Week 1 Flashcards
Random Factoids from Week 1
2 arachidonic acid products affect platelet aggregation
Thromboxane A2 stimulates platelet aggregation; PGI2 inhibits platelet aggregation.
Cause of cystinuria/treatment; Complication; Inheritance; Incidence; Tx (MOA)
Results from an inability to reabsorb COAL in renal tubules: Cystine, Ornithine, Arginine, and Lysine. Hereditary defect renal tubular amino acid transporter in PCT of kidneys for COAL; Inability to reabsorb + Low solubility of cystine ® Excess cystine in urine can lead to precipitation and formation of cystine kidney stones (cystine staghorn calculi); AR; Common (1:7000); Tx: Acetazolamide, Potassium citrate, Potassium bicarbonate to alkalinize urine ® cystine stays dissolved in the urine;
Classic presentation of lobar pneumonia
shortness of breath, malaise, high fever; CXR reveals right-sided consolidation and labs WBC count of 12,000.
E. coli that causes “Traveler’s diarrhea”
Enterotoxigenic E. coli ETEC; Watery, labile toxin/stable toxin; NO inflammation or invasion.
MOA aspirin prevents platelet aggregation and MI
Permanently inhibits COX-1 and COX-2 ® less production of thromboxane A2 ® Less platelet aggregation.
MOA that clavulanic acid, sulbactam, and tazobactam aid penicillins in their activity
Inhibition of β-Lactamase
Most common malignancy in children; Age; Childhood vs. Adolescent presentation; Bone marrow findings; Markers; Responsiveness to therapy; Mets; Prognosis depends on.
acute lymphocytic leukemia (ALL); Age <15yo; may present bone marrow involvement in childhood or mediastinal mass in adolescent males; Bone marrow replaced by ↑↑↑ lymphoblasts; TdT+(marker of pre-T and pre-B cells), CALLA+; most responsive to therapy; may spread to CNS and testes; t(12;21) = better prognosis
Most common malignant bone tumor in children and 2nd most common primary bone malignancy;Association; XR; Prognosis
osteosarcoma (association retinoblastoma; Codman’s triangle or sunburst pattern (from elevation of periosteum) on XR; poor prognosis
Most common primary cardiac tumor in kids
rhabdomyoma (associated w/ tuberous sclerosis)
Most common renal tumor in children; Ages?; microscopic appearance: Presentation; Genetics; May be part of this?
Wilms’ tumor (nephroblastoma); ages 2-4; embryonic glomerular structures; presents w/ huge, palpable flank mass and/or hematuria; Deletion of tumor suppressor gene WT1 on 11p; May be part of WAGR complex: Wilms’ tumor, Aniridia (absent iris), Genitorurinary malformation, mental-motor Retardation
Most common solid tumor in children
brain tumor
Most common supratentorial brain tumor in children; malignant or benign?; Presentation; Often confused with this?; Etiology?
craniopharyngioma; benign, causes bitemporal hemianopia (and is thus confused w/ pituitary adenoma); derived from Rathke’s pouch; Calcification common (tooth enamel-like)
Most common tumor of adrenal medulla in children; location; labs; Is hypertension likely?; Prognosis?
neuroblastoma; occurs anywhere on sympathetic chain; ↑HVA (breakdown pdt dopamine) in urine; HTN unlikely; Overexpression of N-myc oncogene ≈ rapid tumor progression
Name for right ophthalmoplegia, ophthalmic and maxillary sensory loss
cavernous sinus syndrome
Organism that is most common cause of lobar pneumonia
Streptococcus pneumoniae
Organisms most common cause of interstitial (walking) pneumonia
Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila, Viral pneumonia
Overdose of phenoxybenzamine resulting in hypotensive shock; treat with epinephrine or phenylephrine?
Phenoxybenzamine is an alpha blocker; Use phenylephrine because no beta receptor stimulation that would cause vasodilitation (a1a2b1b2 is ++++, +++, 0, 0) epinephrine is (++++, ++++,++++,++)
Possible causes of pericarditis
“DISRRUPTS CC”ause pericarditis” Dressler syndrome, Idiopathic, SLE, Radiation, Rheumatic fever, Uremia, Pericardial metastases, Tuberculosis, Scleroderma, Coxsackie virus A/B, cancer medications.
Signs/symptoms of pericarditis
Pleuritic chest pain, JVD, Kussmaul’s sign, Pericardial friction rub, EKG: diffuse ST elevation/PR depression
Structures found in cavernous sinus
3,4,6, 1st and 2nd divisions of the V; Internal carotid arteries.
