UW2 Flashcards
Thin curivilinear areas of lucency that parallel the lumen
Pneumatosis intestinalis ( necrotizing enterocolitis)
double bubble on xray
doudenal atresia ( air in stomach and proximal duodenal pouch)
Failure to to pass meconium in first 48 hours. Contrast enema with narrow caliber transition zone
Hirschsprung
Non-bilious vomiting after feeding and palpable ball of muscle
Pyloric stenosis
Calculate incidence
new cases/ population risk (total population- people who already have disease)
fatigue, easy bruising, low reticulocyte count, no splenomegaly. Low platelet, low Hb
aplastic anemia
Hypocellular marrow filled with fat cells and fibrotic stroma
aplastic anemia
Hypercellular marrow with megaloblastic hematopoiesis
Myelodysplastic syndrome or megaloblastic anemia (macrocytosis)
Hypergranular promyelocytes with auer rods
Promyelocytic leukemia (AML)
Hypercellular marrow filled with blast forms
Myeloproliferative disorders, myelodysplastic syndrome, AML
Decreased left ventricular chamber size that causes ventricular septum to acquire a sigmoid shape. Increased interstital connective tissue. Accumulation of cytoplasmic granules with brownish pigment
Normal aging ( lipofuscin pigment)
Increased left ventricular size
dilated cardiomyopathy
Asymmetrical septal wall hypertrophy with disproportionate thickening of ventricular septum compared to L ventricular free wall
Hypertrophic cardiomyopathy
Subendocardial vacuolization and fibrosis
Chronic ischemia heart disease
What drug should be given to pts who has hx of MI and congestive heart failure
ACE inhibitor
Drug for essential HTN without CHF or diabetes
Thiazide
Net renal excretion
Total filtration (GFR-measured by inulin * Px) - tubular reabsorption
Empiric treatment of S. auerus with hx of hospitalization
Vancomycin
Reactive arthritis after campylobacter, shigella, salmonella, yersinia, chlamydia, bartonella is associated with what antigen
HLA B27
PDA is associated with what infection?
congenital rubella
Anti-mitochondrial antibodies ( with Florid duct lesions)
Primary biliary cirrhosis
Hepatocellular swelling and necrosis, mallory bodies, neutrophilic infiltration, fibrosis
alcoholic hepatitis
Liver failure and centrilobular necrosis
Acetaminophen overdose
Microvesicular steatosis
Reyes syndrome
Liver is reddish purple and develops a tense capsule. Severe centrilobular congestion and necrosis
Budd chiari (increased intrahepatic BP due to thrombosis of hepatic vein)
steps of collagen synthesis
Signal sequence directs growing polypeptide chain into ER (prepro-alpha chains). Signal sequence is cleaved to pro-alpha chain. Hydroxylation of proline and lysine (vitamin C). Glycosylation of lysine residues. Assembly of pro-collagen. Terminal peptidases cleaved by pro-collagen peptidases to make tropocollagen. Collagen fibrils assemble. Crosslinking by lysyl oxidase
abnormally thin type I collagen fibrils that have disulfide rich globumar domains
procollagen peptidase deficiency causes impaired cleavage of N and C terminals to cause more soluble collagen that does not crosslink properly
PFTs with Hyperinflated lungs and flattened diaphragm
Normal or decreased FVC, decreased ratio, normal lung capacity, increased functional residual capacity. Normal diffusion
why is Diffusion capacity decreased in emphysema?
