test #20 4.10 Flashcards
describe alcoholic cirrhosis
form of micronodular cirrhosis, associated w/ hepatocyte death followed by fine fibrosis of liver.
will result in increased portal HTN.
pathogenesis of ascites in patients w/ cirrhosis. rx (2)?
- mechanical compromise of portal vein (fibrotic tissue)
- vasoactive agents cause dilation of splanchnic arterial vasculature & further intrahepatic vasoconstriction.
ascitic fluid formation –> overall, decreases systemic fluid pressure –> kidney’s RAA –> Na+ and H20 retention.
rx: furosemide and spironolactone
male mesonephric ducts form (3)
internal genitalia: epididymis, ductus deferens, seminal vesicles.
urogenital folds form? in male & female?
male: ventral aspect of penis.
female: labia minora
genital swellings form? in male & female?
male: scrotum
female: labia majora
urogenital sinus in males? females?
male: bladder, urethra, prostate, bulbourethral glands.
female: bladder, urethra, lower vagina, bartholin glands.
female paramesonephric ducts form?
internal genitalia: uterine tubes, uterus, cervix, upper vagina
DHT role in embryonic life? adult life?
embryonic life: formation of external male genitalia.
adult: secondary sex characteristics.
why are inferior MI associated w/ bradycardia? rx?
usu result from right coronary artery occlusion, which also feeds sinoatrial node.
rx: atropine. recall side effects though (i.e. myadriasis: acute-angle glaucoma)
risk for closed angle glaucoma?
asian’s and inuits
iridovyclitis
aka uveitis. anticholinergics can help reduce pain & prevent adhesion formation
rx for bradycardia?
atropine!
PTSD criteria
repeatedly reliving traumatic, life-threatening event in form of nightmare / flashbacks. avoid reminders. social detachment. poor sleep/concentration. hypervigilance. LONGER THAN 4 wks.
acute stress disorder
identical symptoms to PTSD, but symptoms from 2 days - 4 weeks.
adjustment disorder
behavioral or emotional symptoms in response to a psychosocial stressed that arose within 3 months. marked distress in EXCESS of that EXPECTED from exposure to stressor. functional expected.
differentiate PTSD from acute stress disorder? from adjustment disorder?
PTSD > 4 wks. acute stress 2 days - 4wks.
adjustment: distress in excess of what you’d expect for a given exposure.
repeated & prolonged kneeling causes..
PREPATELLAR bursitis. “housemaid’s knee”. see in roofers, carpenters, plumbers. pain erythema, swelling, inability to kneel on affected side.
located between patella & the overlying skin & prepatellar tendon. lined by synovium, contains little fluid.
popliteal and gastrocnemius bursitis associated w/
formation of Baker’s cyst
anserine bursitis (pes anserinus bursitis)
pain along medial aspect of knee. overuse in athletes, or chronic trauma in patients w/ heavy body habitus. tenderness to palpation 4xm distal to anteromedial joint margin of knee.
diabetic ketoacidosis
low total K+: low intracellular stores w/ normal-HIGH extracellular levels.
acidosis, lack of insulin = pulls into extracellular environment.
osmotic diuresis = pulls K+ out of body
MUST REPLACE K+ during ketoacidosis.
what drug reduces morbidity and mortality in class III and IV heart failure patients?
spironolactone / epleperone (more selective)
(in addition to standard therapy of ACEIs, digoxin, diuretic)
less about its diuretic effect. more about blockade of aldosterone on heart remodeling.
elastase can be found..
in macrophage lysosomes & large, azurophil (primary) granules of neutrophils.
what does clara cell CCSP do?
inhibit neutrophil recruitment and activation.
where do goblet cells stop
are not in bronchioles downwards.
urge incontinence / overactive bladder syndrome caused by…
uninhibited bladder contractions (detrusor instability) rx: oxybutynin: antagonist muscarinic receptors, esp M3 on smooth muscle of bladder.
b1 receptors are located..
in heart & renal juxtaglomerular cells
a2-agonists? rx?
methyldopa and clonidine. decrease sympathetic outflow and BP.
B2 stimulation causes..
bronchodilation, vasodilation, and tocolysis (baby extrusion)
5-HT, serotonergic neurons are located in brain…
raphe nucleus of brainstrem (midbrain, pons, medulla)
sleep-wake cycle, arousal.
NE-secreting neurons found in brain…
nucleus ceruleus. DORSAL PONS
acetylcholine neuron cell bodies located in..
nucleus basalis of Meynert
red nucleus of midbrain?
motor coordination of upper extremeities.
for blood flow to be continuous..
systemic blood flow / minute = pulmonary blood flow / minute (in both exercise and rest)
continuous circuit!
in all scenarios, arterial resistance is higher in systemic circulation.
normal systemic & pulmonary blood pressure
systemic: 120/80.
pulmonary: 14mmHg
rx for tinea (pityriasis) versicolor
(1) topical antifungals or (2) selenium-containing shampoo.
present as hypopigmented spots on sun-tanned skin. only really a cosmetic problem.
most important factors locally regulating coronary blood flow?
adenosine and NO
formation of NO in coronary endothelial cells? downstream signalling?
arginine + oxygen —> nitric oxide (with eNOS, endothelial nitric oxide synthase).
works on cytosolic guanylate cyclase
a2 receptors are..
CENTRALLY located!
Courvoisier sign
palpable but not tender gallbladder
(5) risk for pancreatic adenocarcinoma (at head)
- age: 65-75
- SMOKING (most impt environment risk factor; DOUBLE risk)
- diabetes mellitus: increases w/ duration of disease
- chronic pancreatitis
- genetic predisposition: hereditary pancreatitis, MEN, HNPCC, FAP
low-fiber diet increases risk of…
colon adenocarcinoma
alcohol consumption increases risk for which malignant tumors?
head, neck, esophagus, liver
strawberry hemangioma
unencapsulated aggregates of closely packed, thin-walled capillaries. benign, common. found in skin, subcut tissue, oral mucous membranes, lips. can occur in liver, spleen, kidney.
initially, grow in proportion to child. ‘regress spontaneously before/at puberty.
cortisol receptor and downstream signal cascade
cytoplasmic, binding causes homodimerization. translocate to nucleus, control gene expression by binding to DNA at hormone-response elements in promoter region of genes.
increase transcription of genes needed for gluconeogenesis (formation of glucose from fat and protein)
growth hormone signal transduction
membrane bound receptor –> dimierzation, conformational chain in JAK, stimulates tyrosine kinase, activates STAT transcription activity.
increases gluconeogenesis by increasing lipoylysis, gluconeogenesis in liver.
catecholamines & glucagon signal transduction
GPCRs coupled to adenylyl cyclase.
epinephrine and glucagon increase glycogenolysis. stimulate glycogen phosphorylase kinase, which activates glycogen phosphorylates & liberates glucose.
abnormal transformation of mullerian ducts can result in
wide range of defects: hypoplasia or agenesis of vagina / uterus, duplication of vagina, cervix, uterus; and unicornate, bicornuate, septate uterus.
2 most common causes of eugonadotropic amenorrhea
imperforate hymen and mullerian duct abnormalities.
distinguish presentation of HUS and TTP
different points on spectrum of disease. both: fever, thrombocytopenia, microangiopathic hemolytic anemia.
TTP: often adult w/ neurological symptom
HUS: often children w/ renal involvement
BOTH life threatening
