STEP 1 Week 3 Flashcards
Where in the ovaries are androgens converted to estrogens
Granulosa cells
Converstion enzymes from O2 to hydrochlorous acid
NADPH oxidase converts O2 to O- free radical. Superoxide dismutase converts that to H2O2, which is more stable. Myeloperoxidase converts H2O2 to hydrochlorous acid
Most common site of nosebleeds
Usually in the anterior nares at the nasal spetum, where there is watershed of three vessels
Muscles that help you sit up
Rectus abdominus, external abdominal obliques, and hip flexors (iliopsoas, rectus femorus, tensor fascia lata)
What is a dandy-walker malformation
Absence of the cerebellar vermis, leads to cystic dialtion of the fourth ventricle
Strength of binding of class I antiarrhthymics
1C > 1A > 1B
What kind of anemia does celiac cause
Microcytic - caused by iron deficiency (most iron is absorbed in the duodenum)
Characteristics of WPW ECG
What happens to right atrial and LVED pressures in left heart failure
Both go up
Treatment for organophosphate poisoning
Atropine - competitive inhibitor of acetylcholine receptors
Breakdown of heme into billirubin
Pathophys of normal pressure hydrocephalus symptoms
Increased CSF leads to pressure on the decscending cortical fibers in the periventricular tracts and also pressure on the basal ganglia
What is congenital torticollis
Caused by birth trauma or malposition of the head in utero
Causes sternocleidomastoid m. injury and fibrosis - head tilted to affected side and chin pointing away
Casn also have other muskuloskeletal problems
Most common oncogene present in glioblastoma
Overexpression of epidermal growth factor receptors (EGFR)
Liver changes with age
Decreased hepatic blood flow leads to smaller liver size
Decreased P450 enzyme activity
Reduced rate of hepatic regeneration
Aminotransferases should be the same
Features of a glucagonoma
Necrolytic migratory erythema
Diabetes mellitus
GI issues
What is PD-1 on T cells
Programmed death receptor. Binds to PD-L1 on neoplastic cells and inhibits their ability to cause apoptosis
Vector for babesia
Ixodes tick - can have coinfection with Lyme
When does uric acid form stones
Only at low pH - lwoest in the distal tubules and collecting ducts
What is bethenacol
Muscarinic agonst - can help with urinary retention
SX of fetal parvovirus
Interuption of erythropoesis, so get anemia
Also see ascites and oericardial effusion
Hydrops fatal
What amino acid is used to increase ammonia int he urine
Glutamine
What is a developmental field defect
When an initial embryologic disturbance leads to multiple malformations by disturbing tissues in the region
EX: holoprosencephaly
MOA of OCPS on hirsutism
Decrease the release of LH so reduces ovarian androgen production
Effects of a lactase deficiency
When lactos cant be broken down into galactose and glucose, a large amount of medium chain fatty acids are synthesized. This causes an acidification of the stool
Hydrogen gas is also produces so breatghe hydrogen increases and there is elevated stool osmolality which causes diarrhea
Significance of lepromin skin test
Cause of amenorrhea in anorexia
Low leptin levels (low fat stores) decrease pulsative releae of GnRH, so get a drop in LH and FSH, and then a drop in producton of estradiol
Systemic vs local progestin OCPs
Treatment for calcium stones and MOA
Thiazide diuretics - inhibition of Na/Cl induces absorption of calcium
Risk factors for abdominal aortic aneurysm
Where is the highest concentration of B cells in the lymph nodes
In the germinal centers
Some in the outer cortex but there are also T cells
Pathophys of mallory-weiss tear
Occur due to a rapid increase in intraabdominal and intraluminal gastric pressure during repeated retching
What is a metyrapone sensitivity test
Looks to see if the CRH/ACTH/cortisol axis is functioning
Blocks formation of cortisol so should see an increase in ACTH and then 17-hydroxycorticosteroid
How to find CO using O2
CO = rate of O2 consumption / arteriovenous O2 difference
Cause of a unilateral cleft lip
Failure of the fusion of the maxillary prominence with and intermaxillary segment
TX for cyanide toxicity
What are C-Jun and C-Fos
Nuclear transcription factors that bind directly to DNA using leucine zipper motif
