Pharm and week 2 review (8/18) Flashcards
1
Q
Half life equation
A
t half= 0.7* Vd/ CL
2
Q
Where is elastase produced in the lungs?
A
Macrophages and neutrophils
balanced by serum and tissue protease inhibitors
3
Q
What is the effect of excess elastase activity in the lungs?
A
emphysema
4
Q
paramesonephric duct is also called
A
mullerian duct
5
Q
Law of conservation of mass
A
total flow=flow velocity x cross section area=constant
6
Q
IL-12 does what?
A
stimulate Th1–> IFN gamma, IL-2–> macs and CD8 t cells
7
Q
breakdown of odd chain FA, branched chain aa (valine, isoleucine), threonine, methionine leads to production of what?
A
propionic acid
can eventually enter TCA cycle as succinyl CoA
8
Q
CGG repeat
A
Fragile X
Hypermethylation of FMR1 gene
9
Q
Cystic hygroma and bilateral extremity swelling with decreased femoral pulses in a baby
A
Turners syndrome
loss fo paternal X
10
Q
Reactive arthritis signs and symptoms
A
Can’t pee, Can’t see, can’t climb a tree + sacroilitis (HLA-B27 association)
11
Q
Psychosis during depressed episode
A
Major depressive disorder w/ psychotic features
12
Q
Psychotic symptoms +/- mood disorder
A
Schizoaffective disorder
13
Q
Dystrophic calcification
A
Ca deposition in abnormal (injured or necrotic) tissues
localized calcification (aortic stenosis)
Nl levels of Ca
damage can be from aging
14
Q
local calcification of abnl tissue with normal Ca levels
A
Dystrophic calcification
15
Q
Canagliflozin
A
SGLT2 inhibitor that blocks reabs of glucose in PCT
16
Q
Contraindication for SGLT2
A
Renal impairment
17
Q
what is in the femoral ring?
A
Lymphatics coming out of femoral canal
18
Q
what is in the femoral sheath?
A
Femoral artery, vein, lymphatics
19
Q
from lateral to medial what is the femoral triangle
A
Nerve, Artery, Vein, lymphatics (NAVeL)
20
Q
effects of a chronic AV shunt on the heart
A
increased CO output
decreased total peripheral resistance
increased mean systemic pressure (renal retention)
Acute AV shunt no change in mean systemic pressure
21
Q
Effects of pulmonary fibrosis on breathing?
A
rapid shallow breaths
increase elastic resistance
22
Q
Immune SE of corticosteroids
A
Neutrophilia–> demargination
Immunosuppression
Increased risk of infection
23
Q
Fever, generalized lymphadenopathy, facial edema, skin rash, eosinophilia + drugs
A
Drug reaction with eosinophilia and systemic symptoms (DRESS)
phenytoin, allopurinol, sulfonimides
2-8 wks after
24
Q
Viral reassortment
A
only in segmented viruses BOAR Bunyavirus Orthomyxovirus Arenavirus Reovirus
25
mutation in hemochromatosis
C282Y on HFE gene--> increases iron absorption in intestines
decreases hepatocyte hepcidin synthesis
HLA-A3
26
parotid gland hypertrophy with low body weight
Anorexia of the binging and purging flavor
27
parotid gland hypertrophy with normal body weight
Bulimia
28
Majority of OD deaths
opioids
29
Reaction formation
responding in a manner opposite one's actual feelings
30
Tx for mycobacterium avium
Azithromycin + rifavutin or ethambutol
31
fever, wt loss, diarrhea, anemia, hepatosplenomegaly, elevated alkaline phosphatase and lactate dehydrogenase, bacteria grows well at high temp
Mycobacterium avium
CD4 count
32
Proglitazone MOA
PPAR gamma binding
| nuclear transcription regulator increases insulin sensitivity
33
tx for essential tremor
propranolol
34
Thiopental
Barbiturate
short acting general anesthetic
high lipid solubility so rapidly redistributed from brain to skeletal muscle and fat
35
cause of SE from Niacin
Prostaglandins (PGD2 and PGE2) cause flushing, warmth, itching
tx: aspirin
36
Diuretic that improves survival in pts with CHF + decreased EF
SPIRONOLACTONE
| k sparing and improved remodeling of ventricles
