Quiz 4 Flashcards
What is Wilms tumor?
It is a nephroblastoma, a renal tumor found in children, and most common in first 3 years. It is the most common congenital tumor.
Disulfiram
Used to treat Alcoholism. Inhibits ALDH (aldehyde dehydrogenase) with resulting ↑ acetaldehyde after drinking. Abstinence is reinforced to avoid the resulting adverse reaction.
A fetus has severe oligohydramnios and bilateral enlarged kidneys by ultrasound. At birth, there is severe pulmonary hypoplasia, resulting in nearly immediate death. The kidneys are large, but have the normal renal shape. This baby is likely to have: A. Autosomal dominant polycystic renal disease. B. Autosomal recessive polycystic renal disease. C. Renal dysplasia.
B
What are the requirements for chronic bronchitis?
Persistent productive cough for 3 months in 2 consecutive years, and it is caused by smoking, air pollution and has hypersecretion of mucus by airways and infections are often secondarily present. If the mucus glands get expanded and reach greater than 40$ to the epithelium, than it suggests chronic bronchitis - Reid index.
What is primary and secondary hemostasis?
Primary involves platelets, • Typically initiated by injury • Adherence to subendothelium by interacting with von Willebrand factor - Secrete contents of granules • Aggregate with other platelets and form surface for coagulation cascade - Provide a procoagulant surface for the coagulation cascade Secondary involves the coagulation cascade-fibrin formation • Coagulation cascade (factors mostly made from liver) • Cascade of activating enzymatic conversions • Fibrin and platelet aggregates form stable clot a. Factors II, VII, IX and X are vitamin K-dependent-necessary for calcium binding sites activating coagulation cascade b. For final step thrombin catalyzes fibrinogen (soluble) to fibrin (insoluble) [note: thrombin acts at other levels of the cascade]. Fibrin cross-links form under the influence of Factor XIII
What are the pharmacokinetics behind alcohol?
It exhibits passive diffusion, gets everywhere, food slows its absorption, it is distributed everywhere, even through placental barrier and breast milk. it exhibits zero order kinetics, meaning constant rate, and independent of original concentration.
What is COPD?
Chronic Obstructive Pulmonary Disease. Includes emphysema, chronic bronchitis, asthma, bronchiectasis, and the main cause is cigarette smoke.
What can cause thrombocytopenia?
• Decreased bone marrow production • Hemodilution due to multiple transfusions • Immune reaction due to platelet autoantibodies directed at platelet surface proteins
What are the common organisms that cause pulmonary fungal infections?
Histoplasma (Ohio River Valley), Coccidiodes (Valley fever, Utah), Blastomycoses
What are some of the inherited coagulable states?
• Some aspect of cascade abnormal • Factor V Leiden-single nucleotide point mutation in coagulation factor V. Interferes with an anticoagulant factor, thus increasing formation of fibrin and becoming “prothrombic.” The mutation makes factor V resistant to cleavage and inactivation by activated protein C.
What are the basic tests used to evaluate hemostasis?
• Platelet count (part of CBC-complete blood count) Coagulation cascade: • Prothrombin time-PT (12-15 seconds). Extrinsic and common pathways through factor VII • Partial thromboplastin time-PTT. Measures intrinsic and common pathways and includes factors XII, XI, X, VIII • Fibrinolysis • Prolonged coagulation tests may be due to deficiency or inhibitor of a coagulation factor
What are some differences between inherited and acquired abnormalities in coagulation factors?
Inherited usually affect a single coagulation factor, Von-Willebrand disease (associated with factor VIII-get increased bleeding, hemophilia A and B. ), Hemophilia A (factor VIII) and B (factor IX - Christmas Disease): Have prolonged PTT and normal PT and platelet count: severe hemorrhaging internally/organs and soft tissue or into joints Acquired usually affect multiple coagulation factors, liver disease, vitamin K deficiency, DIC
How are influenza viruses classified and what are the main treatments?
They are classified by their core proteins, A, B, or C, species of origin, and geographic site of isolation. Most antiviral drugs for influenza have activity for influenza A. • Oseltamivir (Tamiflu)-prevents separation of virus particle from cell receptors, stopping viral spread—earlier treatment essential (can decrease the duration of flu 1-2 days)-works against type A and B flus.
A 31-year-old otherwise-healthy man presents with severe renal colic, with intermittent mild gross hematuria. He takes megadose vitamin C supplements. Abdominal films show a ureteral calculus. The stone is passed in the urine, and is analyzed chemically. What is the most likely composition? A. Urate. B. Cystine. C. Calcium oxalate. D. Struvite.
C
What does smoking do to alpha-1-antitrypsin?
It inhibits it, so trypsin goes uncontrolled and destroys particles in lungs and good tissue in lungs.
What are the main organisms that cause Community Acquired Pneumonia?
S. pneumoniae, H, influenzae, S. aureus.
Acamprosate
Used to treat Alcoholism. Weak antagonist of NMDA receptors, activator of GABAA receptors; may ↓ mild protracted abstinence syndromes with ↓ feelings of a “need” for alcohol.
What are the symptoms of urinary stones?