Abnormality on CT of someone with myasthenia gravis
Thymoma - a large thymus
Brain changes seen in wernicke kirsakov
Hemmorhage in the mammilary bodies and periaqueductal gray
What do the embyronic cardinal veins form
The systemic venous circulation, inlcuidng vena cava
How are immune complexes removed
Activation of the mononuclear phagocyte system
IgG binds and can use C3b to induce phagocytosis or phagocytes can directly bind IgG
Inhibitors of acetylcholine transmission
What screening should be done before starting antidepressent
History of mania - depression could indicate bipolar
All antidepressents carry a risk of inducing mania
Changes to LV during mitral valve stenosis
There are no changes until late in the disease
Can eventualy lead to a reduction in diastolic pressure and afterlod with an increase in contractility (SNS triggered)
TX for scabies
Permethrin or ivermectin
Where is a lesion that can cause “pie in the sky”
Temporal lobe
Would block lower tracts of meyers loop (upper visual field)
What is metalozone
Thiazide diuretic
Can be combined with a loop to stop the reabsorption of Na that accumulates in DCT
Pathyphys of ankylosing spondylithis
Increased IL-17 activity in the gut that activates inflammatory markers like TNF-alpha and prostoglandins that lead to bony erosions
What causes skalded skin syndrome
Phases of ARDS
What is chronic mesenteric ischemia
Occurs when there is atherosclerosis in the mesenteric arteries
When more blood is needed for digestion, it cannot flow well. Causes post-prandial epigastric pain
What are the S3 and S4 sounds
S3 - right after S2, passive filling
S4 - before S1, atrial contraction with stiff ventricle
When are heart gallops heard best
With bell of stethoscope at apex of heart, end expiration
Where are B1 receptors
Cardiac smooth muscle AND renal juxtaglomerular cells
Causes of epispadias vs hypospadias
Epispadias - faulty positioning of the genital tubercle
Hypospadias - Non-fusion of the urethral folds
Signs of hypocalcemia
Neuromuscular excitabilty - twitching of face when tapped and carpal tunnel spasms
QTC prolongation, seizures
How does hyperphosphatmia lead to hypocalcemia
It can bind free calcium and precipitate in soft tissues
Phosphate also activates FGF 23 which inhibits formation of 1,25 hydroxylase leading to less absorption of calcium from the intestine
What is a risk factor for testicular torsion
Inadequate fixation of the lower pole of tesits to the tunica vaginalis - allows for increased mobility of the testis
When do red dead neurons appear
12-24 hours after ischemia
Most common causes of pneumonia after an influezna infection
Strep pneumo, Staph aureus, and H. flu
T3 and hypothyroidism
Because T3 is made peripherally and fluctuates widely - it is often normal in hypothyroidism
What is neurocysticercosis
Ingestion of pork tapework eggs in stool contaminated food water, leads to invasion of brain
See large cyst/scloex in brain
Endemic to central/south america
What nerves pass through the esophageal hiatus
Trunks of the vagus nerve
Contents of the cubital fossa
Brachial artery and median nerve
What nerve can cause blindness during recurrent VZV outbreak
Trigeminal - V1 innervates corneal reflux
Good predictor is if side of nose becomes infected - nasociliary branch affects both eye and nose
How to calculate filtration fraction
FF = GFR/RPF
RPF = RBF x (1-HCT)
Not all blood through kidney is filtered, so have to find perfusion from blood flow
Characteristics of stages of sleep
Stage 1 - theta waves
Stage 2 - sleep spindles and K complexes
Stage 3 - delta waves, slow waves
REM - eye movement, vivid dreaming, muscle paralysis
Manifestations of entamoeba histolytica
Colitis (flask shaped ulcers, iarrhea, bloody stool)
Liver abscess (single, right lobe)
Brain, lung, pleural abscess
REED STERNBERG
HODGKINS LYMPHOMA
MOA of ketamine
NMDA antagonist, also a sympathetic mimetic - bronchodilation and increased heart rate and cerebral blood flow (releases chatecolamines)
What type of bone loss is seen with aging
First: loss of trabelcular lone with loss of bridging
Second:Loss of cortical bone
Cause of wet macular degeneration
Extracellular accumulation of drusen depositis causes hypoxia and neovascularization due to VEGF - get leaky vessels.
