Uworld Part 3 Flashcards
what side effect of dopamine is central?
does carbidopa increase or decrease?
how to avoid?
anxiety and agitation is central effects.
carbidopa can increase thru increasing central availability by inhibiting peripheral conversion
decrease dose
use atypical antipsychotics like cloazpine
what can carbidopa help you avoid
peripheral effects of dopamine
- postural hypotension
- hot flashes
- tachyarrhthmias
- Nausea and vomiting
RNA polymerase I function
form ribosomal components
RNA polymerase II function
mRNA
snRNA
micro RNAa
RNA polymerase III fxn
tRNA
Component of 60S ribosomal subunit
selectivity for CCB
Verapamil most on heart
Nifedipine most on peripheral vasculature
Diltiazem in between
SE of verapamil
constipation
gingival hyperplasia
bradycardia
first/second/third degree AV nodal block
most acid labile piconravirus
rhinovirus
most acid stable piconravirus
enteroviruses
most common species for aspiration pneumoniae
fusobacterium
peptostreptoccus
bacteroides
16S rRNA fxn
complementary and binds to Shine Delgarno sequence in all prokarotic mRNA 10 bases upstream of AUG start.
mRNA and 30S ribosomal subunit bind, an initiator tRNA binds to AUG, the 50S ribosomal subunit joins and protein synth begins
23s rRNA
found in 50S, faciltates peptide bond formation in protein translation
isoniazid function
req. conversion to active compound by mycobacterial enzyme catalase-peroxidase
inhibits mycolic acid synthesis
rifampin function
imhibits DNA dependent RNA synthesis
50S antibiotics
chloramphenicol
clindamycin
linezolid
macrolides (erythromycin/azithromycin/clarithroycin)
30S antibiotics
tetracycline
doxycycline
aminoglycosides (gentamicin, streptomycin and others)
beta blocker function in thyrotoxicosis
Block increased sensitivity to catecholamines via thyroid hormone mediated upregulation of beta-adrenergic receptor expression
Decrease peripheral conversion of T4 to T3 by inhibiting iodothyronine deiodinase
G6PD genetic
X linked recessive
Hereditary spherocytosis genetic
autosomal dominant
vitamin D-resistant rickets genetic
x-linked dominant inheritance
oxidative phosphorylation mutations tend to be
mitochondrial diseases
autosomal dominant diseases
ADPKD FAP Familial hypercholesterolemia Hereditary hemorrhagic telangietasia Heredtiary spherocytosis Huntington disease Marfan syndrome MEN Neurofibromatosis 1 Neurofibromatosis 2 Tuberous sclerosis Von Hippel Lindau disease
autosomal recessive diseases
Albinism ARPKD Cystic fibrosis Glycogen storage diseases hemochromatosis Kartagener syndrome Mucopolysaccharidoses (except hunter syndrome) Phenylketouria Sickle cell anemia Sphingolipidoses (except Fabry disease) Thalessemias Wilson disease
xlinked recessive disorders
Be Wise, Fool’s GOLD Heeds Silly HOpe
Bruton agammaglobulinemia Wiskott-Aldrich syndrome Fabry disease G6PD deficiency Ocular albinism Lesch-Nyhan syndrome Duchenne (and Becker) muscular dystrophy Hunter Syndrome Hemophilia A and B Ornithine transcarbamylase deficiency
Trinucleotide repeat expansion diseases and the trinucleotide repeats are
Huntington disease (CAG)
Myotonic dystrophy (CTG)
Friedreich ataxia (GAA)
Fragile X syndrome (CGG)
where does digestion of triglycerides occur
duodenum
where does absorption of triglycerides occur
jejunum
hemosiderin laden macrophages in pulmonary alveoli indicates
chronic elevation of pulmonary capillary hydrostatic pressures which is usually the result of left sided heart failure.
how to differentiate b/w lipofuscin or hemosiderin
prussian blue stain, detects intracellular iron, colorless potassium ferrocyanide converted by iron to blue black ferric ferrocyanide.
left ventricular leads in biventricular pacemakers courses through
coronary sinus residing in the atrioventricular groove on the posterior aspect of the heart.
vitiligo is caused by
loss of epidermal melanocytes
characteristic abnormality in huntingtons
bilateral atrophy of the caudate nucleus and putamen (striatum)
characteristic abnormality in parkinsons
decreased dopamine in the substantia nigra and striatum
what causes green sputum
myeloperoxidase, blue green heme based pigmented molecule in azurophilic granules of neutrophils that catalyzes the production of hypochlorous acid from chloride and hydrogen peroxide during phagocytic respiratory burst
Polyarteritis nodosa affects what arteries
affects medium to small arteries in any organ. Kidneys, heart, liver, GI tract.
SPARES PULMONARY ARTERIES and rarely involves bronchial arteries.
how does PAN affect the arteries
transmural inflammation of the arterial wall w/ fibrinoid necrosis
mechanism of korsakoff
dmg to the anterior and dorsomedial thalamic nuclei resulting in memory loss and confabulation.
