Step 3 Flashcards
Azithromycin MOA
Macrolide not aminoglycoside
binds 50s subunit of the ribosome
Txmnt of pseudomonas
Double coverage w/ 2 of 3
Anti-pseudomonal beta lactam (pipi/tazo, cefepime, ceftazadime, aztreonam)
Resp FQ (levofloxacin)
Aminoglycoside (gentamycin or tobramycin)
Cardiac fxn curve increases along the same line and venous return fxn curve shifts right, cause?
The CO has increased due to increased venous return, but the cardiac fxn has not changed. The increased cardiac output is due to Frank-Starling not increased contractility
Cardiac fxn curve shifts up to a new line and venous return curve shifts right, cause?
Exercise/sympathetic stimulation
Increased contractility-> cardiac fxn shift
Venoconstriction-> increased preload, right shift
Cardiac fxn curve moves up or down along the same line, what does it mean?
Up along the same line = arteriolar dilation (decrease preload-Increase CO)
Down along same line= arteriolar constriction (increase preload-decrease CO)
Cardiac fxn curve moves up to a new line
Increased cardiac contractility
Venous fxn curve moves left or right along the same line
Left - decreased vascular volume, venodilation. CO goes down
Right- volume up, venoconstriction. CO goes up
9 yo w/ sensorineural hearing loss, bowing of anterior tibias, frontal bossing, and flattened nose
Congenital syphilis
Deafness
Saber shins
Saddle nose
Hutchinson’s triad
Congenital syphilis
Deafness
Interstitial keratitis
Notched incisors
Which cells release secretin?
D cells
What hormone is increased secondary to Zollinger Ellison syndrome?
Gastrinoma increases gastrin acidifying the lumen. Secretin from the D cells is increased to increase the pH
Signs of VIPoma
watery diarrhea and hypokalemia
What do G cells secrete?
Gastrin
Found in antrum of stomach and duodenum
What do D cells secrete?
Somatostatin
Found in pancreatic islets and GI mucosa
What do I cells secrete?
CCK found in duodenum and jejunum
What do S cells secrete?
Secretin (duodenum)
What do K cells secrete?
Glucose-dependent insulinotropic peptide-gastric inhibitory peptide (GIP) (duodenum and jejunum)
Increased End diastolic volume, same end diastolic pressure, decreased diastolic pressure, increased systolic pressure, same end systolic pressure, and same contractility
Increased preload w/o increased LA pressure
Increased pulse pressure
Same contractility
Aortic regurg w/ dilated LV
What happens to the conjugated bilirubin in cholestasis?
Conjugated bilirubin has increased urinary excretion (tea pee)
Decreased secretion of conjugated bilirubin in the gut, so it is not metabolized by bx into urobilinogen - decreased urinary urobilinogen
What acid base disturbance do diuretics (furosemide) and antacid abuse have?
Metabolic alkalosis
What kind of pt has hypoxemia that can not be corrected by 100% O2?
Right-left shunt
No matter how oxygenated the blood gets, some of the deoxygenated blood is continually sent into the systemic circulation
Ziehl-Nielsen stain
Acid fast carbol fuchsin stain
Nocardia, TB, cryptosporidium
Scaly red plaque w/ ulceration and/or bleeding on the face, neck, or hands
Squamous cell CA
Precursor-actinic keratosis (sun damage)
Molluscum contagiosum Description and virus
Flesh colored papule w/ central depression
Pox virus
Verruca vulgaris, description and virus
Common wart-HPV
Dysplastic nevi may be a precursor to what CA
Melanoma
If the femoral n was injured, what would be affected?
Quadricep weakness
paresthesis/anesthesia of anterior medial thigh, medial shin, and arch of the foot
Difference btwn PCP and cocaine on PE?
PCP - miosis constricted pupils
Cocaine - Mydriasis dilated pupils
Amaurosis fugax
Transient monocular blindness - Carotid stenosis
Evans Syndrome
Thrombocytopenia and autoimmune hemolytic anemia
Lateral aspect of thigh, dorsal foot, decreased sensation in the 1st and 2nd toe web space
L5
Patellar reflex is what nerves?
L3, L4
Egg yolk agar for what organism
Clostridium perfringens
Chocolate agar for what organisms
N. menigitidis
w/ factors X (heme) and V (NAD) - H. influenzae
Cystine-tellurite agar for what organism
Corynebacterium diphtheriae
What chromosome has a mutation in Alpot dz?
X chromosome -Males get Alport
Females w/ one copy just get hematuria
Renal dz w/ mutation on chromosome 6
AR PCKD
Kids
Renal dz w/ mutation on chromosome 16
ADPKD adults
AKI w/ fever, eosinophilia, and urticarial rash. What is the likely cause, what is injured, and what type of hypersensitivity?
