UW5 Flashcards
Which regulatory genes of HIV are required for replication?
Tat and rev
what does the HIV gag protein encode?
Structural genes for viron assembly, nucleocapside proteins p24 and p7
What does the HIV pol protein encode?
Reverse transcriptase
What does the HIV env protein encode
envelope glycoproteins gp 120 and gp 41
what are homeobox genes important for?
Sequential development of organs and tissues during embryogenesis
muscle stiffness and cyanotic skin mottling after inhaled anesthetic
Malignant hyperthermia which causes fever and severe muscle contractions after inhaled anesthetics and succinylcholine
Treatment for malignant hyperthermia
Dantrolene which acts on ryanodine receptor to prevent further release of Ca into cytoplasm of muscle fibers
when does acute organ transplant occur?
1 to 4 weeks after transplant. Rejection is mediated by T cell sensitization against graft MHC
Perivascular infiltrate with abundant eosinophil on endomyocardial biopsy after intiation of a new drug
hypersensitivity myocarditis
Scant inflammatory cells and intersitial fibrosis on endomyocardial biopsy
Chronic transplant rejection mediated by lymphocytes and antibodies months to years after transplant
Dense mononuclear lymphocytic infiltrate with cardiac myocyte damage on endomyocardial biopsy
Acute transplant rejection
Vitamin required to maintain differentialize of specialized epithelia (mucus secreting columnar epitheium, conjunctivia, respiratory and urinary tract and exocrine glands)
Vitamin A
Deficiency in Vitamin E
Infertility and decrease in serum phospholipids
Deficiency in Vitamin D
Rickets in children and osteomalacia in adults
Mutation in Wilms tumor
WT-1 or 2
Corkscrew esophagus on esophagogram
Diffuse Esophageal spasm
Pleuritic chest pain, dyspnea, cough, hemoptysis
Consider pulmonary embolism
ACTH stimulation does not increase serum cortisol
Primary adrenal insufficiency
Labs in primary adrenal insufficiency
Hyponatremia, hyperkalemia, hyperchloremia, non-anion gap metabolic acidosis
fever, nucal rigidity after neurosurgery
Staphylococcus meningitis
Rinne and weber in conductive hearing loss
Rinne: abnormal bone >air. Localized to affect ear
Sensorineural Rinne and weber test
Normal rinne, weber localizes to unaffected ear
brain tumor with concentrically arranged cells and psammoma bodies
meningioma (commonly in parasagittal region)
brain tumor causing tinnitus and unilateral hearing loss
acousting neuroma or tumors in cerebellopontine angle
mechanism of action for Lamotrigine
Blocks voltage gated Na Channel to treat partial and gneralized seizures
Side effect of Lamotrigine
Stevens Johnson Syndrome or TEN characterized by extensive cutaneous and mucosal lesions.
drugs associated with SJS/TEN
Lamotrigine, Carbamazepine, phenobarbital, phenytoin
function of peroxisome
catabolism of very long chain fatty acids, branched chain fatty acids and amino acids
Zellweger syndrome
unable to form myelin leading to hypotonia, seizures, mental retardation
Refsum disease
defect in peroxisomal alpha oxidation leads to accumulation of phytanic acid. Tx by avoiding chlorophyll
Functions to degrade uneeded or improperly formed intracellular proteins
proteosomes
organelle that contain an acidic fluid for degrading fatty acid, carbohydrates, proteins and nuclei acids
Lysosomes
fall on outstretched hand leading to flattening of deltoid muscle
Anterior dislocation of the humerus causes injury to axillary nerve
Which bacteria do polymyxin/ Colistin inhibit
Gram negative
which bacteria does vancomycin inhibit?
Gram positives only
enzyme responsible for green pigment in a bruise
Heme oxygenase
Enzyme defect in porphyria cutanea tarda
Uroporphyrinogen decarboxylase
what drugs inhibit warfarin metabolism
Cimetidine, amiodarone, TMP-SMX
CYP P450 inducers
Chronic alcoholic, Modafinil, St. Johns wort, phenytoin, phenobarbital, nevirapine, Rifampin, Griseofulvin, Carbamazepine
CYP P450 inhibitors
Acute alcohol abuse, Gemfibrozil, Ciprofloxacin, Isoniazid, Grapefruit juice, Quinidine, amiodarone, ketoconazole, macrolides, sulfonamides, cimetidine, ritonavir
which antibiotic has weak MAOi activity?
