uworld deck 9 Flashcards
why anus preffered in drug 1st pass metabolism
the veins below pectinate line basically drain into the systematic circulation-internal iliac and internal pudenal internal iliac gives to rise to middle rectal
internal pudenal gives rise to inf rectal
which part of the intestine has greates blood flow
related to metabolic acitivyt, duodenum has hig active transport more blood flow therefore more absorption
greater BF means high Concentration gradient
why rectum has low absorption of drug vs small intestine
surface area
sacroptes scaiebei
Rapidly spreading, pruritic rash with erythematous papules, small crusted red papules
• Hands and wrists
• Mite burrows into skin (linear pattern)
which antiviral drug is associated with myopathy
integrase inhibtiors
whipplei patients develop what conditon
hyperpigmentation
type 2 dm
velvety patches of brownish discoloration affecting the neck and skinfolds.
shoulder dislocation
Most commonly anterior
• Flattening of deltoid, protrusion of acromion
• Damaged axillary nerve
crocoid process frac
hotgun or rifle related activities have the highest chance of coracoid
midshaft fx
Radial nerve or deep brachial artery damage
head and neck cancer
dysphafgia ,base tounge mass, cervical LADo human papillomavirus (HPV), which may be seen in younger, nonsmoking patients. smoking is also a reason
dissoicative disorders
Dissociative amnesia
Inability to recall personal information, usually of a traumatic or stressful nature
Dissociative identity disorder
Fragmentation into ≥2 distinct personalities
Discontinuity in identity & personal agency
murmur of asd
asd defect murmur
early peaking systolic wide s2
increased pulmonary flow =early peaking systolic murmur 2nd ic space
tricuspid flow=rumble at LLS
avasular necrosis presentation
Avascular necrosis typically presents with pain and limited mobility but not pathologic fractures.
which disease enchondral ossification imparied
Endochondral ossification involves the deposition of hyaline cartilage by chondrocytes and is impaired in achondroplasia,
premotor frontal cortex lesion
abnormal posturing or repetitive movements but not an action tremor.
toical steroid
Telangiectasias, ecchymoses from mild trauma, and atrophic striae may also be found. troubles with corticosteorid use
dermal atrophy as well
why no IGm phagocytosis
here are no receptors on macrophages for the Fc portion of IgM
what is l selectin
L-selectin is an adhesion molecule that aids entry of lymphocytes from the blood into lymphoid tissue
which cells express high telomeres
stem cells
t lymphocytes and neutrophils both cause candida
t cells-superficial
neutrophils-disseminated
primary mechanism of atypical antipsychotics
Dopamine D2 receptor antagonism
Serotonin 2A receptor antagonism
qid 1522
large A-a gradient should always be 10
why give thiamine with glucose
Always give thiamine with glucose > if only glucose you will further deplete thiamine
pathophys of photoaging
hinning of epidermis and flattening of rete ridges > increased crosslinking of collagen + desiccation of corneum = wrinkles
exposure to UVa
produces ROS > increased inflammatory receptors and transcription factos > decreased collagen fibril production and increased MMP and collagenase > degradation of type 1 and 3 collagen
creatinine as abiomarker
Therefore, uncorrected creatinine clearance overestimates the GFR by approximately 10%-20%. Creatinine clearance has further limitations in patients with low muscle mass (eg, malnutrition, lower extremity amputation) or high- or low-protein diets.
how would increased cyp metabolism ijncrease bioavaliability drug
Enhanced CYP enzyme induction by the blue formulation would cause increased drug metabolism over time as additional enzymes are synthesized, leading to decreased serum drug levels.
appearance of a finely granular, diffusely homogeneous, pale eosinophilic cytoplasm ( is what]
hemochromatosis
ground glass appearnecegold-yellow hemosiderin granules in the cytoplasm
pathophys of dot and flame hemorrhage
Severe hypertension in retinal precapillary arterioles causes endothelial disruption, leakage of plasma into the arteriolar wall, and fibrinous necrosis. The necrotic vessels can then bleed into the nerve fiber layers, causing dot- and flame-shaped hemorrhages.
pure sensory branch of the medial leg =
saphenous nerve
osteoporosis in glucortiocids mechanism
mechanism of glucorticoids induced osteoporosis
decreased proliferation and differentiation of osteoblast precursor cells.
homeobox genes
80 nucleotide DNA sequence
• Code for transcription factors that bind to regulatory reions of DNA, altering expression of gene involved with segmental organization of the embryo.
• Hox gene mutation > skeletal malformations and improperly positioned limbs and appendages
side effects of antihistamines
anticholinergic =glaucoma
alpha blockade=postural hypotension
serotonin blocker= weight gain
why coronary vc in cocaine intoxication
why fever
Arterial vasoconstriction, including coronary vasoconstriction, is also enhanced (alpha-1 effect), leading to a decrease in myocardial oxygen supply.
impaired heat loss due to peripheral vc
how bzd help reduce cocaine symtpoms
reduce psymotor agitation,reduce symp outflow
PE causes what
pulmonary infarction, pleuritic chest pain
waht contributes to insulin resistance
RAndalls phenomenon
Define preclampsia
new onset of htn Diastolic>90 or systolic >140
classic px of preclampsia
headache and visual changes:
dysregulated cerebral blood flow, brain ischemia, and/or capillary leakage resulting in cerebral ed
isual changes include blurry vision, photopsia (seeing “sparks”), and scotomata (partial vision loss [blind spots]) and are due to retinal artery vasospasm and optic nerve ischemia
choroidal neovasuclarizaiton
typicall y unilateral affects one eye first
px of acute glaucoma
mid dilated poor light response
heamophilis duceryi
Multiple & deep ulcers
Base may have gray to yellow exudate
Organisms often clump in long parallel strands (“school of fish”)Multiple & deep ulcers
Base may have gray to yellow exudate
Organisms often clump in long parallel strands (“school of fish”)
klebseilla granulomatosis
Extensive & progressive ulcerative lesions without lymphadenopathy
Base may have granulation-like tissue
Deeply staining gram-negative intracytoplasmic cysts (Donovan bodies)
chalmydia
Extensive & progressive ulcerative lesions without lymphadenopathy
Base may have granulation-like tissue
Deeply staining gram-negative intracytoplasmic cysts (Donovan bodies)
clinical features of chinkguinya
Initial MFx incl self-limited fever, severe polyarthralgia, and rash. Relapsed or chronic arthralgias, polyarthritis (e.g. wrist, fingers, ankles), or tenosynovitis occur in >50% of infected individuals.
how do benzos work
they work as positive allosteric modulators that promote an increased frequency of channel openings in response to GABA stimulation.
what cells predominate in hypersensitivity pneumonitis
cd8
explain mechanism of levothyroxine
levothyroxine is basically T4 so when it is exogenous it is converted by peripheral tissues to t3
subclinical thyrodism
Subclinical hyperthyroidism is characterized by a mildly suppressed TSH with normal thyroid hormone levels
euthyroid sick sydrome
euthyroid sick syndrome
hypothyrodid state, normal t4, decrease in t3( because 5 deiodinase fucked) more conversion of t3-rt3
what is anaplastic tumor
inability to resemble previous tissue