Renal Colic, hematuria, pyelonephritis, or asymptomatic
Dabigatran
Is an alternative drug for warfarin, has fewer side effects and is more popular than heparin or warfarin, it affects PTT sensitive pathway, but has unique mechanisms that makes it distinct from heparin and warfarin, used on out patient basis.
What do antimuscarinics do for Asthma?
During an asthma attack, ACh is released from the vagus nerve. Antimuscarinics like ipatroprium bromide reverses the contraction of airway smooth muscles and production of mucus caused in response to this vagal activity.
What are the main features of Benign Prostatic Hyperplasia?
• Very common in older men; 95% > 75 years old • Serious sequelae less common • Cause not well known; perhaps has to do with androgens or even estrogens • Urinary obstruction is common-bladder can’t empty completely • 10% require surgery to relieve
What does a prostatic massage reveal?
leukocytes
Albuterol
Fast acting reliever, the only true “rescue” reliever, acts within 15 minutes and is effective for 4-6 hours. directly relax airway smooth muscle and bronchodilate.
What is the difference between centrilobular emphysema and panacinar emphysema?
Cintrolobular is smoking-related, and panacinar is alpha-1-antitrypsin related.
When does urinary obstruction cause severe, irreversible renal damage if it is a complete obstruction? Partial?
3 weeks, 3 months
Newborn with large renal mass composed of benign- appearing spindled cells. What is it?
Mesoblastic nephroma
What is disulfiram?
-Disulfiram acts as a deterrant and when people drink it they feel awful so it tries to keep individuals from consuming large amounts. -Asians can turn red when they drink, they don’t have as much aldehyde dehydrogenase
Allopurinol
Reduces the amount of uric acid produced in patients with uric acid stones, also used for gout.
What does MCV stand for?
Mean Corpuscular Volume = size of RBC
What is pyonephritis?
Severe pyelonephritis of entire kidney, uncommon, seen with obstruction
How do you treat larger kidney stones (>cm)?
• Lithotripsy (shock wave treatment)-break up stones • Surgical removal • Opioid analgesics for pain
An adult who died of unrelated causes is found to have one small kidney (the other kidney, while slightly enlarged, is essentially normal). The small kidney has several cysts in it, some loose mesenchymal tissue, and cartilage. This patient has: A. Autosomal dominant polycystic renal disease. B. Autosomal recessive polycystic renal disease. C. Renal dysplasia.
C
Where is iron primarily absorbed?
In the duodenum
What is the basic pharmacology of alcohol?
Ethanol, small molecule, gets everywhere in the body, depressant, barbiturate-like.
What are the normal percentages and numbers for a WBC?
Normal WBC (3500-10,000 cells/microliter) differential: Neutrophils- 1800-6700 (55%) Eosinophils-0-570 (3%) Lymphocytes- 1400-3900 (35%) Monocytes 6% Basophils 0.5% •Note: pay attention to both total and percent
What is the leading cause of cancer deaths in the world for both men and women?
Lung tumors. 95% of primary lung cancers are carcinomas.
What are the main adverse effects from alcohol consumption?
Cancer -Increased risk in mouth, esophagus, increase GI cancer, increase liver cancer Malnourishment - Worse if you smoke, Vitamin deficiencies Fetal Alcohol Syndrome - facial abnormalities, impaired cognition, joints/bone problems Hang-Over –Headache, Nausea, Vomiting, Dehydrated
What is macrocytic anemia and what causes it?
Macrocytic (too many cells) • Liver disease • Drugs • Vitamin B12 or folate deficiency-often includes neurological findings (paresthesia, weakness,dementia) (These two are megaloblastic anemia)
A 62 year old female presented with anemia and fever. Peripheral blood examination identified 35% myeloid blasts. This patient is diagnosed with A) chronic lymphoid leukemia B) acute lymphoblastic leukemia C) acute myeloid leukemia D) chronic myeloid leukemia
C
What are the characteristics behind prophylactic antibiotics for dental procedures?
• Use for procedures associated with bleeding • Typically administer 30-60 min prior to procedure • Recommended: -amoxicillin or cefazolin preferred -clindamycin
34-year-old renal transplant patient with large left kidney. It is yellow and has no areas of necrosis. Histologically, it is composed of foamy macrophages containing abundant bacteria. No Michaelis-Guttman bodies are seen. What is it?
Xanthogranulomatous pyelonephritis
What greater risk number do smokers have of developing lung cancer?
10-55X, squamous cell and small cell most closely tied to smoking.
What are the characteristics of the serum PSA testing?
PSA (prostate specific antigen)-only associated with prostate tissue • >4-6 mg/ml is abnormal (usually higher with age) • Rapidly increasing PSA means high risk for cancer • The more PSA bound to alpha-1-antichymotrypsin, the greater the risk of cancer (should be free in plasma) - PSA is also elevated in BPH and cancer
What causes 80-90% of all renal malignancies?
Renal cell carcinoma
What are the characteristics associated with the extrinsic pathway dealing with clotting through fibrin mechanisms?