37
Chlordiazepoxide
Benzo used for alcohol withdrawal
38
Chlorthalidone
Thiazide
39
Metabolic effects of Thiazide
```
HyperGLUC
Glycemia
Lipidemia (decreased insulin secretion increased resistance)
Uricemia
Calcemia
```
Hypo natremia --> inhibition of Na/Cl in DCT
Hypokalemia--> K wasting
40
patient with treated symptomatic coronary artery dz with myopathy
statin induced myopathy
| esp when used with vibrates or niacin
41
SE of CCB
Peripheral edema, dizziness or lightheadedness, constipation
42
Amlodipine
CCB that acts on vascular SM
| tx for HTN
43
Triamterene
diuretic
blocks Na+ channels in cortical collecting tubule
K sparing
44
tx for trauma pt who is obtunded with HTN
Mannitol
45
Tx for decompensated systolic HF
```
beta blocker (carvedilol)
decrease work and after load
```
46
beta blocker treatment for glaucoma
decrease aqueous production by ciliary epithelium
47
Tx for Psoriasis that activates a nuclear transcription factor
Topical Vit D analogs
| calcipotriene, calcitriol, tacalcitol
48
Calcipotriene
Tx for psoriasis
activates a nuclear transcription factor
inhibit keratinocyte proliferation and stimulate keratinocyte differentiation
49
SE of glyburide
hypoglycemia
sulfonyurea (inhibit ATP depends K channels in beta cells leading to exocytosis of insulin)
50
SE of long term use of omeprazole
decreased Ca abs--> osteoporotic hip fracture
| decrease serum Mg+
51
Ribavirin MOA
interfere with duplication of viral genetic material
52
SE of mu opioid (morphine)
smooth muscle contraction of the sphincter of Oddi
increases common bile duct pressure
also addiction, constipation, pin point pupils
53
effect of rat poison
super warfarin (brodifacoum)
deplete vitamin K clotting factors--> like warfarin toxicity
Tx: FFP
54
Medial hypertrophy in lung vessels, intimal fibrosis, luminal narrowing
Idiopathic pulmonary arterial HTN--BMPR2 gene
55
TX for pulmonary arterial HTN
Bosetan
endothelin receptor antagonist
vasodilator--> decreases PA pressure and decreases hypertrophy
56
interstitial myocardial granuloma with plump macrophages and increased cytoplasm.
Aschoff bodies with anitschkow cells
Rheumatic fever--> young kid with myocarditis
57
Fibular neck fracture
injured common peroneal n.
PED= Peroneal Everts and Dorsiflexes
Foot dropPED
58
Knee trauma
Tibial n. injury
TIP
Tibial Inverts and Plantarflexes
can't stand on TIP toes
59
RA antibodies
```
Anti-CCP (anti-cyclic citrullinated peptide)
Rheumatory factor (IgM anti IgG)
```
60
disease frequency in hardy weinberg
q^2
61
Interferon alpha and beta
Interfere with viruses
prime uninfected cells for viral defense
halt protein synthesis in uninfected cells
62
Interferon gamma
Th1 differentiation, increased expression of class II MHC APC, Improves intracellular killing by macs
produced by T cells and NK cells
63
Cause of pulses paradoxus with no pericardia effusion or constrictive pericarditis
Asthma and COPD
64
Down regulation of gastric acid production?
Intestinal infuence
peptide YY binds ECL
somatostatin and prostaglandins
65
Dyspnea, tachypnea, prolonged expiration, bilateral wheezing
obstructive pulmonary disease exacerbation
Tx; Beta agonist increases cAMP
66
Carbon tetrachloride
Free radical injury to liver (H2O2)
| lipid per oxidation
67
where are intracranial schwannomas located?
cerebellopontine angle--> between cerebellum and lateral pons
68
Buprenorphine
partial opioid agonist
| precipitates withdrawal
69
Uncle herniation effects
```
Down and out (oculomotor nerve palsy)
Blown pupil (dilated pupil)
```
70
Anxious, fearful of rejection, wants relationships, timid
Avoidant personality
71
How to test for fat malabsorption?