Two Most common brain tumors in children
1 astrocytoma (pilocytic) #2 medulloblastoma (#1 malignant) (primitive neuroectodermal tumors or PNETs) #3 ependymoma (low-grade or anaplastic)
Scopolamine MOA
antiemetic works as M1 antagonist (anticholineric)
Promethazine MOA
Antiemetic: Histamine and D2 antagonist
One of the most widely used anti-nausea drugs out there. AKA Phenergan
Prochlorperazine MOA
Antiemetic - D2 receptor antagonist
MOA of Metoclopramide
D2 receptor antagonist, antiemetic
MOA Ondansetron
Zofran,an antiemetic; serotonin (5HT3) antagonist
Effect of Platelet disorder on Bleeding time, PT and PTT, clinical features.
Increase bleeding time (platelets act first); Normal (Coagulation factors work fine); Small hemorrhages
Effect of Coagulation factor defect on Bleeding time, PT and PTT, clinical features.
Normal (platelets are fine); Increased (coagulation factors fuck up PT and PTT, clotting); Major bleeding into joints - hemarthrosis.
hemarthrosis
major bleeding into joints
Neoplasm causing: ACTH -> Cushing syndrome
Small cell lung cancer
Neoplasm causing: PTH-related peptide —> hypercalcemia
$ Squamous cell lung cancer
Other squamous cell cancers
Renal cell carcinoma
Breast cancer
Neoplasm causing: Erythropoietin -> polycythemia
Renal Cell Carcinoma
Hemangioblastoma
Hepatocellular carcinoma
Pheochromocytoma
Neoplasm causing: ADH -> SIADH
Small cell lung cancer - (small lung nodule and hyponatremia); Intracranial neoplasms
Calf pseudohypertrophy
Duchenne muscular dystrophy
Gower maneuver
Duchenne muscular dystrophy
Subluxation of lenses
Marfan syndrome
Café-au-lait spots
Neurofibromatosis type 1
Tuft of hair on lower back
Spina bifida occulta
$ Diagnosis of acute rheumatic fever
Evidence of Group A streptococcus infection + 2 major criteria + 1 minor criterion; Major (JONES): Minor criteria: “FAPE” Fever; Arthralgias; Elevated ESR or CRP; Prolonged PR interval.
$ Jones criteria for the diagnosis of acute rheumatic fever
JqNES - Joints: Migratory polyarthritis - swelling pain in large joint, resolves in days migrates to another joint; q: Pancarditis: Endocarditis - mitral valve > aortic, Myocarditis with Aschoff bodies w/ foci of chronic inflammation, reactive histiocytes, slender wavy nuclei (Anitschkow cells), Pericarditis - friction rub; Nodules - subcutaneous nodules; Erythema marginatum - nonpruritic ring like rash; Sydenham chorea - rapid, involuntary muscle movements.
↑ sex hormone-binding globulin (SHBG) in men cause - gynecomastia ; PCOS women have
men cause - gynecomastia ; PCOS women have ↓SHBG which causes hirsutism. Steroids work inside nucleus affecting gene expression.
Age distribution of Hodgkin’s vs Non-Hodgkin lymphoma
Hodgkin lymphoma has a bimodal distribution, age 20, age 65; NHL is heterogeneous, less predictable (20-40, but CLL peak incidence around 70).
Agents used for acute vs. chronic treatment of gout
ACUTE - NSAIDS usually Indomethacin, but also Ibuprofen, Naproxen, Celecoxib; Glucocorticoids, prednisone (second line if NSAIDS don’t work); CHRONIC - Allopurinol (produce less uric acid), Probenecid (helps excrete); Avoid purine-rich foods - red meat, smoked meats, red wine, aged cheeses. NEVER start allopurinol during an acute attack, may make worse.
MOA Alpha-bungarotoxin
binds to nicotinic Ach receptors at the NMJ. Found in chinese/taiwanese snake called a krait
Antibiotics that are nephrotoxic and ototoxic
Vancomycin, aminoglycosides
Asterixis
Involuntary jerking movements, especially in the hands, due to arrhythmic lapses of sustained posture; seen primarily with metabolic and toxic encephalopathies, especially hepatic encephalopathy. SYN flapping tremor [G.a- priv. + sterixis, fixed position]
Bile functions
Composition
- emulsifies fat particles;
- Aids in absorption of digested fat-end products;
- essential for absorption of ADEK;
- excretion of bilirubin;
- excretion of copper;
- excretion of cholesterol.
Contains bile salts, phospholipids, cholesterol, and bile pigments (bilirubin). Bile salts are amphipathic molecules and aid in intestinal digestion and absorption of lipids by emulsifying and solubilizing them in micelles.
