Test 29 Flashcards
How does Nitroprusside work? how does it impact preload and afterload and stroke volume
short-acting balanced venous and arterial vasodilator
- decreases both preload and afterload
- same stroke volume
Specific MOA of Nitroprusside
increase cGMP via direct release of NO
Side effect of Nitroprusside
cyanide toxicity (releases cyanide)
what is the role of carbonic anhydrase activity in erythrocytes
forms bicarbonate from carbon dioxide and water
Explain chloride shift? what does this cause
- bicarb diffuse out of RBC into plasma
- maintain neutrality, Cl- diffuse into RBC
- high RBC chloride content in venous blood
What is spectrin
structural component of membrane of RBC
-gives cell flexibility
Role of 2,3-DPG
combines with hemoglobin
- decreases affinity for oxygen, facilitates oxygen delivery to tissue
Where is glucose-6-phosphate dehydrogenase enzyme found in the pathway
first enzyme in pentose phosphate pathway
how do glucose-6- phosphate deficiency pts present
episodic hemolysis induced by oxidant stressors
Abusive head trauma can be caused by vigorous shaking of an infant and results in what
subdural hemorrhage and retinal hemorrhages
- injuries inconsistent with history or developmental age
- posterior rib fractures
What gets torn in subdural hemorrhages
tearing of bridging veins
When does a child start rolling
by 6 months rolls and sits
what causes idiopathic thrombocytopenia purpura
platelet autoantibody formation
All newborns are deficient in what vitamin
K
What is the difference between shaken baby syndrome and vitamin K deficiency in child
no retinal hemorrhages seen in vitamin K deficiency
What is ocular exam for retinoblastoma
absence of “red reflex”
what is the most common ocular tumor of infancy
retinoblastoma
compare perfusion in the lung
increases from the apex of lung to the base
- base gets most perfusion
compare ventilation of the lung
increases slightly from apex to the base
- apex gets most ventilation
what is the V/Q in the lung
ratio decreases in the lung from apex to base
- highest at apex
What are the zones of perfusion
Zone 1, 2, 3
Zone 1 of lung
- apex of lung
- alveolar pressure, arterial pressure, venous pressure
- pulmonary capillaries collapsed
- alveolar dead space
Zone 2
- middle of lung
- arterial pressure, alveolar pressure, venous pressure
- pulsatile fashion
Zone 3
- lower lung
- arterial pressure, venous pressure, alveolar pressure
in pregnancy who secretes progesterone
- corpus luteum
- then later by placenta
What is the [prolactin] during pregnancy? what inhibits prolactin from doing it’s job
increases as pregnancy progresses
- progesterone works at anterior pituitary
role of prolactin
peptide hormone promotes milk production
where is prolactin released from
anterior pituitary gland
what stimulates prolactin production
thyrotropin-releasing hormone
Who secretes Beta-hCG during first trimester
embryonic syncytiotrophoblast
role of Beta-hCG
- maintains corpus luteum until placenta assumes responsibility for estrogen and progesterone synthesis
- hormones level drop as pregnancy continues
Fibrinolytic system causes what
reperfusion arrhythmia on arterial re-opening
- arrhythmias usually benign
Strepktokinase
non-specific fibrinolytic durg
Tisuse plasminogen activitor (tPA), reteplase, and tenecteplase are what
fibrin specific drugs
- act only on fibrin attached to recently formed clot without systemic activation
Deficiency of vitamin B12 is associated with
- megaloblastic anemia
- neurologic dysfunction
Folate deficiency is associated with
- megaloblastic anemia
treatment of deficiency in vitamin B12 with folate and vice versa can improve what? treatment of B12 deficiency with folate alone can do what
- improve hemoglobin levels
2. worsen neurologic dysfunction
patient being treated with folic acid for anemia. Then experiences bilateral foot numbness. What vitamin is she deficient in
Vitamin B12 (Cobalamin)
What is the relationship between folate and phenytoin? impact
high doses of folate may antagonize phenytoin
- precipitating seizures
What is the most important environmental risk factor for pancreatic cancer? other
- smoking
- greater than 50, chronic pancreatitis, DM, MEN
Courvoisier sign
palpable but nontender gallbladder
- Courvoisier sign
- weight loss
- obstructive jaundice ( associated with pruritus, dark urine, and pale stools)
these indicate what
adenocarcinoma at head of pancreas
what patient would be put on a low-fiber diet
risk for colon adenocarcinoma
H. pylori increases the risk for what
gastric adenocarcinoma
gastric lymphoma
What is sertoli-leydig cell tumors of the ovary
arise from sex cord stroma and secrete testosterone
clinical features of sertoli-leydig tumors of ovary
- large ovarian mass
- virilization
histo for sertoli-leydig tumor of ovary
