Sat Aug 1 Flashcards
what phase is the oocyte arrest in until ovulation?
prophase I
At ovulation, an oocyte continues dividing and is arrested in what phase, until fertilization by sperm
metaphase II
how does low Cl effect HCO?
low Cl- impairs renal excretion of HCO- –> can lead to metabolic alkalosis
Total body chloride depletion may lead to…
metabolic alkalosis (impaired ability to excrete HCO)
What can cause chloride depletion?
Severe vomiting - loss of H and Cl
Loop or thiazide overuse – Cl excreted in urine
If someone has metabolic alkalosis due to Cl depletion, how do you treat them?
Normal saline with Cl repletion
if someone has metabolic alkalosis, measurement of what substance can help determine the etiology?
urine Cl-
what type of genetic material does adenovirus have?
DS DNA
a patient with diverticulosis presents with painless hematochezia, what is the pathophys of the bleed?
- diverticula tend to form in weak points of the colon, usualyl where the vasa recta penetrate through smooth muscle
- enlargement of the diverticula can lead to painless hematochezia, as a result of ulceration/rupture of the vasa recta
is P aeruginosa and B cepacia lactose fermenting?
NOOOO
what is dialtezam?
NON dihydropyridine Ca channel blocker
risk factors for calcium oxalate stones?
- hypercalciuria
- hyperoxaluria
- hypocitraturia
- low Ca diet
how can you prevent calcium oxalate stones?
- reduce sodium, protein and oxalate intake
- increase potassium intake, moderate calcium intake (low Ca diet is actually a risk factor)
- thiazides
risk factors for uric acid kidney stones?
- gout
- myeloproliferative disorders
why does hypocitruria increase the risk of calcium oxalate stones?
-the normal function of citrate in the urine is to bind to Calcium, making it soluble and preventing the formation of calcium oxalate complexes
what type of drug is abacavir?
NRTI
Abacavir A/E?
delayed hypersensitivty reaction (type IV)
whcih patients are at increased risk for a hypersensitivity reaction when taking abacavir?
Those with HLA-B*57-01 allele
what should be done before starting a patient on abacavir?
genetic testing for HLA-B*57-01 allele
what is emtricitabine?
NRTI
emtricitabine A/E?
hyperpigmented macular rash on palms and soles
which bacteria has Protein A?
S aureus
MOA of protein A?
binds Fc region of IgG - prevents complement - impaired opsonization and phagocytosis
which bacteria secrete igA protease?
S pneumonia and N gonorrhea
what are the major risk factors for AAA?
Male
>65
SMOKING
what is kussmauls sign?
increased JVP on inspiratio
POST MI TIMEFRAME: right ventricular failure?
acute
POST MI TIMEFRAME: papillary muscle rupture?
3-5 days OR acute
POST MI TIMEFRAME: interventricular septal rupture?
3-5 days OR acute
POST MI TIMEFRAME: left ventricular aneurysm?
within several months
what will be seen on ECG of someone with carotid sinus hypersensitivity during a symptomatic episode?
A prolonged sinus pause
When does the early, and late, phase of a type I hyersensitivity occur?
Early - immediate
Late- hours later
Findings of early type I hypersensitivty?
Wheal and flare
Pathophys of early type I hypersensitivity?
Preformed IgE from previous exposure crosslinks on mast cells and causes release of histmaine and leukotrienes ->vasodilation and increased permeability
findings of late type I hypersensitivity?
palpable, indurated lesion
pathophys of late type I hypersensitivity?
IgE also stimulates the late phase – stimulates Th2 helper T cells to release cytokines that activate eosinophils, which release major basic protein and peroxidase –> tissue damage
what is metolazone?
thiazide
histologic findings of HNSCC?
- sheets of polygonal cells with abundant eosinophilic cytoplasm
- intercellular bridges and keratin pearls (irregular foci of keratinization)
location of Kiesselbachs plexus?
nasal septum
frontal bossing is a finding in…
rickets
which organelle is required for heme synthesis?
mitochondria
pathophys of hemoglobin C
Mutation on beta chain results in glutamate being replaced by lysine.
-hemoglobin C then forms crystals and promotes red cell dehydration ->mild chronic hemolytic anemia
why are hemoglobin H and hemoglobin barts innefective at oxygen delivery?
they have extreme oxygen affinity
beta globin tetramers =
hemoglobin H
gamma globin tetramers =
hemoglobin barts
what type of bone metastasis does melanoma cause?
osteoLYTIC
which types of cancers result in mixed (osteoblastic AND osteolytic) bone lesions?
breast and GI
does total lung capacity change with aging?
No - the decreased chest wall compliance and increase lung compliance cancer eachother out
attributable risk formula?
ARPe = 100 x ((risk of exposued-risk of unexposed)/risk of exposed)
if you are given the relative risk, what is the attributable risk formula?
ARP = 100 x ((RR - 1)/(RR))
-used the relative risk of the exposed group obviously
what is the function of ApoE3 and ApoE4?
