Test 30 Flashcards
first line therapy for pts w/ hypercholesterolemia
statins
MOA of statins
competitively inhibit HMG CoA reductase> DECREASED cholesterol synthesis>
upregulation of LDL receptors>
increased uptake of LDL from circulation>
lowers LDL
affect of cholestyramine on hepatic cholesterol production
INCREASES hepatic cholesterol production
how do bile acid binding resins like cholestyramine work?
bile acid binding resins bind BA in GI tract>
BA can’t be recycled>
hepatic synthesis of new bile acids>
consumes liver cholesterol>
hepatic uptake of LDL from circualtion is increased> activates HMG Co A reductase>
increased cholesterol synthesis
why do we give combination of simvastatin w/ cholestyramine
together they increase hepatic uptake of cholesterol>
lower LDL
origin of chromaffin cells of adrenal medulla and parafollicular cells
NCC
what causes tumors in BOTH the adrenal medulla and the thyroid?
germ-line mutation in NCC seen in MEN syndromes 2A and 2B
Increased urinary VMA excretion and adrenal mass
pheochromocytoma
assoc w/ MEN 2A and 2B
tumor:
pituitary
parathyroid
pancreas
MEN 1
tumor:
medullary thyroid cancer
parathyroid
pheo
Men 2A
medullary thyroid cancer
neuromas
pheo
Men 2B
genetic defect assocaited w/ MEN 2A and 2B
RET proto-oncogene> afffects multiple endocrine organs b/c they all have the same origin (NCC)!!
arises from the 4th pharyngeal pouch and fuse iwth thyroid follicular cells to form the thyroid gland
parafollicular cells
parafollicular cells
C cells
assocaited w/ thyroid
secrete calcitonin> TONES DOWN Ca
autoimmune destruction of parietal cells (chronic atrophic gastritis)
pernicious anemia
secrete HCL and IF and are found in the SUPERFICIAL region of gastric glands
parietal cells
progressive fatigue
lower extremity paresthesias
megaloblastic RBC
atrophy of gastric body and body (where parietal cells are) and normal antrum
pernicious anemia
loss of parietal cells w/ lymphocytic and plasma cell infiltraiton
chronic atrophic gastritis (autoimmune gastritis)
oxyntic cells found in the UPPER GLANDULAR layer that secrete acid and IF
parietal cells
TP
Sensitivity * number of pts w/ disease
FN
(1-sensitivity) * (number of pts w/ disease)
leads to acute renal failure and precipitation of Ca oxalate crystals in renal tubules> ca oxalate crystals in urine
AG metabolic acidosis
increased osmolar gap
ethylene glycol ingestion
each tRNA can bind a few different codons for the same AA
wobble
catalase negative
streptococci
catalase positive
staphylococci
beta hemolytic
bacitracin susceptible
pyrrolidonyl arylamidase positive
GAS
bile soluble
optochin susceptible
strep pneumoniae
dark urine
facial puffiness
pustular skin lesions that broke down and formed thick scabs on lower extemities
urine w/ RBC cell casts
Impetigo- caused by S. pyogenes
*staph is MC cause
PYR (pyrrolidonyl arylamidase) test
specific for s. pyogenes (bacitracin test is nto very specific)
associated w/ prior strep pharyngeal or skin infection
glomerulonephritis
pain and numbness of the dorsum of the right foot
can’t dorsiflex right ankle
peroneal nerve
MC nerve injured in the leg
common peroneal nerve
superficial location around the lateral neck of hte fibula
**lateral blows, tight plaster casts
sciatic nerve braches
common peroneal nerve
tibial nerve
superficial branch of peroneal nerve
innervates muscles of the lateral compartment of hte leg
gives off braches that provide sensory innervation to majority of foot
EVERTS foot
innervates anterior compartment of hte leg, muscles dorsiflex foot and toes
deep peroneeal nerve
regulates circadian rhythm
suprachiasmatic nucleus
SLEEP to be charasmatic
(processes light info from the retina and relays it to ohter hypothalamic nuclei and pineal gland to modulate body temp and production of hormones like cortisol and melatonin
tx for insomnia associated w/ jet lag
melatonin
stimulated by leptin
mediates satiety
ventromedial
if you zap your ventromedial nucleus you’ll grow ventarlly and medially
inhibited by leptin
triggered when you’re HUNGRY
lateral nucleus (lesion you shrink LATERALLY)
cooling via PNS
destruction leads to hyperthermia
Anterior
AC needed for anterior cooling
mediates heat conservation via sns
destruction leads to hypothermia
posterior nucleus
zap your POSTERIOR nuceuls you become a poikilotherm (snake)
secretes DA
GHRH
GnRH
arcuate
ADH
CRH
oxytocin
TRH
paraventricular
supraoptic
ADH
oxytocin
what causes increased afterload, excess fluid retention and cardiac remodeling in a pt w/ CHF?