Sudan III stain of stool
72
Causes of SCC of the esophagus
Alcohol use, tobacco, smoked foods
73
Borderline personality disorder
SPLITTING
unstable relationships and mood
impulsive, self-mutilitation, emptiness
74
Colorectal, endometrial, ovarian cancer
Lynch syndrome
75
mutation in lynch syndrome
MSH2 and MLH1
76
Excessive emotions, attention seeking, sexually provocative, overtly concerned with appearance
histrionic personality disorder
77
Hormone sensitive lipase
degrades TGs stored in adipocytes
creates FFA and glycerol
activated by stress hormones (starvation)
inhibited by insulin
78
NF kappa B
controls transcription, cytokine production, cell survival
79
osteoclasts histology
multinucleate (2-5)
100s of nuclei in paget's
80
Receptor activation of NF kappa B ligand
RANKL--> differentiation of osteoclasts
81
Differentiation of osteoclasts
RANK-L and Mac colony stimulating factor
82
Osteoprotegerin
OPG
decoy receptor decrease binding of RANK-L to RANK
decreases differentiation of osteoclasts
increase bone density
83
late muscle changes in Duchenne muscle dystrophy
muscle in distal extremities replaced by fat and connective tissue (pesudohypertorphy)
84
Thinning of glomerular BM
```
Alport syndrome (type 4 collagen)
hearing loss, ocular abnormalities, hematuria, progressive renal insuff
```
85
Nesiritide
Synthetic BPN
dilates arterioles and veins
increase cGMP in smooth muscle
decrease after load and preload
86
Use of clevidipine
HTN emergency
87
equations for CO
SVxHR
| =(rate O2 consumption)/(arterial O2 content - venous O2 content)
88
calculation of MAP
CO x TRP=2/3 diastolic + 1/3 systolic
89
Ejection fraction eq
EF=SV/EDV= (EDV-ESV)/EDV
90
SE of Doxorubicin
Dilated cardiomyopathy prevent with dexarzoxane
91
Nitrates effect
VENOdilator, decrease LVEDP and preload
92
Cilostazol
Phosphodiesterase III inhibitor
increases cAMP in plts inhibits plt aggregation
vasodilator
tx for claudication
93
Statin MOA
block HMG-CoA reductase leads to increased surface expression of LDL receptors
94
Dilated cardiomyopathy
```
ABCCCDHS
Alcohol abuse
(wet) Beri Beri
Chagras
Chronic Cocaine use
Chagas Dz
Doxorubicin toxicity
Hemochromatosis
Sarcoid
```
95
Causes of restrictive cardiomyopathy
diastolic dys
sarcoid, amyloid, post radiation
loftier syndrome (endomyocardial fibrosis w/ eosinophilic infiltrate)
96
DNA polymerase I
Degrades RNA primer
97
Which direction are deoxynucleotides added
3'end so building from 5 to 3
reading original strand 3 to 5
98
where are GI stem cells
Crypts of liberkuhn
99
Von Gierke enzyme
G6Pase
100
Enlarged hilar lymph nodes on CXR, elevated ACE and scattered granulomas in liver
Sarcoidosis
arthralgia
101
D cells in pancreatic islet and gut mucosa
Produce somatostatin
102
Diret inguinal hernia cause
breakdown of transversals fascia
older men
103
DIP joint pain, hard, bony enlargement of joints, brief morning stiffness
Osteoarthritis
DIP nodules--heberden
PIP nodules--bouchard nodes
104
Paranoid personality disorder vs. delusional disorder
Paranoid--pattern of suspiciousness or odd beliefs w/ no clear delusions
Delusional disorder--one or more delusions for >1mo. Otherwise normal behavior
105
Acute morbidity due to rheumatic fever
Pancarditis (inflammation of the endocardium myocardium and epicardium)
106
Associations with coarctation of the aorta
Turners, bicuspid aorta, other heart defects, Berry aneurysms of the circle of willis
107
Cause of death in adult type coarctation of aorta
HTN associated complications
| LV failure, ruptured dissecting aortic aneurysm, intracranial hemorrhage
108
Effects of efferent arteriole constriction on GFR and FF
GFR increases
RPF decreases
FF increases
109
Hematuria, mild proteinuria and Discrete subepithelial humps on EM (recently treated for sore throat)
Post streptococcal glomerulonephritis
M protein
cola-colored urine
granular IF--lumpy bumpy deposits of IgG and C3
110
Schizoid vs. avoidant
Schizoid--voluntary withdrawal
| Avoidant--Desires contact anxious about rejection and socially inhibited
111
CYP450 inhibitors
```
AAA RACKS IN GQ Mag
Acute Alcohol Abuse
Ritonavir
Amiodarone
Cimetidine
Ketoconazole
Sulfonamides
INH
Grapefruit juice
Quinidine
Macrolide's (minus azithro)
```
112
Neural crest cell derivatives
```
MOTEL PASS
Melanocytes
Odontoblasts
Tracheal cartilage
Enterocromaffin cells
Laryngeal cartilage
Parafollicular cells
Adrenal medulla
All ganglion
Schwann cells
Spiral membrane (heart)
```
113
fever, puritic skin rash and arthralgias 7-14d after exposure
Acute serum sickness
Type III hypersensitivity rxn
Decreased C3
small vessel vasculitis w/ fibrinoid uncross and PMNs
114
Type III hypersensitivity rxn
Immune complex
deposition of Ab-Ag complexes
leads to localized complement consumption--> decreased serum C3
115
AG resistance
amino glycoside modifying enzymes that attach chemical groups and decrease ability of drug to bind to ribosomes
116
Effects of myasthenia gravis on conduction
Autoantibodies against postsynaptic nicotinic ACh receptors
Reduced motor end plate potential
117
CN VII function
Motor for face
parasymp LACRIMAL, submandibular and sublingual glands
taste of anterior 2/3 of tongue
somatic-pinna and external auditory canal
118
COPD effect on kidney
Hypoxia stimulates erythropoietin production
119
Iliohypogastic n
Risk of damage during appendectomy
L1
motor to anterolateral ab wall
sen. suprapubic region
120
Ilioinguinal n.