What does niacin help form
NAD and NADP
Important for TCA cycle
What causes ataxia telangectasia
Mutation in ATM gene that helps to fix DNA strand breaks after X-ray/UV damage
Who are at increased risk for drug-induces lupus
Slow acetylaters
At what concentration does glucose start to spill into the urine
200 mg/dL
Pathophys of rheumatoid arthritis
Synovial hyperplasia and inflammatory inflitrates lead to a local increase in metabolic demand, causing local hypoxia. This leads to the formation of new blood vessels
The joint space is replaced by a rheumatoid panus(synovial cells, inflammatory cells, granulation tissue) that can destroy the articular cartilage and subchondral bone
What cytokine helps to regulate remodeling of the cartilage scar post MI
TGF-beta
What do the first an second pharyngeal arches form
First - maxilla, zygoma, mandible, incus, malleus
Second - styloid process, stapes, lesser horn of hyoid
Most likely sites of osteomyelitis in adults vs children
Adults - vertebral bodies
Children - metaphysis of long bones (highly vascular)
What muscle attaches to the greater trochanter
Gluteus medius - hip abduction
What is pulsus paridoxus
An exagerated drop in systolic BP during inspiraition
Caused by pericarditis - right heart usually can shift out but cant so shifts left, lowering SV
Effect of estrogen on thyroif function
Estrogen increases TBG, which transiently reduces free T4. Triggers release of TSH which increases T4, leading to an increases in total T4
What is mesna
Used to protect chemotherapy patients from cystitis
Toxic mustard derivate chemotherapy agenst are broken down into acrolein which is toxic to the bladder. Mesna binds to and inactivates toxic compounds in the urine
Pathogenesis of cholesterol gall stones
Phases of acute tubular necrosis
- Initiation - original toxic insult, lasts 24-36 hours
- Maintenance - fall in urine output, tubular necrosis, 1-2 weeks
- Recovery - Re-epithelization of tubules
Effects of coronary autoregulation
WHen an artery is occluded, the initial drop in blood flow will cause vasodilation and a decrease in pressure to maintain blood flow
Osteoarthritis vs rheumatoid arthritis
Drugs that treat bipolar d and epilepsy
Valproate, lamotrigine, carbamazepine
Part of the GI that is always affecte dby Hirshprung
The rectum - neural crest cells travel caudally
What is leuprolide
A GnRH analog use to continuously activate pituitary until LH and FSH are desensitized
Function of brown fat
Prevents hyothermia - large number of mitochondria
Most common cause of COPD exacerbations
Upper respiratory infections
Rhonovirus, H. flu, strep pneumo, moraxella cattarhalis
How does prostate cancer reach the spine
Prostatic venous plexus
What kidney stones are most common in Crohns
Oxalate
In crohns, there is impaired fat absorption in the illeum, so calcium binds to the fat. Calcium usually binds to oxalate and they are excreted
Free oxalate is reabsorbed and extreted in the urine and can form stones
Cancers associated with MEN1
Pancreatic, pituitary, parathyroid
What. disease is associated with anti-mitochondrial antibodies
Primary billiary cholangitis
Also would have elevated alk phos
MOA of rivaroxaban
Direct fatcor Xa inhibior - stops conversion of prothrombin to thrombin
What is akithisia
Subjective restlestness and inability to sit still
Extrapyramidal symptom
What is chostocondritis
MSK problem involving the chest wall- repetitive motions irritate the intercostals and chostocondral junctions
Pain is reproduced with palpation and movement
What landmark can be used to identify the appendix
Tinea coli - converge at the base of the appendix
What cell damage is caused by ionizing radiation used in chemotherapy
Double strand DNA breaks
How can thiazides cause hypokalemia
A. loss of Na leads to activation of renin-angiotensin system
