uWorld 34 Flashcards
what is the course of fetal blood flow from highest O2 concentration to lowest
umbilical vein → liver → IVC → heart → pulmonary circulation or through foramen ovale
pulmonary circulation → ductus arteriosus and pass directly into the descending aorta
what drug that treats UTIs can precipitate THEOPHYLLINE toxicity
CIPROFLOXACIN b/c it is a CYP inhibitor and theophylline is a CYP substrate
how does theophylline work
adenosine receptor blocker
PDE inhibits
used of asthma and COPD b/c it causes bronchodilation by increasing cellular cAMP and it has mild-antiinflammtory effects
what is seen in theophylline toxicity
CNS stimulation (tremor, insomnia, SEIZURES) GI disturbances cardiovascular abnormalities (hypotension, tachycardia, CARDIAC ARRHYTHMIAS)
in southwestern blotting FNA_binding proteins are recognized how
ability to bind SPECIFIC OLIGONUCLEOTIDE PROBES
the concentrations of what substances increase as fluid moves along the proximal tubule
PAH
creatinine
inulin
urea
the concentrations of what substances decrease as fluid moves along the proximal tubule
bicarbonate
glucose
amino acids
what is the rate limiting step of urea synthesis
barcarb, ammonia, and ATP are combined by CARBAMOYL PHOSPHATE SYNTHETASE to yield carbamoyl phosphate
happens in mitochondria
what serves as a regulator of the urea cycle through activation of carbamoyl phosphate synthetase I
N-ACETYLGLUTAMATE
what is the most common urea cycle disorder
ORNITHINE TRANSCARBAMYLASE (OTC) DEFICIENCY
results in excess carbamoyl phosphate, which stimulates pyrimidine synthesis- OROTIC ACID then accumulates and results in increased URINARY OROTIC ACID
HYPERAMMONEMIA (vomiting, confusion/coma) due to impaired ammonia excretion- a METABOLIC EMERGENCY
TACHYPNEA due to cerebral edema from ammonia buildup, resulting in central hyperventilation and respiratory alkalosis
triggered by illness, fasting or increased protein intake
what is seen in uridine monophosphate synthetase (UMPS) deficiency
part of pyrimidine synthesis pathway
deficiency leads to buildup of OROTIC ACID
MEGALOBLASTIC anemia
GROWTH DELAY
NO HYPERAMMONEMIA (differentiates this from OTC deficiency)
what causes tabes doralis
syphilis DIRECTLY damages the DORSAL SENSORY ROOTS
secondary degeneration of DORSAL COLUMNS
what are the clinical findings of tabes doraslis
sensory ataxia
lancinating pains
neurogenic urinary incontinence
associated with Argyll Roberson pupils
what two pathways does insulin binding to the insulin receptor activate
RAS/MAP kinase pathway: CELL GROWTH, DNA SYNTHESIS
PI3K pathway: lipid, protein, and GLYCOGEN (via PROTEIN PHOSPHATASE which activates GLYCOGEN SYNTHASE by dephosphorylation) synthesis
what is the optimal site for a femoral nerve (L2-L4) block
INGUINAL CREASE at the lateral border of the femoral artery
anesthetizes the skin and muscles of the anterior thigh, femur, and knee
also blocks the saphenous nerve (terminal extension of the femoral nerve) to decrease sensation to the media leg below the knee
what is the adductor hiatus
opening i nth e aponeurosis of the adductor magnus at the distal one-third of the femur that allows passage of the femoral vessels into the popliteal fossa
saphenous nerve passes near the hiatus
what is the femoral ring
upper opening of the femoral canal (which contains lymphatic vessels and a lymph node)
glucose is the most inprotant stimulator of glucose relate, how does this work
glucose enters via GLUT-2 and generates ATP via citric acid cycle
ATP binds ATP-sensitive K+ channel that then CLOSES causing MEMBRANE DEPOLARIZATION
this opens voltage-gates calcium channels that RELASE INSULIN
if patient has varices visible only in the gastric fundus (not esophagus or rest of stomach) what is the cause
SPLENIC VEIN THROMBOSIS due to chronic pancreatitis, pancreatic cancer, and abdominal tumors
GASTRIC VARICES only in the fundus form because the SHROT GASTRIC VEINS drain the fundus of the stomach into the splenic vein