follows spermatic cord through superficial inguinal ring
| sensation to upper and medial thigh and part of genitals
121
hypotension, distended neck veins, distant heart sounds
Beck's triad
Cardiac tamponade
+pulsus paradoxus
122
increased JVD with inspiration
Kussmaul sign
impaired filling of RV
causes: constrictive pericarditis, restrictive cardiomyopathies, RA or RV tumors
123
Smooth area of the ventricles comes from
Bulbus cordis
124
the trabeculated parts of the right and left ventricles comes from
Primitive ventricle
125
What disease is associated with sterile small vegetation's made up of platelet rich thrombi on the mitral valve
Advanced malignancy (adenocarcinoma)
or hyper coagulable states
antiphospholipid syndrome
SLE (libman-sacks endocarditis)
126
Treatment for acute obstructive pulmonary exacerbations
Beta 2 adrenergic agonist
increases intracellular cAMP
Bronchial smooth muscle relaxation
127
ACE inhibitor side effect for people with HF or on diuretics
1st dose hypotension and syncope
High plasma renin activity
removal of Ang II vasoconstriction--> drop in BP
128
Appearance of pulsus paradoxus on physical exam
Due to cardiac tamponade
| Drop in pulse amplitude during inspiration
129
Beat to beat variation in pulse amplitude
Pulsus alternans
| Severe LV dysfunction
130
Electrical alternans
beat to beat variation in QRS amplitude on ECG due to swinging motion of hear in pericardial fluid due to effusion or tamponade
131
Vasculitis with granulomatous inflammation of the media
Giant cell arteritis
| takayasu arteritis
132
Systolic pressure gradient between the LV and aorta is suggestive of...
LV outflow tract obstruction (aortic stenosis)
remember that dilated cardio myopathy is a diagnosis of exclusion
133
Pathogenesis of IE
first disruption of normal endocardial surface
| Second focal adherence of fibrin and plts making a sterile fibrin-plt nidus.
134
migratory septic arthritis in a 25yo
Nisseria gonococci
135
tx: nisseria gonococci
Ceftriaxone
136
Causes of infectious arthritis
S. aureus, streptococcus, Nisseria gonorrhoeae
migratory and asymmetric
sinusitis, tenosynovitis, dermatitis
137
Vd equation
Vd=(amount of drug in body)/(plasma drug concentration)
138
Loading dose calculation
LD=Cp x Vd/F
139
First line for otitis externa
Fluoroquinolone's (ciprofloxacin)
140
primary amyloidosis
AL amyloid made up of ig light chain
seen in multiple myeloma (abnormal plasma cell dyscrasia)
141
Secondary amyloidosis
AA amyloid
Serum amyloid-associated protein (SAA)
increased by chronic inflammation (autoimmune states, TB, RA), malignancy and familial mediterranean fever
142
Multiple myeloma
```
CRABB
hyperCalcemia
Renal involvement (Bence-Jones casts from high ig in the urine, nephrocalcinosis, metastatic)
Anemia
Bone lytic lesions
Back pain
```
Monoclonal M protein
Rouleaux formation--stacking of RBCs
143
recurrent bacterial infections and no tonsils
X-linked (Bruton) agammaglobulinemia
Defect in BTK tyrosine kinase--> no B cell maturation
decreased Ig of all classes
144
Tetany (hypocalcemia), recurrent viral/fungal infections, ToF
Thymic aplasia
DiGeorge syndrome
absent thymic shadow on CXR
decreased T cells
145
airway and GI infections, autoimmune diseases, atopy
Selective IgA deficiency
decreased IgA with normal IgG and IgM
Anaphylaxis to IgA containing products
Type I hypersensitivity rxn
146
Effect of strenuous exercise on blood gas content
skeletal muscle removes more O2-->decreased O2 in venous blood
Muscle produces more CO2--> increased CO2 in venous blood supply
Increased CO2 in venous blood leads to decreased venous pH
147
Kinesin function
move from negative to + end (anterograde) of microtubule carrying vesicles and organelles away from cell body to nerve terminal
+ end is far away
148
PCP MOA
N-mentyl-D-aspartate receptor antagonism
agitation, hallucinations, violent behaviors
Horizontal AND vertical nystagmus
disorientation and memory loss
149
Diagnosis of Mucormycosis
Mucosal biopsy
150
Causes of elevated CK and myopathy
```
Inflammatory myopathy (polymyositis-prox ask weakness)
Statin-induced myopathy (weeks to months after starting statin)
Hypothyroid myopathy (hypothyroid features, delayed tendon reflexes and myoedema)
```
151
which enzyme determines the rate of glycolysis
phosphofructokinase
152
which non-glucose monosaccharide enters the glycolytic pathway downstream of phosphofructokinase?