Aldosterone leads to a loss of potassium in the urine
What is increased in keloids
TGF - beta
What landmark is used surgically to differentiate between direct and idirect hernia
Inferior epigastric vessles
Direct - originates medially
Indirect - originates laterally
What is Hartnup disease
AR metabolic order that causes inactivation of the neutral amino acid transporter
Tryptophan cant be absorbed and converted to niacin so get a pellagra-like reaction. Test is neutral amino acids in the urine. TX: high protein diet and niacin
What can be damaged by fracture of 12th rib
Kidney
Where is NADPH used metabolically
Reductive biosynthesis - formation of fatty acids, cholsterol, steroids
P450 metabolism
Formed by G6PD in the PPP
What is human placenta lactogen
A hormone produced by the syncitiotrophoblast that causes insulin resistance – allow more glucose for baby. Also triggers ketone and fatty acid metabolism (lipolysis) in the mother so glucose goes to baby
hCl also increaes production of insulin so diabetes doesnt occur
How does anti-Rh Ig work
It is Anti-D IgG
Given to mother, will bind any Rh+ RBCs that cross into the mother and sequester them in the spleen so no immune reaction occurs
Cause of spastic bladder
Loss of descending inhibitory control from upper motor neurons
Major risk factors for CAD
How do ANP and BNP work
Bind to ANP receptors that are bound to guanylyl cyclase that triggeres an increase in cGMP. This leads to vasodilation
What two things does tetanus block the release of
GABA and GLYCINE
What is enthesitis
Pain at sites of mechanical stress and insertion of tendons
Can be associated with ankylosing spondylitis
Actions of NF-kB
Activation of TLRs on surface lead to the degradation of IkB, which regulates NFkB
NFkB then goes to the nucleus and triggeres production of inflammatory signals
Maternal tests that indicate trisomy 21
Alpha 1 antitrypsin deficiency in liver
Misfolded A1a proteins can accumulate in the liver and can lead to hepatomegaly and cirrhosis
Drugs that can cause SIADH
Carbamazapine
SSRIs, TCAs, cyclophosphamide, chlorpropamide, ecstasy,
What seperates the lungs from the abdominal organs
The pleural peroteneal folds
If they dont close, can cause diaphragmatic herniation and no lung development
Function of RNA polymerase I
Helps to syntehsize rRNA so only in the nucleolus
What causes skin dimpling in breast cancer
Spread to the suspensory ligaments (cooper ligaments)
pH change that occurs in hypovolemic shock
A drop in blood volume leads to less perfuysion of muscles which causes lactic acidosis as muscles stop oxidative phosphorylation
Causes metabolic acidosis with hyperventilation
Function of DNA polymerase
A bacterial enzyme that removes RNA primers and inserts DNA
What kind of reaction is henoch schonlein purpura
Type III hypersensitivity mediated by IgA
What cancers are associated with EBV
Nasopharyngeal carcinoma
Burkitt lymphoma
Hodgkins lymphoma
What does a lesion in the left cerebellum cause
Left Dysdiadochokinesia (problem with rapid alternating movements), distance imperception (overshooting), intention tremor
What causes an S3 sound
Volume overload - forceful passive filling during diastole that exceeds the relaxation capacity of the ventricle
What does the murmur sound like in an atrial septal defect
Wide and fixed splitting of S2 that doesnt change with breathing
What to give for patients with absecne and tonic-clonic seizures
Valproate
Function of HER2
Increases proliferation and resistance to apoptosis
It spans the cell membrane and has a tyrosine kinase activity in the intercellular domain
Antibodies against ___ are the main source of protection against reinfection from the same influenza strain
Hemaglutinin
What are the walls of a Meckels diverticulum composed of
It is a true diverticulum so the same as the intestine - mucose, submucosa, and muscularis layer