MOA Black widow spider toxin
causes excessive release of Ach at the NMJ
MOA Botulinum toxin
inhibits release of Ach at the NMJ (degrades SNARE proteins for vesicle fusion)
Campylobacter jejuni
major cause of bloody diarrhea, especially in children; fecal-oral transmission through foods such as poultry, meat (pork tacos), unpasteurized milk; gram (-) Comma or S-shaped, oxidase positive, grows at 42 deg.
Cancers that cause lambert-Eaton syndrome
Small cell lung carcinoma Hodgkin lymphoma; Malignant thymoma
Causes gallbladder contractions
CCK the most potent stimulator of gallbladder contractions, is released in response to small peptides and fatty acids in the duodenum; tells gallbladder that bile is needed to emulsify and absorb lipids in duodenum; causes contraction of gallbladder and relaxation of sphincter of Oddi; Ach causes contraction of gallbladder
Cystic Fibrosis Presentation
Pulmonary manifestations - Bronchiectasis, recurrent infections (pseudomonas), respiratory failure; Pancreatic manifestations: Malabsorption, Impaired fat digestion, Pancreatic failure, diabetes; Other GI manifestations: Intussusception, rectal prolapse; Infertility (don’t develop vas deferens, women thick cervical mucous and ammenhorea)
Difference between case-control study, cohort study, and clinical trial; Odd ratios vs relative risks
Case-Control study is retrospective, Study people with a disease, compared to a group without a disease, calculate odds ratio; Cohort study - study people with a proposed risk factor, compared to a group without the risk factor and see what happens; usually prospective, calculate RR; Clinical trial - prospective, experimental study, comparing outcomes of two different treatments, doesn’t use OR or RR.
Disorders that can cause cotton-wool spots on the retina of the eye
cotton-wool spots are pale white spots on the retina of various sizes; look like wisps of cotton - infarcts of nerve fiber layer of retina: “CD ALT PW” 2 MOST COMMON Chronic hypertension and Diabetic retinopathy; occasionally seen in AIDS, Lupus, Temporal arteritis; Polyarteritis nodosa; Granulomatosis w/ Polyangiits
Function of the enzyme calcineurin
Binds and activates the transcription factor NFATc (nuclear factor of activated T cells in cytoplasm) and NFATc will ↑ IL-2 ® ↑T-cell growth, differentiation, and activation. Guaifenesin - common over-the-counter medication used to remove excess thick sputum by stimulating the vagus nerve to generate low viscosity secretions in the bronchial tree. Found in robotusin
Guaifenesin
common over-the-counter medication used to remove excess thick sputum by stimulating the vagus nerve to generate low viscosity secretions in the bronchial tree. Found in robotusin
Heart is on opposite side of chest, primary defect in this syndrome, characteristic symptoms/signs
Kartagener syndrome - Cilia are non-motile; Bronchiectasis, respiratory infections, and cough; Recurrent sinusitis; Infertility; Situs inversus - all organs swapped.
Homocysteine has 2 possible pathways
Homocysteine (B6) ® Cystathionine ® Cysteine or Homocysteine (B12) ® Methionine
Homocystinuria 3 possible causes and their treatments
3 forms, all Autosomal Recessive - all resulting in excess homocysteine - Clinical findings: VERY HIGH levels of homocystein in urine, Mental retardation, osteoporosis, tall stature, kyphosis, lens subluxation, atherosclerosis.
- Deficiency of homocysteine methyltransferase (Tx?);
- Deficiency of cystathionine synthase (Tx: reduce dietary methionine, ↑B12 and folate, supplement cysteine);
- Mutated Cystathionine synthase with decreased affinity for pyridoxal phosphate (B6) (Tx: Give vitamin B6)
Hydatidiform mole is the most common precursor of what ovarian germ tumor?
Choriocarcinoma. Need to monitor beta hCG
Left untreated, may result in proximal fracture of scaphoid
Avascular necrosis of proximal fragment
Liver failure results in loss of these 3 major functions
break it down into 3 functions hepatocytes do. 1. Secrete bile (take bilirubin out of the blood and put it into bile) if not doing this you see jaundice 2. Make proteins (↓ coagulation factors (bleeding/bruising), ↓Albumin - decreased ability to carry hormones/drugs, peripheral edema and ascites; 3. Clear toxins (hepatic encephalopathy - delirium, hypersomnia, coma and death) asterixis - extend arms but continue to flap because they can’t maintain extension
Macrolides MOA
Uses?
inhibit protein synthesis by blocking translocation; binds to the 23S rRNA of the 50S ribosomal subunit; Bacteriostatic;
- Atypical pneumonias (Mycoplasma, Chlamydia, Legionella),
- URIs
- STDs
- gram-positive cocci (streptococcal infections in patients allergic to penicillin)
- Neisseria
MOA cyclosporine
Binds cyclophilin ® inhibits calcineurin (enzyme that activates transcription factor NFATc); Less activation of NFATc (nuclear factor of activated T cells in cytoplasm) ® less IL-2; Inhibits T cell growth, differentiation, and activation.
