question log things that won't stick! Flashcards
antibodies against polyribitol rbose phosphate(PRP) would most likely confer protection against _____
H influenze that caues epiglottitis
what are three mitochondrial disorders “red ragged fibers”
myoclonic epilepsy with ragged red fibers
leber optic neuropathy (blindess)
mitochondrial encephalopathy with stroke like episodes(ELAS)
burkitt lymphoma translocation
C-MYC (8;14)
FOLLICULAR LYMPHOMA TRANSLOCATION
T(14;18)
bcl-2 overexpression
what is elevated in neural tube defect?
AFP and acetylcholinesterase
what is fondaparinux?
synthetic factor 10a inhibitor
pentazocine
partial opiod agonist at mu receptors.
features of carcinoid syndrome from excess seretonin from carcinoid tumor?
bronchospasm,diarrhea, flushing of skin
what is pre-eclampsia?
what is HELLLP
pre-eclampsia = triad of HTN, proteinuria and edema and may progress to
HELLP(hemolytic anemia, elevated liver enzymes, low platelets). Eclampisa = pre-eclampisa + seizures.
rate limiting ezyme for bile acid syntehsis from cholesterol?
7-alpha hydroxylase
describe **single base excision **repair
single base excision repair corrects defects in single bases by 1. glycosylases - remove defective base pair and corresponding sugar-phosphate is cleaved and removed by endonuclease -->action of lyase. DNA pol replaces the missing nucleotides and ligase connects DNA strand.
what is the valsalva maneuver?
which musle important?
vasalva increases vagal tone and can be used to abolish paroxysmal supraventricular tachycarida.
Rectus abdominis = most important muscle in achieving intraabdominal and intrathoraci pressure of vasalva maneuver.
why do you need to space out MAO tx and SSRI tx?
Need to wait at least 14 days btw stopping an MAO inhibitor and giving an SSRI. Why? b/c need to regenerate MAO so that you don’t have too much seretonin running around—>increased risk of seretonin syndrome.
which condition?
infant presents with: flaccid lower extremeities, absent ankle reflexes bilaterally + x-ray showing poorly developed lumbar spine and sacrum
infant presents with: flaccid lower extremeities, absent ankle reflexes bilaterally + x-ray showing poorly developed lumbar spine and sacrum has caudal regresssion syndrome (sacral agenesis causing lower extremity paralysis and urinary incontinence) and is commonly associated with **poorly controlled maternal diabetes. **
what are the bones associated with the 1st pharyngeal arch(4)?
BONES + cartilage ASSOCIATED WITH ARCH 1:
Meckel’s cartilage: mandible, malleus, incuse, sphenomandibular ligament
classic location for anal fissure
anal fissure location: anal canal distal to dentate line posterior midline and associated with severe tearting pain when trying to pass bowel movement and other associations: low fiber diets and constipation.
oversuse: results in intracranial HTN, skin changes, hepatosplenomegaly.
vitamin A oversuse: results in intracranial HTN, skin changes, hepatosplenomegaly.
lithium-induced diabetes insipidus =
result of lithium antagonizing effect on action of vassopressin (ADH) on principal cells within collecting duct system.
labs of DIC
DIC: prolonged PTT and aPTT, thrombocytopenic migroangiopathic hemolytic anemia, low fibrinogen, elevated fibrin split products (D-dimer), low factor 5 and 8 levels.
____________binds to HIV envelope protein gp41 preventin fusion of of gp41 to CD4+ t-cell –> HIV can’t enter t-cell.
Enfurvitide binds to HIV envelope protein gp41 preventin fusion of of gp41 to CD4+ t-cell –> HIV can’t enter t-cell.
when would you see eosinophils?
DNAACP
D-drugs
N-neoplastic
Allergic
Asthma
A-Addison’s disease and acute interstitial nephritis
Connective tissue disease- churg strauss
Parasites (invasive) - ascaris (loeffer)
role of IL-5
eosinophils and IgA
3 acute phase reactants secreted by macropphages
Il-1, IL-6, TNFalpha
what is the MOA of finasteride?
anti androgen that inhibits 5-alpha reductase which means testosterone not converted to DHT! + increases hair growth
ALSO CYPROTERONE HAS THIS SAME ACTION.
what does alpha-amantin, found in amanita phalloides (death cap mushrooms inhibit)?
inhibits RNA polymerase II which makes mRNA(massive) causes severe hepatotoxicity if ingested
What is treacher collins syndrome?
