test #45 5.4 Flashcards
1
Q
when to involve ethics committee or risk management?
A
basically never on USMLE. handle it on your own.
2
Q
sudden onset headache and nuchal rigidity
A
subarachnoid hemorrhage
meningeal irritation from blood
can also see papilledema and pupillary dilation, but no other focal neurological signs
3
Q
xanthochromia
A
blood in CSF
4
Q
diff between intracerebral hemorrhage & subarachnoid hemorrhage
A
intracerebral: focal neurological impairment
subarachnoid: no focal issues
5
Q
carrier frequency for mom 1/30
carrier frequency for dad: 1/100
chance child will have disease?
A
(1/30 x 1/2) x (1/100 x 1/2)
6
Q
what % of observations fall in 1 standard deviation of mean
A
68%
7
Q
what % of observations fall in 2 standard deviations of mean
A
95%
8
Q
what % of observations fall in 3% of standard deviation of mean
A
99.7%
9
Q
normal pulmonary arterial pressure
A
< 20mmHg
10
Q
definition of pulmonary artery hypertension
A
> 25mmHg
11
Q
major causes of pulmonary artery HTN
A
- hereditary (AD: BMPR2 mutation)
- left heart failure
- chronic hypoxia: obstructive sleep apnea, COPD
- chronic thromboembolism
- HIV infxn
12
Q
idiopathic pulmonary artery HTN inheritence
A
autosomal dominant w/ variable penetrance
2 hit:
- mutation in BMPR2. normally suppresses smooth muscle proliferation
- activates disease process (i.e. infxn, drug)
13
Q
cardiac sounds that can arise w/ pulmonary HTN (2)
A
- accentuated S2
2. holosystoic tricuspid regurg (diastolic) due to increased ‘afterload’
14
Q
etiology of pulmonary HTN in COPD, obstructive sleep apnea, interstitial lung disease
A
hypoxic vasoconstriction
15
Q
compensation for chronic respiratory acidosis
A
3-5 days
(at least 24hr)
kidney excrete acid & retain HCO3-
> 30
16
Q
Kussmal breathing
A
shallow breathing seen in diabetic ketoacidosis, attempt to blow off CO2 to compensate for metabolic acidosis (low bicarb, low CO2, low pH)
17
Q
adverse effects of succinylcholine (3)
A
- malignant hyperthermia in genetically susceptible people
- hyperkalemia in pts w/ burns, myopathy, crush injury, denervation -> quadriplegia, guillan-barre
(due to upregulation of muscle nAChR & rhabdomyolysis –> increase K+ efflux)
- bradycardia, from parasympathetic stimulation or tachycardia, from sympathetic ganglion effects
18
Q
side effects of atracurium
A
- release histamine ->
bp drop, flushing, bronchoconstriction - spontaneous degradation to laudanosine –> seziure
but, good for renal/hepatic insufficiency
19
Q
baclofen mechanism
A
GABAb at level of spinal cord
CNS
20
Q
phase I of succinylcholine
A
strong agonist of nAChR
binds & depolarizies
insensitive to AChE, so prolonged depolarization –> twitching
potentiate: AchE inhibitors, bc Ach will help further depolarize & inactivate muscle.
eventually degraded by plasma cholinesterases
21
Q
phase II of succinylcholine
A
w/ continuous infusion or SLOW metabolizers
eventually nAChR insensitive to succinylcholine, which can bind & block site, but can no longer depolarize
–> becomes nondepolarizing blocker
antidote: AChE inhibitors (increase Ach concentration)
22
Q
infective dose of shigella, salmonella, and vibrio cholera, ETEC
A
least --> most shigella -- 10 - 10^2 salmonella -- 10^ 7 vibrio cholera: 10^5- 10^7 ETEC: 10^ 8-10^ 10
23
Q
why is shigella so infective? when does infxn start
A
- survive stomach acid & bile
- uniquely bind to mucosal M cells in peyer’s patches
24-72 hrs incubation
24
Q
tenesmus
A
painful spasm of rectum associated w/ urge to defecate, yet little passage of stool occurs
25
infective dose of c. perfinges
500 organisms
26
organisms that can cause diarrhea w/ small innoculum
- camplyobacter jejuni - 500
- entamoeba histolytica - as few as 1
- giardia lamblia - as few as 1
27
TB virulence factor: cord factor
- inhibit macrophage & neutrophil maturation
- induce release of TNF-alpha
- damages mitochondria
mycoside (2 mycolic acid molecules bound to disaccharide trehalose)
correlates w/ virulence.
no cord factor -> no disease.
