Random Questions Flashcards
Dihydrofolate reductase inhibitors (3):
Trimethoprim (microbes), methotrexate (antimetabolite, rapidly prolif cells), pyrimethamine (parasites)
Which structure contains the nerves, arteries, and vessels supplying the ovary?
Suspensory ligament of ovary (infundibulopelvic ligament) Ligate during oophorectomy!
Infectious Urethritis tx:
Ceftriaxone (gonorrhea) + Doxycycline or macrolide like azithro (chlamydia)
When a study population affects the outcome of the study because they know they are being studied, this is called:
Hawthorne effect
A bias that results from selecting hospitalized patients as the control group is called:
Berkson’s Bias
Researcher’s beliefs in the efficacy of tx that can potentially affect the outcome are called:
Pygmalion effect
Lead-time bias
apparent prolongation of survival after applying a screening test
Ototoxic drugs (4)
loop diuretics, aminoglycosides, salicylates, cisplatin
Renal Cell Carcinoma origin:
epithelium of proximal tubules
Uncal Herniation
Medial Temporal Lobe (downwards - transtentorial/central) Compresses: Ipsi CN III - fixed, dilated pupil, down and out gaze Ipsi PCA - Contra homonymous hemianopsia Contra crus cerebri (CP) - ipsilateral paralysis
Cinculate Herniation
Subfalcine, under falx cerebri Can compress ACA - contralateral lower limb motor/sensory loss
Cerebellar Tonsillar Herniation
into foramen magnum Compress brainstem
Mature Defenses:
SASH Sublimation, Altruism, Suppression, Humor
Depression: Neurotransmitter Changes
DECREASED NE, 5-HT, DA
VHL associations
AD, capillary hemangiolastomas in retina &/or cerebellum, cavernous hemangiomas, pheochromocytomas, congenital cysts in kidney, liver, pancreas, risk for bilateral renal cell carcinoma cs 3, constit expression of HIF (tf) and activ of angiogenic gfs
Tuberous Sclerosis
AD, kidney, liver, pancreatic cysts, CNS cortical and subependymal hamartomas, cutaneous angiofibromas (adenoma sebaceum), visceral cysts, renal angiomyolipomas, cardiac rhabdomyomas, seizures, mental retardation, subependymal astrocytomas, ungal fibromas, shagreen patches
Osler-Weber-Rendu syndrome
hereditary hemorrhagic telangiectasia AD inheritance of congenital telangiectasias. Rupture may cause epistaxis, GI bleeding, or hematuria
BH4 is cofactor for syth of:
Tyrosine (phenylalanine hydroxylase), DOPA (tyrosine hydroxylase), Serotonin (from tryptophan), and NO (from arginine)
Alkaptonuria
AR, defic of homogentisic acid oxidase - breaks down homogentisic acid, toxic tyrosine to fumarate degradation byproduct - harmful to bones and cartilage. Dark CT, brown pigmented sclerae, urine turns black on prolonged exposure to air
Which statin is not metabolized by CYP 3A4?
Pravastatin
CYP 450 Inducers:
Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin
CYP 450 Inhibitors:
Cimetidine Ciprofloxacin Erythromycin Azole antifungals Grapefruit juice Isoniazid Ritonavir (PIs)
Which BLs are not susceptible to penicillinase?
Cephalosporins, carbapenems, and penicillinase-resistant penicillins (nafcillin, methicillin…)
What drugs are effective against Mycoplasma and why can’t you use most others?
Anti-ribosomal agents like macrolides, tetracyclines They lack peptidoglycan cell walls, so cell wall syth inhibitors don’t work. They have a single phospholipid bilayer membrane, containing cholesterol
Meds that can prolong QT:
Some Risky Meds Can Prolong QT: Sotalol Risperidone (APDs) Macrolides Chloroquine Protease Inhibitors (-navir) Quinidine (class 1a; also class 3) Thiazides
Act on nuclear receptors:
Thyroid hormones, retinoids, PPARs, fatty acids
TK Receptors
Insulin, growth factors (epidermal growth factor, TGF-beta) Extracellular ligand binding domain, transmembrane region, and carboxy-terminal domain with TK activity.
