Thurs July 2 Flashcards
If someone has a rapid ventricular rate, where should the radiofrequency ablation occur?
at the AV node
where ist he AV node?
endocardial surface of the right atrium, near the insertion of the septal leaflet of the tricuspid valve and the orfice of the coronary sinus
where should radioablation occur with atrial flutter?
between the tricuspid valve and IVC opening
where should radioablation occur with an abberant current leading to afib?
left atrium near the pulmonary veins
what class of antiarythmic is amiodarine?
class III
how do class III antiarythmics work?
They block K channels, prolonging phase 3 (repolariztiation)
which antiarythmic has little risk of causing torsades de pointes?
amiodarone
which enzyme converts glucose to sorbitol?
aldose reductase
why does sorbitol formation lead to oxidative stress?
the conversion of glucose to sorbitol requires NADPH, depleting it -> ox stress
how do B2 receptors effect potassium?
they cause an intracellular shift of K
gram stain of actinomyces
gram + bacillia, filamentous and branching
actinomyces is associated with which procedures?
dental extraction
oxygen preferance of actinomyces?
facultative/strict anearobe
what might you find in an infection with actinomyces?
Draining sinus tracts and sulfur granules
would an infection with actinomyces be painful?
not usually
are varicose veins usually in the superficial or deep veins?
SUPERFICIAL
the activation of which system increases endothelin release?
renin angiotensin aldosterone system
how would lobar consolidation effect tactile fremitus and breath sounds?
increased tactile fremitis and intensity of breath sounds since sound travels better in fluid than air
what type of shock does anaphylaxis cause?
Distributive shock - massive peripheral vasodilation from inflammatory mediators
what is methylnaltrexone?
A peripheral u-opioid antagonist that does not cross the BBB - can treat constipation
does methylnaltrexone cross the BBB?
no
is methylnaltrexone the first option for opioid induced constipation?
NO -give laxative first. If constipation is refractory, give methylnaltrexone
what types of polyps in the intestine are neoplastic?
serrated and adenomatous
Are adenomatous polyps that are tubular or villous more neoplastic?
VILLOUS
how should you pharmacologically treat a patient with low HDL?
As raising HDL is not associated with improved outcomes, you should focus on lowering LDL cholesterol - via HMG-coa reductase inhibitors
does niacin improve cardiovascular outcomes?
No
It does raise HDL, but raising HDL is not associated with improved outcomes
Sevelamer MOA
binds phosphorous in the intestine and leads to reduced absorption
Sevelamer USE
high phosphate caused by kidney disease that was not improved by dietary restriction
which liver cells are responsible for fibrosis?
Stellate cells - activated stellate cells transform to myofibroblasts which proliferate, induce chemotaxis and lay down collagen
which enzyme do H pylori bacteria produce?
urease - splits urea into ammonia and CO2
why is urease important for H pylori survival?
the production of ammonia lowers the pH and allows for survival in the stomach
what causes atresia of the duodenum?
failure to recanulize at 8-10 weeks gestatino
what causes atresia of the jejunum/ileum ?
vascular occlusion in utero
how will an atresia caused by vascular occlusion look on imaging?
‘apple peel’ sign -blind pouch followed by a spiral configuration
what causes hirschsprung disease?
failure of neural crest cells to migrate
What is hirschsprung disease associated with?
Down syndrome
methanol metabolites can lead to
blindness
Ribosomes attached to the RER usually make which types of proteins?
secreted proteins, membrane proteins, and proteins for within the lysosome, golgi, and ER
Free ribosomes mostly make which type of proteins?
cystolic proteins
symptoms of digoxin toxicity?
YELLOW TINT and other vision changes, anorexia, nausea, vomiting, fatigue, confusion, weakness
how is digoxin metabolized?
renally
where is digoxin primarily stored in the body?
the muscles
what is the blood supply to the lesser curvature of the stomach?
right and left gastric arteries
what is the blood supply to the greater curvature of the stomach?
right and left gastric epiploic
what does the common hepatic artery split into?
proper hepatic, and Gastroduodenal arteries
where does the right gastric artery come off of?
the proper hepatic
what is adenomyosis?
the presence of endometrial glandular tissue in the myometrium
how will someone with adenomyosis present?
uniformly enlarged uterus with normal tissue biopsy
-may present with heavy bleeding or abnormal bleeding
what is chlordiazepoxide?
a benzo
carbemazapine MOA
Na channel blocker
what family does measles belong to?
paramyxoviridea
what is the polarity and genetic type of measles?
- sense RNA
how does desmopressin help to treat von willibrand disease?
it induces the release of vWF from endothelial cells
vWF factor stabliziles which coag factor?
VIII - they circulate bound together
a small cavitary lesion in concordence with stroke symptoms is likely a …
lacunar infart
where do lacunar infarcts usually effect?
small arterioles that supply deep brain structures
what is the function of hormone sensitive lipase?
catalyzes the mobilization of stored triglycerides into FFAs and glycerol in adipose tissue, in response to glucagon, catecholamines, ACTH
what do cells infected with viruses produce?
interferons alpha and beta
what does IFN alpha and beta bind to?
IFN I receptors on neighbouring cells and their own cels
what does the binding of IFN I receptor result in intracellularly?
transcription of antiviral enzymes that can halt protein synthesis such as RNase. They only become active in the presence of dsRNA (viral replication),
during which step of the TCA cycle is GTP synthesized?
the conversion of succinyl-coa to succinate
what is the only part of the respiratory tract that has stratified squamous epithelium?
The true vocal chords (these face a lot of friction and thus need squamous stratified epithelium)
which part of the respiratory tract may HPV infect?
the true vocal cords - stratified squamous
in which schizophrenic patients is the drug clozapine particularly useful?
Treatment resistant schizophrenia
Schizophrenia with suicidality
is clozapine a first or second generation antipsychotic?
second gen
Adverse effects of clozapine?
Agranulocytosis
Seizures
Metabolic dysfunction
Myocarditis
Patients with congestive heart failure who are given mannitol are at risk for?
pulmonary edema
what percent of means would lie within one standard deviation?
68%
what percent of means would lie within two standard deviations?
95%
what percent of means would lie within three standard deviations?
99.7
what is the most posterior chamber of the heart?
left atrium
which chamber of the heart lies directly infront of the esophagus?
left atrium. Enlargment -> dysphagia
how far down do the lungs go?
Anteriorly: 6th rib
Posteriorly: 10thrib