28
TB virulence factor: sulfatides (surface glycolipids)
- inhibit phagolysosomal fusion
29
thick, ropelike cords of mycobacterial organisms in twisted "serpentine" pattern
TB, consistent w/ presence of cord factor
30
eyes, lies, and capsize
wernicke encephalopathy
-opthalmoplegia / nystagmus:
anterograde amnesia: mamillary body
ataxia : cerebellum
31
what nutrient is often deficient in alcoholics
thiamine!
wernicke korsakoff
give IV dextrose & thiamine
32
wernicke encephalopathy is exacerbated when..
IV dextrose WITHOUT THIAMINE
thiamine needed for pyruvate dehydrogenase (pyruvate --> acetyl CoA for glycolysis -> TCA)
33
Wernicke encephalopathy?
| Korsakoff psychosis?
acute thiamine def:
Wernicke encephalopathy
ataxia, nystagmus, opthalmoplegia, anterograde amnesia
chronic thiamine def:
Korsakoff
- anterograde & retrograde amnesia, apathy, lack of insight, confabulation
34
what brain structure is most affected by thiamine deficiency
mammillary body, undergoes necrosis.
papez circuit, neural pathway of limbic system involved in cortical control of emotion & memory.
35
fornix
originate from hippocampal subiculum, projects to mamillary body
36
alexia w/o agraphia
suggests corpus callosum lesion
37
before giving dextrose to alcoholic / malnourished, must give..
THIAMINE! to avoid ppt of wernicke encephalopathy.
38
virus w/ nuclear membrane envelope
herpesfamily!
herpes, CMV, EBV, etc
39
how do antithyroid drugs work (3)
1. oxidation of iodine
2. iodination of tyrosine residues
3. coupling of iodotyosine molecules
40
different between PTU and methimazole (3)
1. propylthiouracil also blocks peripheral conversion of T4 -> T3
2. PTU shorter half life
3. PTU for pregnancy!
methimazole = teratogen
41
both PTU and methimazole as associated with..
agranulocytosis.
| both: thioamides
42
preferred rx for hyperthyroidism in US
radioactive iodine
43
definition of agranulocytosis
absolute neutrophil count of less than 500/mL
44
presentation of agranulocytosis
fever & sore-throat
| often induced by medication
45
drugs that cause agranulocytosis
drugs cccrush myeloblasts & promyeloblasts
```
dapsone
clozapine
carbamazepine
colchicine
methimazole
propylthiouracil
```
46
how to check for agranulocytosis?
WBC & differential
47
patient w/ hyperthyroidism w/ fever & throat pain?
