Our Clues 4 Flashcards
MEN 3 or 2b
Medullary carcinoma of thyroid (= incr calcitonin)
Pheochromocytoma
Marfanoid features, neuroma/ganglioneuroma
What are the 3 syndromes with Marfanoid features?
1) Marfan’s
2) MEN 3 or 2b
3) Homocystinuria
Drug cause of osteonecrosis (especially mandible)
Bisphosphonates (end in “-nate”)
MOA: inhibit osteoclastic activity
Bind Ca and Mg, causing Hypocalcemia and hypomagnesemia
Foregut:
- Blood supply
- Innervation
- What organs?
- Rotation?
Blood supply: celiac trunk
Innervation: sympathetic = T5-9, parasympathetic = vagus
Organs: Lungs & GI tract = mouth to 2nd part of duodenum
Rotation: 90 degrees
Midgut:
- Blood supply
- Innervation
- What organs
- Rotation?
Blood supply: superior mesenteric artery
Innervation: sympathetic = T9-12, parasympathetic = vagus
Organs: 2nd part of duodenum to splenic flexure
Rotation? 270 degrees counterclockwise from yolk sac via dynein/kinesin
Hindgut:
- Blood supply
- Innervation
- What organs?
- Rotation?
Blood supply: inferior mesenteric artery
Innervation: sympathetic = L1-2, parasympathetic = splanchnic nerve
Organs: Splenic flexure to anus
No rotation, just septation
Causes of incr amniotic fluid (polyhydramnios)
- autonomic dysfunction
- neuromuscular disease
- unable to digest
Riley-Day Syndrome
- cannot swallow
- familial dysautonomia
- baby cries w/o tears
Werdnig-Hoffman Syndrome
- cannot swallow
- floppy baby with fasciculations
UGI atresia
- esophagus
- duodenal
Causes of decr amniotic fluid (= Oligohydramnios)
Fetus cannot pee
Renal agenesis
- associated with ACE inhibitor use in mom
Bladder obstruction
Metanephros did not develop -> Potter syndrome
Ureteric bud fails to make contact with metanephros -> Potter syndrome
Posterior urethral valves
What is the hunger center of hypothalamus?
What is the satiety center of hypothalamus?
Hunger center -> lateral nucleus
(Stimulated by decr glucose or NT (NE, serotonin) 20%)
Satiety center -> Ventromedial
(Stimulated by incr glucose, gastric stretch, or NT (NE, serotonin) 80%)
Dx with aggressive appetite, where they typically die from overeating?
(What is the genetic component?)
Prader-Willi
- Lesion of satiety center (= ventromedial nucleus of hypothalamus)
- uniparental disomy
- genomic imprinting
- trinucleotide repeats
- chromosome 15
DOC for ADHD
- MOA
- side effects
Methylphenidate
Amphetamine -> taken up presynaptically => causes release of catecholamines (incr DA, NE, 5-HT)
SE: vertical nystagmus (all amphetamines) and hypogognic hallucinations
How to differentiate amphetamines
All cause vertical/rotary nystagmus
Methylphenidate -> hypogognic hallucinations (go to sleep)
LSD -> colorful hallucinations
PCP -> violent, aggression, hallucinations from serotonin
Ecstasy -> excessive thirst, hallucinations from serotonin
Differentiate type (serous/mucus) and nerve:
Salivary Glands
- parotid
- lingual
- sublingual
- submandibular
Parotid: serous (CN IX)
Lingual: mixed, mostly serous (CN VII)
Sublingual: mixed, mostly mucus (CN VII)
Submandibular: mucus (CN VII)
MOA of Cimetidine
H2 blocker, w/ famotidine, nizatidine, ranitidine
MOA: block H2 to decr HCl secretion
Use: mild GERD, gastritis
SE: gas, nausea, vomiting
Cimetidine inhibits cyp450
MOA of lansoprazole
PPI = proton pump inhibitor
Ends in “-prazole”
MOA: block 90% production of acid in parietal cells
Use: PUD, severe GERD, H pylori
SE: bleeding, bloating, gas
What is the only pancreatic enzyme that cuts to the left?
Carboxypeptidases
(Cuts to the left of carboxy terminal)
Cutting locations for Pancreatic Enzymes:
- trypsin
- elastase
- chymotrypsin
- amylase
Trypsin (trip to LA): to the right of Lys, Arg
Elastase (is GAS): to the right of Gly, Ala, Ser
Chymotrypsin (o for aromatic ring): to the right of Phe, Tyr, Trp
Amylase: breaks down alpha-1,4 bonds
Which bilirubin causes jaundice?
Unconjugated (= Indirect)
-> It’s fat soluble, leading to distribution to tissues
(Conjugated (= Direct) is water soluble, therefore no jaundice)
Dx with increased unconjugated bilirubin:
Crigler-Najjar Type 1
- autosomal recessive
- complete deficiency of UDP-glucuronyl transferase
Dx with increased unconjugated bilirubin:
Crigler-Najjar type 2
- partial deficiency of UDP-glucuronyl transferase
Dx with increased unconjugated bilirubin:
Gilbert’s syndrome
In stress, glucuronyl transferase becomes saturated
Dx with increased conjugated bilirubin:
Rotor’s syndrome
- mild compared to Dubin-Johnson
- defective bilirubin transport
- Rotor = Regular liver, d/t absence of black pigment
Dx with increased conjugated bilirubin:
Dubin-Johnson syndrome
- defective bilirubin transport
- Dublin = Dark liver b/c black pigment
Dx with increased conjugated bilirubin:
Cholestatic Jaundice
D/t Post-hepatic obstruction