- tubular structures lined by Sertoli cells
- surrounded by fibrous stroma
What is granulosa cell tumor
sex cord-stromal tumor
- produces excessive estrogen
hist for granulosa cell tumor
Call-exner bodies - small follicle-like structures filled with eosinophilic secretion that lined by granulosa cells containing coffee bean nuclei
how does endodermal sinus (yolk sac) tumor present
abdominal pain due to ovarian torsion without virilization
histo for endodermal sinus (yolk sac)
Schiller-Duval bodies: glomerulus-like papillary structures with a central vessel
What is the most common benign germ cell tumor
mature cystic teratoma
what is mature cystic teratoma on histo
keratinized epithelial tissue with sebaceous glands
What is the most common epithelial ovarian cancer
serous cystadenocarcinoma
how does serous cystadenocarcinoma present
- post-menopausal
- adnexal mass
- ascites without excess hormonal activity
autopsy for serous cystadenocarcinoma
Psoamma bodes: concentrically laminated, calcified spheric deposits
A side effect of using inhaled glucocorticoids
- oropharyngeal candidiasis
- dysphonia - myopathy of laryngeal muscles and mucosal irritation
young Female patient with virilization, amenorrhea for 5 months, adnexal mass, large ovarian cyst
Sertoli-Leydig tumor
increased alpha-fetoprotein is a serum tumor marker for what liver stuff
chronic viral hepatitis
hepatocellular carcinoma
Serum tumor marker CA19-9
pancreatic
serum tumor marker CA125
ovarian
When is alpha-fetoprotein produced
fetal liver and yolk sac during gestation
what should be suspected in young otherwise healthy patients with fatigue, progressive dyspnea, atypical chest pain or unexplained syncope
pulmonary hypertension
pulmonary hypertension impact on heart
hypertrophy and/or dilation of the right ventricle (cor pulmonale)
severe right ventricular hypertrophy in young women with progressive dyspnea suggests
pulmonary arterial hypertension
what is the physical finding of PAH pulmonary arterial hypertension
intimal hyperplasia
fibrosis
medial hypertrophy
capillary tufts
Wolff-Parkinson-White syndrome
electrophysiological abnormality of AV node conduction
histo: small accessory AV impulse conduction pathway anatomically separate from AV node
when should a doctor suspect Wolff-Parkinson-White syndrome
sudden cardiac death in otherwise healthy young individual
clinical presentation of tertiary syphilis
- cardiovascular involvement
- gummas
what is a guma
necrotizing granulomas occurring on skin, mucosa, subcutaneous tissue, and bones within other organs
when does neurosyphilis occur
any stage of infection
what is physical presentation of primary syphilis
chancre at the treponema pallidum inoculation site
- 1-3 weeks after contact
- resolves 3-6 weeks
Secondary syphilis PE
- macular rash on palms and soles
- Condylomata lata: large gray wart like growths
Latent syphilis PE
asymptomatic
Tertiary Late syphilis
- Gummas
- ascending aortic aneurysms ( calcifications seen on X-ray)
- aortic valve insufficiency
patients with granuloma inguinale, a sexually transmitted disease caused by what
Klebsiella granulomatis
define cachexia
anorexia malaise anemia weight loss generalized wasting
role of tumor necrosis factor - alpha (TNF-alpha)
- causes necrosis of some tumors in vitro
who releases TNF-alpha
macrophages
Where does TNF-alpha do?
hypothalamus, leading to appetite suppression
- increases basal metabolic rate
- fever
Eaton-Lambert Syndrome
autoantibodies to voltage-gated calcium channels
PE for eaton-Lambert syndrome
- progressive, symmetric proximal muscle weakness ( rather than wasting)
- Ocular and autonomic symptomts
who synthesizes interferon-alpha
leukocytes
- anti viral and anti tumor
who produces IL-3
activated CD4+ Th cells
- stimulates growth and differentiation of myeloid cells
Transforming growth factor-beta function
inhibition of inflammatory response
- decreases T cell proliferation and cytokine production
What does Thiazolidinediones bind to
peroxisome proliferator-activated receptor gamma (PPAR-gamma)
what is peroxisome proliferator-activated receptor-gamma (PPAR- gama)
intracellular nuclear receptor
- transcriptional regulator of many genes involved in glucose and lipid metabolism
one of the most important genes regulated by PPAR-gamma is one that codes for
adiponectin: cytokine secreted by fat tissue that enhances insulin sensitivity and fatty acid oxidation
- low in diabetics
Diabetic drug target: intracellular mitochondrial enzyme
Metformin, reduces hepatic gluconeogenesis
Diabetic drug target: membrane-bound enzymes
alpha-glucosidase inhibitors
Diabetic drugs target: membrane ion channel
Sulfonylureas
Diabetic drug target: surface adenylate cyclase-coupled receptor
Glucagon-like polypeptide-1 (GLP1-)