worry about methimazole / PTU induced agranulocytosis
48
PO2 in venous blood
| PCO2 in venous blood
PO2: 40mmHg
PCO2: 47 mmHg
49
PO2 in arterial blood
| PCO2 in arterial blood
PaO2: 104
PaCO2: 40
50
describe bronchial arterial supply
left & right arise from descending thoracic aorta
oxygenated to bronchi & bronchioles
w/ pulmonary artery, form dual blood supply to lungs
51
describe bronchial drainage
drainage:
- part to right heart via azygous, accessory hemiazygous, intercostal veins
- MOST drain to left heart via pulmonary veins
DEOXYGENATED blood into LEFT ventricle
52
explain why pO2 (100) in left ventricle is lower than pO2 (104) in pulmonary capillaries
bc admixture w/ venous blood from bronchial VEINS
most drain into right heart via pulmonary vein
53
what normally limits blood gas exchange in alveoli
CO2 & O2: usu perfusion limited
CO2 equilibrates really fast
O2 also does
54
perfusion limited
CO2, N2O
also O2
55
diffusion limited
CO
56
what shifts hemoglobin curve to the right
unload O2
high temp, pCO2, 2,3DPG
57
degenerate code
more codons (61) than there are amino acids (20)
each tRNA molecule = specific for an AA
multiple tRNA can code for same aa
wobble
58
explain basis of wobble in tRNA
5' tRNA has different spatial orientation than other 2 bases
may be inosine, which can hydrogen bond w/ uracil, adenine, and cytosine
allows for different codons to = same amino acid
59
3 categories of vitamin A toxicity
think: intracranial HTN, skin changes, hepatosplenomegaly
1. acute
- n/v, vertigo, blurred vision
2. chronic
- alopecia, dry skin, hyperlipidemia, hepatoxicity, hepatosplenomegaly, visual difficulty, papilledema (pseudotumor cerebri)
3. teratogenic
1st trimester: microcephally, cardiac anomalies, fetal death
60
thiamine deficiency associated w/
beri beri wet & dry
| wernicke korsakoff
61
large doses of vitamin C associated w/
diarrhea, abdominal bloating
| false negative stool guaiac results
62
large doses of vitamin E
- hemorrhagic stroke in adult
| - necrotizing enterocolitis in infants
63
major use of ELISA
quantiative
to measure AMOUNT of protein in body fluid
64
indirect vs. direct ELISA
indirect: test antigen to see if patient has antibody
indirectly assume if you Ab, you must have antigen
direct: test antibody to see if patient has antigen
[directly see if you have antigen]
65
HIV ELISA
look for patient antibody
| indirect
66
name loop diuretics (4) & major use
furosemide, toresemide, bumetanide, ethacrynic acid
use for volume overloaded state: CHF
67
name thiazide diuretic (4) & major use (2)
hydrochlorothiazide, chlorthalidone, indapamide, metolazone
use: HTN, calcium nephrolithiasis prophylaxis
68
ENaC blockers (2)
amiloride, triamterene
69
mineralcorticoid receptor antagonist (2)
spironolactone, eplerenone
70
which diuretic is most likely to produce hyponatremia
thiazides
have normal corticomedullary concentration, better able to retain free water in response to ADH
(loop diuretics loose some corticomedullar gradient in TAL, less able to absorb free water in loop of henle & CD)
71
diuretic causing hypocalcemia?
loop (furosemide etc)
BAD for renal nephrolithiasis
72
hepatitis w/ isoniazid presentation
fever, anorexia, nausea
73
how can isoniazid peripheral neuropathy be averted?
administer vitamin B6
74
fever, urticaria, arthalgia, proteinuria, lymphadenopathy 5-10 days after drug exposure
serum sickness
| type III HSR
75
fatigue & new onset cardiac murmur in young adult
bacterial endocarditis
76
nephritic issues with bacterial endocarditis?
can have circulating immune complexes --> diffuse proliferative glomerulonephritis
77
inheritance of hemophilia A? hemophilia B?
A: factor 8; X-linked recessive
B: factor 9; X-linked recessve -> christmas disease
78
difference between hemophilia A & B
clinically indistinguishable
79
common cause of PT prolongation
warfarin therapy
80
common causes of increased bleeding time
von willebrand disease
NSAID use
81
general side effect of sulfonylurea?
1st generation risk?
2nd generation risk?
general: hypoglycemia w/ renal failure
1st gen: disulfram-like rxn
2nd gen: hypoglycemia
82
risk of rapid acting insulin
hypoglycemia, rare HSR
83
side effect of metformin
lactic acidosis
| CONTRAINDICATED in renal failure
84
diabetes drug contraindicated w/ renal failure
metformin!
can cause lactic acidosis
85
side effect of thiazolidinediones (4)
1. weight gain (fluid)
2. edema
3. hepatotoxicity
4. heart failure (bc of fluid retention)
86
which diabetes drug can cause weight gain, edema, hepatoxicity, and heart failure
thiazolidinediones
87
which diabetes drugs can cause hypoglyemia
insulin & sulfonylureas
not TZD or metformin
88
drugs associated w/ pulmonary fibrosis
amiodarone, bleomycin, mitomycin C, busulfan, methysergide
89
how to identify lunate on X-ray
most medial articulation w/ radius!
be careful when counting!