Diffusing capacity depends on thickness of surface area and volume of capillary blood. Interalveolar wall destruction decreases the alveolar-capillary surface area thus decreasing diffusing capacity
why is lung elastic recoil decreased in emphysema?
destruction of interalveolar walls causes lung elastic recoil to decrease
leukocytosis, hypotension, tachycardia
septic shock
Causes of lactic acidosis
Enhanced metabolic rate, reduced oxygen delivery, diminished lactate catabolism, decreased oxygen utilization, enzymatic defects in glycogenolysis or gluconeogenesis
Incereased anion gap, decreased bicarb
metabolic acidosis
anion gap
Na- (Cl + HCO3)
Predisposing factors for aspiration pneumonia
altered consciouness imparing cough reflex and glottis closure, dysphagia due to neurologic deficiets, upper GI tract disorders (GERD), mechanical compromise of aspiration defenses, protracted vomiting, large volume tube feedings in recumbent position
Pancreatic insufficiency, infertility due to absent vas deferens
Cystic fibrosis
Situs inversus, infertility due to immotile spermatozoa
Primary ciliary dyskinesia
why do NSAIDS result in decreased loop diuretic response?
NAIDS inhibit prostaglandin synthesis. Proastaglandins have a vasodilatory effect to increase renal blood flow and increase GFR. Loop diuretics also increase proastaglandin release
ANP and BNP
vasodilation, natriuresis, diuresis in response to volume expansion
weak forearm flexion, absent bicep reflex, decreased sensation in lateral forearm
musculocutaneous n (upper trunk)
posterior arm sensation
radial nerve
posterior forearm sensation
radial nerve
medial forearm sensation
ulnar
thenar eminence sensation
recurrent branch of median nerve
bilious vomiting after first 24 hours of life
intestinal stenosis and atresia secondary to vascular accidents in utero
apple peel atresia
missing a segment of large bowel with distal ileum winding around vascular stalk
what should you check in metabolic alkalosis
volume status and urine chloride
how does hemolytic anemia lead to macrocytic changes?
Predisposition to folic acid deficiency due to increased erythrocyte turnover
central collection of tightly clustered epithelioid macrophages surrounded by rim of mononuclear cells
non-caseting granuloma
hilar adenopathy, pulmonary infiltrates, non-caseating granuloma in AA female
sarcoidosis
TH1 cells
drive cell mediate immunity. Secreted by CD4 T cells. Autocrine proliferation of TH1
CD4 T cells secrete what cytokines?
IL2 and interferon gamma
TH2 cells
stimulates eosinophil production and activation by secretion of IL5. B cell synthesis of IgA
Fever, pruritic skin rash and arthralgias after administration of chimeric monoclonal antibody. skin biopsy shows fibrinoid necrosis and neutrophil infiltration involving small blood vessels.
Acute Serum sickness. Deposition of circulating immune complex (type III HSR). Deposition of IgG or IgM complement fixing antibodies result sin localized complement consumption and hypocomplemntemia (low serum C3). Aso seen in PCN, cefaclor and TMP-SMX
Anaphylaxis, allergies are examples of what type of HSR
Type I (immediate), IgE, Basophils and mast cells
Autoimmune hemolytic anemia, Goodpasture’s are examples of what type of HSR?
Type II (cytotoxic), IgG, IgM autoantibodies. Phagocytes, complement mediated cell injury.
Serum sickness, PSGN, lupus nephritis are examples of what type of HSR?
Type III (immune complex), Deposition of antibody-antigen complexes. Neutrophils, complment activation
Contact dermatitis, TB skin test are examples of what type of HSR?
Type IV (delayed), T cells and macrophages
Harsh crescendo-decrescendo systolic ejection mumur along lower left sternal border and apex
Hypertrophic cardiomyopathy (left ventricular outflow tract obstruction)
what will increase the intensity of a murmur in Hypertrophic CM?
Decrease preload or afterload reduce LV chamber size, which decreases the separation between the mitral valve and interventricular septum, increasing obstruction
What maneuvers will decrease preload?
Sudden standing, valsalva or Nitroglycerin administration
What maneuvers will increase preload and/or afterload?
Squatting, sustained handgrip, passive leg raise
99mTc-pertechnetate scan
Detects presence of gatric mucosa. Accumulation in right lower abdominal quadrant is diagnostic for Meckel diverticulum ( ectopic gastric mucosa) Failure of obliteration of omphalomesenteric duct
Black, tarry stool, right lower quadrant pain in a two year old
Meckel diverticulum
anal agenesis or imperforate anus
failure of hindgut descent along IMA
Muscarinic effect on peripheral blood vessels?