Impact of testosterone on blood
Stimualtes red blood cell proliferation, so increases hematocrit
What would the lungs look like in ACUTE MI
Transudate and pulmonary edema - engorged capillaries and alveoli filled with pink material
Two types of galactose metabolism disorders
Galactokinase deficiency - usually just cataracts from conversion to galacticol
GALT deficiency - more serious, liver and kidney disfunction. Early failure to thrive from builduo of galactose-1-phosphate
What is fenoldopam
A periferal dopamine receptor agonist
Increases cAMP so leads to vasodilation - increased renal profusion and natriuresis
Good for hypertensive emergencies
Most commonly injured bone in fall on outstretched hand and complication
Scaphoid
Avascular necrosis
Complication from break of the anatomical neck of the humerus
Avascular necrosis of the head
Signs of congenital hypothyroidism
Lethargy, bulginf fontanelle, puffy face (accumulation of matrix substances), protruding tongue, umbilical hernia, risk of nonreversible intellectual disability
Most important cause of aortic disection
Hypertension
What vitamin is necessary for conversion of homocysteine to cysteine
B6
Effect of dopamine
Low dose: actiovates D1, vasodilation
Medium dose: activates B1, increased HR and CO
High dose: actovates a1, vasoconstriction
Glucorticoids impact on liver and bone
Liver: increase liver enzymes to favor gluconeogenesis and increasing glycogen reserves
Bone: decrease bone mass by decreasing calcium absorption from intenstine, and inhbiting osteoblast function
MOA of hydroxyurea
Inhibits ribonucleoside reductase so slows DNA/RNA synthesis
Favors production of HgF
TX for trigeminal neuralgia
Carbamazepine
Inhibits sodium channels so slows high frequency firing
How to make a patent foramen ovale open
Look at the release phase of the valsalva maneuver - a decrease in SVR will lead to higher pressure in the Right side
What is characteristic of islet cells in T2DM
Amyloid deposition
Phases of lobar pneumonia
- Congestion - increase in permeability as. eutrophils secrete chemokines, see abundant proteinaceuous fluid
- Red hepatic - appears red with fibrin, erythrocytes, neutrophils
- Grey hepatic - macrophages invade
- Resolution - macrophaes liquefy fibrous necrosis
What does CNS reponse to injury look like
Gliosis - astrocytes proliferate and form a glial scar
What forms from the third pharygeal pouch
Thymus and inferior parathyroid gland
Cause of epidiodymitis
Young men - chlamydia or gonorrhea
Older men - bladder outlet syndrome
How does actin chain change to cause contraction in skeletal muscle
In the relaxed state, tropomyosin covers the binding sites of actin
Calcium influx leads to calcium binding to troponin C which shifts tropomyosin and leads to exposure of myosin binding sites
What stops glycolysis during anaerobic respiration in patients with lactate dehydrogenase deficiency
There is not enough NAD+ regenerated
Effect of insulin
Leads to decrease in hepatic glucose proudction and uptake of glucose from insulin-responsive tissues
AND inhibits the release of glucagon
Most common nerve injured in axillary lymph node removal
Interchostobrachial nerve - causes decreased sensation over upper arm
What type of leukemia shows auer rods (needle shape crystals)
Acute myeloid leukemia
SX of cocaine withdrawal
Hyperphagia, vivid dreams, lethargy, fatigue, hypersomnia, depression
How to calculate if effusion is exudate
pleural protein/serum protein > 0.5
Pleural LDH/Serum LDH > 0.6
Pleural LDH > upper 2/3 limit of normal LDH
In a healthy person with kidney stones, what are the calcium levels
Normocalcemia, hypercalciuria
What does ubiquitination do to transcription factors
Leads to their degradation by proteasomes - so get less DNA expression
What causes an isolated supine hypotension in pregnancy
The baby compresses the SVC!
