Random Q set 1 Flashcards
What are the some possible side effects of amIODarone class III antiarrhymic?
thyroid dysfunction (b/c a lot of iodine in it) corneal micro-deposits blue-grey skin discoloration drug-related hepatitis pulmonary fibrosis
What are the typical symptoms of vertigo from vestibular dysfunction?
sudden onset
interferes w/ walking
N/V
What are the symptoms of damage to the posterior columns of the spinal cord?
ataxia
decreased TVP
hyporeflexia
WHat are some things that can cause damage to the posterior columns of the spinal cord?
syphilis
vit B12 deficiency
What are the symptoms of cerebellar dysfunction?
ataxia
imbalance
incoordination
nystagmus
What is the 68/95/99 rule?
68% falls within 1 SD
95% falls within 2 SD
99% falls within 3 SD
Ham is Thick Sarcomeres. What does this mean?
Z line for actin, I band is actin only.
When sarcomeres contract, which bands become smaller?
H band (only myosin) I band (only actin)
A patient with exertional syncope & a murmur may have what?
aortic stenosis
specifically: systolic ejection-type, crescendo-decrescendo
Describe the symptoms of galactosemia.
following breastfeeding vomiting lethargy failure to thrive **sometimes irreversible eye or liver damage OR cataracts
Describe the enzymes involved in galactose metabolism.
Galactose (galactokinase)–>Galactose 1P (Galactose-1-P uridyl transferase)–>UDP-galactose
Galactose–>Galactitol (via aldose reductase)
What is the most common enzyme deficiency that causes galactosemia?
Most common: Galactose-1-P uridyl transferase deficiency
What is the requirement for diagnosing schizoaffective disorder?
depressive & manic periods of time w/ psychotic features for majority of illness
+ >2 wks of psychotic features w/o mood symptoms.
What is schizophreniform disorder?
a disorder that has the psychotic features of schizophrenia, but lasts b/w 1-6 mo
What is fat embolism syndrome?
days after severe bone fractures, multiple fat emboli clog the pulmonary micro vessels
get resp distress, neurological impairment, petechiae (thrombocytopenia)
Lung tissue in a patient with fat embolism syndrome has black globs. Why are they black?
stained by osmium tetroxide
Explain why you get the symptoms you do w/ fat embolism syndrome?
resp distress-fat clogging vessels
neurology–fat clogging cerebral vessels
thrombocytopenia–platelets used by coating fat emboli
anemia–pulmonary hemorrhage or RBC aggregation
Which valve is most commonly affected in infective endocarditis from IV drug users?
tricuspid valve
get tricuspid regurgitation, early systolic murmur accentuated with inspiration
To access the cardia of the stomach for gastric banding surgery, which structure must you pass through?
lesser omentum
Describe the location & structure of the lesser omentum.
double layer connects the liver to the stomach/SI hepatogastric ligament hepatoduodenal ligament **inside:
What’s the deal with the falciform ligament?
attaches the liver to the anterior body wall
derivative of embryonic ventral mesentery
contains round ligament (old fetal umbilical vein)
What type of vision deficit does a Meyer’s loop temporal lobe lesion cause?
contralateral superior quadrantanopia
What does a lesion to the occipital cortex (only one side) produce?
contralateral homonymous hemianopsia w/ macular sparing
How do you get bitemporal hemianopsia?
with a lesion to the optic chiasm.
What is the MOA of entacapone?
used only in combination with levodopa
inhibits COMT peripheral degradation of levodopa
What is the MOA of tolcapone?
inhibits both peripheral & central degradation of levodopa.
A man takes antimalarial drugs & develops anemia, reticulocytosis, indirect hyperbilirubinemia. What could have caused this?
a man with G6PD deficiency can develop hemolysis w/ antimalarial drugs
would show Heinz bodies on peripheral smear
How is G6PD deficiency inherited?
X-linked recessive inheritance
How does CO do its damage in the blood?
it binds heme competitively
has 220X higher affinity for it than O2
**causes a leftward shift of the oxygen dissociation curve, so that it is harder to let go of oxygen at targets sites=tissue hypoxia
T/F Partial pressure of oxygen becomes lower w/ CO poisoning.
False. Doesn’t change. b/c has to do with the amount of oxygen dissolved in the blood, not the amount bound to hemoglobin
You see a graph with increased CO & a steeper curve, also increased venous return & a steeper curve. WHat could cause this?
a chronic AV fistula
- *causes decreased TPR=increased CO & venous return
- *body compensates w/ increased sympathetic–>means increased CO
- *steeper curve=lower TPR
What is a good medication used to treat male pattern baldness?
finasteride–5 alpha reductase inhibitor
**male pattern baldness can be caused by increased DHT
If you have an elderly person with chronic anemia…what deficiency might they have? How would you have to administer it?
probably Vit B12 deficiency
prob have to administer IV, unless dietary insufficiency
most often–malabsorption
Describe the process of Vit B12 absorption?
R factor released in stomach binds VB12 & then in the duodenum, pancreatic protease releases it. Intrinsic factor (secreted by parietal cells in stomach) bind it for absorption in the terminal ileum.
Drugs that affect the extrinsic pathway do what? Intrinsic pathway? Thrombin inhibitors?
Extrinsic pathway–elongates PT
Intrinsic pathway–elongates PTT
Thrombin inhibition–elongates TT
What do factor 7a, factor 10a, and unfractionated heparin do to coagulation cascade measurements?
factor 7a: work on extrinsic pathway–>prolong PT
factor 10a: work on extrinsic & intrinsic–>prolong PT & PTT
unfractionated heparin: affect extrinsic, intrinsic, and thrombin, but only prolong PTT & TT
WHat is the usual treatment for DVT?