Vasodilation. Binding of muscarinc receptors on endothelial cells causes release of NO (endothelium derived relaxing factor) which activates guanylate cyclase and increases cGAMP. cGAMP activates Ca pump that causes smooth muscle relaxation
Cholinergic effects on smooth muscle of visceral walls
Increase smooth muscle tone to increase motility and secretions in GI tract. Anti-cholinergics relax GI wall and increase contraction of sphinters causing constipation
Drugs with anti-muscarinic effects
Atropine, TCA, H1 antagonist, neuroleptics, antiparkinsonian
Upper motor neuron signs
spastic paralysis, hyperreflexia and upgoing plantar reflex
Lower motor neuron signs
Flaccid paralysis, areflexia, atrophy and fasciculation
stab wound above clavical between midclavicular and lateral stenal line
lung apice and cervical pleura extend above clavical injury can punchture pleura and cause pneumothorax
Hypotension, tachypnea, hypoxemia, absent breath sounds and hyperresonance on affected side
tension pneumothorax
surgery involve posterior triangle of neck can damage which nerve
Accessory (CN 11), posterior triangle= scm, trapezius and clavicle
Penetrating trauma to neck above cricoid
Damange to ansa cervicalis (C1-3) innervates sternohyoid, sternothyroid and omohyoid
What stimulates activation of endothelial nitric oxide synthase and what does it do?
stimulated by AcH, bradykinin and shear stress. Synthesizes NO from Arginine and O2 to make NO and citrulline. NO activates Guanylate cyclase to increase cGMP
Rb mutations increase risk for what cancers?
Retinoblastoma, Osteosarcoma
Visual field defect in macular degeneration, optic neuritis
Mono-ocular scotoma. Lesion can be in retina, optic disc or optic nerve. Ipsilateral
Visual field defect in retinal artery occlusion
Anopia. Lesion in optic nerve. Ipsilateral
Visual field defect in pituitary tumor, craniopharyngioma
Bi-temporal hemianopia. Lesion in optic chiasm
Visual field defect due to calcification or aneurysm of R. internal carotid artery
Right peri-chiasmal lesion leading to right nasal hemianopia. Compression causes impingement of uncrossed fibers
Visual field defect due to occlusion of anterior choroidal artery or occlusion of MCA or posterior limb of internal capsule
Lesion in Right optic tract or radiation leads to contralateral homonymous hemianopia.
Visual field defect due to stroke of temporal lobe
Right temporal lobe (meyer’s loop) leads to left homonymous superior quadrantanopia
Visual field defect due to stroke involving parietal lobe
Right parietal lobe (dorsal optic radiation) causes left honomymous inferior quadrantopia. Contralateral
Visual field defect due to PCA
Left homonymous hemianopia with macular sparing due to lesion in occipital lobe. Contralateral
Pain and stiffness in knee, brown spots on sclera and darkening of helix on the ear
Alkaptonuria. Autosomal recessive caused by deficiency in homogentisic acid oxidase. Accumulated homogentisic acid deposits in connective tissues. Urine turns black when exposed to air
Enzyme defect in PKU
Phenylalanine hydroxylase
Enzyme defect in Albinism
Tyrosinase
Enzyme defect in maple syrup urine disease
Branched chain ketoacid
Add primaqine for treatment of which species of malaria
vivax and ovale
Fasting hypoglycemia
Defect in gluconeogenesis or glycogenolysis
Lactic acidosis
tissue hypoxia or oxidative phosphorylation defects
Treatment of CF
N acetylcysteine is a mucolytic agent that cleaves disulfide bonds to loosen thick sputum. Dornas alpha (DNAse) to clear leukocytic debris
DOC for aspiration pneumonia
Clindamycin
Cervical spinal cord
ovoid with more white matter than grey. Both gracilus and cuneate present. Large ventral horns
Thoracic spinal cord
Intermediolateral cell column (preganglionic sympathethic)
Lumbar spinal cord
