Test 89: All Flashcards
aphasia
lost of inability to understand or express speech
What are some unique features of herpes simplex virus type 1 encephalitis
aphasia and personality changes
Herpes simplex virus type 1 encephalitis impacts what part of the brain
temporal lobe
Post-mortem macroscopic brain examination of herpes simplex virus type 1 encephalitis?
edema and hemorrhagic necrosis of temporal lobe
What is the most common cause of viral meningitis in children
Enterovirus, group B coxsackievirus
Doxazosin, Prazosin, and Terazosin are what type of drugs
alpha 1 selective antagonists
Name the alpha 1 selective antagonists
Doxazosin
Prazosin
Terazosin
What is Doxazosin used to treat
- Urinary symptoms of BPH
- hypertension
Patients with coronary artery disease and heart failure along with hypertension will benefit from what drug class
- cardioselective beta-blockers
What is the first line-medication for the treatment of essential hypertension in the general population
Hydrochlorothiazide
Difference between amlodipine and dihydropyridine
- amlodipine is selective for vascular smooth muscle
Trichomonal vaginitis and bacterial vaginosis is treated with what
Metronidazole
What is the adverse effect of metronidazole
- disulfiram-like effects ( abdominal cramps, nausea, headache) when combined with alcohol
- due to acetaldehyde accumulation
MOA for fluconazole
inhibits ergosterol synthesis in the P450 system of fungi
Hippocampal atrophy on MRI suggests what
Alzheimer’s disease
What is the drug of choice for oropharyngeal candidiasis on patients without advanced immunodeficiency?
Nystatin
MOA for Nystatin
- binding to ergosterol in fungal cell membrane
- formation of pores and leakage of fungal cell contents
how is Nystatin administered
- not absorbed from GI tract
- oral “swish and swallow” agent
MOA for Acyclovir
- nucleoside analog
- converted into acyclo-GTP in infected cells
- inhibits viral DNA polymerase
MOA for Griseofulvin
- inhibits fungal cell mitosis at metaphase
What is Terbinafine used to treat
dermatophytosis
how does Neisseria meningtitis get to the brain
- Pharynx
- blood
- choroid plexus
- meninges
Spread from pharynx, lymphatics, meningitis
Haemophilus influenzae
How does sunlight exposure catalyze vitamin D
- converts 7-dehydrocholesterol to Cholecalciferol ( vitamine D3) in skin
What drug can be used to prevent cerebral vascular spasm following subarachnoid hemorrhage ?
Nimodipine
- calcium channel blocker
The autonomic nervous system utilizes what 3 types of signal pathways
- cAMP
- IP3
- ion channels
Nicotinic receptors use what signal pathway? what is the flow of the ion?
- ligand-gated ion channels that open after binding acetylcholine
- influx if Na and Ca into the cell
- outflow of K from cell
binding of epinephrine to alpha1 adrenoceptors uses what signal system
IP3
Beta 1 and 2 adrenoceptors use what signaling
cAMP
M1 and M2 muscarinic receptors utilize what signal pathway
-Inositol triphosphate
M2 muscarinic receptor uses what pathay
cAMP
MOA for protease inhibitors
- inhibit cleavage of polypeptide precursor into mature viral proteins
- HIV antiretroviral medication
What are 3 side effects of Protease inhibitors
- Hyperglycemia
- lipodystrophy
- inhibits cytochrome P450
Atazanavir is what type of drug
protease inhibitor
Most important side effect for Acyclovir
renal toxicity
Side effects for Trimethoprim-sulfamethoxazole
- megaloblastic anemia
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
What type of drug is Zidovudine? MOA?
- nucleoside reverse transcriptiase inhibitor (NRTI)
- suppressing DNA synthesis from viral RNA
common side effects of Zidovudine
bone marrow toxicity, resulting in anemia
Prostatectomy or injury to prostatic plexus can cause what other problem
erectile dysfunction
Injury to what muscle is responsible for erectile dysfunction
corpus cavernosa
The lesser and great cavernous nerves arise from what
prostatic plexus
Branches of pudendal nerve innervate what
- external urethral and anal sphincters
- sensory to external genitalia
When is loss of cremasteric reflex commonly seen
testicular torsion or L1-L2 spinal injury
Contraction of the detrusor muscle is stimulated by what
muscarinic cholinergic agonists
What is a good medication to use postoperative urinary retention
Bethanechol, muscarinic agonist
MOA for Finasteride
5 alpha reductase inhibitor
All hormone-containing contraceptives prevent pregnancy through the actions of wha
progestins
How do progestins inhibit ovulation
decreasing FSH and LH
Most common cause of retinitis in HIV-positive patients is what
CMV infection
HIV patients with retinitis from CMV should be treated how
ganciclovir
CMV retinitis is most frequently affects AIDS patients with what CD 4 count
less than 50
What can be injured from a hysterectomy due to its close proximity to uterine structures
ureter
How does the ureter pass in female reprdocutve
ureter passes inferior and lateral to the uterine artery at the level of the internal cervical os prior to entering the bladder
What is the most important mediator of coronary vascular dilation in large arteries and pre-arteriolar vessels
Nitric oxide
how do endothelial cells make NO
arginine and oxygen
areflexic
absent reflexes
subuxation
partial dislocation
In rheumatoid arthritis, what is more prone to subluxation
atlantoaxial joint, cervical spine
