questions missed Flashcards
which two meds implicated in coronary steal syndrome
adenosine + dipyrimadole = selective dilators of coronary vessels–> coronary steal in ischemic myocardium –> worsen ischemia b/c of hypoperfusion.
virus associated with primary B-cell lymphoma and which cell markers?
EBV –> primary CNS lymphoma in AIDs pts —> diffuse large B-cell lymphoma that is CD20 + CD79a +
what is triad of wernicke’s encephalopathy?
confusion + ataxia +opthalmoplegia = triad ofWernicke encephalopahty
what is mech of high estrogen in cirrhosis?
high estrogen in alcholic cirrhosis due to decreased catabolism of estrogens as well as increased sex-hormone binding globulin (which decreaess the free-testosteron to estrogen ratio)—>gynecomastia, testicular atrophy, decreased body hair, spider angiomata.
what congenintal abnormality does valproate increase risk for?
valproate increases risk of neural tube defects b/c it inhibits folic acid absorption –>teratogenicity
t-cell maturity: thymic cortex? thymic medulla?
immature t-cells express both CD4 and CD8 cell surface antigens in addition to complete TCR or a pro-TCR. These lymphocytes exist in thymic cortex where they undergo positive selection in the thymic medulla-negative selection.
diff btw pt w/acute mitral regurg and chronic mitral regurg
pt w/acute mitral regurg has near normal left atrial compliance —>pulm HTN and EDEMA
; chronic mitral regurg pt has had time to adapt to mitral regurg via dilation of LA(increased LA volume and compliance)—> atrial fib and mural thromboembolism and less prone to pulm HTN/edema.
what other AI conditions can pts w/ type I diabetes develop?
why don’t primary hyperaldosteronism(conn syndrome) patients have an increased serum Na+?
pt with type 1 diabtes mellitus prone to develop other AI endocrinopathies including Hashimotos, Grave’s, and Addisons (hypoadrenocroticocism - hyponatremia, hypochloremia, hyperkalemia, metabolic acidosis) + vitiligo and pernicious anemia.
note in primary hyperaldosteronism, no increased Na+ b/c of aldosterone escape.
equation for bioavailability
bioavability = fraction of administered drug that reaches systemic circulation in a chemicall unchanged form and bio availability of drug admin by non-IV route is ALWAYS less than 1. F(bioavailability) = (AUC oral x dose IV)/ (AUC IV x dose oral)
when does hemoglobin S polymerize?
2,3-DPG binds two beta chains by ionic bonding and stablizies taut(T) deoxyhemoglobin –> decreased affinity for O2–> O2 unloading in tissues. HemoglobinS aggrgates in deoxygenated states including anoxia, low pH and high 2,3-DPG—>inflexible erthryocytes predispose to microvascular occulsions and microinfarction
what does EBV bind to on B-cells?
what does LPS bind to on macrophages?
CD21= C3d complement component receptor on B-cells; CD14= cell surface marker expressed on monocytes and macrophages. It serves as a receptor for LPS. Bindning of LPS —-> activation of macrophage. Atypical lymphocytes in blood smears of pts w/infectious mono (EBV) = CD8+ t-cells trying to destroy infected b-cells
murmur of bicuspid aortic valve
turner syndrome: bicuscpid aortic valve = MC congential cardiac malformation + coarctation of the aorta. **Bicuspid valve can be heard as early systolic murmr (high frequency clikc over cardiac apex above right 2nd interspace). **
what is heteroplasmy?
heteroplasmy = coexistence of both mutated and wild type versions of mitochondrial genomes in an individual cell and is seen in mitochondrial disorders (lactic acidosis and rugged muscle fibers)
which staph can ferment mannitol
s. aureus
how do you calculate attributable risk percent?
attributable risk percent = represents excess risk in exposed population that can be attributed to the risk factor and is calculated using: **ARP = (RR-1)/RR where RR = relative risk **
anti-mitochondrial ab
primary billiary cirrhosis
what is pure red cell aplasia?
pure red cell aplasia = rare form of marrow failure characterized by severe hypoplasia of marrow erythroid elements in setting of normal granulopoiesis and thrombopoiesis**. Pure red cell aplasia associated w/thymoma, lymphocytic leukemias, and parvovirus B19 infection. **
how would you get a biotin def?
too many egg whites (avidin)
what does HIV gag, env, and pol code for?