More gray matter. No lateral horns. Dorasal nerve root, ventral nerve root, prominent ventral horn
Muromonab
OKT3 inhibits T lymphocytes (anti-CD3 antibody) useful for treatment of acute rejection in pts with kidney, heart and liver transplants
recent viral infection, discomfort in neck, reduced radioactive iodine uptake
De Quervains thyroiditis (granulomatous thyroiditis). Mixed, cellular infiltration with multinucleate cells
Branching papillary structures with concentric calcifications in thyroid gland
Papillary thyroid cancer
Diffuse mononuclear infiltration with germinal centers in thyroid
Chronic lymphocytic thyroiditid (hashimoto)
Extensive fibrosis of thyroid gland
Riedel thyroiditis
treatment of acute leukemia with uric acid crystals
Tumor lysis syndrome. High cell turnover causes uric acid to be released in serum and filtered by kidney. pH is lowest in PT DT and CT so they can cause precipitation (acidic)
diplopia, disphagia, dysphonia
Botulism
Diseases associated with travel
infectious diarrhea, malaria, hepatitis, yellow fever, dengue fever, hantavirus
STDs
Gonorrhea, Chlamydia, Mycoplasma hominis, Ureaplasma, Treponema, Haemophillus, HIV, HSV, Hep B, HPV, trichomonas
Family history of recurrent infections
Agammaglobulinemia, Wiskott aldrich syndrome
Embryology: Unilateral aplasia of fibula
Failure of proliferation
Embryology: Autoimmune disease due to persistence of autoreactive T or B cells
Failure of apoptosis
Embryology: Branchial cleft cyst
Failure of obliteration
Embryology: Hirshsprung disease
Failure of migration of neural crest cells
Embryology: Hypospadiase
Failure of fusion (urethral folds)
most common GI cancer
Colon adenocarcinoma in the rectosigmoid colon
Western blot
Protein ( translation)
Northern blot
RNA (trascription)
Southwestern blot
RNA bound protein (transcription factors)
Avoiding unacceptable feelings by behaving badly
acting out
Behaving as if an aspect of reality does not exist
Denial
Altering perception of upsetting reality to be more acceptable
Distortion
Disrupting memory, identity and consciouness to cope with an event
Dissociation
Transferring feelings to a more acceptable object
Displacement
Substituting imagingary scenarios
Fantasy
Using intellect to avoid uncomfortable feelings
Intellectualization
Attributing one’s own feelings to others
projection
Responding in a manner opposite to ones actual feelings
reaction formation
Reverting to an earlier developmental stage
Regression
Blocking upsetting feelings from entering consciouness
Repression
Seeing others as all bad or all good
Splitting
Avoiding negative feelings by helping others
Altruism
Using humor to avoid uncomfortable feelings
Humor
Channeling impulses into socially acceptable behaviors
Sublimation
Putting unwanted feelings aside to cope with reality
Suppression
Alpha ketoglutarate dehydrogenase
TCA cycle. A-kg to succinyl co-A requires Thiamine, lipoic acid, CoA, FAD, NAD
Funciton of vWF
Promotes platelet adhesion at injury sites by crosslinking glycoproteins with exposed collagen and serves a carrier for factor 8 that prevents it degradation
proximal muscle weakness, violaceous discoloration of upper eyelids, scaling eruptions of knuckles. Elevated CPK
Dermatomyositis
When is captopril contraindicated?
C1 esterase deficiency
Alkaptonuria
Tyrosine metabolism. Deficiency of homogentisate oxidase. Prevents conversion of tyrosine to fumarate
Cysteine is formed form what amino acids?
Serine and homocystein (methionine)
Epithelium of the paranasal sinus
ciliated, pseudostratified, columnar, mucus secreting
larygneal vestibule epithelium
ciiated, pseudostratified, columnar, mucus secreting epithelium
Trachea epithelium
cilated, pseudostratified, columnar, mucus secreting
Reccurent candida infections. At risk of developing a malignant B lymphocyte proliferation associated with what virus?
