UW12 Flashcards
fever, malaise, weight loss, clubbing, leukocytosis, coupious foul smellig sputum
Lung Abscess
Aspiration when supine
Posterior segment of R. upper lobe. Superior segment of R. lower lobe
Aspiration when upright
Basal segment of R. lower lobe
Risk for aspiration
Altered consciousness (alcoholism, seizure, dementia), Immunosuppression (steroid, old age, long hospitalization), Poor dental hygiene, dental infections
Abnormal uterine bleeding, endometrial hyperplasia (or precocious puberty), right sided adnexal mass
Granulosa cell tumor
Ovarian tumor with small follicle like structures filled with eosinophilic secretions
Call-Exner bodies (Granulosa cell tumor)
Ovarian tumor that does not make estrogen. Sheets of “fried cell” cells
dysgerminoma
A type of ovarian tumor that contain skin and cartilage, can also produce what hormone
Dermoid cyst (teratoma) can produce thyroid hormone (struma ovarii)
Surface ectoderm
anterior pituitary ( Rathke’s pouch), lens, cornea, sweat and mammary glands, epidermis
Neuroectoderm
Brain, spinal cord, Posterior piuitary, retina (CNS)
Neural crest
PNS (sensory ganglia, schwann cells, endocardial cushions, branchial arch, skull bones, melanocytes, adrenal medulla
Mesoderm
muscles, connective tissue, serosal linings, CV system, spleen, kidney, ureters, adrenal cortex
Endoderm
GI tract, liver, pancreas, thymus, parathyroid, thyroid follicular cells, bladder, urethra
“claw hand”
ulnar nerve damage at the medial epicondyl of the humerous. Loss of flexion of wrist and medial fingers. Cant extend pinky
Difficulty with fine motor control of thumb
Carpal tunnel (median nerve compression)
Radial head subluxation
Deep branch of radial nerve (weakness of muscles in extensor compartment)
Innervation of the coracobrachialis
Musculocutaneous n
Fracture of the surgical neck of humerous
axillary nerve ( paralysis of deltoid)
psychotic episodes that last
Brief psychotic disorder
anxiety, depression, disturbed behavior that develops within 3 months of an identifiable stressor. Last no more than 6 months after stressor ends
Adjustment disorder
How do you manage somatic symptom disorder?
Regular visits with the same provider. Limit unnecessary workup and referrals. Mental health referral once physician-patient relationship is well established
what ethnicities are at an increased risk for osteoporotic fractures
white, hispanic, asian
First line agents for anti-convulsant therapy
Benzodiazepines ( diazepam, lorazepam, midazolam)
DOC for complex partial seizures
Carbamazepine
Phenobarbital can be used for what types of seizures
Partial and generalized tonic-clonic
What are some mood stabilizers for bipolar disorder?
Lithium, valproate, carbamzepine, Lamotrigine
Lithium
Manic and depressive episodes. SE: Diabetes insipidus, hypothyroidism, Tremor, Ebstein’s
Valproate
Manic episodes. Also absence, generalized tonic-clonic, myotonic seizures. SE: hepatotoxic, neural tube defects
Carbamazepine
Manic episodes. Also partial and generalized seizures and trigeminal neuralgia. CYPE inducer. SE: agranulocytosis, SIADH, Neural tube defects
Lamotrigine
Depressive episodes. Focal seizures. SE: Stevens Johnson syndrome
What drugs should be avoided in treating bipolar disorder?
SSRIs because they can induce mania
Lesion of the lateral hypothalamic nuclei
Anorexia
Lesion of the ventromedial hypothalamic nuclei
Hyperphagia, aggressive
Lesion of the Supraoptic hypothalamic nuclei
Decreased ADH synthesis
Lesion of the supraventricular hypothalamic nuclei
Decreased oxytocin synthesis
Lesion of the Anterior hypothalamic nuclei
Uncontrolled hyperthermia and death
Suprachiasmatic nuclei regulates
circadian rhythmn
Lesion of the posterior hypothalamic nuclei
Hypothermia ( cold)
increased contractility and strove volume causes what change in a pressure volume loop?
Increased ejection volume and higher systolic pressure
how does increased preload change a pressure volume loop?
increased EDV
How does increased afterload change a pressure volume loop?
increased left ventricular pressures. Decreased SV
How does systolic dysfunction change a pressure volume loop?
Decreased contractility leads to decreased stroke volume
Substrate level phosphorylation step in TCA
Succinyl-CoA to Succinate (Succinyl-CoA Synthetase). Makes GTP
Substrate level phosphorylation steps in gycolysis
1,3 BPG –> 3PG (phosphoglycerate kinase). PEP –> Pyruvate (pyruvate kinase). Makes ATP
Which steps in gluconeogenesis requires GTP?
Oxaloacetate –> PEP
Where is pyruvate carboxylase located?
Mitochondria ( used for gluconeogenesis)
Where is Phosphoenolpyruvate Carboxykinase located
Cytoplasm (gluconeogenesis)
Where is Glucose 6 phosphatase located?