90
how to identify scaphoid on X-ray
lateral articulation w/ radius
be careful when counting
91
what carpal bone articulates w/ thumb?
trapezium
thumb swings on trapezium
92
linitis plastica
stomach wall grossly thickened & leathy, diffuse stomach adenocarcinoma
93
progression of gastric adenocarcinoma
early aggrssive local spread & node/liver mets
recall
1. virchow node
2. krukenberg tumor
3. sister mary joseph node
94
signet cells in stomach
diffuse adenocarcinoma, associated w/ linitis plastica
95
nodular, polypoid-well demarcated masses in stomach.
microscopy: well-formed glands w/ columnar/cuboidal cells
intestinal-type adenocarcinoma
resembles colon cancer
96
prognostic factors of gastric adenocarcinoma
depth of invasion through gastric wall & regional lymph involvement
97
what type of gastric carcinoma can ulcerate
intestinal type, can present as upper GI bleed
98
rugal thickening w/ acid hypersecretion in stomach
think zollinger-ellison; bc gastrin increases acid secretion & parietal cell growth factor
99
hypertrophy of brunner's gland
suggests peptic ulcer disease
brunner gland in duodenum --> secrete mucous via crypts of lieberkuhn
100
bicarbonate in small intestine comes from.. (2)
1. pancreatic duct secretions
| 2. brunner's gland (only in duodenum)
101
brunner gland. where am i?
duodenum
102
crypt of lieberkuhn. where am i?
anywhere from small intestine to colon.
stomach: has gastric glands
103
CCK and secretin on pancreatic secretions
CCK stimulates mostly acinar cells (enzymes)
secretin stimulates mostly ductal cells (bicarb)
104
CCK and secretin on gallbladder
CCK stimulates gallbladder contraction & sphincter of Odi opening
secretin stimulates bile secretion
105
chronic gastritis w/ h. pylori leads to..
diffuse gland atrophy & intestinal emtaplasia
increase risk of gastric carcinoma
106
resistance to rifampin
mutation in DNA-dep RNA pol
107
best indicator of MR severity?
presence of S3 gallop
reflects increase rate of left ventricular filling due to large volume of regurgitant flow re-entering ventricle during mid diastole
108
functional diastolic rumbling?
suggests mitral regurg leading to high rate of regurgitant flow across MV in diastole
109
is intensity of murmur a good indicator of mital regurg?
no, bc low intensity means larger regurg orifice --> worse!
110
what causes mid systolic click in MVP?
tensing of chordae tendineae as they are being pulled taut by valve leaflets into atrium.
111
chordae tendinae
connect papillary muscles to AV valves leaflets (mitral & tricuspid)
collagen & elastin
112
most common cause of aortic stenosis?
degenerative senile calcification of valves
result of prolonged hemodynamic stress on valves
common >65 y/o
113
physical exam of aortic stenosis (3)
1. pulsus parvus et tardus:
- small & slow rise in carotid pulse
2. diminished aortic component to S2
3. harsh systolic crescendo-decrescendo murmur right upper border
114
valve issues w/ rheumatic fever (3)
1. mitral stenosis (late)
| 2. mitral & aortic regurg
115
what type of valvular issue is caused by infectious endocarditis
insufficiency of any valve
(regurg)
NOT stenosis
116
cystic medial necrosis can lead to what valve issue
aortic regurg
| dilation of ascending aorta
117
non-musculoskeletal issues associated w/ ankylosing spondylitis
peripheral enthesopathies
uveitis
apical pulmonary fibrosis
aortic insufficiency
118
medical to prevent calcium stone formation
DON'T GET CONFUSED
thiazides!!
reduce calcium in tubules
119
diuretic that worsens calcium stones
furosemide!
