Rx Incorrect Flashcards
What is absent in McArdle Disease
Myophosphorylase deficiency
What is used to treat Renal Cell Carcinoma, where does it often metastasize
Recombinant IL-2, Lung
Describe Bernard Soulier-Dsease
autosomal recessive deficiecny of GPIb; so can’t adhere to vWF. Get a prologned bleeding time, with normal PT and PTT. No platelet aggregation seen on Riscotetin test. See GIANT PLATLETS
What do you need parental consent for as a minor
Medical care and treatment (with the exceptions of if they are a determint, there are none, or the treatment is absolutely necessary). An example of a case you need is traetment of an anxiety disorder
Name two antibiotics that are CYP450 inhibitors
TMP-SMX (I think the SMX part) and Macrolides (except azithromycin)
What test should you get before treating ankylosing spondylitis
You often prescribe TNF antagonists (infliximab, adalimumab), so need to check for TB (do a Purified protein derivative skin test PPD)
What lymphoma stains positive for CD15 and CD30 with bilobed nuclei
Hodgkin lymphoma
Name some electrolyte consequences of giving large quantities of blood to a patient in an acute setting
Can cause hypocalcemia (due to blood being anticoagulated with sodium citrate and citric acid—so a large dose of citrate is given, this binds ionized calcium). This also can cause metabolic alkalosis
What is a structure with a “central pair with nine peripheral pairs of microtubules”, defective in
This is describing a cilia; so kartanger syndrome
Describe Acute Intermittent Porphyria
defect in prophobilinogen deaminase; autosomal domiannt. Accumulate prophnobilinogen, ALA. Get the 5Ps: Port wine-colored urine, polyneuropathy, psych disturbances, painful abdomen and is PRECIPITATED BY DRUGS, ALCOHOL, STARVATION
tx is hemin and glucose which inhibit ALA synthase
What neoplasm expresses CD5 and will have a splenic mass with open vesicualr chromatin, prominent nucleoli, variant amounts of cytoplasm
Diffuse large B cell lymphoma
Describe drug elimination in first order kinetics
the rate of elimination is proportional to the drug concentration
A kid is missing part of his iris and has a kidney mass; what does he have?
WAGR Syndrome (Wilms Tumor, Aniridia–partiial or complete lack of iris), Genital anomalies, Mental retardation—-important that Wilm’s can also happe nwith beckwith widemann
Describe alkaptonuria
congenital deficiecny of homogeinsate oxidase (in the degenerative pathway of tyrosine to fumarate). Autosomal recessive, get that bluish lack connective tissue, BLACK URINE, ear cartilage, scelerae, can get debilitating arthralgias (the accumulated homogenestic acid in this dmaages cartilage)
What specific body might you see in sickle cell disease?
A howell jolly body.
kid with a smooth philtrum and a small head; what is it?
Fetal alcohol syndrome; can also get cardiac, lung abnormalities, ADHD, delayed growth, shortened palpebral fissures, low set ears
Biggest sign of testicualr torsion, what mediates this?
abscence of cremasteric reflex; dont ultrasound, get fuckin treating. The internal oblique controls the reflex and ilioinguinal nerve
What type of epithelium lines the site of spermatogenesis?
these are SF tubules’ pseudostratified with sterocilia
Where is testosterone generated in men
leydig cells
Infant at six months that has hepatomegaly, elevated respiratory rate, and hypoglycemia; whaht is it what enzyme is fucked
Von Gierke disease’ glucose 6 phosphatase (final step glucioneogenesis). infiants get hypoglycemia, seizures, hepatomegaly, lactic acidosis
Initial test for HIV diagnosis?
Immunoassay/Eliza
what secretes the alkaline componetn of semen
the prostate
What lymphoma can present with a big ass mediastinal mass and SVC syndrome? What is its tumor marker?
Acute lymphoblastic leukemia/lymphoma; look for tons of lymphoblasts, TdT+, B10+
Patient presents with fatigue, weight loss, mucosal bleeding, wide spread brusing (ecchymosis), HSM and lymphadenopathy with ruptured lymphocytes; what is it
This is Chronic Lymphocytic leukemia; most common feature is also wide spread lymphadenopathy. Have thrombocytopenia, potentially autoimmune hemolytic anemia. The ruptured lymphocytes are called smudge cells
signs of pancreatic adenocarcinoma
present late so get jaundice, often a palpable gallbladder and a migratory thrombopllebitis (inflammation and painful blood clots in lower extremeties). Also weigt loss, abd pain potentially radiating to back. usually arises from ventral pancreatic bud
Probably the worse side effect of methotrexate and its antidote
Myelosuppression, reversible with leucovorin (this is folonic acid). Bypasses the folate block.