Diabetic drug target: surface tyrosine kinase receptor
insulin
what kind of drug is prioglitazone
thiazolidinediones
MOA of fibrinolytic agents like alteplase
- bind to fibrin in thrombus
- activate plasmin
- leads to thrombolysis
most common adverse effect of thrombolysis
hemorrhage
When is it advisable to give fibrinolysis
acute MI patients within 12 hours of symptoms
which is preferred and why PCI vs. fibrinolysis
PCI: lower rates of intracerebral hemorrhage
MOA of alteplase
binds fibrin in thrombus
- converts entrapped plasminogen to plasma
- plasmin hydrolyzes bonds in fibrin matrix
- causing clot lysis
signs of increased intercranial hemorrhage
- decreased level of consciousness
- asymmetric pupil
- irregular breathing
man comes in with MI, given Alteplase, then gets irregular breathing patterns and asymmetric pupils? what caused this condition
intracerebral hemorrhage
what is the preferred disease-modifying treatment for patients with moderate to severe rheumatoid arthritis
Methotrexate
adverse effects of Methotraxate
stomatitis
bone marrow suppression
liver function abnormalities
middled- aged women with polyarthritis, morning stiffness , and systemic symptoms has what
Rheumatoid arthritis
MOA for Methotrexate
folate antimetabolite
- halting purine and pyrimidine synthesis through irreversible binding of dihydrofolate reductase
When is hydroxychloroquine used? toxicity
mild RA and systemic lupus erythematous
- irreversible retinopathy
Minocycline MOA? toxicity
tetracycline antibiotic with weak antirheumatic activity
- photosensitivity dermatitis
A women with RA, painful mouth ulcers and nausea. AST and ASP elevated. what drug is she taking
Methotrexate
Ace inhibitors or angiotensin II receptor blockers cause what to arteries and GFR
- efferent arteriolar vasodilation causes GFR to fall, may lead to acute kidney failure
Atherosclerosis involving renal arteries can cause
bilateral renal artery stenosis
reduced renal blood flow does what to GFR
decreased
role of angtiotensin II on kidney
constricts the efferent arteriole
difference between urethritis and cystitis
- suprapubic pressure and tenderness more specific for cystitis
where are pyuria and bacteriuria found in the urinary tract
both upper and lower urinary tract infections
where are white blood cell casts found in urinary tract
form in renal tubules
what does white blood cell casts with UTI indicate
acute pyelonephritis
Sterile pyuria
WBC with no bacteria
MOA of Rifamycin (Rifampin)
block action of bacterial DNA-dependent RNA polymerase
- inhibit transcription
MOA for Isoniazid
inhibit mycolic acid synthesis
side effect of rifamycins
harmless red-orange discoloration of body fluids
what is the major cause of the morbidity and mortality from theophylline intoxication? other major concern
Seizures
- tachyarrhythmias
how is theophyllin intoxication treated
- activated charcoal: reduce GI absorption
- beta blockers: cardiac tachyarrhythmias
Benzodiazepines and barbiturates
what can cause hematemesis and melena
iron poisoning
what is used to treat acetaminophen toxicity
acetylcysteine
- glutathione donor
severe sedation
respiratory depression
constricted pupils
what happened
opioid intoxication
treatment for opioid intoxication
naloxone
Cholesteatomas ? lead to?
collections of squamous cell debris that form a mass behind the tympanic membrane
- may have hearing loss due to erosion into auditory ossicles
- pearly mass
A complete mole is composed of what ( reproductive)
multiple cystic edematous hydropic villi
- result from trophoblast proliferation
what should be measured in complete mole?
Beta-hHCG
as increased levels may signify invasive mole or choriocarcinoma after uterine evacuation
macroscopic appearance of complete mole
bunch of grapes
What is the immunochemistry staining for complete moles
p57- negative
classical clinical findings for complete mole
vaginal bleeding
hyperemesis gravidarum
theca-lutein cysts
MOA for Baclofen ? impact?
agonist at GABA-B receptor at spinal cord level
- inducing skeletal muscle relaxation
Duloxetine ? MOA? uses
norepinephrine reuptake inhibitor
- treat anxiety/depression
what type of drug is Levetiracetam
anti-epileptic
What type of drug is Nortriptyline? used for
tricyclic antidepressant
- treat neuropathic pain and migraine headaches
MOA of Metformin
- inhibits hepatic gluconeogenesis
- increases peripheral glucose utilization
complication of metformin with a patient with underlying renal insufficiency
lactic acidosis
What should be checked before placing someone on Metformin
serum creatinine
3-hour glucose tolerance test used for
diagnose diabetes, esp. gestational diabetes
Vanillylmandelic acid (VMA)? what is it. what is it used to screen
- metabolite of catecholamines
- catecholamine-producing tumors ( pheochromocytoma_