HIV genes: gag: p24 capsid and p7;
env: gp120, gp41;
pol: reverse transcripase, protease, intergrase; tat and rev gene needed for viral replication
MOA of ethmabutol and pyrazaminide
pyrazinamide = TB drug that required acidic environment present in macrophage phagolysosome to exert antimicrobial effects therefore good for intracellular TB. Other TB drugs work better extracelluary.
Ethmabutol inhibits arabinosyl transferase —> inhibition of myobacterial wall synthesis.
what is ADE of ethmabutol?
optic neuropathy and red-green colorblindness
what is ADE of pyrazinamide?
hyperurecemia + hepatotoxicity
t/f.
almost all volatile anesthetics —> increased cerebral blood flow –>increased ICP. Other ADE: myocardial depression, hypotension, respiratory depression, and decreased renal function (decrease in GFR and RPF).
true
what are the ADEs of the HIV navir protease inhibitors?
protease inhibitors: NAVIRs- inhibit cleavage of polypetide precursor into mature viral protein and ADE include: hyperglycemia, lipodystrophy, D-Drug interaction due to inhibition of cyp p-450.
FA: Hyperglycemia, **GI intolerance, lipodystrophy, nephropathy(hematuria) **
LA enlarged in mitral stensosi and LV failure—>
LA enlarged in mitral stensosi and LV failure—>cardio dysphagia.
how can the coronary sinus become dilated?
coronary sinus dumps into RA and may become dilated secondary to any factor that causes right atrial dilatation. MC factor = pulm artery HTN –>elevated Right heart pressures. Only way coronary sinus gets dilated post MI is if MI –> pulm HTN–>increase pressure in RA
refecoxib
rofecoxib = selective COX-2 inhibitor
name 4 meds that can cause seizures:
B
C
I
I
meds that cause seizures: bupropion (anti-depressant), clozapine (antipsychotic at high doses), isoniazid(anti-TB drug w/out pyridoxine) cipro(antibiotic), imipenem = antibiotic
where would you see following:
- pure motor hemiparesis
- pure sensory stroke
- ataxia-hemiplegia
- dysarthria-clumsy hand sydnrome
note: pure motor hemiparesis —>posterior limb of internal capusle; pure sensory stroke—> VPL and VPM; ataxia-hemiplegia—->base of pons; dysarthria-clumsy hand syndrome—>base of pons or genu of internal capsule
lynch syndrome: which mutation?
Lynch syndrome = AD disease caused by abnormal nucleotide mimatch repair. Mismatch repair involves: MSH2 +MLH1 ==>code for components of human MutS and MutL homologs. Mutations in these two genes account for 90% of cases of lynch syndrome.
which vitamin would be decreased in carcinoid syndrome?
carcinoid syndrome ==> decreased levels of _niacin. _
what is dobutamine?
dobutamine = selective B1 adrenergic agonist that increases HR, contractility and conductin velocity, and myocardial O2 demand.
how would you prevent tumor lysis syndrome?
tumor lysis syndrome = due to increased uric acid (also K+ and phosphorous released from lysted cells) that is soluble at physiologic pH but can precipitate out of ACIDIC pH of distal tubules and collecting ducts. Prevent tumor lysis syndrome via urine alkalinazation and hydration b/c high urine flow and high pH along nephron prevents precipitation of uric acid. URIC acid does not precipitate in Henles loop or promixal tubule
what is pathogenesis of appendicitis?
pathogeneis of acute appendicitis = obstruction of appendix lumen. Fecaliths, hyperplastic lymphoid follicles, tumors may cause obstruction.
opsoclonus-myoclonus
opsoclonus-myoclonus = paraneoplastic syndrome associated w/neuroblastoma (=N-myc amplification and MC extracranial neoplasm in kids).
pantethonic acid
pantethonic acid = coenzymeA which binds to oxaloacetate in 1st step of TCA to form citrate and then succinyl -CoA
_ pyrrolidonyl arylamidase (PYR) -_ positive, beta hemolytic Gram + cocci that grows in chains and casues necrotizing fasciitis.
strep pyogenes = pyrrolidonyl arylamidase (PYR) - positive, beta hemolytic Gram + cocci that grows in chains and casues necrotizing fasciitis.
relatonship of mitral stenosis and opening snap
in mitral stenosis , the opneing snap and second heart sound (A2) are inversely proportional to the degree of stenosis. Worse the mitral stenosis, the earlier the OS is in diastole —>shorter A2-OS interval. Other sounds w/mitral stenosis: diastolic rumble + presystlic accentuation due to left atria contraction. right sided S3/S4 might arise w/end stahge MS severe enough to produce severe pulmonary HTN–>RVH
3 things desmopressin treats
desmopressin: used to tx diabetes inisipidus, nocturnal enuresis, and von Willebrand’s disease b/c it increases circulating levels of vonWillebrand factor.