1st-arch neural crest fails to migrate—> no bones or cartilate = mandiblar hypoplasia, facial abnormaltities
only gram - w/out endotoxin
bacteriodes fragilis (strict anaerobe)
only gram + w/endotoxin?
listeria
Di George
Catch-22
C-cleft palate
A-abnormal facies
T-thymic aplasia
C-cardiac defects
H- hyocalcemia
22-chr 22q11 microdeletion
include: DiGeorge syndrome(thymic, parathryoid, caridc) and Velocardiofcial syndrome(palate, faical, and cardiac)
what is the defect in Job syndrome?
Th1 cells fail t produce IFN-gamma —>inability of neutrophls to respond to chemotactic stimuli
leads to FATED:
Coarse Facies, cold staph **Abscess, **retained primary **Teeth, Increased IgE, **Dermatologic issues (eczema)
withdrawal = tremors, agitation, anxiety, delirium, psychosis
seizures, **tachycardia, palpitations **
withdrawal for sedative substnaces ie: alcohol and benzodiazepines
withdrawal = N/V abdominal cramps, msucle aches
**dilated pupils, yawning, piloereection, lacrimation, hyperactive bowel sounds **
heroin
withdrawal: increased appetite, hypersomnia, **intense psychomotor retardation, severe derpession(“crash”) **
stimulant(cocain, amphetamines)
withdrawal symptoms: dysphoria, irritability, anxiety, **increased appetite **
nicotine
what are hirano bodies?
hirano bodies - eosinophilic rod like inclusions in hippocampus of alzheimers pt
tx for loa loa and Wucheria bancrofti
diethycarbamazine
tx for strongyloides and onchocera volvululus
ivermectin
tx for diseases caused by trpanosomes eg chagas disease by T. cruzi
nifurtimox
what is used to tx infections caused by Schistosoma, Clonorchis sinesis, and Paragonimus westermani
praziquantel
DOC for enterobius vermicularis(pinworm)
how about in pregnant women?
Doc: bendazoles(mebendazole)
pyrantel pamoate for pregnant women
vancomycin MOA
and 2 ADE
MOA: binds D-alanyl-alanine and blcoks glycopeptide polymerization
ADE: redman syndrome and nephrotoxicity
MOA of daptomycin and 2 ADE and use
daptomycin: depolarization of the cellular membrane
ADE: myopathy and CPK elevation
inactivated by pulmonary surfactant
use: MRSA (gram + only) cannot be used to tx pneumonias bcinactivated by surfacant
linezolid MOA
and 3 ADE
linezolin: inhibits bacterial protein synthesis by binding to 50S subunit
ADE: thrombocytopenia, optic neuritis, high risk for sereonin syndrome
Sulfa Drugs
Popular FACTSSS
P-probenecid
F-furosemide
A-acetazolamide
C-celecoxib
T-thiazides
S-sulfasalzine
S-sulfonamide anitibiotics
S-sulfonylureas
FFA and insulin resistance
FFA and serum trigs increase insulin resistance in overweight individuals, not homocystine. Note: high FFA +insulin resistance +betacell dysfunction = lipotoxicity.
kid w/imperforate anus on 1st day
patient with imperforate anus. Manifests during first days of life by inability to pass meconium, alt. meconium may dishcarhge from urethra or vagina if fistula is present. Pt w/imperforate ansum may have other conditions ie: VACTERL: vertebral defects, anal atreasia, cardiac anomalies, TE fisutla, esophageal atreasia, renal anomalies, limb anomalies.
hormones of ant pit?
FLAT PiG:
FSH
LH
ACTH
TSH
PROLACTIN
GH
ACIDOPHILS ON ANTERIOR PITUITARY
GH, prolactin
Basophils of anterior pituitary
Basophilic cells: FSH. LH, ACTH, TSH
4 hormones that share an alpha subunit?
TSH, LH, FSH, hCG
what are the catabolic effects of glucagon
glycogenolysis
gluconeogenesis
lipolysis
ketone production
3 molecules derived from POMC that are stimulated by CRH?
ACTH, melanocyte stimulating hormone, beta-endorphin
somatostatin inhibits which two hormones?
GH, TSH
TRH stimulates release of which two hormones?
TSH
prolactin
what inibits GH secretion (2)?
glucose
somatostatin
actions of cortisol BBIG
5 ways it is anti-inflammaootry
its affect on glucose
- maintain BP by upreg of alpha 2 receptor on arterioles (increases sensitivyt of NE and EPi)
- decrease bone formation
- Anti-inflammatory: 5 ways
a. inhibits production of leukotrienes + prostaglandins
b. inhibit leukocyte adhesion —->neutrophilia
c. block histamine release from mast cells
d. reduce eosinophils
e. blocks IL-2 production
cortisol effect on glucose and gluconeogensis?
increases insulin resistance
increases gluconeogenesis, lipolysis, proteolysis and _inhibits fibroblasts(causes striae) _
how does PTH stimulate osteoclasts?
incrases M-CSF and RANK-L in osteoblasts —>osteoclast stimulation
how does very very low Mg2+ affect PTH?
low Mg2+ –> increased PTH secretion
very very low Mg2+ –> decreased PTH secretion
4 common causes of decreased Mg2+
diarrhea
aminoglycosides
diuretics
alcohol abuse
hormones that use cAMP
FLAT ChAMP
FLAT ChAMP
FSH, LH, ACTH, TSH, CRH, hCG, ADH(V2receptor), MSH, PTH, calcitonin, GHRH, **glucagon **
which hormones use cGMP (think vasodilators)?