Drug induced acute interstitial necrosis - abx, NSAIDS, thiazides, PPI
Type IV sensitivity even though there are eosinophils
Is ristocetin cofactor assay normal or abnl in Von Willebrand dz?
Abnl, using ristocetin (activates Gp1b) doesn’t cause Plt agglutination, b/c the VWF is too low
Hydroxyurea MOA
Increases Fetal Hgb, which inhibits the polymerization of HgbS
What should be measured regularly in a pt taking hydroxyurea?
CBC for myelosuppression and LFT for hepatotoxicity
Compliance, radial traction, FEV1, and DlCO in obstructive dzs
Compliance is increased -damaged alveoli (floppy)
Radial traction is decreased due to alveoli damage, radial traction pulls airways open, FEV1 is decreased -less ability to push air out
DlCO - Low due to alveolar wall damage
Where in the lung is centriacinar emphysema?
Smoking emphysema upper lobes
Where in the lung is panacinar emphysema?
Alpha 1 antitrypsin deficiency
Lower lobes
What cause rouleaux formation?
Excessive IgG causes RBCs to stick together
What effect does a PPI have on the blood?
Higher Cl in the blood
Inhibits H/K ATPase so less bicarb and H is generated, less bicarb means less Cl entering the cell via bicarb/Cl antiporter, more in venous blood
Stage 2 pubic hair vs Stage 3
2-scanty long hair at base of penis
3- small amount of dark, curly, coarse hair
Testes size
Stage 1-5
1 -1.5 cc 2 -4 cc 3 -10 cc 4 -16 cc 5 -20 cc
Allotype Idiotype Isotype Subisotype of Ig
Allotype-part of constant region dictated by inheritance
Idiotype -antigen recognizing sections
Isotype- IgG or IgA
Subisotype - IgG4
Which factor is most important in mediating septic shock?
TNF-alpha
Activated by LPS
Leads to vasodilation and activation of cytokines
What NSAID should be avoided in person w/ sulfa drug injury?
Celecoxib
Sulfonamide side chain
Sulfa drugs w/o sulfa in the name:
Celecoxib Diuretics Anticonvulsants: topiramate, zonisamide Bosentan Arrhythmic drugs - Dofetilide, sotalol, dronedarone Sumatriptan Tamsulosin
Tramadol MOA
Very weak opioid
Block reuptake of NE and 5HT
Risk of 5HT syndrome
Hyperammonemia w/ decreased citrulline, low BUN
Ornithine transcarbamylase deficiency
Ornithine and carbamoyl phosphate to citrulline
Protein losing gastroenteropathy in elderly w/ enlarged rugal folds
Menetrier dz
Hyperplasia of mucus secreting foveolar cells
Parietal cell atrophy->decreased acid
Keratizing or non-keratizing squamous cell carcinoma in the nasopharynx of an Asian man
Nasopharyngeal carcinoma associated w/ EBV
Pill OD: impaired cognition, slurred speech, ataxia, nystagmus, and muscle weakness
BZD toxicity
Tx w/ flumazenil
Pill OD: Diarrhea, increased urination, miosis, bronchospasm, bradycardia, Lacrimation, sweating, salivation
Atropine OD
Tx w/ physostigmine - Phyxes atropine OD
Pill OD: nausea, vomiting, and abd pn
Acetylcystine (tylenol)
Tx w/ N-acetylcysteine
Pill OD: hyperventilation, tinnitus
Asprin OD Tx w/ bicarb to alkalinze the urine and remove acid
3 Cs of TCA OD
Convulsions, Coma, Cardiotoxicity
Cinacalcet MOA
Calcimimetic that increase the sensitivity of the PTH CaSR to Ca
What med should be used for pts w/ ESRD who have secondary hyperPTH?
Cinacalcet increases PTH’s sensitivity to Ca -> decreased PTH
Is the most important pathogenic attribute of Pseudomonas the capsule or pigment formation?
Capsule protects from phagocytosis
What do pyocyanin and pyochelin do for Pseudomonas?
Pyocyanin - impairs cilia, injures respiratory epithelium, and increases inflammation
Pyochelin - Siderophore that sequesters Fe to enhance growth in low Fe states
Hour glass shaped stomach
Sliding hiatal hernia
Near complete absence of smooth muscle peristalsis and LES tone
Systemic scleroderma
Difficulty swallowing (motility unaffected), anemia, and atrophic glossitis
Plummer -Vinson
Esophageal webs
Inherited Hemolytic anemia affecting both men and women
Pyruvate kinase deficiency
Autosomal recessive
RBC can’t produce enough pyruvate to undergo oxidative phosphorylation. Low ATP -> hemolysis
Acute intermittent Porphyria: 5 Ps
Peripheral neuropathy Painful abd Pink urine Psych - depression, hallucination Paralysis
What can exacerbate AIP?