MC in children younger than 2 years and in region of ileocecal vavle: manifests w/ severe colicky ab pain, currant jelly stools and at times palbable mass in RLQ.
intussusceptin = MC in children younger than 2 years and in region of ileocecal vavle: manifests w/ severe colicky ab pain, currant jelly stools and at times palbable mass in RLQ.
what part of nephron most susceptible to ischemic inury?
proximal tubule
and Thick ascending limb of henle b/c both in medulla
note:
aldosterone excess will cause HTN, hypokalemia, metabolic alkalosis + depressed renin and tx w/aldo antagonist spironolocatone or eplenerone. Note: hypoaldosteronism = cause of type 4 Renal tubular acidosis.
DOC for parosyxmal supraventricular tachycardia =
DOC for parosyxmal supraventricular tachycardia = adenosine w/ t/1/2 of less than 10s and commonly causes chest burning (bronchospasm), flushing, and high grade block as ADE.
corticosteroids on immun system cells?
acute effects of corticosteroids on CBC: increased neutrophil count due to demargination, decreases: lymphocyte, monocyte, basophil, eosinophil count.
which condition
AR disorder from defect in DNA repair genes: 1. cerebellar atrophy –> ataxia 2. ocucolcutaneous telangiectasisa(abnormal dilatations of capillary vessels) later 3. severe immunodeficiency –> repeated sinopulm infections 5. risk of cancer increased b/c of ineffcient DNA repair. 6. IgA or IgE def 7. increased AFP
ataxia telengiectasia:
what is claudication?
intermittent muscle pain reproducibly caused by exercise and relieved by a brief period of rest = claudication. Claudication almost always result of atherosclerosis of larger, named arteries w/atheromas –>obstruction of blood flow –>fixed stenotic lesions–>not enough blood flow to exercising muscle –>ischemic muscle pain.
heparin reversal?
protamine sulfate
aminocaproic acid used for?
reversal of tPA type drugs
consider _______when old person presents with: 1. easy fatigability (due to anemia) 2. constipation (due to hypercalcemia) 3. bone pain, MC in back and ribs(due to produciton of osteoclast activating factor by myeloma cells and subsequent bone lysis) 4. renal failure. Myeloma kindey = bence jones protein +tamm horsfall protein forming eosinophillic casts that compress tubular epithelium and obstruct tubular lumen –> impede on renal function.
multiple myeloma
what is Gibbs free energy and how do you calculate it?
Gibbs free energy = -RTlnK(eq); If G0 = negative number, then Keq is >1 and at equilibrium,products more than substrate; if G0=positive number, then Keq is <1 and formation of substrates is favored.
what is colistazol?
what is abximicab?
decreases in platelet cAMP –> decrease platelet aggregation by preventing platelet shape change and granule release. ** Cilostazol** = phosphodiesterase inhibitor used in pt w/intermittend claudication b/c it aslo acts as direct vasodilator and is superior to aspirin in tx of PAD. ABCIXIMAB = inhibits Gp2b/3a receptor on platelets and used b4 percutaneous coronary intervention.
4 rxns that take place in mitochondria only?
fatty acid oxidation(beta oxidation)
acetyl-CoA production
TCA cycle
oxidative phosphorylation
4 rxns that are cytoplasm specific
glycolysis
FA synthesis
HMP shunnt
protein synthesis
steroid synthesis
cholesterol synthesis
both cholesterol and mitochondrial specific?
Heme synthesis and urea cycle
= hypercoagulable state. Sudden onset of Ab or flank pain + hematuria + left-sided varicocele suggests renal vein thrombosis, complication of _________. Loss of anticoagulant factors esp antithrombin III –> thrombotic and thromboembolic complications.
neprhotic syndrome = hypercoagulable state. Sudden onset of Ab or flank pain + hematuria + left-sided varicocele suggests renal vein thrombosis, complication of nephrotic syndrome. Loss of anticoagulant factors esp antithrombin III –> thrombotic and thromboembolic complications.
what are three things that mediate acute phase reaction?