What branchial arch supplies the muscles and nerves for speaking?
The sixth. (except for cricothyroid)
What color blood do you see in Abruptio placentae vs placenta previae, risk factors for the first?
Dark red in abruptio (its venous), bright red in the second. (first has risks of early contracitons, fetal death, DIC). Risks are HTN, smoking, cocaine in preg
What is the origin and presentation of Wilm’s tumor
Arises from neoplastic embryonic renal cells of the metanephrosis (WT1 tumor suppressor gene on chromo 11). Get renal calyces distoreted by a mass, flank pain, painless hematuria.
What diuretics can induce a metabolic alkalosis?
thiazides and furosemide (inhibit sodium uptake,collecting duct compensates by secreting potassium and acid)-> hypokalemia, alkalosis
What results in isolated cleft LIP?
Failure of fusion of nasal processes
Describe essential thrombocythemia
overproduction of plateltes by megakaryocytes’ obstruction in capillaries and arterioles. Get epistaxis, thrombosis, bruising, bleeding, mild splenomegaly, erythromelalgia, transient ischemic attacks. Treat with hydroxyurea
Cartilage ucked in Ehlers-Danlos Classical vs vascular
Classical: Type V, Vascular: Type III (vascular is worse; get ruptured berry aneryusms, vascular and organ rupture).
presentation and tx of warm reactive autoimmune hemolytic anemia
signs of anemia, complications of hemolysis (eg jaundice frmo more indirect bili), increased reituclocyte count, positive warm-agglutination test. May get spherocytes. TX IS CORTICOSTEROIDS
Bleomycin moa, use, adverse effects
Induces free radical formation (breaks DNA strands). Testicular cancer, hodgkin lymphoma. PULMONARY FIBROSIS. Hyperpigmentation
Describe I cell disease
inherited lysosomal storage disorder; defect in N-acetylglucosaminyl-1-phosphotransferase (CANT PHOSPHORYLASE MANNOSE RESIDUES in GOLGI). Get coarse facial features, gingival hyperplasia, clouded corneas, restricted joint movements, claw hand, high lplasma lysosomal enzymes, kyphoscoliosis. Often fatal.
Describe Thrombotic thrombocytopenia purpura
abscene/decrease d amount of normal vWF protease ADAMTS13. Get CNS symptoms, renal insuff, fever, thrombocytopenia, microangiopathic hemolytic anemia (schisocytes and shit)
What nerve supinates
radial
What is damaged in diabetes that might fuck up your perception of pressure, coarase touch, high frequency vibration, tension?
Pacinan corpuscules
What are pain receptors, what are they responsive to?
Nociceptors; response to cytokines like bradykinin, histamine, presure, mechanical stress
Patient has numbness, tingling in lower extremeties with allergic rhiniitis, chornic sinusitis, asthma, elevated eosinophils; what do they have and tx? Cell that has antibodies to it?
This is Churg Strauss (aka eosinophilic granulomatis and angitis. Has p-anca (antimyeloperoxidase) to neurophils, Often have pulm involvement, can have heart too
What cell types can revert back from G0 to G1 of cell cycle in vivo?
stable cells like hepatocytes, lymphocytes (hepatocytes are really rich in smooth endoplasmic reticulaum if you need to distinguish between the two)
What might you give to control hirusitism in PCOS if OCPs fail?
Spirinolactone (blocks androgen receptors and inhibits androgen iosynthesis)
Azathiopine use?
Reduce risk of acute graft rejection. Interferes iwth purine nucleotide synthesis (A, G), so DNA synthesis and repair—has same MOA as 6-MP (its just converted in body to 6-MP)
Describe essental thrombocythema
massive proliferation fo megakaryocyets and platlets; get bleeding and thrombosis. Get some weird fucking platlets; like can have tendrils and shit and be huge
Loading Dose Calculation?
LD = Desired plasma concentration * (VD/F)
Most likely class of antidepressants to cause orthostatic hypotension and why?
TCAs; they block alpha 1 (Gq); hence why they are terrible in the elderly
Describe ADPKD gene and gene product deform; any other abnormal tissue
PKD-1 o PKD-2, abnormal production of polycystin 1(protein for cell adhesion molecules)
Cysts in kidney, liver, pancreas, berry aneruysms, aortic aneryusms, diverticulosis, mitral valve prolapse (average of onset of all these guys? 30)
Why do you give someone with warm reactive autoimmune hemolytic anemia Corticosteroids?
IgG is attacking your erythrocytes. Interferes with this destruction.