Drugs that induce CYP450 (barbs, smoking , drinking) and sulfonamides
Nerves affected by C5-C6 n injury
Suprascapular n.
Musculocutaneous n.
Axillary n.
Long thoracic n. affects what muscle, what on PE?
Serratus anterior
winging of the scapula
Weakness of the ability to protract the scapula
Nerve roots of FPL and FPB
FPL: C7 C8
FPB: C8, T1
Angiogenesis is primarily driven by which two factors?
VEGF and FGF
Cleaved and noncleaved follicular cells, waxing and waning LAD
Follicular lymphoma t(14,18)
Bcl-2
Classic triad of paroxysmal nocturnal hemoglobinuria
Hemolytic anemia (heomglobinuria)
Pancytopenia
Thrombosis at abnl sites
Can cause hemosiderosis in the kidney
Erythematous maculopapular lesions on the chest and trunk w/ bloody diarrhea? Shigella or Salmonella
Salmonella - Salmon colored spots
Phenytoin CNS SE
Ataxia and nystagmus
Phenytoin long term use SE
Gingival hyperplasia, coarsening of facial features, hirsutism
Phenytoin hematologic SE
Megaloblastic anemia-Interferes w/ folic acid
Phenytoin SE in pregnancy
Fetal hydantoin syndrome (teratogen)
Why do asians have higher incidence of gastric CA?
Food preservatives
Nitrosamine
Polycylic hydrocarbons found in smoked fish, red meats, and preserved food
Classic tests for identifying PNH
Sucrose and Ham test
Serum is acidified to activate complement and then PNH cells are added to lyse
Fluphenazine MOA
High potency typical antipsychotic
D2-R blocker like haloperidol
Trazodone class and MOA
Atypical antidepressant
used mainly for insomnia
Block 5HT, Alpha 1, and H1
Menopause: GnRH, FSH, and LH
All are increased due to no Estrogen being produced
What is the name for fragmented and helmet shaped cells? Why?
Schistocytes due to mechanical damage including massive trauma
Difference btwn acetazolamide and latanoprost and when to use them
Acetazolamide - Carbonic anhydrase that decreases aqueous humor production. Turns down faucet. Acute close angle glaucoma
Latanoprost - Opens drain. open angle glaucoma. Topical agent
Most common cause of 1st trimester pregnancy loss
Chromosome abnormalities
Most common cause of 2nd and 3rd trimester pregnancy loss
Chorioamnionitis-ascending infxns
Common cause of 3rd trimester pregnancy loss
Abruptio placentae and Placenta previa
Why would you see prolonged PT and mildly prolonged PTT in pancreatitis?
Poor fat soluble vitamin absorption
Vit K is low
Fibrosis of the intrahepatic and extrahepatic bile ducts
Primary sclerosing cholangitis often associated w/ UC
3 potential complications of MI from days 5-10
Free wall rupture
Papillary muscle rupture
Ventricular septal perforation
What does papillary muscle rupture lead to following MI?
Acute mitral valve prolapse
True ventricular aneurysms, when are they likely to occur after MI and what makes them true?
Occur several weeks later
Outpouching of damaged tissue lined by fibrosis
Adverse effects of glucocorticoids
Hypocalcemia Fluid retention Hypokalemia Hyperglycemia HTN chronic use - osteoporosis and vascular necrosis
1st line disease modifying antirheumatic drug. What do you bridge with?
Methotrexate
Bridge w/ glucocorticoids
How to remember Glucocorticoid adverse effects?
Mineralocorticoid SE, insulin resistance, and osteoporosis HTN Hypokalemia Hyperglycemia Hypocalcemia - > osteoporosis
Effects of cocaine, prazosin, and phenoxybenzamine on NE
Cocaine potentiates NE
NE reuptake blocker
Prazosin is a competitive inhibitor
Phenoxybenzamine is a noncompetitive inhibitor
7 week kid w/ pneumonia and conjunctivitis
Chlamydia trachomatis
Chlamydia pneumonia
Large, round densely eosinophilic viral inclusions in epithelial cells
Molluscum contagiosum
Pox virus
AA amyloid
Acute phase reactant amyloid (rheumatoid arthritis
AL amyloid
Light chain
Multiple myeloma
B cell lymphomas
AF amyloid
Familial and old fogies
Transthyretin
A Cal amyloid
Calcitonin
Medullary carcinoma of the thyroid and pancreatic islet cell adenomas
Punched out ulcers in the esophagus of a HIV pt
HSV
Glassy, basophilic intranuclear eosinophilic inclusions in cells of esophageal ulcer
HSV
Where does urobilinogen come from?
