Set 1 Flashcards
What is the difference between standard deviation and standard error?
Standard Deviation looks at the spread of individualism with in a normal distribution sample.
Standard Error looks at the variability due to sampling, and helps estimate the true mean of the underlying population.
How do Fibrates work? Name one?
Fibrates block Cholesterol 7-alpha-hydroxylase, which catalyze the rate-limiting step in the synthesis of bile acids.
Reduced bile acid production on results in decreased cholesterol solubility in bile and favors the rotation of cholesterol stones.
Gemfibrozil or Fenofibrate
Pt. W/ recurrent abdominal pain, + “ultrasonic Murphy sign”, and multiple cholesterol gallstones
Cholelithiasis
Risk factors for gallstones?
- Obesity or Rapid Weight loss
- Female
- Glucose intolerance
- Hypomotility of the gallbladder (pregnancy or prolonged fasting)
How do aromatase inhibitors work? Name one?
Aromatherapy catalyze the conversion of androgens to estrogen; inhibiting this would cause decreased gallstone formation.
Estrogenic medications cause an increase in the amount of cholesterol secreted in bile and contribute to formation of gallstones.
Anastrozole is anaromatase inhibitor,
How do estrogens increase cholesterol biosynthesis?
Estrogen uptrgulate hepatic HMG-CoA reductive activity.
Beta-glucuronidase
Deconjugates bilirubin, and the resulting free bilirubin precipitates with calcium in the bile to form pigmented gallstones.
Thiolase
1st step in cholesterol synthesis, condenses 2 molecules of acetyl-coA to form acetoacetyl-CoA
What is the difference between an erosion and an ulcer?
Erosions are mucosal defects that do not fully extend through the muscularis mucosa.
Ulcers can extend into the submuscosal areas and the muscularis propria.
Multifactorial Disease
The complex interaction of numerous genetic and environmental factors to determine phenotypic expression.
Progressive Joint pain and swelling involving the proximal interphalnageal joints, metacarpophylangeal joints and wrists bilarterally.
Morning stiffness lasting longer than 30 minutes
Six present for >6 weeks
Rheumatoid Arthritis
Serum antibodies found in RA?
Anti-cyclic citrullinated peptide (anti-CCP) antibodies
What species of bacteria can survive boiling?
Spore forming bacteria - Clostridium and Bacillus species
How do you kill spore-forming species?
Autoclave
What is a cryptogenic stroke?
When an embolism travels through a Right-to-left cardiac shunt.
Elevated Right Heart Pressure
Eisenmenger syndrome
Fixed S2 splitting
ASD
Incomplete development of the aroticopulmonary septum
Truncus arteriosus
Holosystolic murmur at the lower left sternal border
Ventral septal defect
A small VSD will cause a smaller or greater sound?
Greater
Continuous “machine-like” murmur
Patent ductus arteriosus
What do you use to close a PDA?
Indomethacin
What do you do to keep a PDA open?
Prostaglandin E
HBeAg
An indication of HBV infectivity
A person vaccinated against HBV has this serology
(+) anti-HBsAb, (-) anti-HBcAg, anti-HBeAg, or any viral antigens
Class IA antiarrhythmics
Quinidine, procainamide, and disopyramide.
Na channel blocking agents that depress phase 0 depolarization.
Side effects of Class Ia Antiarrhythmics
- Cinchonism (Headache, tinnitus) ->Quinidine
- Reversible SLE-like syndrome -> Procainamide
- Heart Failure -> Dispyramide
- Thrombocytopenia and TdP -> all
MOA of class Is antiarrhythmics
- increased AP
- increased effective refractory period
- increased QT prolongation
Class IB antiarrhthymics
Lidocaine, Mexiletine
- prevent Post MI arrhythmia (acute ventricular arrhythmia & digitalis-induced arrhythmia)
SE for class Is antiarrhythmics
CNS stimulation/depression, cardiovascular depression
MOA for Class Ib antiarrhythmics
- decreased AP duration
- preferentially affect ischemic or depolarizer purkinje and ventricular tissue.
Class Ic drugs
Flecainide, Propafenone
- SVT’s including: a-fib (last resort refractory VT)
SE of Class Ic antiarrhythmics
- Proarrhythmic, especially post-MI
MOA of class Ic antiarrhythmics
Significantly prolongs refractory period in AV node
Minimal effect on AP duration,
Class II antiarrhythmics
Beta-blockers
- Used for SVT, slowing ventricular rate during a-fib and a-flutter
SE of Class II antiarrhythmics
- Impotence, exacerbation of COPD and asthma, cardiovascular effects (bradycardia, AV block, CHF)
- Sedation, sleep alteration
SE of metoprolol only
Dyslipidemia
SE of propranolol only
Exacerbation vasospasm in prinzmetal angina.
