test #33 4.22 Flashcards
antiarrhythmic prolonging QT & bradycardia (prolonged PR)
sotalol
beta-blocker w/ class III antiarrhythmic properties
how do beta blockers work?
(1) slow AV nodal conduction
(2) prolonging phase 4 depolarization
triglyceride breakdown. fate of fatty acid & glycerol?
triglyceride –> fatty acid & glycerol (via lipases)
FATTY ACID –> fatty acyl-coA
via fatty acid CoA synthetase
carnitine carries fatty acyl-CoA into mitochondria
fatty acyl-CoA –> beta oxidation
GLYCEROL (IN LIVER)
glycerol –> glycerol 3-phosphate
(via glycerol kinase)
glycerol 3-phosphate -> DHAP
DHAP can go into (1) energy via glycolysis or (2) glucose via gluconeogenesis
glycerol also can be used for triglyceride synthesis in any tissue
liver-specific enzyme for energy generation & glucose synthesis
glycerol kinase (converts glycerol into glycerol 3 phoshpate)
glycerol 3-phosphate -> DHAP -> either glycolysis or gluconeogenesis
ONLY in liver.
acetyl-CoA carboxylase
first committed step in fatty acid SYNTHESIS!
acetyl-CoA –> malonyl-CoA
(acetyl-CoA carboxylase)
eventually make palmitate
occurs in cytoplasm
where does fatty acid oxidation occur? synthesis?
oxidation in mitochondria
synthesis in cytoplasm
fatty acid synthesis movement from mitochondria to cytosol?
oxaloacetate + acetylCoA –> citrate
citrate shuttled out
converted into oxaloacetate + acetylCoA again (via ATP citrate lyase)
acetyl-CoA –> malonyl CoA–> fatty acid
oxaloacetate –> malate –> pyruvate, back into mito
which is the only organ that can use glycerol as energy source?
LIVER
how do adipocytes make glycerol for triglyceride synthesis?
synthesizes glycerol phosphate from DHAP
nail clubbing suggests? nail spooning [koilonychia] suggests
clubbing: PROLONGED hypoxia
associated w/ large-cell lung cancer, TB, CF, suppurative lung disease: empyema, bronchiectasis, chronic lung abscesses
(not asthma, bc brief, episodic?)
spooning: Fe2+ deficiency anemia
nail clubbing:
drumstick appearance, flattening of nail folds, shininess of nail and distal portion of finger.
pressing of nail: spongy, fluctuant (unstable) sensation –> softening of nail beds
potential pathophysiology of digital clubbing
failure of platelet precursors to fragment completely within pulmonary circulation
increased peripheral megakaryocytes & platelet clumps –> impact finger & toe –> release PDGF and VEGF –> increased fibrovascular proliferation –> clubbing!
also, elevated levels of prostaglandin E2 implicated.
c-ANCA targets
lysosomal enzymes
wegners: granulomatosis w/ polyangiitis
wegner’s (granulomatosis w/ polyangiitis)
what’s involved (3)
necrotizing granulomatous vasculitis
- upper respiratory: ear, nose, sinus, throat: chronic sinusitis, mucosal ulceration (due to mucosal granulomas that later ulcerate)
- pulmonary symptoms: cough/hemoptysis, focal necrotizing granuloma in lung, can coalesce and undergo cavitation
- renal disease: RPGN: crescentic
RPGN due to wegner’s differs bc
pauci-immune.
RPGN 1: immunoglobulin against basement membrane
RPGN 2: immune complex mediated
nephritic 2-3 days after upper respiratory infection? nephritic 2-3 wks after URI?
2-3 days: IgA nephropathy
2-3 wks: PSGN: postinfectious strep glomerulonephritis
A is earlier
indirect jaundice post-stress (i.e. hiking, fasting)
gilbert syndrome! weak UDP-glucoronyl-transferase. usu not a big deal, unless stressed.
normal serum total bilirubin
.2-1 mg/ml
< 0.2mg direct bilirubin
which TB virulence factor allows for intracellular bacterial proliferation
sulfatide
horseshoe nuclei
langhan’s giant cells
classic locations for disseminated TB
- basal meninges (tuberculous meningitis
- lumbar spine (Pott disease)
- psoas muscle (psoas abscess)
- serous membranes like pericardium and pleura
disseminate TB vs milary
milliary -> extreme form; small scattered seed-like foci of infection throughout body.
preventative measure for all kidney stones?
drink fluids
most stones result from supersaturation
low calcium diet on Ca2+ kidney stone formation?
INCREASES risk.
serum Ca2+ is low, compensatory increase in intestinal Ca2+ absorption and Ca2+ release from bone –> increase risk of stone formation