Fructose
allows for rapid metabolism
converted to F1P-->glyceraldehyde--> G3P-->-->pyruvate
153
Histology of acute organ rejection
interstitial lymphocytic infiltrates
154
What is the purpose of giving fluids in hypovolemic shock?
Increase volume--> increase preload--> increase myocardial stretch--> increase stroke volume
155
Cancers associated with hereditary retinoblastoma
Soft tissue sarcoma
Osteosarcoma (distal femur, proximal tibia, proximal humerus)
melanoma
Brain cancers
156
Cause of Zener Diverticulum
abnl spasm or diminished relaxation of cricopharyngeal muscles while swallowing
increased pressure leads to herniation through pharyngeal mucosa through zone of muscle weakness-->false diverticulum
157
Live attenuated oral (sabin) poliovirus vaccine vs. inactivated Salk
Sabin greater mucosal secretory IgA immune response
better protection at the site of viral entry
158
chalky white lesions on mesentery with fat cell destruction and Ca2+ deposition
Acute pancreatitis
Acute interstitial pancreatitis--> edematous with Ca deposition
Necrotizing pancreatitis--> chalky white fat necrosis + hemorrhage
159
Heme-positive stools and noncaseating granuloma in colonic mucosa
Crohn dz
+ transmural inflammation
Cobblestone appearance
skip lesions
160
Microscopic morphology of ulcerative colitis
Crypt abscesses and ulcers, bleeding, NO granulomas
161
Follow up for elevated alk phos
Gamma glutamyl transferase (GGTP)
162
Abetalipoproteinemia
AR inability to synthesize apoB--> can not transport lipids from small intestine into blood--> enterocytes with clear or foamy cytoplasm
Clinical: first year malabsorption, low TG and cholesterol and NO chylomicrons or VLDL or apoB
Neurologic abnormalities (ataxia, retinitis pigmentosa)
Spiky blood cells (acanthocytes)
163
source of and cancer from G to T mutation in gene p53 associated with moldy grains
Aspergillus flavus and Aspergillus parasiticus grown on corn, soy and peanuts--> aflatoxins--> HCC
164
Gallbladder hypomotility risk factors
Pregnancy
rapid wt. loss
high spinal cord injuries
prolonged use of TPN or octreotide
165
Effect of gallbladder hypomotility
usually gallbladder reabsorbs water from bile so w/ bile stasis get bile concentration--> accumulation of particulate material--> biliary sludge
166
Black pigmented gallstones
chronic hemolytic anemia (SC) and increased enterohepatic cycling of bilirubin (crohn)
167
brown pigmented gallstones
increased amount of unconjugated bili from biliary tract infections (microbes producing beta glucuronidases)
168
Esophageal cancer prognosis
poor
169
solid food dysphagia, retrosternal discomfort, wt. loss in older man (>50) who smokes
Esophageal SCC
see keratinization and intercellular bridges
170
Right sided colon cancer
exophytic masses, iron deficiency anemia (fatigue, pallor) from bleeding. Also wt. loss, anorexia, malaise
171
Left sided colon cancer
infiltrating mass, partial obstruction, colicky pain, hematochezia, Apple core lesion.
172
What lines a pancreatic pseudocyst?
Fibrous and granulation tissue
173
abdominal wall pain, chronic diarrhea, wt. loss, regular alcohol use, calcification in the epigastric area
Chronic alcoholic pancreatitis
alcohol induced secretions of protein-rich fluids--> precipitate in duct--> duct plugs that calcify
174
what is worse Villous colonic polyps or Tubular polyps?
Villous
