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
