Test 1 June 21 Flashcards
first line treatment for acute gouty arthritis?
NSAIDs, but contraindicated if patient has peptic ulcer history
What does colchicine bind?
tubulin, blocking polymerization of microtubules
how does tolerance to alpha adrenergic decongestants commonly occur?
receptor internalization
Patau syndrome AKA
trisomy 13
What defect causes patau syndrome?
meiotic nondisjunction leads to trisomy 13 which results in a defect in the fusion of the prechordal mesoderm
presentation of patau syndrome?
Most babies will die in utero, but of those who do not:
Midline defects:
holoprosencephaly, cleft lip/palate, microphthalmia, microcephaly, omphalocele, cutis aplasia and polydactyly
edwards syndrome AKA
trisomy 18
presentation of edwards syndrome
fetal growth retardation, hypertonia, micrognathia, congenital heart defects, clenched hands with overlapping fingers, meckels diverticulum, malrotation
Presentation of williams syndrome
Elfie facies, supravalvular stenosis, and extroverted personality
Patients receiving anti-complement therapy are at risk for which infection?
Neisseria meningitis (complement is important for killing gram - bacteria, especially neisseria)
how do you prevent a patient on anticomplement therapy from getting N meningitis?
immunization and antibiotic prophylaxis
how is paroxysmal nocturnal hemoglobinuria treated?
monoclonal antibody to complement protein C5 (eculizimab)
How do nitrites cause poisoning?
They convert Fe 2+ to Fe 3+ (methemoglobin) which cannot bind oxygen
what does the partial pressure of oxygen in blood represent?
the amount of oxygen dissolved in plasma
is the partial pressure of ox in blood changed in nitrite poisoning?
no
presentation of methemoglobin?
dusky colour to skin (similar to cyanosis), and functional anemia
What is projection?
attributing one’s feelings to another
what is identification?
modelling ones behaviour after someone who is believed to be more powerful or prestigious. EX: abused son abuses his own kids
What is the pentose phosphate pathway (HMP shunt)?
pathway that generates NADPH and ribose-5-phosphate for use in reductive reactions and synthesis of nucleotides, respectively
When there is excess ribose-5-phosphate, which enzymes convert it to the intermediates glyceraldehyde-3-P and fructose-6-phosphate for ATP generation?
transketolase and transaldolase (these also work in the reverse direction when ribose-5-phosphate is needed)
cardiac output formula?
SV x HR
rate of O2 consumption/arteriovenous O2 content difference
What typically causes atrial flutter? where is this abnormality found?
A large reentry circuit. Found transversing the the cavotricuspid isthmus (between the inferior vena cava and triscuspid valve annulus)
Patients on metronidazole may develop what when drinking alcohol?
disulfuram-like-reaction
when you perform an emergency cricothyrotomy, what layers do you cut through?
skin, superior cerival fascia, investing/pretracheal layers of the deep cervical fascia and the cricothyroid MEMBRANE
Where is locus ceruleus located?
rostral pons, floor of 4th ventricle
What does the locus ceruleus produce?
norepinephrine
where are histamine and orexin produced?
the posterior hypothalamus
statins MOA
inhibit HMG-Coa reduction, leading to decreased hepatic cholesterol synthesisis. LDL receptor upregulation occurs and decreased LDL from the blood
how do penicillians and cephalosporins work?
irreversibly bind to penicillin-binding proteins such as transpeptidase
how does vancomycin work?
binds D-alanine on cell wall GLYCOPROTEINS which inhibits transpeptidases from forming cross links
what cells do the cutaneous neurofibromas in NF1 derive from?
Schwann cells (which are from the neural crest)
is the initial lesion of chancroid painful?
yes
What causes lymphogranuloma venerum?
Chlamydia trachomatis
What is the presentation of lymphogranuloma venerum?
Multiple, small painless ulcers
Then large and painful inguinal lymph nodes (buboes)
which serotypes of chlamydia cause lymphogranuloma venerum?
L1-L3
how may you treat achalaisa?
botulinum toxin
what are the side effects of bile acid sequesterants?
GI upset, impaired absorption, increased triglycerides
MOA of ezetimide?
inhibits intestinal absorption of cholesterol -> lower LDL
Fibrates MOA?
inhibit hepatic production of triglycerides
what is the first line treatment for hypertriglyceridemia?
fibrates
using topical decongestants for more than 3 days may result in what?
Rebound rhinorhea -nasal congestion without cough, sneeze or postnasal drip, due to tachypylaxis
What causes chronic granulomatous disease?
X linked deficiency of NADPH oxidase (lack of respiratory burst)
a myeloperoxidase deficiency may result in recurrent infections with what?
candida
how does one get infected with schistosoma species?
swimming in freshwater contaminated with snails (sub saharan africa or east asia)
presentation of schistosoma infection?
most patients are asymptomatic but it can cause hepatosplenomegaly, liver fibrosis and portal hypertension, diarheaa/pain, intestional ulceration with iron deficiency anemia, hematuria, pyelonephritis, SCC of bladder
is eosinophilia present with malaria infection?
no
is eosinophilia present with infection from schistosoma?
yes
what is the name of the disorder that presents the same as schizophrenia but lasts <6 mo?
schizophreniform disorder
What is schizoaffective disorder?
Major depressive or manic episodes with concurrent symptoms of schizophrenia, PLUS delusions or hallucinations in absence of the manic/depressive episodes lasting > 2 weeks
what is the difference between schizoaffective disorder and bipolar/major depressive disorder with psychotic features?
with schizoaffective disorder, psychotic features have been present without the episode of mania/depression, whereas with bipolar or major depressive disorder with psychotic features, the psychotic features occur EXCUSIVELY during the episode
agranulocytosis is a complication of which thyroid drugs?
PTU and methimazole
which thyroid drug is associated with hepatotoxicity?
PTU
excess thyroid hormone results in the increased expression of which type of receptors?
Beta adrenergic -> hyperadrenergic state
which type of receptors are PTH (ca sensing) receptors?
G protein coupled (Gq)
EPO, growth hormone and prolactin have which kind of receptors?
JAK/STAT
which enzyme is deficient in acute intermittent porypheria?
porphobilinogen deaminase
AIP attacks result in accumulation of which two substances?
ALA and PBG
how do you treat an attack of AIP?
glucose and heme
how does glucose and heme work to treat AIP?
they have negative feedback on ALA synthase, the first and rate limiting step in the pathway preventing build up of ALA and PBG
which drugs may cause an attack of AIP?
any drugs that induce CYP 450s, including smoking and alcohol use - (these induce ALA synthase)
In addition to cat feces, toxoplasmosis can be transmitted how?
contaminated food
name 3 examples of cancers that spread hematogenously?
sarcomas
renal cell carcinomas
hepatocellular carcinomas
MOA of finasteride? how does it help BPH?
5 alpha reducatse inhibitor, prevents conversion of testosterone to DHT thus decreasing prostate size over time
how does tamsulosin and terazosin work to treat BPH?
these are alpha adrenergic antagonists that relax SM
how do glucocorticoids cause antiinflammatory effects?
inhibit phospholipase A2 - decreases leukotriene and prostaglandin production
-also suppress transcription of cytokines and proteins for adhesion, decreasing leukocyte recruitment and activation