3 in particular here
IL-1, IL-6, TNF-alpha - mediate systemic inflammatory response and stimulate hepatic secretion of acute-phase proteins (fibrinogen) and high levels of fibrinogen increase the erthryocyte sedimentation rate (ESR) –> nonspecific marker of inflammation.
most imporrtant risk factor for aortic dissection?
HTN = single most important risk factor for development of intimal tears that lead to aortic dissection!
what are alpha glucosidase inhibitors?
what are their actions?
alpha glucosasidase inhibitors decrease activity of the membrane bound disaccharidases on the intestinal brush border. Carbohydrates absorbed as monosaccharides –> action of alpha-glucosidase inhibitos prevent dissacharide breakdown–>delay carb absortion. drugs: acarbose and miglitol; insulin binds to a tyrosine kinase receptors.
what is attrition bias?
attrition bias = form of selection bias that occurs in prospective studies when follow-up btw exposed and unexposed group occurs.
what are normal pressures in LA? LV? RA? RV?
pulm artery
normal pressures: RA: 0-8mmHg; RV: 4-25mmHg; PulmA: 9-25mmHg; LA: 2-12mmHg; LV: 9-130mmHg; Aorta: 70-130mmHg
= unconcius shifting of emotions or desires associated with one person (eg sibling, parent, spouse) to another person (eg physician, therapist). It can be positive or negative.
transferance
=shifting of feelings or conflicts from one situation or person to another seen as safter and less distressing
Displacement
ade of thioridazine (low potency anti-psychotic - non-neuro ADE: anticholinergic, anti-histamine, alpha 1 blockade)
retinal deposits that resemble retinitis pimgentosa
what is the ADE of chlorpromazine?
CORNEAL DEPOSITS
EXCLUSIVELY KETOGENIC AA
LEUCINE AND LYSINE
what is green discoloration of pus or sputum associated with?
green discoloration of pus or sputum in bacterial infection = associated w/release of myeloperoxidase from neutrophil azurophilic granules! MPO = heme-containing pigmented molecule!
what does galactokinase def lead to?
galactokinase def —> galactose can’t go to galactose 1-P–>galactose converted to galactitol by aldose reductase–>galacticol accumulates in lens of patient w/galactosemia and causes osmotic damage –>cataract formation.
which receptor responsbile for inhibition of uterine contractions
inhibition of uterine contractions (tocolysis) = result of B2 adrenergic receptor stimulationinhibition of uterine contractions (tocolysis) = result of B2 adrenergic receptor stimulation
how much energy in 1g or protein/carbs
1g of fat
1g of protein or carbs = 4 cal of energy; 1g of fat = 9 cal redo prob on 755.
which deficiency?
individuals manifest w/symtoms resembling marfan syndrome—-> ectopic lens, developmental delay + thromboemoblism from HIGH homocysteine levels!!!!! Tx: high doses of vitamin B6(pyridoxine).
homocystinuria = cystathionine synthetase def. affected individual manifest w/symtoms resembling marfan syndrome—-> ectopic lens, developmental delay + thromboemoblism from HIGH homocysteine levels!!!!! Tx: high doses of vitamin B6(pyridoxine).
drugs in asthma:
name 2 leukotriene inhibitors?
1 antimuscarinic
leukotrienes (LTC4, LTD4, LTE4) antagonists zafirlukast +montelukast may control long term atopic asthma via increasing airway caliber + reducing mucosal inflammation. Inhaled ipratropium =M3 blocker –> less bronchoconstriction.
: 99mTc-pertechnetate scan to detect presence of gastric mucosa.
Meckel’s diverticulum. Presentation: lower GI bleed. Cause: diverticulum from failure of obliteration of the omphalomesenteric duct that contains ectopic gastric mucosa –> ulceration and bleeding that presents like RUQ acute appendicitis dx
which bacteria can grow w/S. aureus colonies? why?
can grow H. influenza in presence of beta hemolytic S. aureus b/c S. aureus colonies produce X(hematin) and V(NAD+) factors that H. flu needs to grow–>satellite phenomenon! Lactose = e.coli growth (lac operon)
MC bening lung tumors that present as asymptomatic peripherally located “coin lesion” w/”popcorn calcification in 50-60yr old pts and are composed of disorganized cartilage, fibrous and adipose tissue.
hamartoma
Ca2+ blocker with ADE of flushing and peripheral edema
amlodipine
where does C1 complement bind immunoglobulin?