EBV
What is the function of transepeptidase in bacteria?
Penicillin binding protein that functions to cross link peptidoglycan in bacterial cell wall
Bitemporal hemianopia with elevated prolactin. Lab values:
Decreased GnRH, LH, Testosterone
Effect of TCAs
Tachycardiac, delirium, dilated pupils, flushing, hyperthermia, ileus, urinary retention. Peripheral vasodilation, arrhythmia, hypotension, seizures, tremors, sedation
TCA
amitriptyline, nortriptyline, imipramine, desipramine, clomipramine
Sporadic encephalitis in teenage. Aphasia, olfactory hallucinations, personality changes
HSV-1 has a predilection for temporal lobe
Constriction of the efferent arteriole produces what change in GFR?
Increases GFR by increasing flomerular capillary hydrostatic pressure due to reduction of glomerular blood flow. Increase in GFR also leads to an increase in filtration fraction
What is responsible for the toxic effects of N. meningitidis?
Lipooligosaccharide (LOS)
What cytokines do TH2 cells secrete?
IL4 and IL5 which activate B cells. Some B cells transform into plasma cells that produce IgM. Majority of B cells proliferate in germinal lymph nodes and transform into memory cells. Antibody switching allows B cells to secrete IgG, IgA, IgE during subsequent encounters
IL-4
B cell growth and isotype switching. Also stimulates differentiation of naïve T cells to TH2 helper
IL-5
B cell differentiation. Stimulates IgA production and eosinophil activity
IL-1
Produced by macrophages. Activates naïve T cells to differentiated into TH1 and TH2. Endogenous pyrogen
IL-2
Secreted by Th1. Stimulates development of CD4, CD8 and B cells
IL-3
Stimulates growth and differentiation of bone marrow stem cells. Produced by T helper cells
IL-10
helps regulate balance between TH1 and TH2. Produced by TH2 and inhibits production of interferon gamma leading to decrease in TH1
IL-12
synthesized by macrophages and stimulates growth and development of TH1
increase orotic acid in urine. Megaloblastic anemia
Orotic aciduria. Defect in pyrimidine synthesis. Enzymes that convert orotate to UMP. Tx: Uridine
Increase in orotic acid in urine. No megaloblastic anemia
OTC deficiency. Urea cycle. Excess orotic acid is converted to pyrimidine due to increase in carbamoyl phosphate (by CPS II)
What is Modafinil used for?
Narcolepsy. (p450 inducer)
What marker suggests good prognosis in ALL?
ALL mostly affects children and blast cells positive for CD10 suggests good prognosis
Diuretic. Hypokalemia, Metabolic acidosis, Hypocalcemia
Loop diuretic
Diuretic. Hyponatremia, Hypokalema, Metabolic alkalosis, Hypercalcemia
Thiazide
Diuretic. Hypokalemia. Metabolic acidosis
Acetazolamide
Diuretic. Hyperkalemia. Metabolic acidosis
Spironolactone
Primary defect in cells or tissues that form an organ
Malformation (holoprosencephaly, congenital heart disease, anencephaly, polydactyly, syndactyly)
Fetal structural anomalies that occur due to extrinsic mechanical forces
Deformations ( clubbed feet, congenital hip dislocation)
Secondary breakdown of previous normal tissue or structure
Disruption ( amniotic band syndrome)
abnormalities that result from a single primary defect
Oligohydramnios in Potter Syndrome
Complete absence of organ
Agenesis (renal agenesis)
Pill induced esophagitis is seen with what medications?
Tetracyclines, potassium choloride and bisphosphonates
What is contained in the hepatoduodenal ligament?