3 months of anticoagulant therapy
beginning w/ heparin & transitioning to oral anticoagulant (warfarin)
What are some signs of aortic regurgitation?
head bobbing (widened pulse pressure) head throbbing (large stroke volumes to intracranial arteries) palpitations (forceful ejections)
What normally happens after 16-24 hours of fasting?
break down fats for energy, beta oxidation becomes higher & then acetyl coa goes into TCA
**if TCA gets backed up, acetyl coa is shunted to make ketone bodies
Describe the energy produced by 1 round of beta oxidation v. 1 round of TCA?
beta oxidation: 1 NADH, 1 FADH2, 1 acetyl coa
TCA: 3 NADH, 1 FADH2, 1 GTP
You have a kid who has fasted & has hypoglycemia, low ketones, vomiting, lethargy, enlarged liver, seizure. Which enzyme deficiency is quite possible?
hypoglycemia + no ketones w/ fasting
problem with beta oxidation
most common deficiency: acyl coa dehydrogenase (1st step)
What should patients who overdose on beta blockers be given? MOA?
glucagon
- *they activate cardiac myocytes via GPCR, adenylate cyclase activation & increased cAMP
- *increases HR & contractility without touching the adrenergic receptors
How does C. diphtheria get its ability to make its exotoxin?
via lysogenization (Bacteriophage integrates its tox gene) then it can make the diphtheria AB exotoxin
WHat is a severe thing that C. diphtheria can cause?
severe pseuodmembranous pharyngitis
What does the neurotoxin released by C. tetani do?
inhibits inhibitory neurons ability to release GABA & glycine
get constant firing
What’s the deal with cryptococcus neoformans?
affects immunocompromised patients, like HIV+ pts
yeast with polysaccharide capsule (antiphagocytic)
affects lungs first, and likes to disseminate to the CNS
When the neural tube doesn’t close in the ____ week of gestation, you get NTDs, particularly in which locations?
4th week of gestation
anterior & posterior neuropores
folic acid supplementation reduces these risks
How does a maternal rubella infection present?
low grade fever
maculopapular rash w/ cephalocaudal progression
posterior auricular & suboccipital LAD
In Mom, can result in polyarthalgia or polyarthritis
What can happen to children exposed to rubella during pregnancy?
sensorineural deafness
cataracts
cardiac malformation-patent ductus arteriosus
As the fluid runs along the tubules in the kidney, which substance increase their conc’n? secreted…
PAH (90% secreted)
Creatinine (20% secreted)
Urea
As fluid runs along the tubules of the kidney, which substances decrease their conc’n? reabsorbed…
Bicarb
Glucose (super reabsorbed), AA
Ceftriaxone is used to treat gonococcal urethritis. But doesn’t work as well for nongonococcal urethritis. Why?
NGU: chlamydia, u. urealyticum
Chlamydia: lacks peptidoglycan
urealyticum: lacks cell wall entirely.
**better to use macrolides & tetracyclines
WHat is phenotypic mixing?
two viruses infect a cell & make a thing with proteins of one & genome of the other (no real genetic exchange). Their progeny don’t have these characteristics.
With an ischemic stroke, when do you see red neurons on histo?
12-24 hours after the stroke
What does the retinoblastoma protein do?
regulates the entry from G1-S phase of the cell cycle
CDK4 can cause phosphorylation & inactivation of Rb, allowing unchecked cell cycle
What is the basic structure of capitation?
physicians paid per enrollee, not per service
What is the idea behind minimal alveolar conc’n?
measure of the potency of an inhaled anesthetic
MAC is the amount of anesthetic when 50% of people can’t feel painful stimuli
lower the MAC–>higher the potency
Which syndromes show mild proteinuria & RBC casts?
Which syndromes show heavy proteinuria & no RBC casts?
Nephritic syndrome (including glomerulonephritis): mild proteinuria, RBC casts Nephrotic Syndrome: heavy proteinuria, no RBC casts
What are the lab values for iron deficiency anemia?
low ferritin, high transferring, microcytic anemia, hypo chromic
What are the first symptoms reported for primary biliary cirrhosis?
pruritis at night (severe)
middle-aged women
What are the symptoms of Horner’s syndrome?
ptosis
miosis (constricted pupil)
anhidrosis
enopthalmos (shrunken eyeball)
**damage to sympathetic trunk, ipsilateral signs.
**can be from pan coast tumor in the apex of the lung (can also cause brachial plexus problems)
What is ataxia telangectasia?
aut rec disorder w/ bad DNA repair enzymes
hypersensitive to ionizing radiation (gamma & xray)
What are the symptoms of ataxia telangectasia?
ataxia b/c of cerebellar atrophy
oculocutaneous telangectasia
immunocompromised–>recurrent sinopulmonary infections.
risk for cancer
What is the pathogenesis & clinical manifestation of chronic granulomatous disease?
X-linked impaired NADPH oxidase so you can’t get a respiratory burst & intracellular phagocytic killing
get a lot of catalase + infections & granulomas
How do you diagnose chronic granulomatous disease?
nitroblue tetrazolium test– don’t see normal blue pigment
dihydrorhodamine flow cytometry–don’t see fluorescent green pigment
Give some examples of some non depolarizing NMJ blockers. What does neostigmine do to these?
pancuronium
tubocurarine
**neostigmine counteracts these w/o delay
Give an example of a depolarizing NMJ blocker. What does neostigmine do to this?
succinylcholine
if neostigmine is used during phase 1, augments the effect.
if used in phase 2, dampens.
Why is ornithine so important to the urea cycle?
Need to get ornithine into the mitochondria to combine with carbamoyl phosphate to become citrulline & get back into the cytosol. Then you eventually get urea.
If your urea cycle isn’t working…which dietary restriction would you consider?
stop the protein
b/c with your urea cycle messed up could get too much ammonia