Linezolid which can precipitate serotonin syndrome in pts taking MAO inhibitors
What drugs can induce serotonin syndrome when used with serotonin agonists
Tramdol, ondansetron, linezolid
Side effect of TMPSMX
hemolysis (G6PD deficiency), hyperkalemia, megaloblastic anemia
Side effect of doxycycline
Photosensitivity, pill induced esophagitis. Enamel hypoplasia or tooth discoloration in children
Side effect of vancomycin
Red man syndrome: flushing erythema, pruritus
Interviewing: Support
expressing concern and interest. Does not claim to personally understand how the pt feels
Interviewing: Facilitation
encourages pt to talk more about experiences
Interviewing: Empathy
expression of interviewer’s understanding of pts experiences
Interviewing: Reflection
interviewer repeats what the pt is telling him
Interviewing: confrontation
draw pt to discrepancies in responses
Mechanism of Amantadine
dopaminergic agent, anticholinergic
Selegiline
MOA-B inhibitor that prevent degradation of dopamine
COMT inhibitor
Decrease break down of levodopa in peripheral disease and increase amount of levodopa to cross BBB
Drugs for drug induced parksinsonism
Trihexyphenidyl and benztropine
ANP
secreted by cardiomyocytes in response to atrial stretch. Activates adenylate cyclase to dilate afferent arterioles (increases GFR) and increases sodium and water excretion. Decreases aldosterone secretion. Relaxes vascular smooth muscle in arteriles and venules
sharp pleuritic chest pain relieved by sitting up and leaning forward. Scratchy sound on auscultation when leaning forward
Pericarditis
Failure of neural crest migration is responsible for which congenital heart diseases?
Tetralogy, Truncus arteriosus and transposition of great vessels
failure of urethral folds to close
hypospadias
faulty positioning of genital tubercle
epispadias
Philadelphia chromosome is associated with which cancer
Chronic myelogenous leukemia t(9:22)
Kartagener syndrome
Immotile cilia, autosomal recessive, bronchiectasis, situs inversus
Macroorchidism, mental retardation
Fragile X
Eczema, recurrent infections and thrombocytopenia
Wiskott aldrich syndrome (x linked, combined B and T lymphocyte disorder)
hemolytic anemia, thrombocytopenia, acute renal failure
HUS
Oculocutaneous albinism, peripheral neuropathy, immunodeficiency
Chediak Higashi (dysfunction of pahgocyte pahgolysosome-lysosome fusion)
progressive ataxia and telangietasia and immunodeficiency
Ataxia-telangiectasia syndrome. Defect in ATM gene. IgA deficiency
N-myc
neuroblastoma, small cell carcinoma
BCR-ABLE rearrangement
CML and some ALL, increases tyrosine kinase activity
overexpression of BCL2
t(14;18) follicular lymphoma
which part of the bone does osteomyelitis usually affect in children
Metaphysis
most common location for hematogenous osteomyelitis in adults
vertebral body
paradoxical rise in JVP during inspiration
Kussmaul sign seen in constrictive pericarditis
increase JVP, Kussmaul sign, pulsus paradoxus, pericardiac knock
Constrictive pericarditis
Loud P2
pulmonary hypertension
Pericardial knock
Constrictive pericarditis reduces ventricular compliance
S3 heart sound
Restrictive cardiomyopathy. Due to sudden deceleration of incoming blood as the ventricle reaches its elastic limit
Quinidine
IA antiarrhythmic. Phase 0 and 3
Lidocaine
IB antiarrhythmic. Blocks Na channels on rapidly depolarizing cells
Flecainide
IC antiarrhythmic. Blocks Na and acts by slowing phase 0
Esmolol
class II antiarrhythmic that slows phase 4
ST elevation in V1-V3
LAD
ST elevation in V4-V6
LAD or LCX
ST elevation in I, AVL
LCX
ST elevation in II, III, AVF
RCA
non-cyanotic congenital heart disease
ASD, VSD, PDA, COA
Cyanotic congenital heart disease
Truncus arteriosis, Transposition, Tricuspid atresia, TOF, TAPVR
mediators of the BBB
tight junctions (zona occludens)
Rasburicase