ER of Liver. (gluconeogenesis)
neurological abnormalities, hypoxemia, petechial rash with long bone fracture
Fat embolism syndrome
Cisplatin
Forms reactive free radicals that crosslinks DNA. SE: nephrotoxic so give with Amifostine or chloride diuresis (keeps cisplatin in nonreactive state due to high Cl concentration)
Amifostine
Free radical scavenger that decreases nephrotoxicity d/t cisplatin
N-acetylcysteine
increases glutathione production and conjugation of toxic NAPQI metabolite. Used as a mucolytic agent in patients with bronchitis. Prevents radiocontrast induced nephropathy
Fomepizole
antidoe for methanol or ethylene glycol poisoning (preventes conversion into toxic metabolites)
Dexrazoxane
Iron chelating agent that prevents anthracycline-induced cardiotoxicity
What organism is pyrrolidonyl arylamidase (PYR) positive
S. pyogenes
How does nitroglycerin work?
venodilator ( decreases preload)
what is the volume of distribution
Volume into which the administered amount of drug will need to be uniformly distributed to produce the observed plasma concentration (amount of drug/plasma concentration)
which properties decrease a drugs volume of distribution
large molecular weight, bound extensively or is highly charged
pathogenesis of alcoholic hepatic steatosis
increased NADH causes decrease in fatty acid oxidation
what is formed when methyl-THF donates a methyl group to homocystine? What co-factor is required.
Forms Methionine and THF. Requires B12
What vitamin is required for conversion of methylmalonyl CoA to succinyl CoA?
Vitamin B12
What is elevated in Vit B12 deficiency
Methylmalonyl CoA
What is elevated in folic acid and B12 deficiency?
Homocysteine
What does pleuritic pain that increases with swallowing and radiates to the neck, fever tell you?
Pleuritic= pericardial. Swallowing= posterior pericardium. Radiation= inferior pericardium (adjacent to phrenic nerve). Fever= inflammatory
Brain tumor: soft, poorly defined with areas of necrosis and hemorrhage
Glioblastoma multiforme
Phenoxybenzamine
irreversible non-selective alpha blocker
Phentolamine
reversible non-selective alpha blocker ( used for pts on MAOi that eat tyramine containing foods)
Prazosin
alpha 1 blocker (HTN, BPH)
When are waxy casts een in the urine?
Chronic renal failure. (shiny, translucent casts formed in dilated tubules)
polyuria, polydipsia, polyphagia with fatigue and weight loss
Type I DM
which rash spreads faster? Rubella or rubeola?
Rubella (blueberry muffin rash) that does not darken or coalesce
floppy baby, poor feeding, jaundice, macroglossia, constipation and umbilical hernia
congenital hypothyroidism (cretinism)
at risk of injury during thyroidectomy
superior laryngeal (courses deep to the superior thyroid artery)
Brain tumor: elongated cells with regular, oval nuclei, biphasic pattern of growth with areas of dense cellularity interspersed with myxoid regions
Schwannoma
tumors that are S-100 +
Scwannoma, melanoma
Brain tumor: pseudopalisading necrosis
Globlastoma
elongated, or corkscrew intracytoplasmic eosinophilic bundles
Rosenthal fibers
Preferred anticonvulsants for focal seizures
Carbamazepine, gabapentin, Phenobarbital, phenytoin
Preferred anticonvulsants for generalized seizures
Lamtotrigine, Levetiracetam, Topiramate, Valproic acid
Sudden onset jerking movements involving both arms, occurs within first hour of waking and provoked by sleep deprivation
myoclonic seizure
abdominal pain, vaginal bleeding, hemorrhagic shock, tachycardia, cold clammy extremities, hx of amenorrhea
Ectopic pregnancy
What type of reaction is methylmalonyl CoA –> Succinyl CoA
Isomerization
which bacteria can cause gastroenteritis with only 10-500 cells
Shigella
anorexia, nausea, dark urine, low grade fever, RUQ pain
Viral hepatitis
diffuse ballooning degeneration, councilman bodies, mononuclear cell infiltrates
acute viral hepatitis
What does Antithrombin inhibit?
Factor Xa and thrombin
Enoxaparin
LMWH that inhibits Xa (not thrombin)
What do you use to treat restless leg syndrome
Dopamine agonist ( pramipexole)
What is P-glygoprotein?
ATP dependent efflux pump
how can pyogenic bacteria gain access to the liver?
Ascending cholangitis, portal vein pyemia, hepatic artery (systemic seeding), direct invasion or penetrating trauma
contralateral homonymous hemianopia, with macular sparing indicates an infarct in what artery?
PCA
treatment of choice for ectopic pregnancy
methotrexate
46XY, normal leydig cells. No sertoli cells
Male and female internal genitalia and male external genitalia
No sertoli cells
no MIF. Retain mullerian duct (female internal genitalia)
What cell produces MIF
Sertoli cells
Male external genitalia in genetically female fetus
Congenital adrenal hyperplasia
blue lesion under nails, tender to touch. What tumor?
Glomangioma. Glomus bodies shunt blood for thermoregulation
what is crucial to defense against mycobacterial diseases?
INF-y
when are black pigment stones seen?
increased extravascular hemolysis (increased unconjugated bilirubin)
what is the enzymatic defect in XP?
nucleotide excision repair (ENDOnuclease deficiency)
enzyme defect in HNPCC
Mismatch repair (3- -5’ EXONnuclease)