looses Ca2+ means more in the tubules
120
how to thiazides reduce hypercalciuria (2)
1. block Na/Cl -->
- less Na+ in tubular cell, activates basolateral Na/Ca2+ antiporter, which pumps Na into cell in exchange for Ca2+
-this increases uptake of Ca2+ across apical membrane
2. hypovolemia --?
increases Na and H20 absorption in PCT, leading to passive Ca2+ too
121
acetazolamide on calcium levels
induces metabolic acidosis -> increase bone release of Ca2+ PO4-
hypercalciuria, worsens calcium stones
122
comedocarcinoma
DCIS w. solid sheets of pleomorphic, high grade cells w/ central necrosis
chroni inflammation & periductal concentrib fibrosis
calcify necrosis --> mammographic detection
123
paget's disease of nipple
malignant cells spread from DCIS into nipple w/o having crossed basement membrane
erythema and scale crust
124
medullary breast carcinoma
good prognosis
invasive, lymphocytic infiltrate
solid sheets of vesicular, pleomorphic, mitotically active cells w/ lymphoplasmacytic infiltrate around & within tumor & pushing noninfiltrating border
125
sclerosing adenosis
central acinar compression & distortion by surrounding fibrotic tissue w/ peripheral ductal dilation
fibrocystic change
slight association w/ carcinoma risk
126
breast ductal dilation, inspissated breast secretion, chronic granulomatous inflammation in periductal & interstitial area
mammary duct ectasia
127
phyllodes tumor
like fibroadenoma but increased cytological atypia & stromal cellularity & overgrowth
biphasic
leaflike
128
how long will myocardium look normal on histology post MI
up until 4 hours post MI.
then waviness in myofibrils (due to relaxation) will start, w/ edema, hemorrhage, early coagulative necrosis
129
earliest sign of coagulative necrosos of cardiac myocytes
cytoplasmic hypereosinophilia
also: punctate hemorrhage & edema
130
when do neutrophils come into myocardium post MI
days 1-3
131
when do macrophages come into myocardium post MI
days 5-10
132
when does granulation tissue form post MI
10-14 days post MI
133
when does collagen start to lay down post MI
2 weeks post MI -> 2 months
134
causes of acute pancreatitis (common & uncommon)
usu gallstones & alcoholism
also
1. drugs: azathioprine, sulfasalazine, furosemide, valproic acid
2. infxn: mumps, coxsackie virus, mycoplasma pneumoniae
3. hypertriglyceridemia
4. structure abnormalities of pancreatic duct (stricture, cancer, divisum) or ampulla (choledochal / bile duct cyst, stenosis of sphincter of odi)
5. hypercalcemia
6. surgery of stomach / bilary tree
7. recent endoscopic retrograde cholangiopancreatography
135
repeated acute pancreatitis that resolves on fasting w/ no risk factors in young patient?
consider hypertriglyceridemia
136
how does hypertriglyceridemia lead to acute pancreatitis
DIRECT TISSUE TOXICITY
high TG -> increased production of free fatty acids within pancreatic capillaries via pancreatic lipase
normally is bound to albumin
when TG >1000mg/dl -> will exceed albumin's binding capacity & directly injure pancreatic acinar cells
137
increased cholesterol predisposes to.. (3)
1. coronary artery disease
2. peripheral vascular disease
3. stroke
138
hemachromatosis on pancreas
pancreatic fibrosis --> secondary diabetes
does NOT cause pancreatitis
139
things that can cause pancreatitis mnemonic
GET SMASHED
1. gallstones
2. ethanol
3. trauma (seat belt)
4. steroids
5. mumps
6. autoimmune
7. scorpion sting
8. hypercalcemia / hypertriglyceridemia
9. ERCP
10. drugs (esp sulfa)
140
wilson disease signs
Copper is Hella BAD
unable to loose Cu2+ in bile
1. low ceruloplasmin, cirrhosis, corneal deposit (kaiser-fleisher ring), hepatocellular carcinoma
2. hemolytic anemia
3. basal ganglia degeneration (parkinsonian)
4. asterixis
5. dementia, dyskinesia, dysarthria
141
turbid plasma
suggests lots of chylomicrons in blood stream
| think: turbid blood 30min post hamburger!
