test #25 4.13 Flashcards
skin rash, photosensitivity, arthralgia, renal disease in young women. general pathogenesis of disease
SLE. generally: autoantibodies bind autoantigens, immune complex deposition in vessel walls –> complement activation –> tissue inflammation and injury.
acute: fibrinoid necrosis
chronic: fibrosis & narrow lumen
anti-Smith (anti-snRNPs) and anti-dsDNA
highly specific for SLE, but absence does not rule out!
60% have anti-dsDNA, 20-30% have anti-snRNP/smith. virtually all have anti-ANA, but not specific for lupus
transposition of the great vessels
failure of aorticopulmonary septum to spiral normally during fetal development. aorta to right ventricle. pulmonary artery to left ventricle.
incompatible w/ life unless PDA, septal defect, or patent foramen ovale to allow for mixing.
failure of proliferation
unilateral aplasia of fibula
failure of oblieration
branchial cleft cyst
failure of apoptosis
autoimmune disease due to persistence of autoreactive T/B cells
failure of migration
hirschsprung, Kallman’s
failure of fusion
hypospadius
where can the saphenous vein be harvested?
just inferolateral to the pubic tubercle
when left anterior descending is occluded by plaque, which vein is often harvested?
left internal mammary artery (left internal thoracic artery).
when multiple coronary arteries are needed, which veins are used?
saphenous vein grafts. longest in body, located superficially. courses up from medial foot –> medial malleolus –> up medial aspect of leg and thigh. joins femoral vein in proximal anterior thigh 3-4cm infeolateral to pubic tubercle. in femoral triangle (inguinal ligament, sartorius, adductus longus)
most common type of hair less in males and females? genetics?
androgenetic alopecia (male pattern baldness). POLYGENIC inheritance w/ variable penetrance.
relationship between type of androgen receptor gene on X chromosome (X-linked recessive component)
NOT autosomal dominant as once thought
common polygenic medial conditions
androgenetic alopecia, epilepsy, ischemic heart disease, schizophrenia, glaucoma, hypertension, malignancy, DM type II
persistent vegetative state
severe brain damage that results in wakefulness without awareness. 50% of cases will regain consciousness in 6 months, but with severe subsequent disability
acute salicylate intoxication
2 different acid base abnormalities simultaneously.
(1) respiratory alkalosis: SOON AFTER INGESTION. directly stimulate medullary respiratory center –> hyperventillation, increased loss of CO2.
(2) few hours later, anion gap metabolic acidosis, due to accumulation of organic acids in blood. (high doses, salicylates increase lipolysis, uncouple oxidative phosphorylation, inhibit TCA –> accumulate ketoacid, alctate, pyruvate.
winter’s formula
PaCO2 = (1.5 x HCO3- + 8) +/- 2
used to see if respiratory compensation for metabolic acidosis is appropriate or not.
(i.e. respiratory compensation or independent respiratory alkalosis)
adverse effect in drugs w/ selective vasodilation of arterioles (hydralazine and minoxidil)
reduced arterial pressure, stimulates baroreceptor-mediated activation of sympathetics –> increased heart rate, contractility, increased RENIN –> Na+ and fluid retention
when given, add diuretics and sympatholytics
persistent cough and angioedema with a anti-HTN drug?
ACE inhibitors
angioedema
rapid swelling of dermis, subcutaneous tissue, mucosa, and submucosa
how can c. botulinum be prevented?
thoroughly heating food prior to consumption (toxin is heat labile)
classic paralysis in c. botulinum
descending paralysis, first manifesting w/ cranial n. involvement (diplopia, dysphagia, difficulty speaking).
note, both nicotinic and muscarinics aren’t getting Ach
hemicholinium
blocks choline entry into neuron
bromoacetylcholine
inhibits chAt (choline acetyltransferase) blocking synthesis of acetate + choline –> ACh
vesamicol
noncompetitively blocks vesicular Ach transporter.
transference
unconscious shifting of emotions or desires associated with one person to another. often arise from childhood parent child relationship
single most preventable cause of death and disease in US
smoking!
most effective preventative intervention
increased risk for macrovascular (MI, stroke), microvascular (retinopathy, nephropathy), complications of diabetes.
risk of MI-associated mortality decreases immediately upon smoking cessation
omeprazole
inhibit H+/K+ ATPase, decreasing concentration of HCl in stomach lumen
primary active transport
lidocaine
block voltage gated Na+ channels in sensory neurons, purkinje fibers, and ventricular cells
drug to reduce nicotine cravings while decreasing pleasurable effects of cigarettes?
varenicline PARTIAL AGONIST of a4b2 nAChR.
prevents nicotine binding & reduces symptoms of withdrawal by mildly stimulating receptor –> limited release of dopamine, less stimulation of reward parthways than nicotine would.
reduce cravings and rewarding effects of use
reinforcing effects of nicotine mediated by..
stimulate alpha-4-beta-2 nAChR in CNS
biopsy of skin lesion w/ celiac disease & appearance
dermatitis herpetiformis. groups of small vesicles (papulovesicular) on extensor surfaces.
biopsy: neutrophil & fibrin & IgA at tips of dermal papilla –> forming microabscesses.
gluten-free items? gluten-containing
gluten free: oats & rice.
gluten-containing: wheat, rye & barely
abetalipoproteinemia
inherited inability to form chylomicrons - absence of B48. presents in first year of life w/ malabsorption, failure to thrive, progressive ataxia, abnormal RBCs (acanthocytes)
skin manifestations of crohn’s disease & ulcerative colitis. what additional feature foes crohn’s have?
- erythema nodosoum (tender subcutaneous nodules) &
- pyoderma gangrenosum (deep ulcers w/ violaceous borders).
- apthous ulcers