Hepatic artery, portal vein and common bile duct
Pringle maneuver
Occlusion of portal triad by clamping the Hepatoduodenal ligament to determine source of bleeding. If bleeding continues, source is likely to be inferior vena cava or hepatic vein
What drugs act to antagonize leukotriene D4 receptors
Zafirlukast and Montelukast
irregular tachycardia after binge drinking
a-fib (holiday heart syndrome). Irregularly irregular with absent p waves
A fig EKG
irregularly irregular QRS with absent P (coordinated atrial contractions do not occur)
Ventricular tachycardia, regular rate with shifting sinusoidal waveforms
Torsades. Tx with magnesiums sulfate
High QRS voltage in precordial leads
Ventricular hypertrophy
Prolonged QRS interval
Ventricular dysynchrony or slowed interventricular conduction ( bundle branch block)
Pyruvate dehydrogenase
Pyruvate to acetyl coA (aerobic), TCA
Pyruvate carboxylase
Pyruvate to oxaloacetate (Gluconeogenesis)
Lactate dehydrogenase
Pyruvate to lactic acid (anaerobic)
ambiguous genitalia in girls, salt wasting, hypotension, low Na, high K
21-hydroxylase deficiency
Ambiguous genitalia in girls. Fluid and salt retension, hypertension
11B hydroxylase deficiency
Phenotypically female, fluid and salt retention, hypertension
17a-hydroxylase deficiency
Mechanism of sulfonylurea
increase insulin secretion of pancreatic islet B cells in TypIIDM (glyburide)
oral antidiabetic medication that reduce hepatic glucose production and increase insulin sensitivity
Metformin and rosiglitazone
Maintence dose
Css x Cl (adjust for dosing intervals x 60min/hr x interval)
Half life
Vd x0.7/CL
How many half lives does it take to achieve steady state concentration?
5-Apr
Loading dose
Vd x Css/bioavailability
Mechanism of action for amantidine
impairs uncoating or disassembly of influenza A
Heparin reversal
Protamine
Reverse fibrinolysis
Aminocaproic acid
What does cryoprecipitate contain?
Factor 8, Fibrinogen, vWF
Warfarin reverse
Fresh frozen plasma and vitamkin K
Dobutamine
Beta adrenergic agonist. Increases cardiac contractilty to increase cardiac output. Increase HR. Thus leads to increased myocardial oxygen consumption
High blood/gas partition coefficient
More soluble in blood. Slower equilibrium with brain, longer onset times (Halothane)
Low blood/gas partition coefficient
low solubility in blood. Saturates brain quickly. Rapid onset. Nitric oxide
Pseudogout crystals
Calcium pyrophosphate
Acid buffers in urine
HPO4 and NH3 in urine due to increase acid production in metabolic acidosis
Causes of dilated cardiomyopathy
Coxsackie B, peripartum, alcohol, chronic SVT, Doxorubicin, Thiamine deficiency
Changes in ischemic infarct of brain
1 week: ischemic area is hypodense and poorly delineated from surrounding tissue. Edema and loss of distinction of gray white matter on CT. Neurons show signs of irreversible damage ( red neurons). Neutrophils move into area, followed by microglia (days after onset). As neurons disintegrate, fragments are phagocytosed (lipids is cytoplasma of microglial is due to myelin breakdown products)
Progression of changes after ischemia infarct of brain
Microglial move to ischemia infarct after 3-5 days. Cystic space forms. Astrocytes form glial scar along periphery
relative risk
Ratio of (developing disease with risk factor) to (developing disease without risk factor)
Sarcomere: H band
Only myosin thick filaments
Sarcomere: A band
Entire thick myosin filament
Sarcomere: I band
Only thin filaments
Sarcomere: Z line
hold actin thin filaments
Down syndrome comorbidities
Early onset alzheimer, Atrioventricular septal defect, VSD, ASD, duodenal atresia, Hirshsprung, Hypothyroidism, T1DM, obesity, acute leukemia, Atlantoaxial instabiity
occurrence of multiple manifestations as a result of single gene defect
Pleiotropy
alleles that tend to be inherited jointly because there are near one another on same strand of DNA
Genetic linkage
infant with jaundice, hepatosplenomegaly, generalized edema, low HB, nucleated erythrocytes. Extramedullary hematopoiesis
Hemolytic disease of newborn (hydrops fetalis)
Mechanism of Isoniazid
inhibits syntheisis of mycolic acids
Mechanism of Ethambutol
Inhibits mycobaterial cell wall synthesis by blocking arabinosyl transferase (carbohydrate polymerization) Associated with vision changes
Mechanism of Rifampin
Inhibits mycobacterial DNA-dependent RNA polymerase
Mechanism of pyrazinamide
acidify intracellular environmentc in phagolysosome (after TB is engulfed by macrophages)
blood filled vascular spaces lined with single epithelial layer in liver
Canvernous Hemangioma. Benign. Do not biopsy due to risk of rupture
Subacute bacterial endocarditis after dental work
Viridans Strep
Infective endocarditis after GU procedures
Enteroccoci
Infective endocarditis with colonic cancer
Strep. Bovis
What is the course of the esophagus in the thorax?