These are found on chylomicrons and VLDL -they bind to hepatic apolipoprotein receptors and are then taken up by the liver
what will mutated ApoEs result in?
the liver wont be able to remove chylomicrons and VLDL remnants from the blood, leading to increased circulating triglycerides and cholesterol
which familial dyslipedemia has defective ApoE proteins?
type III - familial dysbetalipoproteinemia
patient symptoms of cataracts
- excessive glare at night
- halos around bright lights
- difficulty reading
clinical findigns of cataracts?
- loss of red reflex
- cloudiness of the lens
- decreased visualization of retinal detail
pathogenesis of cataracts?
from oxidative damage -> opacification of the lens
which drugs increase the risk for cataracts?
glucocorticoids
what is a normal alveolar pO2?
104
what is a normal alveolar pCO2?
40
is blood gass exchange at the lungs usually diffusion or perfusion limitied?
Perfusion limited- the gases equilibrate after transversing only one third the lenght of the capillary
What findings may indicate diffusion limited gas exchange in the lungs?
An increased gradient between alveolar pO2 and pulmonary venous pO2 -enough gas isnt able to diffuse to equillibrate in time
Will pCO2 in the venous blood usualyl be affected in diffusion limited gas exchange?
No - it equibilrates much faster than O2 so is usually normal
What normal condition can result in diffusion limited gas exchange?
Exercise — blood very high perfusion rates so that diffusion cant keep up
Is a pulmonary vein PO2 of 70 normal?
NO - should be closer to 100 - this indicates diffusion limited gas exchange
antigenic shift AKA
genetic reassortment - reassortment of RNA segments between different strains
statins MOA
HMG coa reductase inhibitors
statins effects
-decreased LDL, decreased triglycerides
statins S/E
hepatotoxicity, muscle toxicity
ezitimibe MOA
decreased intestinal cholesterol absorbtion
ezitimibe effects
decreased LDL
ezitimibe A/E
Increased hepatotoxicity when given with statins
bile acid sequesterants MOA
prevent reabsorption of bile from intestine
bile acid sequesterants effects
decreased LDL
bile acid sequesterants A/E
- nausea, bloating, cramping
- impaired absorption of drug and fat soluble vitamins
niacin MOA
- decreases FA release
- decreases VLDL synthesis
- decreases HDL breakdwon
niacin effects
decreased LDL
increased HDL
niacin A/E
- flushing and pruritis
- gout/hyperuricemia
- hepatoxicity
fibrates MOA
- activate PPAR-alpha
- decrease VLDL synthesis
fibrates effects
- decreased triglycerides
- increased HDL
fibrates A/E
- muscle toxicity
- gallstones
fish oil MOA
- decrease VLDL synthes
- decrease apolipoprotien B synthesis
fish oil effects
- decrease triglycerides
- increase HDL
clinical manifestations of congenital hypothyroidism?
- initially normal at birth
- enlarged fontanelle
- protruding tongue
- umbilical hernia
- poor feeding
- constipation
- dry skin
- jaundice
why are babies with congenital hypothyroidism normal at first?
they have maternal T4
inheritance of vWF disease?
AD
what causes a decreased maternal alpha fetoprotein?
Aneuploides - trisomy 18, 21, etc.
What causes an increased maternal alpha fetoprotein?
- open neural tube defects
- abdominal wall defects
- multiple gestations
does the maternal quadrupel screening test detect fetal alcohol syndrome?
NOOO
what does adalimumab bind?
TNF-alpha
chronic lymphadema is a risk factor for which cancer?
cutaneous angiosarcoma
what is stewart treves syndrome
the development of angiosarcoma in the presence of lymphadema - often after radical masectomy
pharmacological treatment of restless leg syndrome?
Dopamine agonists
Gabapentin/pregabalin
pramipexole moa?
dopamine agonist (DR3)
lacy, reticular rash =
parvovirus
what is the purpose of carnitine acyltransferase?
shuttles fatty acids into the mitochondria for beta oxidation
what substance inhibits carnitine acyltransferase?
malonyl-coa
in what state is there increased malonyl-coa?
well-fed state
explain trastuzomab cardiotoxicity?
it causes a decrease in cardiac contractility but does not cause any cardiomyocyte destruction or fibrosis. Often results after cessation of treatment
antidote to serotonin toxicity?
cyproheptidine
which drugs may cause a significant first dose hypotension?
ACE inhibitors -should start with low doses
in the presence of preexisiting volume depletion
what is dystonia?
sustained, involuntary muscle contraction
what is myoclonus?
sudden, brief, muscle contraction
phenylalanine is converted into waht?
tyrosine
what enzyme converts phenylalaline to tyrosine?
phenylalaline hydroxylase
what is the cofactor for phenylalaline hydroxylase?
BH4
what is the precursor to serotonin?
tryptophan
what is the cofactor of tryphtophan hydroxylase?
BH4
Neurologic manifestations of PKU?
developmental delay, hypotonia, dystonia and seizures
the superior thryoid artery runs along with which nerve?
external branch of the superior laryngeal nerve
what muscle is innervated by the external branch of the superior laryngeal nerve?
cricothyroid
all laryngeal muscles except for the cricothryoid are innervated by what nerve?
reccurent laryngeal nerves
the recurrent laryngeal nerves are at risk during ligation of which artery?
the inferior thyroid artery