Reduced venous return and Cardiac output
How are MABs metabolized
They are not metabolised in the liver or kidney - usually just broken down in macrophages
Naloxone half life
Short - 6 hours
redosing may be necessary
Most susceptible areas to ischemic colitis
Splenic flexure and rectosigmoid junction - watershed zones
At what age should fetal corticosteroids be given
Any premature birth before 32 weeks
Why does glycolysis in erythrocytes yield no ATP
The step that yields ATP is swapped for the production of 2,3 BPG
Features of amniotic fluid embolism
Locus heterogeneity vs allelic heterogeneity
Locus heterogeneity is when two different mutations on two different loci result in a similar mutation
Allelic heterogeneity is when two mutations at the same loci result in a similar mutation
Effect of erythromycin on GI
It is a motilin receptor agonsit so causes gastric motility
Metoclopramide MOA
It is a GI prokinetic that is a D2 receptor antagonist
Can cause extrapyramidal sx
Why is the S2 split in an ASD
Usually, S2 is only split during inspiration when venous return is greatest
In ASD, right sided pressure is continuously. higher, leading to a constant forceful ejection into the pulmonary vessels (systolic murmur) and splitting of S2 from higher poressure and volume
What is Fanconi syndrome
A defect in absorption of basically everything in the proximal tubule - leads to hypercalciuria and glucosuria - UTIs and stones
Impact of fibrates on cholesterol
Lead to increased lipoprotein lipase so increae in oxidized fatty acids. Block the conversion of cholesterol into bile salts so increased risk of cholesterol stones
What determines L or R heart dominance
Whether the Posterior descending artery comes off the right coronary or left circumflex
AV node artery comes off dominant artery
Origin of innervation for pelvic floor muscles and urinary retention muscles
S2-S4
Function of neprolysin
Cleaves ANP and BNP - inhibiting would lead to increase in urine and antagonizing RAAS
Also inactivates Angiotension II so if you inhibit it you would want to give an ARB to block angiotension II
Why is the RV less damaged during ischemia
It has a lower oxygen demand (lower mass and afterload) and relatively low systolic rpessure means it recieved coronary blood flow in diastole and sistole
Where can ketones not be utilized
In erythrocytes (no mitochondria) and the liver (cant form acetoacetyl coA)
What causes a murmur in athletes
Athletes may have an increase in Stroke volume due to eccentric heart expansion. Leads to a pulmonic murmur
What is a cerebral arteriovenous malformation
Occurs when blood flows directly from arteries to veins, without flowing through any capillaries
Causes tangles of large vessels at risk for rupture
What causes ataxia in Friedrichs ataxia
Expansion of GAA repeat in frataxin gene causes decreased mitochondrial fxn and increased oxidative stress that causes degeneration of the spinocerebllar tracts and dorsal columns
How do beta blockers lower BP
- Reduce myocardial contractility and HR
- Decrease renin release in JG cells
How does actinomyces appear on biopsy
FIllamentous branching and can see sulfur granules
On staining, granules appear purple or red
What is epidermolysis bullosa
Genetic mutations in epidermal adhesion complexes, most commonly in keratin fillaments
MOA of capsaisin
Used for neuropathic pain
Causes an influx of calcium that leads to disfunction of nocireceptors
Decreases substance P, a pain related neurotransmitter
What cytokine activates eosinophils
IL-5
Pathophys of pericarditis after MI
Peri-infarction pericarditis occurs 2-4 after MI due to inflammation of the pericardium around the area of necrosis of the myocardium
What happens to SBP, DBP, and PP during exercise
SBP increases, DBP is unchanged, PP increases
SVR goes down but there is a shunting of blood to arterioles so DBP is unchanged. SV goes up so SBP and PP increase
Characteristics of tissue in PBC
Dense lymphocytic infiltration of portal tracs and granulomatous destruction of interlobular bile ducts
AST and ALT should be normal becuase hepatocytes arent targeted
Most common cardiac neoplasm and location
Myxoma in left atrium
Looks like cattered cells with mucopolysaccharide stroma and hemorrhage (high VEGF)
Common association with oropharyngeal cancer
HPV 16 and 18 - esepcially at base of tongue and tonsil
Associations with tuberous sclerosis
