UW12 Flashcards by Unknown Unknown

fever, malaise, weight loss, clubbing, leukocytosis, coupious foul smellig sputum

Lung Abscess

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Aspiration when supine

Posterior segment of R. upper lobe. Superior segment of R. lower lobe

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Aspiration when upright

Basal segment of R. lower lobe

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Risk for aspiration

Altered consciousness (alcoholism, seizure, dementia), Immunosuppression (steroid, old age, long hospitalization), Poor dental hygiene, dental infections

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Abnormal uterine bleeding, endometrial hyperplasia (or precocious puberty), right sided adnexal mass

Granulosa cell tumor

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Ovarian tumor with small follicle like structures filled with eosinophilic secretions

Call-Exner bodies (Granulosa cell tumor)

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Ovarian tumor that does not make estrogen. Sheets of “fried cell” cells

dysgerminoma

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A type of ovarian tumor that contain skin and cartilage, can also produce what hormone

Dermoid cyst (teratoma) can produce thyroid hormone (struma ovarii)

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Surface ectoderm

anterior pituitary ( Rathke’s pouch), lens, cornea, sweat and mammary glands, epidermis

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Neuroectoderm

Brain, spinal cord, Posterior piuitary, retina (CNS)

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Neural crest

PNS (sensory ganglia, schwann cells, endocardial cushions, branchial arch, skull bones, melanocytes, adrenal medulla

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Mesoderm

muscles, connective tissue, serosal linings, CV system, spleen, kidney, ureters, adrenal cortex

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Endoderm

GI tract, liver, pancreas, thymus, parathyroid, thyroid follicular cells, bladder, urethra

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“claw hand”

ulnar nerve damage at the medial epicondyl of the humerous. Loss of flexion of wrist and medial fingers. Cant extend pinky

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Difficulty with fine motor control of thumb

Carpal tunnel (median nerve compression)

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Radial head subluxation

Deep branch of radial nerve (weakness of muscles in extensor compartment)

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Innervation of the coracobrachialis

Musculocutaneous n

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Fracture of the surgical neck of humerous

axillary nerve ( paralysis of deltoid)

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psychotic episodes that last

Brief psychotic disorder

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anxiety, depression, disturbed behavior that develops within 3 months of an identifiable stressor. Last no more than 6 months after stressor ends

Adjustment disorder

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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

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what ethnicities are at an increased risk for osteoporotic fractures

white, hispanic, asian

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First line agents for anti-convulsant therapy

Benzodiazepines ( diazepam, lorazepam, midazolam)

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DOC for complex partial seizures

Carbamazepine

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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)