Bilirubin passing through the GI tract gets changed to urobilinogen and can be excreted through urine or feces. Low in cholestasis
What do you look for in urine to confirm cholestasis?
Urinary bilirubin not urobilinogen
How do you tx acute RA?
NSAIDS -Celecoxib
DMARD drugs
Methotrexate and sulfasalazine
What is one thing aspirin can do that acetaminophen can not?
Anti-inflammatory
Both have anti-pyretic and analgesic effects
Meperidine MOA
Opioid
Hyaline membranes within alveolar walls, alveolar septal thickening, neutrophilic infiltrate, no hemosiderin deposit
ARDS
diffuse alveolar damage
Desquamative interstitial pneumonitis
Tobacco smoke
Hyperplasia of pneumocytes
Accumulation of histiocytes that fill alveolar cavities
What does hemodynamic pulmonary edema mean?
Increased hydrostatic pressure
Which areas of the renal tubule are impermeable to water?
Early DCT and cortical thick ascending loop of henle
What is MAP?
Mean arterial pressure
Pressure as it leaves the heart - pressure that returns to the heart
Wrinkling of the intimal surface of the aorta?
Syphilis
Obliterative endarteritis of the vasa vasorum of the aorta
3 Cs of measles
Cough Coryza (rhinorrhea) Conjunctivitis Blanching erythematous macules Photphobia
Do glucocorticoids affect Vitamin D or PTH?
NO
How do glucocorticoids cause osteoporosis?
Decrease intestinal Ca reabsorption and increase urinary Ca elimination
What hormone will be increased during exercise and what factor will be increased an hour after exercise?
During -GH
1 hr later - VEGF. Non-endothelial cells secrete VEGF in hypoxic conditions to increase endothelial proliferation
Mucinous cystadenoma “Jelly belly”. Where is the primary disease process?
Appendix or Ovary
Pseudomyxoma peritonei
Cyclophosphamide: DNA alkylator or intercalator?
Guanine alkylator facilitating DNA crosslinking
Chemo drug that inhibits purine synthesis?
G,A
6-mercaptopurine
Chemo drug that inhibits pyrimidine synthesis?
C,T,U
5-Fluorouracil
DNA intercalators
Doxorubicin
Bleomycin
3 alkylating agents
Cyclophosphamide
Cisplatin
Procarbazine
What are neurofibrillary tangles made of? (Intracellular)
Hyperphosphorylated Tau
What are extracellular senile plaques?
A-beta amyloid
Rod-shaped, crystal-like eosiniphilic intracellular aggregates of actin
Hirano bodies
Alzheimer’s dz
Flame shaped intracytoplasmic inclusions in the neocortex and hippocampus. Consist of paired helical filaments
Neurofibrillary tangle made up of hyperphosphorylated Tau
Kid w/ posterior fossa tumor filling the 4th ventricle. What PE finding?
Papilledema
Blocking 4th ventricle would lead to hydrocephalus, increased ICP and papilledema
What causes preeclampsia?
Placental ischemia - > Maternal HTN
Ovoid (nodular) hyaline masses in the periphery of the glomerulus
Nodular glumerolosclerosis (Kimmelstiel-Wilson nodules) DM nephropathy
PAS +, electron dense depositis distributed along the epithelial side of the capillary basement membrane
Membranous glomerulonephritis
SLE, HBV, NSAIDS
Fibrosis of the endocardium, focal myocardial necrosis and prominent inflammatory cell infiltrate
Loeffler endocarditis
Endomyocardial fibrosis w/ (idiopathic) hypereosinophilia
Oka strain live attenuated vaccine
Prophylaxis for VZV in children
Causes of increased pulse pressure
Arteriosclerosis, aortic regurgitation. Big difference btwn systolic and diastolic
Causes of decreased pulse pressure
Aortic stenosis, mitral stenosis
The systolic and diastolic pressures are close
Cause of increased diastolic pressure
Mitral stenosis
Causes of decreased diastolic pressure
Aortic regurgitation, Patent ductus arteriosus
Fentanyl, propofol , and midazalom are administered, what should be used to revers respiratory depression
Naloxone for fentanyl
and flumazenil for midazolam
Both opioids and BZD cause respiratory depression