Renal angiomyolipoma, subependymal hamartomas in brain, ash-leaf patches, facial angiofibromas
Pathophys of hypertrophic cardiopmyopathy
Cardiomyocyte hypertrophy with disordered arrangement - due to defective structural sarcomere proteins - myosin chains and binding proteins
Main branches of the external illiac artery
Inferior epigastric artery
circumflex illiac artery
What reactions does riboflavin participate in
Important for the electron transport chain, especially succinate dehydrogenase which also is in the TCA cycle
Important source of FAD
Muscles that attach to the greater trochanter and used inhip abduction and internal rotation
Gluteus medius and gluteus minimus
Three ways that trisomy 21 can occur
- Parental nondisjunction in meiosis
- Unbalanced translocation
- Mosaicism- nondisjunction during mitosis so two distinct cell lines
Where are long chain fatty acids and branch chain fatty acids metabolized
Peroxisomes
Zellweger syndrome - AR defect of peroxisomes
Main virulence factor of Staph a. that causes tissue necrosis
PVL - panton-valentince leukocidin
What is a Gleason score
How grade of prostate cancer is determined
1-similar to prostate, 5-poorly differentiated (sheets of abnormal cells with no glands)
Score is found by adding together two most common grades
Bleomycin MOA and adverse effects
Induces free radical formation that causes DNA strand breaks
Causes pulmonary fibrosis
What directions do the clavicle pieces go in a fracture
Distal - down due to deltoid
Proximal - Up due to trapezius and sternocleidomastoid
What viruses are associated with CNS lymphoma
HIV and EBV
Side effects of erythropoeisis stimulating agents
Thromboembolic events and htn (may stimulate vascular smooth muscle)
P450 inducers
Barb’s funny mom refuses greasy carb shakes
Phenobarbital, phenytoin, modafinil, rifampin, greseofulvin, carbamazapine, st johns wart
P450 inhibitors
Inhibitors stop cyber-kids from eating grapefruit
Isoniazid, sulfonamides, cimetidine, ketoconazole, eryhtromycin, grapefruit juice
What is a permissive effect of two drugs
When one drug has no effect on a certain process on its own but when combine with another will amplify. the effect of the second drug
Effect of preeclampsia on kidneys
Third spacing and vasoconstriction leads to less urine output - lower volume and higher specific gravity
Damage to the glomerulus will lead to proteinuria but no RBC
Cause of hypogonadism in hemochromatosis
Iron deposits in the pituitary and leads to a drop in gonadotropins
Function of the rectus femoris
Hip flexion and knee extension
What would cause a systolic murmur during an MI
Ischemia of the papillary muscle causing mitral regurgitation
Most common mutation in CF
F508 mutation in the CFR gene that causes a 3 base pair deletion that alters the protein structure
This impairs post-translational processing which causes the protein to be targeted for degradation by proteasomes so it never reaches the cell surface
Path of the jaw jerk reflex
afferent: CN V3 from masseter (mandibular division)
nuclei: trigeminal mesencephalic and trigeminal motor
efferent: Also V3
Describe HIV docking to cell
gp 120 first binds the CD4 receptor and then CCR5 chemokine receptor as a coreceptor. Binding of both receptors leads to a confirmation change that allows gp41 to fuse with the membrane and allow for fusion
What are the factor Xa inhibitors
Apixaban and rivaroxaban
both have Xa in them
What is andexanat alfa
It is a factor Xa decoy that will serve to inibit Xa inhibitors if bleeding occurs
What kind of Ig are anti-A, B and O
Anti - A and B = IgM
Anti-O = IgG and IgM so can cross placenta
Three causes of neonatal hyperbilirubinemia
- Increases production - more breakdown of RBC
- Less conjugation - UDP glucuronosyltransferase is immature
- Higher enterohepatic circulation - less bacteria in gut to convert to urobillinogen so it is coinverted back to billirubin by enteric B-glucuronidase and reabsorbed
What does HIV look like in the brain
Infection of microglial cells causes microglial nodules and multinucleated giant cells
What mutation is seen in Acute promyeloid leukemia
a 15;17 translocation involving the PML gene and retinoic acid gene on 17 (inhibits myeloid cells)
Sx of fibromyalgia
Widespread MSK pain with fatigue and neuropsychiatric distubrances
What is reverse T3
An inactive form of T3 that is generated from T4
Drop in T4 would cause a drop in rT3