An endotracheal intubation with a person with severe rheumatoid arthritis can cause what problems
- neurological deficits like areflexic paralysis
- b/c of vertebral subluxation
What is the case of duchenne muscular dystrophy
deletion of dystrophin gene
role of dystrophin
allows interaction between extracellular connective tissue and intracellular contraction apparatus
Dystrophin is located on what chromosome
X p21
Charcot-Marie-tooth disease , what is wrong
mutation of genes responsible for myelin synthesis
Endoneural inflammatory infiltration is characteristic of what
Guillain-Barre syndrome
difference between Duchenne and Becker mutations
Duchenne: frameshift mutation
Becker: non-framshift
investing rat poison is similar to what type of toxicity
Warfarin toxicity
how is rat poison treated
fresh frozen plasma in addition to vitamin K
Protamine sulfate used to an overdose of what
heparin
Desmopressin increases what in the clotting cascade
- von Willebrand factor
- factor VIII
Cryoprecipitate contains what
- Factor VIII
- Factor XIII
- von Willebrand factor
- fibrinogen
What goes wrong in achondroplasia
gain-of-function mutation in FGFR3 gene
Aminoglycosides inhibit what process
- inhibit genetic code reading and protein synthesis by binding to prokaryotic 30S ribosomal subunit
Adverse effect of aminoglycoside
- nephrotoxicity
- neuromuscular blockage
- Ototoxicity
- Teratogen
Patients who receive the equivalent of more than one body blood volume of whole blood transfusions or packed red blood cells over a period of 24 hours my develop elevated plasma levels if what substance? what does this cause
- citrate: chelates calcium and magnesium
- can cause paresthesias
internuclear ophthalmoplegia is damage to what structure
medial longitudinal fasciculus
Lesion to the right dorsal paramedian pons can disrupt what other structure and cause what
- right MLF
- internuclear ophthalmoplegia
Mu receptors bind to what type of receptor and what happens
G protein
- increase potassium efflux
- hyper polarization of postsynaptic neurons, blocking pain
Naproxen
NSAID
Adverse effects of TCA overdose
- convulsions
- coma
- cardiotoxicity ( widened QRS interval or ventricular arrhythmias)
how do TCAs create cardiotoxicity
block sodium channel on heart
How do you treat arrhythmias in cardiotoxicity
- sodium bicarbonate
Classic presentation for benzodiazepine overdose
CNS depression with normal vital signs
patient with pancreatitis and subsequent respiratory failure likely has what
acute respiratory distress syndrome
what are causes of acute pancreatitis
I GET SMASHED Idiopathic gallstones ethanol trauma steroids mumps autimmune scorpion sting hypercalceia/hypertriglyceridemia ERCP Drugs
What are causes of acute respiratory distress syndrome
Sepsis Pancreatitis, pneumonia Aspiration uremia trauma amniotic fluid embolism shock
pathology of acute respiratory distress syndrome
- endothelial damage
- increase alveolar capillary permeability
- protein-rich leakage into alveoli
- diffuse alveolar damage and noncardiogenic pulmonary edema
intra-alveolar hyaline membranes
autopsy of 78 year old man died of esophageal cancer and has small heart without significant coronary artery atherosclerosis. Myocardial cells show prominent intracytoplasmic granules that are tinged yellowish-brown. what is this in the heart?
lipid peroxidation
what does monoamine oxidase do
- degrades exces monoamine neurotransmitters in presynaptic nerve terminals
- detoxifies dietary tyramine in GI tract
What is a hypertensive emergency
- severe hypertension
- headache
- blurry vision
What are changes in Km and Vmax in competitive inhibitors
Km increased
Vmax is unchanged
effect of Km on noncompetitive inhibitors
does not change
how do you diagnose Mucro and Rhizopus
- mucosal biopsy
- broad nonseptate hyphae with right-angle branching
what is the difference between leading and lagging strand
- lagging need more DNA ligase
Everytime GFR halves, what happens to creatinine
doubles
MOA for naloxone
pure opioid receptor antagonist
MOA for cyanide toxicity
- cyanide binds ferric ( Fe3+) iron
- inhibits cytochrome C oxidase in mitochondria
What is the PE for cyanide poisoning
reddish skin discoloration
laboratory studies for methemoglobin
- lactic acidosis
- narrowing of the venous-arterial PO2 gradient
edetate disodium calcium chelates what
lead
what are the key cells involved delayed-type hypersensitivity reaction ( type IV)
- marcrophages
- CD4 helper T cells
- CD8 cytotoxic T cells
failure to generate a Type IV hypersensitivity is called
anergy
Severe combined immunodeficiency is caused by what
- genetic defect in T cell development,
- leading to loss of both cellular and humoral immunity
What is a common clinical presentation for SCID
- failure to thrive
- chronic diarrhea
What is pernicious anemia
- autoimmune disease characterized by CD4 mediated destruction of parietal cells
What are 2 effects of having loss of parietal cell mass
- megaloblastic anemia
- elevated intraluminal pH that stimulates gastrin secretion
Location of indirect inguinal hernias
lateral to the inferior epigastric vessels
Location of direct inguinal hernia
medially to the inferior epigastric vessels
Which type of hernia protrudes into the scrotum
indirect inguinal hernia
for the degree of overlap between healthy and diseased population curves, what effects sensitivity and specificity
chosen cutoff value