GPCRs:
Peptide hormones (glucagon, PTH, ACTH, gonadotropins) Hormone binds N terminal, C terminal activates G-protein, which increases second messengers like cAMP by activ. adenylyl cyclase. Also can increase PLC and form IP3 and DAG
Cytoplasmic Receptors:
steroid hormones, migrate to nucleus once activated
DA agonists for PD:
Ergot: bromocriptine, pergolide Nonergot: pramipexole, ropinirole
Amantadine
Enhances effects of endogenous DA, some anticholinergic prop perhaps too Antiviral influenza agent
MAO-B inhibitor that delays PD progression:
Selegiline, decreases central DA degradation
Findings of DIC:
Prolonged PTT and PT Thrombocytopenia and microangiopathic hemolytic anemia Low fibrinogen Elevated fibrin split pdts (D-dimer) Low factor V and VIII levels
Intravascular hemolysis findings:
Decreased haptoglobin Increased LDH, schistocytes, and reticulocytes Urobilinogen in urine
Extravascular hemolysis findings
Spherocytes Increased LDH and unconjugated bilirubin, causes jaundice, pigmented gallstones
Cryoprecipitate contains:
Factor VIII, XIII, vWF, and fibrinogen
NADPH Consumed in:
fatty acid and steroid synthesis, CYP p450 pathway, generation of superoxide in phagocytes So oxidative rxns of HMP shunt are active in liver, adrenal cortex, gonads, adipose, and erythrocytes
Insulin MOA:
Inhibits glycogenolysis/gluconeogenesis. Promotes synth of glycogen, TAGs, nucleic acids, and proteins (anabolic) TK receptor causes phosphoryl of insulin receptor substrates, leads to activation of protein phosphatase. Protein phosphatase dephosphorylates glycogen synthase, which ACTIVATES it and promotes glycogen synthesis Also dephosphorylates fructose 1, 6 - bisphosphatase which INACTIVATES it and inhibits gluconeogenesis
Positive stranded RNA viruses:
retro, toga, flavi, corona, hepe, calici, picorna
Naked DNA viruses:
PAPP Papilloma, Adeno, Parvo, Polyoma
Naked RNA viruses:
CPR Hepe Calici, Picorna, Reo, Hepe
dsRNA:
Reovirus Naked, linear, icosahedral
Which kidney stones precipitate at an increased pH?
Calcium phosphate, struvite CaOxalate, Uric Acid, Cystine all precip at acidic pH
Which type of kidney stones are radiopaque?
CaPO4, CaOxalate, Struvite, Cystine
Which stones are radiolucent?
Uric Acid = radiolUcent
Ketogenic AA’s/importance
Leucine and Lysine (lysine is essential) Don’t contribute to lactic acidosis because not glucogenic. Contrib towards acetoacetate production. Important for PDH deficiency: give ketogenic diet
Tumors that stain positive for keratin:
Epithelial surface origin: carcinoma, mesothelioma, thymoma, sarcomas, trophoblastic, desmoplastic small round cell tumors
Cofactors in PDH, Alpha-ketoglutarate DH, and Alpha-ketoacid DH (degrades branched chain AAs, defic causes maple syrup dz):
Tender Loving Care For Nancy TPP, Lipoate, CoA, FAD, NAD
Lead Poisoning Tx:
Dimercaprol and EDTA
Copper Chelation:
Penicillamine
Drugs like Isoniazid that have fast and slow acetylators:
dapsone, hydralazine, procainamide
Ulcer vs. Erosion:
Erosion is limited to mucosal layer, doesn’t fully extend through muscularis mucosa. Ulcer penetrates through mucosal layer and into submucosal layer.