MOA of local anesthetics, which nerve fibers are blocked first
Blocking Na+ channels, prevents nerve from firing and causing pain; Small myelinated fibers are blocked first.
Most common cause of right-sided heart failure
left-sided heart failure
Most CSF is formed
choroid plexus of the lateral ventricles; Functions are to suspend the brain, bathes neurons and glial cells in homeostatic medium, provides route for chemical messengers to be widely distributed in the nervous system
Why are NSAIDs bad w/ declining kidney function?
Avoid NSAIDS with kidney insufficiency b/c NSAIDS inhibit cyclooxygenase -> Blocks synthesis of prostaglandins (dilate blood vessels), can’t keep afferent arteriole of kidney open so Renal plasma flow and GFR will decrease; NSAIDS reduce renal perfusion
NSAIDs’ inhibition of PGE2
cause increased vascular tone (vasoconstriction) and increased bronchial tone (bronchoconstriction)
Penicillin MOA
binds penicillin-binding proteins; blocks transpeptidase cross-linking of peptidoglycan; activates autolytic enzymes; used for gram-positive and syphilis; Bactericidal
Physical exam finding you must presume scaphoid fracture despite normal initial x-ray (how you get sued)
Tenderness in anatomical snuffbox; Avascular necrosis of proximal fragment
Portal hypertension causes
varices, ascites, etc. Vascular abnormalities present in a patient with portal hypertension = Esophageal and gastric varices; Varices around the anus/rectum; varices around the umbilicus (caput medusae)
Factors that control renal circulation
Prostaglandins dilate the afferent arterioles and increase GFR and ANG II constricts efferent arteriole and increases GFR
$ Signs of left-sided heart failure
Pulmonary edema; Orthopnea (discomfort in breathing while lying flat); Dyspnea on exertion; Paroxysmal nocturnal dyspnea (PND)
Signs of right-sided heart failure, most often cause
JVD; Peripheral edema; Hepatic congestion; #1 cause of RSHF is LSHF.
Strychnine MOA
Blocks glycine receptors, inhibitory neurotransmitter, if you block it causes wide-spread muscle spasms.
Synthetic agent used both as pituitary hormone analog and treatment for von Willebrand disease
Desmopressin (DDAVP) a synthetic analog of ADH
Tetanus toxin MOA
inhibits Renshaw cell release of glycine and GABA
Use of allopurinol in leukemia and lymphoma
Treatment of lymphoma may cause Tumor lysis syndrome (massive lysis of cells); Uric acid levels rise; Give allopurinol to prevent urate nephropathy and gout.
$$$$$ Wallenberg syndrome
“Wally PICked A lattle med Sized Vest before he SINeD”
Caused by occlusion of one of the Posterior Inferior Cerebellar Arteries (PICA). Unilateral infarct of lateral portion of rostral (beak, toward tip of frontal lobe) medulla (AKA posterior inferior cerebellar artery syndrome)
- Spinal V: Loss of pain and temp. over ipsilateral face (trigeminothalamic tract damage)
- Vestibular nuclei: Vertigo, nystagmus, nausea/vomiting (vestibular nuclei damage)
- Spinothalamic tract: Loss of pain and temp. over contralateral body (spinothalamic tract damage)
- Inferior cerebellar peduncle: lpsilateral cerebellar deficits (i.e., ataxia, past pointing) (inferior cerebellar peduncle damage)
- Nucleus ambiguus (CN IX, X, XI):Hoarseness, difficulty swallowing, loss of gag reflex (nucleus ambiguus: glossopharyngeal and vagus damage)
- Descending hypothalamics: lpsilateral Horner syndrome (descending sympathetic tract)
Inhaled treatment of choice for chronic asthma
Inhaled steroids: Fluticasone & Budesonide
Inhaled treatment of choice for acute exacerbations
Albuterol and Levalbuterol
Narrow therapeutic index, drug of last resort
Theophylline
Blocks conversion of arachidonic acid to leukotriene
Zileuton
Inhibits mast cell release of mediators, used for prophylaxis only
Cromolyn
Inhaled treatment that blocks muscarinic receptors
Iptratropium and Tiotropium
Inhaled long acting ß2 -agonist
Salmeterol
Blocks leukotriene receptors
Montelukast, Zafirlukast