142
lipoprotein lipase deficiency
1 form of hyperchylomirconemia:
autosomal recessive
childhood: hyperlipidemia, abdominal pain (pancreatitis), lipema retinalis, xanthomas, hepatosplenomegaly
reduced LPL response to heparin
143
what converts nascent HDL to mature HDL
LCAT: which esterifies cholesterol
144
role of CETP
cholesterol ester transfer protein: transfers cholesterol liporotein particles from mature HDL to VLDL, IDL, LDL
145
hyperchylomicronemia can develop with what 2 deficiencies
autosomal recessive.
1. deficiency of lipoprotein lipase
2. mutation in apo C-II
recall, apo C-II activates LPL
146
hypertriglyceridemia results from..
autosomal dominant.
hepatic overproduction of VLDL
CAUSES PANCREATITIS
increased blood levels of VLDL and TG
147
presentation of hyperchylomicronemia
increased chylomicrons & TG
PANCREATITIS, hepatosplenomegaly, eruptive/pruritic xanthoma
no increase risk of atherosclerosis
148
heparin on lipase activity
heparin releases endothlium-bound lipases, encourage triglyceride clearance from circulation.
149
pain w/ hyperchylomicronemia / hypertriglyceridemia?
pain w/ hypercholesterolemia?
high chylomicron & TG --> abdominal pain --> PANCREATITIS
high LDL cholesterol --> chest pain --> MI
150
hallmark of familial hypercholesterolemia
tubular xanthomas (tendon)
also have: xathelasma & acrus cornea
151
what increases risk of pancreatic cancer?
- tobacco smoke
| - obesity
152
what increases risk of gastric cancer?
- dietary nitrates (smoked food)
- alcohol & tobacco
- h. pylori
153
what increases risk of liver cancer?
- hep B & C
- liver cirrhosis
- hemochromatosis
- wilson's
- aflatoxin
- carbon tetrachloride
154
what increases risk of colorectal cancer?
- hereditary colorectal cancer
- inflammatory bowel disease
- obesity
- charred / fried food
155
what increases risk of renal cancer?
- tobacco smoke
- obesity
- hypertension
156
what increases risk of bladder cancer
- tobacco smoke
- occupational exposure to..
- rubber
- aromatic amine-containing dyes (benzidine, 2-napthylamine,
- textiles
- leather
- aniline dye
- phenacetin
157
what increases risk of breast cancer
- early menarche
- late menopause
- nulliparity
- BRCA mutation
158
what increases risk of prostate cancer
age
| african american race
159
what increases risk of leukemia / lymphoma
alkylating agents
160
what increases risk of angiosarcoma in liver
arsenic
| vinyl chloride
161
what increases risk of papillary thyroid cancer?
ionizing radiation
162
2nd leading cause of lung cancer?
radon exposure
163
angiosarcoma prognosis
aggressive & difficult to treat
164
gross appearance of transitional cell carcinoma of bladder?
histology
gross cystoscopy: multifocal sessile or papillary tumors
histology: pleomorphic, hyperchromatic nuclei, increased NC ratio, disrupted oritentation & polarity
165
how does cyclophosphamide & ifosfamide cause hemorrhagic cystitis
acrolein -- irritates bladder mucosa
166
carcinoma, mesothelioma, thymoma, sarcoma, trophoblastic tumor, desmoplastic small round cell tumor all..
stain positive for ketatin!
167
desmin, caldesmon, actin +
muscle tissue stain
168
stain for endothlium
CD34+, von willebrand factor
169
presentation of dermatomyositis (3)
grotton papule
- red violaceous fat-topped papules w/ light scale. over bony prominences.
heloptrope rash: erythematous or violaceous edematous eruption on upper eye-lid & periorbital skin
proximal muscle weakness!
170
serum findings in dermatomyositis
```
ANA +
anti-Jo1 +
anti-SRP
anti-Mi2
elevated creatinine kinase
```
171
prognosis of dermatomyositis
if present after age 50 --> increased risk of underlying occult malignancy
172
dermatomyositis is associated w/ underlying
lung cancer!