C1 complement molecule binds to the FC poriton of the heavy immunoglobulin chain near the hinge point.
what is pleitropy?
polyploidy?
pleiotropy = where multiple phenotypic manifestations arise from single gene mutation; polyploidy = when more than 2 complete set of homologus chromsomes exist w/in an organism or cell. Eg hydraditiform mole partial (69XXY)
chlamydia trachomatis _serotypes L1-L3 cause _
chlamydia trachomatis serotypes L1-L3 cause lymphogranuloma venereum = painless ulcer —>painful ingiuina lymphadenopathy and ulceration. LGV = chlamydial inclusion bodies in cellular cytoplasm.
cofactors needed for:
- pyruvate DH
- alphaketo-glutarate DH
- branched chain aa DH
branched chain alpha-ketoacid DH and alpha-ketoglutarate DH and pyruvate DH need following cofactors: **Thiamine pyrophosphate, Lipoate, Coenzyme A, FAD, NAD (Tender loving care for nancy). **
master iron controller
hepcidin = acute phase reactant produced by liver that governs iron content by binding to ferrorportin and causing ferroportin to be degraded; w/out ferroprotin, the basolateral iron transporter of the enterocyte, iron cannot enter circulation
how does flu vaccine work?
component of hemagllutin in it and circulating Abs against hemmaglutin prevent live influenza virus from binding its HA to siailic acid.
= type III hypersensitivy rxn characterized by deposition of circulating complement fixing and resulting vasculitis. Associated with: fever, urticaria, arthralgias, glomerulonephritis, lymphadenopathy, low serum C3 level 5-10 days post antigen expsoure. mech - antigen-antibody complex activates complement –>c5a produced —> neutrophils recruited and decreased levels of complement. SULFONAMIDES CAN DO THIS!
serum sickness
where do you digest lipids?
absorb them?
duodenum = lipid digestion; jejunum = lipid absorption. Cholecystetmocy = little effect on lipid digestion though pt may not eat large fatty meal.
4 steps to prevent catheter infection
preventing central venous catheter infections: 1. proper hand washing
- full barrier precautions during insertion of a central line 3. chlorhexidine for skin disinfection
- avoidance of femoral insertion site.
- removal of catheter(s) when no longer needed.
describe apsirin poisoining acid-base wise
must know formula = Winter’s formula = 1.5x[HC03-]+8 (+/-2). Aspirin poisioning: first resp alkalosis –> metabolic acidosis.may also be slight metabolic alkalosis resulting from volume contraction related to vomiting.
vit b6 and levopoda
vitamin b6 increases peripheral metabolism of levodopa —>decrased effectivness. Cimetidine = CYPinibitor and causes gynecomastia.
function of tyrosinase
function of BH4- 4 reactions involved in
tryosinase = used to convert tyrosine to melanin. BH4 = cofactor for synthesis of 4 things: 1. tyrosine, 2. DOPA from tyrosine. 3. seretonin from trypophan 4. nitric oxide.
what is phenotypic mixing?
phenotypic mixing: virus A + B infect same host cell===>virus A takes some of virus B’s surface protein; but not genetic material —> virus A progeny can enter cells that virus B can enter(b/c now has B surface coat), but can’t infect them (b/c still have virus a genetic materia). Transfomration = uptake of Naked DNA from the environment.
______________responsible for many toxic effects observed in meningitis and meningococcemia. Blood levels of LOS correlate closely w/morbidity and mortality.
meningococcal lipooligosaccharide (LOS) =
what is
an autoimmune paraneoplastic syndrome that presents with limb and truncal ataxia, lack of coordination, dysarthria, and nystagmus and dx made clinically by detecting ab in serum. Most common tumors: lung, breast, ovary, uterus, and lympoma proudcing anti-Yo(ovary and breast), anti-P/Q(lung) and anti-Hu(lung).
paraneoplastic cerebellar degeneration = autoimmune paraneoplastic syndrome that presents with limb and truncal ataxia, lack of coordination, dysarthria, and nystagmus and dx made clinically by detecting ab in serum. Most common tumors: lung, breast, ovary, uterus, and lympoma proudcing anti-Yo(ovary and breast), anti-P/Q(lung) and anti-Hu(lung).
3 steps of RNA processing
RNA processing: 1. capping: addition of methylated guanine to 5’ end. 2. polyadenylation: addition of adenine nucleotides to 3’ end (poly-A-tail) 3. RNA splicing: removal of introns(non-coding region). Splicing performed by spliceosomes, which constinst of snRNPs plus proteins. synthesis of snRNP also occurs in the nucleus, catalzyed by RNA pol II.