Puncture of the femoral artery above the inguinal ligament would lead to accumulation of blood in
the retroperotoneal space
Blood supply of the ureter
Proximal - renal artery
Distal - superior vesical artery
Function of T tubules in muscle
Allow for rapid propogation of impulse evenly throughout the muscle so you get a coordinated contraction
RA impact on the spine
RA can affect the cervical spine and cause subluxation (misalignment) that could lead to acute spinal injury
Best drugs for chemotherapy induced emesis
Dopamine antagonists, serotonin antagonists, NK1 receptor anatgonists
What is TDP-43
Transactive response DNA binding protein 43
Abnormal ubiquitination is seen in frontotemporal dementia and ALS
Histology of syphillis
Proliferative endarteritis (around arteries) with plasma cell-rhc infiltrate
What test is used to monitor warfarin
PT - impacts factor VII most
What allows many different proteins to be formed from a single mRNA
Alternative splicing
What causes ARDS
Can come from sepsis, pancreatitis, trauma
Increased cytokines leads to capillary permeability and edema - neutrophil accumulation and hyaline membranes
Isoniazid impact on the liver
DIRECTLY hepatotoxic - can cause hepatitis with jaundice, nausea, anorexia
What would differentiate CML from leukomoid reaction
Alk phos is decreased in CML but normal/high in a leukomoid reaction
How is the insulin transporter inhibited
Serine phosphorylation, glucagon, and Epi
Where is procollagen hydroxylated
In the RER
What cellular signal allows neutrophils to squeeze through epithilium into a site of inflammation
Platelet endothelial cell adhesion molecule (PECAM-1)
MOA of diphenoxylate
Opioid anti-diarrheal
Binds to Mu receptors to slow motility
How can heat stroke cause DIC
Rapid shunting of blood to the skin can cause hypoperfusion of organs leading to ischemia and necrosis. Tissue factor is released that causes coagulation
Adrenergic effects of epinephrine
Agonist
Low dose: B1=B2>a1
High dose: B1=a1>B2
Description of a VSD murmur
Harsh holosystolic murmur in the left lower border of sternum
Pathophys of euthyroid sick syndrome
Low circulating T3 that occurs in the context of severe disease
Happens because high levels of cortisol, ffa, and inflammatory cytokines suppress the deiodination of T4
What part of the prostate does finasteride target
Epithelial tissue - those with stromal type (smooth muscle or collagen predominance) dont respond as well
What is the blood supply to the ovary and where is it located
Ovarian artery, branches off the abdominal aorta
Located in the suspensory ligament, attaches laterally
Impact of acetaminophen toxicity in chronic vs acute alcohol ingestion
Acute: Alcohol can be a competitive inhibitor becuase it is also somewhat broken down by P450 – good
Chronic: P450 is upregulated so there is more conversion to NAPQI – bad
What is carcinoid heart disease
When a carcinoid tumor spread past the liver, serotonin can enter the heart
Causes fibrinous thickening of the endometrium, especially of the right heart with thickening of the tricuspid and pulmonic valves
Serotonin is broken down by MOA in the lung so left not affected
Clozapine side effects
Second gen antipsychotic for tx resistent schizophrenia
Neutropenia with life threatening agrunolocytosis
Gastritis caused by H. Pylori vs autoimmune
Most likely predisposing factor for pyelonephritis
Vesicoureteral urine reflux
Although colonization of the urethra can cause a lower UTI, pyelonephritis usually doesnt occur unless the vesicouteral junction has been weakened (functional abnormality, recurrent UTIs)
Steps in digestive phases
Cephalic phase (cholinergic and vasal)
Gastric phase (gastrin)
Intestinal phase (proteins entering intestine)
Phentolamine MOA
A1 adrenergic antagonist
Can be given to counteract epinephrine that causes venous blanching and necrosis (too much constriction)
SX of lateral medullary syndrome
Caused by occlussion of PICA
Vertigo and nystagmus (vestibular nucleus)
Ataxia (inferior cerebellar peduncle)
Loss of pain in temp in ipsalateral face and contralateral body
Bulbar weakness (dysphagia, dysarthria)
Horners syndrome
What is deficienct in alkaptonuria
Homogentisic acid dioxygenase
Comparison of muscle twitches between non-depolarizing and depolarizing muscle blockers
Non-d = gradual decrease (competitive inhibition, eventually more are occupied)
D =. first all are lower (mobilized Ach), then phase II is same as non-d