173
lichen sclerosis
elevated white lesion near vagina
174
acute pyelonephritis pathogenesis
must have vesicoureteral reflux in some way
175
fat embolism syndrome triad
1. acute onset neuro issues
2. hypoxemia
3. petechial rash
trauma of long bone/pelvis
176
pathogenesis of fat embolism syndrome
1. trauma dislodge fat in marrow
2. travels in bone marrow sinusoud
- pulmonary vasculature
- CNS (via AV shunt)
- thrombocytopenia & petechial rash due to platelet coating fat microglobules
177
why see petechial rash in fat embolism syndrome?
thrombocytopenia
platelet coats fat globule in vasculature
178
presentation of epidural hematoma
talk and die
may loose consciousness after injury. then lucid interval -> loss of consciousness
179
epicranial aponeurosis & periosteum cover..
outer surface of skull
180
why is there a physiological drop in systolic pressure with inspiration
increased pulmonary vascular capacitance --> reduced left ventricle preload
181
what is there a exacerbated drop in systolic pressure w/ inspiration w/ pulsus paradoxus?
physiologic: increased pulmonary capacitance -> reduced preload
+
increased filling of right heart, normally bulges into pericardium, but when filled will blood -> push against interventricular septum, reducing LV stroke volume
182
low potency antipsychotics associated with
non neurologic:
histamine block: sedation
cholinergic block
alpha-1 block: orthostatic hypotension
183
name 2 low potency 1st generation antipsychotics
chlorpromazine
| thioridazine
184
name 2 high potency 1st generation antipsychotics
haloperidol
| fluphenazine
185
migratory thrombophlebitis suggests
underlying visceral malignancy
trousseau's sign
186
explain trousseau's sign
migratory thrombophlebitis
bc common paraneoplastic syndrome: hypercoagulability, esp adenocarcinoma (of pancreas, lung, colon)
secrete thromboplastin-like substance -> cause chronic intravascular coagulation --> disseminated & tend to migrate
187
superficial venous thromboses that appear in one site, resolves & appears elsewhere
migratory thrombophlebitis --> underlying visceral malignancy
188
WBC casts ppt by what in renal tubular cells
Tamm-Horsfall protein, secreted by tubular epithelial cells
189
what will have highest rate of metabolism in glycolytic pathway: glucose 6-phosphate, mannose 6-phosphate, galactose 1-phosphate, fructose 1-phosphate, glucose 1-phosphate
fructose 1-phosphate, bypasses rate limiting step of PFK-1
all others enter before PFK-1
190
rate limiting enzyme in glycolysis
phosphofructokinase
F 6-phosphate -> F 1,6 bisphosphate
191
mannose metabolism
formed from metabolism of several polysaccharides & glycoproteins
phosphorylated to mannose 6-P, converted to fructose 6-P (by mannose isomerase) then acted on by PFK-1
192
galactose metabolism
galactoskinase makes galatose 1-P
transfer of UDP to galactose 1-phosphate, then epimerization to UDP-glucose (by galactose 4-epimerase).
resultant glucose 1-P -> glucose 6-P via phosphoglucomutase
then PFK-1
193
fructose metabolism
fructokinase
fructose 1-phosphate
F 1P--> DHAP & glyceradehyde
via aldolase B
glyceraldehyde -> glyceraldehyde 3-P
via tiokinase
becomes pyruvate eventually
bypass PFK-1
194
gaucher disease
defect: glucocerebrocidase
accumulate: glucocerebroside
hepatosplenomegaly, aseptic necrosis, gaucher cells
195
presentation of fabry's
1. peripheral neuropathy of hand and feet
2. angiokeratoma
3. cardiovascular / renal disease (COD)
196
DNR means (3)
1. no intubation or mechanical ventillation
2. no defibrillation or IV drugs to acutely treat terminal rhythm
3. no chest compressions
can otherwise specify additionally:
- no artificial feeding
- etc
197
order of next of kin
spouse
adult children
parents
adult siblings