• Extrinsic factors pathway (i.e. from damaged tissue)-works through factor VIIa and leads to Xa and is measured by PT (Prothrombin time)/INR (international normalized ratio) • Normal PT is 11-13.5 seconds • Normal INR is 0.8-1.1 • Sensitive to warfarin (Coumadin) or -side effects: hemorrhage, numbness, pain, headache, dizziness -oral warfarin is prescribed for out patient
Penicillamine
Chelating agent that binds to cystine and improves its solubility in patients with cystine stones.
What is bacterial cystitis and what does it cause?
It is pyuria, dysuria, positive culture, and you get edema and neutrophils in mucosa.
What percentage of chronic renal failure does pyelonephritis cause?
10-20%
What does Hemodialysis do?
It removes waste and excess water from blood through diffusion (waste removal) and ultrafiltration (fluid removal) and restores proper electrolyte balance, but does not correct kidney’s endocrine functions like producing EPO.
Although rare, what are some of the side effects associated with statins?
rare: elevate blood sugar, cognitive problems, muscle weakness, G.I irritation
Cellular polypoid bladder tumor in 6-year-old girl. What is it?
Rhabdomyosarcoma
Montelukast
Selective leukotriene receptor antagonist (leukotrienes are associated with the pathophysiology of asthma (airway edema, smooth muscle contraction)). Used for prophylaxis and chronic treatment of asthma. So this blocks the synthesis of leukotrienes, this would be good for patients who comply poorly to inhaled therapies.
What is sarcoidosis?
It is also a restrictive lung disease, believed to be driven by anormally stimulated CD4+ helper T cells. Abnormal connective tissue and reduced elastic properties; multi-organ involvement.
Acetohydroxamic Acid (AHA)
Used for kidney stones, is an irreversible inhibitor of bacterial urease, which will prevent formation and slow growth of struvite crystals, but has many side effects like increasing risk of phlebitis, deep venous thrombosis, and hemolytic anemia.
In terms of pulmonary pharmacology, what are relievers?
They are rapid bronchodilators (Beta-2 agonists), used at minimum dose and frequency. They are short-acting, for less severe cases. Drugs include albuterol and salmaterol.
What is Virchow’s triad?
- Endothelial injury 2. Abnormal blood flow (stasis, turbulence) 3. Hypercoagulability of blood (acquired or inherited factors) -These are things that can cause pathological clotting
What is bronchiectasis?
Results from obstruction of the bronchi and persistent necrotizing infections. You get destruction of elastin and muscles in bronchial walls-congenital expression often caused by cystic fibrosis. You get persistent productive cough, and the infection which causes the suppurative pneumonia is usually caused by TB, Staph, Klebsiella (Alcoholics).
Bupropion
Is a tetracyclic antidepressant that also helps people quit smoking. Smoking cessation name is Zyban.
How do you treat small kidney stones (
• Drink considerable water • Dietary changes • OTC analgesics (ibuprofen, Naprosyn) • Tamsusolin (Flomax)—relaxes ureter muscle (often have spasm due to irritation of the stone)
What do leukotriene modifiers do for Asthma?
Use is for prophylaxis and chronic treatment-for patients who have trouble with inhaled therapies (e.g., nasal bleeding)-can take orally-especially good for aspirin-induced asthma. Montelukast is an example drug. Mechanism: block leukotriene-binding to receptor.
What is microcytic anemia and what causes it?
Microcytic (too few cells) • Iron deficiency (most often caused by hemorrhaging)-often has glossitis • Lead poisoning
What are the natural anticoagulants and what do they do?
Protein C, protein S, and antithrombin. They inactivate activated coagulation factors and prevent growth of existing clot.
What are the four main types of kidney stones?
- Calcium oxalate (75%) 2. Magnesium ammonium phosphate (struvite, triple phosphate, 15% stones, alkaline urine) 3. Uric acid stones (5%), half are gout associated 4. Cystine stones (5%), defective tubular transport of cystine
Ipatroprium Bromide
Is an antimuscarinic used to treat Asthma and specifically bronchospasms, related to Tiotropium Bromide-(Spriva)-which is not approved for asthma, but is approved to treat COPD) –reverses contraction of smooth muscle from vagal activity-usually backup for beta 2 agonists-sometimes combine antimuscarinics with β2 agonists (eg, albuterol). Reversible blockade of acetylcholine by antimuscarinics prevents the release of IP3 and prevents the inhibition of ACh at postganglionic muscarinic receptors. • Side effect of dry mouth • Used as an inhalant for bronchospasms
73-year-old male smoker with intermittent hematuria and a small tan papillary bladder mass. Histologically, there are small papillary structures but the papillae are coated by benign-appearing urothelial cells. Urine cytology is negative. What is it?
Transitional Cell Papilloma
What are the features of platelets?
• Anucleated • Lifespan ~10 days • Circulating platelets do not adhere-during stasis, adhesion occurs
What is platelet-type bleeding and what causes it?
Mucocutaneous bleeding pattern from like skin and mucous membranes, petechiae, ecchymoses, epistaxis, GI bleeding are examples. Causes include vascular abnormalities, thrombocytopenia, qualitative platelet dysfunction, von Willebrand disease (interferes with von Willebrand factor preventing clot from adhering to endothelium and clot formation).