Acyl-CoA dehydrogenase deficiency:
Can’t produce ketone bodies during fasting due to impaired beta-oxidation. Can’t utilize fats for energy or prod ketone bodies. Gluconeogenesis is impaired during fasting, and glucose consump is increased, causing hypoglycemia
Essential Fructosuria:
fructokinase deficiency, AR, benign, frucosuria
Fructose intolerance:
Aldolase B deficiency, AR, F-1-P accum, decreases available phosphate, inhibits glycogenolysis and gluconeogenesis Hypoglycemia, jaundice, cirrhosis, vomiting
Retroperitoneal organs:
SAD PUCKER Suprarenal glands, Aorta/IVC, Duodenum (2-4 parts), Pancreas (except tail), Ureters, Colon (descending and ascending), Kidneys, Esophagus (lower 2/3), Rectum (lower 2/3)
MEN 1:
Parathyroid tumor (hypercalcemia) Pancreatic endocrine tumor (gastrin, ZES, insulinoma, VIPoma) Pituitary adenoma (prolactin, ACTH)
MEN 2a:
assoc with ret mutation Medullary carcinoma of thyroid (calcitonin) Pheochromocytoma Parathyroid tumor
MEN 2b:
assoc with ret mutation Medullary carcinoma of thyroid Pheochromocytoma Marfanoid habitus/mucosal neuromas
Hartnup Disease:
AR, deficiency of neutral AA transporters in PT and on enterocytes. Get neutral aminoaciduria and decreased absorp from gut. Tryptophan-get B3 deficiency, pellagra
Renal Tubular Acidosis:
Non-anion gap hyperchloremic metabolic acidosis
RTA Type 1:
Distal, urine pH > 5.5, defect in ability of alpha intercalated cells to secrete H+, don’t generate new HCO3-, get metabolic acidosis. Hypokalemia, incr risk of CaPO4 kidney stones (b/c incr urine pH) Causes: ampho B, analgesic nephropathy, congenital anom (obstruction)
RTA Type 2:
Proximal, urine pH < 5.5 (b/c distal segs still can secrete H+). Defect in PT HCO3- reabsorption. Hypokalemia, incr risk for hypophosphatemic rickets Causes: Fanconi syndr (eg. Wilson dz), toxicity to PT (lead, aminoglycosides), MM, CA inhibitors
RTA Type 4:
hyperkalemic, pH < 5.5. Hypoaldosteronism, aldosterone resistance, or K sparing diuretics. Hyperkalemia impars ammoniagenesis in PT, so decr H+ excretion into urine
Nitrate poisoning effect by: Tx:
Oxidizing the heme to the ferric (3+) state, get methemoglobinemia Tx: methylene blue
Entacapone:
COMT inhibitor, increases bioavailability of levodopa by inhibiting peripheral methylation. Only effective if used with levodopa! also Tolcapone: hepatotoxic, inhibits peripheral and central methylation
Crohns Dz most frequently involved site:
Terminal ileum
Pleural Effusion: transudate vs exudate
Exudate if pleural:fluid protein > 0.5 or plural:serum LDH > 0.6 or pleural LDH > 2/3 ULN
How does GABAa Receptor function?
inhibitory nt, opening Cl- channel to hyperpolarize the postsynaptic cell
Caudal regression syndrome
sacral agenesis, anal atresia to sirenomelia
maternal diabetes teratogenic effects:
caudal regression syndrome, congenital heart defects (TGV), neural tube defects, macrosomia, hypoglycemia
Ebstein anomaly
atrialized RV lithium teratogenic effect
Menkes disease
CT dz caused by impaired Cu absorp/transport Get decreased activity of lysyl oxidase (crosslinks tropocollagen) –>brittle, kinky hair, growth retardation, hypotonia
Hypertensive emergency:
180/120 w/ evidence of acute, ongoing target organ damage
Urease positive bugs
Cryptococcus, H. pylori, Proteus, Ureaplasma, Nocardia, Klebsiella, S. epidermidis, S. saprophyticus
VIPoma
pancreatic tumor secretes VIP
watery diarrhea, hypokalemia, achlorhydria (WDHA)
-increases intest H2O and electrolyte secretion, increases relax of sm mm and sphincters
Parinaud Syndrome
Pineal gland tumor, usually a germinoma
Compresses tectal area, dorsal midbrain, above SC
paralysis of convergence, upward gaze, absent pupillary light reflex, wide based gait