Courses between trachea and vertebral bodies. Typically collapsed with no visible lumen
Where are serotonergic neurons found?
Raphe nuclei
What neurons are found in the nucleus ceruleus (dorsal pons)
NE secreting cells
What neurons are found in the nucleus basalis of Meynert?
Cholinergic neurons
what is the function of the neurons in the red nucleus?
motor coordination of upper extremities
What neurons are found in the substantia nigra?
Dopaminergic
Steps in base excision repair
Glycosylase, endonuclease, lyase, DNA polymerase, ligase
which biochemical processes occur in the mitochondria?
Beta oxidation, ketogenesisi, TCA, parts of urea cycle and pyruvate carboxylation
Which enzyme of the pentose phosphate pathway is found in the cytoplasm?
Transketolase (requires thiamine)
Regulation of insulin secretion from beta cells
Glucose enters (GLUT2) undergoes oxidative phosphorylation which makes ATP. ATP activates K+ channels which allow K+ to leave cell causing depolarization. Depolarization opens Ca channels that leads to insulin release
What is used to treat SVTs (a-fib) and is use-dependant?
Flecainide (sodium block prolonges QRS duration) Slowest to dissociate from sodium channel so sodium blocking effects intensifies as heart rate increases due to less time between AP for medication to dissociate from receptor
Capsule of ribose, ribitol and phosphate
HIB
Schilling test
Normal excretion of urinary B12 suggest normal absorption. Give radiolabled B12 with IF to distinguish between pernicious anemia and malabsorption
low radiolabled vitamin B12 not corrected by IF supplementation
Celiac disease or Diphyllobothrium latum
Low urinary B12 excretion corrected with intrinsic factor
Pernicious anemia
Filtration fraction
Calculate clearance. GFR/RPF (inulin or Cr/ PAH) Normal is usually 20
Side effects of protease inhibitors
(avir) Lipodystrophy (increase fat deposition), Hyperglycemia, Inhibition of P450
Side effects of TMP-SMX
Megaloblastic anemia, Stevens-johnson syndrome, toxic epidermal necrolysis
Side effects of Zidovudine
NRTI. Bone marrow toxicity
Side effects of Acyclovir
renal toxicity
Side effects of Foscarnet
Hypocalcemia, hypomagnesemia, hypokalemia. Nephrotoxic
complication of hysterectomy
hydronephrosis
Complication of prostatectomy or bladder surgery
Vesicoureteral reflux
very high fever, diarrhea, headache, confusion. Sputum gram stain shows neutrophils but no organisms
Legionella ( treat with fluoroquinolones)
Aortic stenosis in eldery is usually due to what process?
Dystrophic calcifications ( usually a hallmakr of cell injury and death). Normal calcium levels
Episodic angina chest pain during nighttime and ST segment elevations on Holter
Prinzmetal angina that can be provoked by Ergonovine
Murmur: inspiration
increase venous return to R. Decrease venous return to left
Murmur: valsalva strain
Decrease preload, decrease afterload
Murmur: abrupt standing
Decrease preload, decrease afterload
Murmur: squatting
Increase preload, increase afterload
Murmur: passive leg raise
Increase preload
Murmur: handgrip
increase afterload
