Set 28 Flashcards
What is Kallmann syndrome?
Failure to complete puberty; a form of hypogonadotropic hypogonadism. Defective migration of GnRH cells and formation of olfactory bulbs; decreased synthesis of GnRH in the hypothalamus; anosmia (agenesis or hypoplasia of olfactory bulb - can’t smell); decreased GnRH, FSH, LH, testosterone, and infertility (low sperm count in males; amenorrhea in females). May also see midline facial defects like a cleft palate. Usually sporadic but often x-linked (more common in men).
A 67-year-old male CHF patient lost his job and medical insurance, so he stops buying and taking his digoxin, and develops dyspnea. What will this do to his cardiac output (CO)? What are the mechanisms behind his development of dyspnea?
CO will decrease due to loss of positive ionotropic effect (increased contractility) of digozxin
Decreased CO —> decreased pumping of blood from LV —> backup of blood in pulmonary vasculature —> pulmonary edema = dyspnea
A 17-year-old girl is brought to the emergency room for abdominal pain and vomiting. She has a fever, and further questioning and exam reveal that the pain is in the right lower quadrant and has rebound tenderness. She says the pain began around the umbilicus. She is very nauseated and vomits again during the exam. What must be ruled out prior to coming to the final diagnosis in this patient?
Appendicitis differential: diverticulitis (elderly), ectopic pregnancy (use B-hCG to rule out)
A 31-year-old man is post-op day 1 after an exploratory laparotomy. The surgery was performed emergently for intraperitoneal hemorrhage after a motorcycle crash. His creatinine today is elevated to 2.0 mg/dL. His pain is currently uncontrolled. Explain why an NSAID could lead to a potential complication in this patient.
Prostaglandins are protective in the renal vasculature (dilate) - NSAIDs decrease PGs (by inhibiting COX). Without PGs the afferent arteriole of glomerulus does not dilate (decreased GFR and renal plasma flow)
Which phagocyte dysfunction disease increases patient susceptibility to S. aureus and E. coli? What is the cause of this disease?
Chronic granulomatous disease
Defect of NADPH oxidase —> decreased ROS (e.g., superoxide) and absent respiratory burst in neutrophils; XLR
Increased susceptibility to catalase positive organisms (PLACES); Pseudomonas, Listeria, Aspergillus, Candida, E.coli, S. aureus, Serratia
What is the mechanism of action of local anesthetics? Which nerve fibers are blocked first with local anesthesia?
Block Na+ channels by binding specific receptors on inner portion of channel (block nerve firing). Preferentially bind to activated Na+ channels, so most effective in rapidly firing neurons. Tertiary amine local anesthetics penetrate membrane in uncharged form, then bind to ion channels as charged form.
Order of nerve blockade (small diameter>large, myelinated>unmyelinated): small myelinated > small umyelinated > large myelinated > large unmyelinated
Order of loss (1) pain, (2) temperature (3) touch (4) pressure
What medications are used in the treatment of urge incontinence?
Anticholinergic drugs: Oxybutynin Tolterodine Darifenacin Solifenacin Trospium
What are the 3 different eukaryotic RNA polymerases? What type of RNA does each make?
RNA polymerase I makes rRNA
RNA polymerase II makes mRNA
RNA polymerase III makes tRNA
A 45-year-old obese woman comes to your clinic with complaint of polyuria and polydipsia. Glucose tolerance tests are abnormally elevated. Which cell types do not require insulin for the uptake of glucose?
BRICK L Brain* RBCs* Intestine Cornea Kidney Liver
What are the layers of the epidermis beginning with the most superficial layer? What is Auspitz sign?
Stratum Corneum (keratin) Stratum Lucidum Stratum Granlosum Stratum Spinosum (spines = desmosomes) Stratum Basale (stem cell site) “Californians Like Girls in String Bikinis”
Auspitz sign = pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off (psoriasis)