compensatory activation of RAS and SNS leads to an increase in HR, vasoconstriction and ECV
What causes CHF?
heart is unable to pump a sufficient amt of blood to meet body’s metabolic demands>
decreased CO
decreased CO seen w/ CHF leads too…
compensatory neurohumoral stimulation to maintain BP
pulsus paradoxus
decrease in systolic BP greater than 10 mmHG w/ inspiration
cuases of pulsus paradoxus
acute cardiac tamponade**
constrictive pericarditis
severe obstructive lung disease
restrictive cardiomyopathy
what causes pulsus paradoxus
increased right ventricular volume that occurs with inspiration pushes hte interventriculiar septum LEFT
so left heart volume/stroke volume are reduced leading to decreased system blood pressure during inspiration
*normally, inspiration causes an increase in systemic venous return, causing the RV to expand into hte pericardial space w/ litle impact on left side of the heart. Can’t do that when heart is RESTRICTED
pulsus paradoxus can occur insettings of severe obstructive pulmonary disease like asthma. who do you tx this?
beta adrenergic agonists
control actue asthma exacerbatoins by causing bronchial SMOOTH MUSCLE RELAxation by increasing cAMP
MC pathogen causing cystitisa nd acute pyelonephritis
E. coli
second MC uUTI in sexually active owmen
staph saprophyticus
when should screening for group B strep occur in pregnant women?
vaginal rectal culture at 35-37 weeks to identify women who require INTRAPARTUM antibiotics
What intrapartum antibiotics are used to prevent neonatal GBS sepsis, pneumonia and meningitis
peniciliin
ampcillin
first line therapy for tx of acute gouty arthritis
NSAIDS> COX inhibitor
colchicine is second line d/t nausea and diarrhea
Glucocorticoids in pts w/ renal failure
Recurrent respiratory infection by Pseudomonas, chronic diarrhea, FTT
+ early sibling death from pulmonary infection
CF
cause of steatorrhea and FTT in pt w/ CF
pancreatic insuficiency
tx for CF pt w/ pancreatic insufficiency
pancreatic lipase
decreass gut motility, blood flow, and endocrine/exocrine pancreatic function (decreass secretion of pancreatic enzymes into intestine)
octreotide
causes depolarization of bacterial cellular membrane and inhibition of DNA/RNA and protein synthesis
Daptomycin
SE of Daptomycin
increased CPK (creatine phosphokinase) myopathy
TU daptomycin
gram + orgs (MRSA)
drugs commonly used for invasive MRSA
vanco
dapto
linezolid
blocks glycopeptide polymerization by binding tightly to D alanyl D alanine
vancomycin
depolarizes cell membrane
daptomycin
inhibits bacterial protein synthesis by binding 50S
linezolid
red man syndrome
vanco
thrombocytopenia
optic neuritis
high risk for 5HT syndrome
linezolid
prevention of red man syndrome
pre treatment w/ antihistamines and slow infusion rate
irreversible effects on COX
NSAID
selective COX2 inhibitor
Rofecoxib
reversibly inhibit cox 1 and 2
aspirin ibuprofen naproxen indomethacin ketrolac diclofenac
Malignancy is going to be removed from the htird part of hte duodenum. What sturcutre is at greatest risk for directe penetration by the tumor?
SMA
thickened bronchial walls
neutrophil infiltrate
mucous gland enlargement
patchy squamous metaplasia of bronchial mucosa
chronic bronchitis
leading cause of chronic bronchitis
smoking
lethal tissue ischemia in myocardium (and most tissues) causes
coagulative necrosis
ischemic cell death in CNS
liquefactive necrosis
fat necrosis
acute pancreatitis
caseous necrosis
most TB infections and some fungal infections (histoplasmosa, cryptococcus, coccidioides)
how do you make hte dx for tetanus
CLINICAL
hx of penetrating wound in pt who hasn’t been VACCINATED
trismus
sardonic smile
muscle spasma
high clincial suscpision for tetanus
what is used to excise RNA primers in prokaryotes
bacterial DNA pol I (has 5’ to 3” exonuclaease activity)
*used to excise RNA primers
gaps are then replaced by DNA pol I in 5’ to 3’ direction
*has same fxn as DNA pol III but also can excise primer
T cell maturation process htat occurs in the thymic medulla
negative selection
t cell maturation process that ocurs in the thymic cortex
positive selection
negative selection
eliminates T cells that bind SELF MHC/Ags wtih HIGH affinity
*if these selves were permitted to survive they would induce immune/inflammatory rxns against SELF rxns and lead to autoimmune disease