANKL)
kinesin moderates ____ transport
anterograde
dynein moderates ____ transport
retrograde
Which movement is the infraspinatous muscle responsible for?
external rotation (attaches from the scapula to the humeral head, on the back)
the subscapularis helps with which movements of the arm?
ADDuction and internal rotation
what movement does the supraspinatous perform?
ABduction of the arm