ANP
Nitric oxide(EDRF)
which hormones use IP3?
GGOAT
GGOAT
GnRH
GHRH
Oxytocin and ADH(V1)-both post pit hormones
TRH, histamine H1, _angiotenstin II, gastrin _
angiotensin II uses which signalling pathway?
IP3
which hormones use a steroid receptor?
VETTT CAP
VETTT CAP
V-vitamin D, E-estrogen, T-testosterone, TT-t3 + t4, C-cortisol, A-aldosterone, P-progesterone
which hormone use intrinsic tyrosine kinases?
5
Insulin, IGF-1, FGF, PDGF, EGF
(map kinase pathway)
think growth factors
which hormones use receptor associated tyrosine kinase? (PIG)
prolactin
**immunomodulators(cytokines IL-2, IL-6, IL-8, IFN), GH **
**JAK/STAT pathway **
**thik acidophiles and cytokines **
four functions of thyroid hormones?
4 B’s?
Brain maturation
Bone growth
Beta-adrenergic effects
basal metabolic rate increaed
which enzyme converts T4 to active T3 in peripheral tissues? in
5’-deiodinase
what is the wolff-chaikoff effect?
excess iodine temporarily inhibitds thyroid peroxidase –> decreased iodine organificaition —> decreased T3 and T4 production
which thyroid drug inibits both peroxidase and 5’ deiodinase?
which one inhibits peroxidase only?
5’ deiodinase and peroxidase inibitor = propylthiouracil
only peroxidase = methimazole.
what inhibits iodine uptake into cells (2 things here)
anions: perchlorate, pertechnetate
5 Ps of pheochromocytoma
Pressure (elevated BP - give irreversible alpha blocker phenoxybenzamine b4 removing tumor)
Pain (headache)
Perspiraiton
palpitations(tachycardia - tx w/ beta blockers)
pallor
rules of 10% for pheochromocytoma
10% malignant
10% bilateral
10% extraadrenal
10% calcify
10% kids
4-characteristics of adrenal medulla neuroblastomas?
N-myc
bombesin
neurofilament stain
homer wright pseudorossettes
what is Jod-Basedow phenomemon?
thryotoxicosis if a pt w/iodine def goiter is made iodine replete
what is a stress induced catecholamine surge leading to deathy by arrhytmhmia?
thryoid storm
what is osteitis fibrosa cystica
cystic bone spaces filled with brown fibrous tissue (bone pain) “stones, bones, and groans”
what is renal osteodystrophy
bone lesions due to secondary or tertiary hyperparathyroidsm due in turn to renal disease
casues of primary, secondary, tertiary hyperaparthyoidims
primary - adenoma in parathyoid glands (**hypercalcemia, **increaed PTH, alkphos, ad cAMP in urine)
secondary - renal disease - **hypocalcemia, alk phos,and increased PTH **
tertiary - refractory (autonomous) hyperparathyroidism resulting from chronic renal disease increased PTH and Ca2+
what is pseudohyporathryodisim?
end organ resistance to PTH
albrights hereditary osteodystrphy
autosomal dominant kidney unresponsiveness to PTH
hypocalcemia, short 4th/5th ditigs/ short stature
which 4 drugs can cause SIADH?
cyclophosphamide
psychotropics(SSRIs, TCAs, haloperidol)
sulfonylureas
3 drugs to tx SIADH?
conivaptan
tolvaptan
demeclocylince
IV saline
what is the most common tumor of appenxdix?
carcinoid syndrome (1/3 metastisize, 1/3 present w/2nd malignancy, 1/3 mutliple)
zollinger ellis on syndrome?
what does stomach show?
which MEN syndrome?
gastrin secreting tumor of pancrease of duodenum
stomach shows rugal thickening w/acid hypersecretion
may be associated with MEN type 1
what is Wermer syndrome?
MEN 1
what is sipple sydndrome?
MEN2A
endoneural inflammatory infiltrate found in pt w/ascending paralysis after a febrile illness
guillan barre
what are dadrocytes
tear drop cells seen in primary myelofibrosis