IMPAIRMENT IN MEMORY AND LEARNING IS USUALLY PERMANENT
rapid correction of hypernatremia results in
cerebral edema
rapid correction of hyponatremia results in
Mechanism
presents
Central pontine myelinolysis
Mech:
osmotic demyelination syndrome of the axons in the central part of the pons.
demyelination of corticospinal tracts and corticobulbar tracts of CN IX, X, XI (Pseudobulbar b/c nuclei of CN intact).
presents as spastic quadriplegia and pseudobulbar palsy
what factors does H. influenzae require
X factor (exogenous hematin)
V factor (NAD+)
blocking alpha2 adrenergic receptors results in
release of norepinephrine from nerve endings
insulin from pancreas
D1 adrenergic (dopaminergic) receptors are located where and cause what
located in walls of renal, splanchnic, mesenteric blood vessels
Vasodilatation and increase in renal and splanchnic blood flow
silicosis distinguished by
eggshell calcification of hilar nodes
birefringent silica particles surrounded by fibrous tissue
asbestosis distinguished by
calcified pleural plaques ferruginous bodies (fusiform or beaded rods w/ a translucent asbestos center and coated w/ an iron containing proteinaceous material best seen w/ prussian blue staining)
berylliosis and hypersensitivity may produce
noncaseating granulomas
coal miners lung assoc w
perilymphatic accumulations of coal dust laden macrophages
aortic arch baroreceptor transmits via… to…
to what does it respond
vagus nerve to solitary nucleus of medulla.
only responds to increase
Carotid sinus baroreceptor transmits via… to…
to what does it respond
glossopharyngeal nerve (Hering branch) to solitary nucleus of medulla
responds to increase or decrease
distinguish bullous pemphigoid from pemphigus vulgaris
bullous pemphigoidhave intact bullae (negative nikolsky sign) and mucosal involvement is uncommon
CNS fried egg tumor cell appearance (nuclei w finely granular chromatin surrounded by clear cytoplasm)
oligodendroglioma
presentation of meningiomas
mechanism
personality change
New onset seizures
(from frontal lobe compression)
culture negative endocarditis causes
Bartonella Coxiella Mycoplasma Histoplasma Chlamydia HACEK -Haemophilus -Actinobacillus -Cardiobacterium -Eikenella -Kingella
vitamin E deficiency results in what
what condition does it mimic?
How do they both present?
degneration of spinocerebellar tracts, dorsal column of the spinal cord, and peripheral nerves
mimics Friedrich ataxia
Ataxia
Dysarthria
Loss of both position and vibration sensation
Lead intoxication presentation
irritability
loss of devo milestones/learning problems
GI issues
Thiamine deficiency has what triad
ataxia
confusion
ophthalmoplegia
Creutzfeldt jacob disease presents how
rapidly progressive dementia and myoclonic jerks of the extremities
Acute intermittent porphyria presents how
acute abd pain
peripheral neuropathy
hyponatremia
what atypical antipsychotic most likely to cause EPS?
Risperidone
What atypical antipsychotic least likely to cause EPS?
Clozapine (but watch out for agranulocytosis)
treatment of acute dystonia
antihistamines (diphenhydramine)
Anticholinergics (benztropine/Trihexyphenidyl)
treatment of parkinsonism
anticholinergic (benztropine)
presence of erythroid precursors in organs like liver and spleen is indicative of..
what causes it
extramedullary hematopoiesis
caused by severe chronic hemolytic anemias (beta thalessemia for example)
visual impairment in HIV patient is caused by
secondary to CMV induced retinitis
treatment for CMV induced retinitis
ganciclovir
foscarnet
cidofovir
SE of foscarnet
why does this happen?
hypocalcemia and hypomagnesemia, both of which promote seizures.
mech:
calcium chelator, renal wasting of magnesium induced, reduction in release of parathyroid hormone
lamivudine SE
peripheral neuropathy
lactic acidosis
(this is unusual compared to other NRTIs)
B6 involved in
transamination and decarboxylation steps in amino acid metabolism
heme (ALAS) and neurotransmitter synthesis (L-DOPA to Dopamine)
what uses TLCFN
branched chain alpha-ketoacid dehydrogenase
pyruvate dehydrogenase
alpha-ketoglutarate dehydrogenase
acute irrev injury to neuron results in a what?
what signs?
Red neuron 12-24 hr after -shrinkage of cell body -eosinophilia of the cytoplasm -pyknosis of the nucleus -loss of Nissl substance
important prognostic factor in poststreptococcal glomerulonephritis
AGE
95% of affected children recover completely
60% of adults recover completely
psoriasis is characterized by
hyperparakeratosis acanthosis rete ridge elongation mitotic activity above the epidermal basal cell layer reduced or absent stratum granulosum
neutrophils may form spongiotic clusters in the superficial dermis and the parakeratotic stratum corneum (Munro microabcesses)
diabetic mononeuropathy presents how?
predominantly central ischemia affecting somatic nerve fibers but sparing peripheral parasympathetic fibers
ptosis
down and out gaze
normal light and accommodation reflexes
granulation tissue is comprised of what type of collagen
Type III collagen. this is replaced eventually by type 1 as the infarct matures.
what benzodiazepines are not metabolized by liver
LOT
Lorazepam
Oxazepam
Temazepam
confidence intervals z values
90%=1.645
95%=1.96
99%=2.57
speed of transmission in the heart
park at ventura avenue
purkinje
atrial
ventricle
av node
where do dna viruses replicate
all in nucleus except poxvirus
where do rna viruses replicate
all in cytoplasm except
- influenzae
- retrovirus
segmented viruses
BOAR
bunyavirus
orthomyxovirus (influenza)
arenavirus
reovirus
