Week 2 Flashcards
Constituent of NAD+
Cofactor in oxidation and reduction FADH2 and FMN
Constituent of CoA
Niacin, B3
Vitamin B2, riboflavin
Vitamin B5
23 yo G1P0 refuses any meds during pregnancy despite mild, constant nausea. When is fetus most susceptible to damage from teratogens ?
Embryonic period (weeks 3-8) Organs are being formed.
50 year old roofing worker develops cough w/ hemoptysis. Denies smoking history, X-ray reveals left-sided lower lung coin-shaped lesion. Type of lung cancer suspected?
Appearance of asbestos fibers in lung?
Cancers associated with asbestosis?
RO small cell, squamous cell (smoker);Mesothelioma and bronchogenic carcinoma (looks like a coin shaped lesion);
Asbestos bodies look like Golden-brown rods that resemble dumbbells.
Mesothelioma and bronchogenic carcinoma
A 24-yearold young man is fired from his job and when explaining the chain of events to his roommate he explains that “it doesn’t really matter. I didn’t even need that job.” His roommate is perplexed, wondering how they will pay their rent, Of which Immature ego defense could this be an example?
Rationalization
A 45-year-old woman presents to the ER with complaints of chest pain, a racing heart beat and dizziness. Examination reveals a heart rate of 120 beats/minute, BP of 116/74, and 20 respirations/minute. The patient Is diaphoretic and anxious. An initial EKG reveals ventricular tachycardia with shifting sinusoidal waveforms. What is this classic EKG finding?
What are the possible causes of this patient’s condition?
Torsades de Pointes
- Drugs that prolong the QT interval
- Hypokalemia
- Hypomagnesemia
- Congenital long QT syndromes
A 49-year-old trauma patient comes into the ER unconscious and in need of surgery. What are the exceptions to informed consent?
Emergency situations (consent implied); Patient lacks decision-making capacity; “Therapeutic privilege” (extremely rare); Waiver
A patient comes to the clinic complaining of severe low back pain that radiates down the back of her leg. What is the most likely explanation for her pain?
Herniated intervertebral disc; Nucleus pulposus protrudes into vertebral canal and compresses the spinal nerve roots.
Anatomical layers of penis
- Outer dermis
- Dartos muscle layer
- Deep fascia (Buck’s fascia)
- 3 masses of cavernous erectile tissue encased and separated by tunica albuginea -
- 2 dorsolateral corpora cavernosa
- 1 ventral corpus spongiosum
- Urethra (within the corpus spongiosum).
B-cell surface protein that the monoclonal antibody rituximab targets
CD20. used for B cell lymphomas, Rheumatoid arthritis
Can an emergency procedure be done on a 15 yo boy without his parents signing a consent form?
Yes, consent is implied during emergency situations (even if minor)
Causative organism of osteomyelitis; organism in SCA; drug addict with osteomyelitis
- Staph aureus
- Salmonella in SCA
- Pseudomonas aeruginosa in drugs abuser
Chronic cough + coughing blood + XR coin lesion. Lug cancer is on differential. Most common locations of lung cancer mets?
“LABB” Liver, Adrenal glands, Bones, Brain
Cytokines secreted by 2 different types of helper T cells (Th1 and Th2)?
Th1 make IL-2 and INF-γ; TH2 make IL-4, IL-5, and IL-10
Diabetic complications of sorbitol-induced osmotic damage?
enzyme that converts glucose to sorbitol?
Neuropathy (motor, sensory, and autonomic degeneration); Cataracts;
Aldose reductase converts glucose to sorbitol; Sorbitol dehydrogenase converts sorbitol to fructose in the schwann cells.
Drug in treatment of HTN that is a teratogen?
Effect on fetus?
ACE inhibitors - Captopril, lisinopril, enalapril; Angiotensin receptor blockers (ARBs) - Losartan, valsartan, candesartan
Fetal kidney damage. Acts on kidneys, ruins kidneys - don’t put preganant or women that may become pregnant on ACE inhibitors or ARBs!
Drugs that cause Lupus like syndrome
“SHIPP”
- Sulfasalazine
- Hydralazine
- Isoniazid
- Procainamide
- Phenytoin
Due to injuries of neck, you must place central line in the groin. Describe anatomy of the femoral sheath. Where do you place in relation to the femoral pulse?
Tube of fascia deep to inguinal ligament - Femoral artery and vein; Femoral nerve is outside the sheath;
Lateral to medial - “NAVEL” Nerve; Artery; Vein (Empty space); Lymphatics. Palpate femoral pulse; Insert needle medial to the artery.
During morning rounds you check on a 70-year-old man with congestive heart failure. You observe marked jugular venous distention. What gives rise to the jugular venous a, c, and v waves?
** A wave:** atrial contraction;
C wave: ventricular contraction;
V wave: atrial filling against the closed tricuspid valve.
Eating fugu sashimi in Japan is at risk for what toxicity? Mechanism?
Fugu is puffer fish. Tetrodotoxin - Binds voltage-gated Na+ channels; Prevents depolarization - Coma, Respiratory arrest, Cardiovascular collapse 17minutes to 4 hours after ingestion. If chef prepares properly you will have a pleasant tingly sensation in your mouth.