Difference in MOA between Chloramphenicol and Clindamycin
BOTH affect 50s ribosome
but chloramphenicol inhibits bacterial 50s peptidyltransferase (resistance: acetylation)
Clindamycin inhibits 50s peptide bond formation
Describe Anterior Communicating Artery Damage/stroke
Headache, vision change
Describe Left posterior inferior cerebellar artery infarction
Lateral medullary syndrome (Wallenberg syndrome): Ataxia, loss of IPSILATERAL face and CONTRALATERAL body pain and temp sensation, no paralysis
Describe Left Anterior Inferior cerebellar artery infarction
ipsilateral facial paralysis
Describe anterior spinal artery infarct
Medial Medullary Syndrome
Deviation of tongue upon protrusion
Contralateral weakness in UMN pattern (hyperreflexia in arm and leg)
Loss of propriocepton and vibratory sensation (Medial leminiscus damage) below the neck, SPARE face
Describe anterior cerebral artery infarct
contralateral lower extremetiy motor and sensory issues
Describe middle cerebral arterry infart
contralateral UPPER extremeity motor and sensory issues
Side effect of Thazolidineiones
These are the guys that activate pPAR to increase insulin receptors.
(Pioglitazone, Rosiglitazone)
side effect; WATER RETENTION-> heart fialure (with pulm edema and weight gain)
Describe Adult T cell Leukemia
Associated with HTLV-1 (Human T cell lekemia virus). More assoc with Japan and the caribbean
Infected T cells have a “cloverleaf” or “flower” on blood smear. They’re like little sun/spiky bois.
Symptoms: Neuro symptoms (like erectile dysfunction, but could be gait issues, bladder dysfunc, sensory neuropathy), HSM, Cutaneous elsions, HYPERcalcemia, abnormal blood smear.
More acute versions can get lytic bone lesions with the hypercalcemia
Which antibiotic can cause nephrogenic diabetes insipidus?
Democlocycline
Describe Paget Diseases of the Breast
Inflamamtory, eczematous lesions of nipple or areola. Characteristic Large halo like cells on histology. Can look pretty fuckin messy. High risk of ductal carcinoma.
Describe NF2
Mutation of merlin gene (NF2) on chromosome 22. Get multiple tumors in nervous system (esp bilateral schwannomas), but also meningiomas, ependymomas, neurofombromas, psoterior subacasualr lenticualr opasities.
Also some eye issues: cataracts, benign eye tumos (so often have cloudy or blurry vision)
Important to note that rinne test will be NORMAL (it is a sensorineural hearing loss issue if they have a schwannoma not conductive)
What do you stain for in esophageal adenocarcinoma
Cytokeratin (neoplasia of glandular epithelial cells)
What is pes cavus, diseases that have it?
Abnormally high arch.
Freidrich ataxia, Charcot Marie Tooth
What is Pes Exctavus, what diseases have it?
caved in chest
Homocystinuria, Marfan
Histologic apperance of a seminoma
Most common testicular neoplasms in 15-35 age range. Painless, radiosensitive (great prognosis).
Large cells in lobules, watery cytoplasm, “fried egg”
Lymphoma stains positive for CD15 and CD30, any histologic aspects
Hodgkin Lymphoma
Reed-Sternberg cells (small lymphocytes, eosinophils, macrophages, reed sternbergs are bilobed nuclei)
How do we acutely buffer excess H+ Ions? More long term?
We’d get an overload in a situation like hypoventilation (eg from opioids) or some sort of metabolci acidosis situation.
The first mechanism is the excess H+ enters cells and is buffered by binding to intracellular proteins; this is balanced by K+ efflux, which leads to hyperkalemia.
Another mechanism is H+ binding to hemoglobin (which reduces affinity for oxygen—a right shift)
Bone matrix plays a minor role as well.
More long term: an increase in bicarb reabsorption at the kidney (compensation response). Bicarb does not buffer in the acute phase; it forms more CO2 (already have some from hypercapneia), but someone may not be able to expire it in the case of opioid induced hypoventilation. So we get a big CO2 increase. More long term we can secrete out the H+ (which comes with the bicarb resorb)
CAT MUDPILES
C (Carbon Monoxide, cyanide, congenital heart failure)
A: Aminoglycosides
T: Teophylline/ Toulene (Glue sniffing)
M: Methanol U: Uremia D: DKA/Alcoholic ketoacidosis/Starvation ketoacidosis P: Phenformin/Paralyene aldehyde (also tylenol)? I: Iron toxicity/isonazid L: Lactic acidosis E: Ethanol/Ethylene glycol S: salicyates (aspirin)
Anion gap metabolic acidosis