recombinant urate oxidase that converts uric acid to allantoin to preven hypuricemia and renal manifestations of tumor lysis syndrome
Denosumab
MAB that prevents osteoclast activation by binding RANK L to decrease bone loss and fracture in pts with bone metastasis
N-acetylcysteine
Acetaminophen overdose for enhancing glutathionne production and conjucation of toxic NAPQI metabolite. Also used as a mucolytic agent for patients in CF and for prevention of radiocontrast induced nephropaty in pts with renal failure
beta error
conclusion that is is no difference when a difference truly exists
Foscarnet
Pyrophosphate analog that directly inhibits DNA polymerase and RT. Used for acyclovir reesistant HSV or Ganciclovir resistent CMV
Acyclovir
requires conversion by thymidine kinase
Lamivudine
cytosine analog (NRTI)
Ganciclovir
guanine nucleoside analog that requires conversion by viral kinase
Amatidine
binds to M2 channel protein to block viral uncoating
Oseltamivir
silalic analog inhibitor of neuraminidase
Fru 2,6 BP
inhibits gluconeogenesis and promotes glycolysis (induces PFK1)
insulin
Dephosphorylates
Glucagon
phosphorylates
which antibody crosses the placenta
IgG
what can cause crescentic GN
Goodpasture, granulomatosis with polyangiitis, microscropic polyangiitis
BM splitting
Alport syndrome and MPGN
nephritis, deafness and eye problems
alport syndrome
uniform, diffuse capillary wall thickening on renal biopsy
Membranous glomerulopathy
segmental sclerosis and hyalinosis on renal biopsy
Focal segmental glomerulosclerosis
Pulmonary hemorrhages, rapidly progressive GN
Goodpasture. Anti-GBM against a3 chain of collagen type IV
what can help prevent renal calculi formation
increased citrate an high fluids
how do ACE inhibitors affect GFR
Decrease GFR be causing vasodilation of efferent arterioles
tremor when posture is maintained
Essential tremor, tx with propranolol
Benztropine
Anti-cholinergic used to treat tremor in Parkinson
Clozapine
atypical antipsychotic that blocks serotonin
coffee ground emesis
Upper GI bleed
1st line therapy for chronic asthma
Fluticasone, beclomethasone (systemic corticosteroids)
Albuterol
short acting beta 2 agonist for acute asthma
Theophylline
inhibits phosphodiesterase to increase cAMP causing bronchodilation
Ipratropium
antimuscarinic that decreases mucus production
thrombocytopenia, ecchymoses, petechia, mucosal bleeding
ITP
Thrombocytopenia with decrease fibrinogen and elevated PT
DIC (widespread activating of clotting factors (sepsis, Trauma, OB, acute pancreatitis, malignancy, nephrotic syndrome, Transfusion)
hyaline arteriolosclerosis
nonmalignant HTN or diabetes. Leakage of plasma against endothelium and excessive extracellular matrix production by smooth muscle cells
onion-like concentric thickening of walls of arterioles
Malignant hypertension (laminated SMC and reduplicated BM)
Granulomatous inflammation of media
Temporal (giant cell) arteritis
Suppression
Voluntary withholding of unpleasant thoughts from ones mind
Identification
Modeling ones behavior after someone who is perceived to be more powerful
repression
removal of disturbing psychological material from conscious awareness (more thorough than supression)
Displacement
transfer of an impulse or desire towards a safer and less distressful object
Projection
Transplantation of ones unacceptable impulses or behavior onto another person or situation
Succinylcholine
Strong ACH receptor agonist that produces SUSTAINED depolarization and prevents muscle contraction
Reversal of succinylcholine
Phase I (prolonged depolarization) has no antidote. Phase II (repolarized but blocked– use neostigmine to reverse
Dantrolene
Malignant hyperthermia and neuroleptic malignant syndrome
Pancuronium, tubocurarine
competative Ach agonists. Train of 4 responses always show fading pattern. Reverse with neostigmine