Class III antiarrhythmics
Potassium channel blockers
Amiodarone, Ibutilide, Dofetilide, Sotalol
- Used in A-fib, a-flutter, ventricular tachycardia
SE of sotalol
TdP
Excessive Beta-blockade
SE of Ibutilide
TdP
SE of Amiodarone
Pulmonary fibrosis, hepatotoxicity, hypothyroidism/hyperthyroidism, corneal deposits, skin deposits resulting in photodermatitis, neurological effects, constipation, cardiovascular effects
Always Check PFTs, LFTs, and TFTs when using amiodarone
MOA of class III antiarrhythmics
- Increased AP duration
- Increased ERP
- increased QT prolongation
Class IV antiarrhythmics
Ca-channel blockers
Verapamil, Diltiazem
- Prevention of nodal arrhythmia, rate control in a-fib
SE of Class IV antiarrhythmics
Constipation, flushing, edema, CV effects (CHF, AV block, sinus node depression).
MOA of class IV antiarrhythmics
- decrease conduction velocity
- increase ERP
- increased PR interval
MOA of Adenosine
Increase potassium effluent from cell, causing hyperpolarization of the cell and decreased Ca conductance.
- used in abolishing supraventricular tachycardia
- Short acting
SI of adenosine
Flushing, hypotension, chest pain
- effects blocked by caffeine and theophylline use.
What do you use in TdP or digit in toxicity
Mg
What is the inheritance of Sickle Cell Anemia?
Autosomal recessive
What is the mutation in Sickle Cell Anemia?
Glutamic acid -> Valine
- polar -> non-polar => allows for hydrophobic accumulation
The drug do you give sickle cell patients
Hydroxyurea - increases production of HbF
They subunits are in HgF
Gamma -2 & alpha -2
prevalence effects which statistical modalities
PPV and NPV
Lesser Omentum
Double layer of peritoneum that extends from the liver to the lesser curvature of the stomach and the beginning of the duodenum.
The two ligaments of the lesser omentum
Hepatogastric ligament -connecting the lesser curvature of the stomach,
Hepatoduodenal legament- connecting to the duodenum
Falciform ligament
Attaches the liver to the anterior body wall
Greater Omentum
Large Fold of visceral peritoneum that extends from the greater curvature of the stomach, travels inferiority over the small intestine, and then reflects on itself and ascends to encompass the transverse colon before reaching the posterior abdominal wall.
Splenorenal ligament
Lies between the left kidney and the spleen. Contains the splenic vessels and the tail of the pancreas.
T(9;22)
Philadelphia chromosome -> CML
T(8;14)
C-myc activation -> Burkett Lymphoma
t(11;14)
Cyclin-D1-activation -> Mantle Cell Lymphoma
T(14;18)
Bcl-2 activation - > Follicular Lymphoma
T(15;17)
M3 type AML
What M3 AML respond best to
All-trans retinoic acid
Sx of CML
- Fatigue, weight loss, excessive sweating
- Splenomegaly, Leukocytois w/left shift
- Myelocytes, metamelanocytes, band forms
Mutation of CML
BCR-abl fusion protein - t(9;22)
Essential Thrombocytopenia
Hemorrhagic and Thrombotic symptoms - easy bruising, microangiopathic occlusion
- Thrombocytosis
- Megakaryocytic hyperplasia
Mutation in Essential Thrombocytopenia
JAK2
Mutation in Polycythemia Vera
JAK 2
Mutation in Primary Myelofibrosis
JAK 2
Polycythemia Vera
- Pruritis, erytheromylegia, splenomegaly, thrombotic complications, erythrocytosis and thrombocytosis
Primary myelofibrosis
Sever fatigue, splenomegaly, hepatomegaly, anemia + bone marrow fibrosis
Blood work for Polycythemia Vera
RBC - increased
WBC - increased
Platelets - increased
Blood Work with Essential Throbocytosis
Platelets - increased
RBC/WBC - normal
Myelofibrosis Blood Work
RBC - decreased
WBC/platelets - variable
CML Blood Work
RBC - decreased
WBC - increased
Platelets - increased
Treatment of primary myelofibrosis
Ruxolitinib
Starry sky histology
Burkett Lymphoma - Associated with Ebstein Barr Virus
Facial Pain, Headache, and black nectrotic eschar in the nasal cavity in a patient with diabetic ketoacidosis
Murcormycosis
Ischemia of the inferior surface of the heart
Right coronary artery occlusion
Ischemia of the anterior 2/3s of the interventricular septum, anterior wall of the left ventricle, and part of the anterior papillary muscle.
Occlusion of the LAD
Ischemia of the LAteral and posterior superior walls of the left ventricle
Left cricumflex artery occlusion
Ischemia of the right ventricle
Occlusion of the right rational branch of the right coronary artery.
SE of Thiazide Diuretics
- Volume Depletion
- Hypokalemia and metabolic alkalosis
- Hyponatremia and Hypercalcemia
SE of Loop Diuretics
Volume Depletion
Hypokalemia and metabolic alkalosis
Hypokalemia
First line for Panic Disorder, acutely
Benzodiazepine
First-line pharmacology for panic disorder, chronically
SSRI and CBT
Pathology of PE causing hypoxemia
Ventilation/perfusion mismatch
Abnormal interaction between the uterine bud and metanephric mesenchyme, resulting in a nonfunctional kidney consisting of cysts and connective tissue. Most likely unilateral.
Multicystic dysplastic kidney