Foods high in mercury to be avoided during pregnancy
Mercury causes brain damage; FDA recommends pregnant women avoid: Shark; Swordfish; King mackerel; Tilefish
Football player suffers lateral blow during football game now complaining of pain in right knee. Which structures were likely injured in “unhappy triad” knee injury
ACL, MCL, Lateral meniscus
Hepatic failure w/ normal renal function, change LD or MD because of hepatic failure. Hepatorenal failure?
No need to change any, lower dose. Only drugs that affect clearance will affect maintenance dose. Maintenance does doesn’t change. Renal failure wont affect LD, but MD will need to be redued b/c it is determined partially by clearance.
Hospitalized 40 yo patient 3 days ago w/ MI, given usual meds and today his platelet count is 30,000. Cause of low platelets?
Next step?
Heparin or LMWH (enoxaparin) - Heparin-induced thrombocytopenia. At risk for thrombosis because platelets are aggregating together.
Tx: Stop heparin, Treat with: Lepirudin or Bivalirudin
How does MRI differ from CT imaging?
MRI -
- More expensive
- No radiation
- Better for soft tissue
- No metal
- Bones look gray
- Claustrophobia
- Takes >1 hour
CT -
- Less expensive
- Radiation
- Better for bone and blood
- Metal no problem
- Bones look white
- No claustrophobia
- Takes about 10 minutes
INFγ stimulates macrophages and inhibits T2 helper cells. Release by these cells?
TH1 helper T cells
LMN lesion vs. UMN lesion
LMN -
- Muscle atrophy
- Flaccid paralysis
- Muscle fasciculations;
- ↓ reflexes
- negative Babinski reflex
UMNL -
- ↑ muscle tone
- Spasticity
- ↑ reflexes
- Positive Babinski sign
Location of B cells in lymph node?
T cells,
plasma cells,
macrophages?
- B cells found in cortex of follicle of lymph node.
- T cells in paracortex between follicles and medulla.
- Plasma cells found in medullary cords of lymph node.
- Macrophages found in medullary sinus
MOA hyperosmolar laxatives, examples.
Substances not absorbed, stay in the gut, draw fluid into the bowel.
- Magnesium citrate
- Polyethylene glycol - Miralax, GoLytely, NuLytely
- Lactulose (osmotic but creates acidic stool to trap ammonia as ammonium to be excreted)
- Sorbitol
- Glycerine
Most common cancer in non-smokers, location
Bronchial adenocarcinoma, Bronchioalveolar adenocarcinoma and mesothelioma are not closely linked to smoking. Peripheral location.
Most common renal malignancy in adults; gene deletion in this malignancy
- renal cell carcinoma. Chromosome 3
- Von Hippel lindau syndrome.
Muscles of mastication
Temporalis, Masseter, lateral pterygoid, medial pterygoid
Mutation in this proto-oncogene associated with Hirschsprung disease
** RET gene mutation** - assists neuroendocrine (NCC) move to the GIT.
Narcoleptic sleep episodes begin with what stage of sleep?
What are the different stages of normal sleep?
How doe they differ from one another?
REM sleep
- Awake (alert) - Beta waves (high frequency and low amplitude);
- Awake (relaxed) - Alpha waves;
- Stage N1 (light sleep) - Theta waves;
- Stage N2 (deeper sleep) - Sleep spindles and K complexes;
- Stage N3 (slow-waves sleep, deepest non-REM) - Delta waves (low frequency, high amplitude);
- REM sleep - Beta waves (high frequency, low amplitude)
Neuron lost in PD │ NT │ Tx │ MOA of surgical lesion of subthalamic nucleus
Deterioration of dopamine-producing neurons in the substantia nigra pars compacta;
↓Dopamine, ↑ Acetylcholine
- ↑ dopamine synthesis - **levodopa, carbidopa; **
- Prevent dopamine breakdown - selegiline, entacapone, tolcapone;
- Dopamine agonists - bromocriptine, pramipexole, ropinirole;
- Anticholinergic drugs - benztropine, trihexyphenidyl.
Surgical lesion - Subthalamic nucleus stimulates the internal globus pallidus, which inhibits movement. If you lesion the subthalamic nucleus or the globus pallidus internus, you are inhibiting an inhibitor of movement.
Peripheral smear most consistent with lead poisoning
basophilic stippling of RBCs; Treatment is Succimer; dimercaperol or EDTA for adults
Rendu-Osler-Weber sydnrome
Hereditary hemorrhagic telangiectasia
- AD
- Telangiectasias in the skin/mucous membranes, possibly other organs
- Bleeding (nosebleeds and GI bleeds)
- High-output heart failure
SD vs SEM; used in calculating confidence intervals?
SD is measure of variance in a sample - 1 SD captures 68% of values, 2 captures 95% and 3 captures 99.7%. SEM - how well the mean of the sample will predict the mean of the entire population. SEM = SD/square root of N; Confidence Intervals calculated using standard error of the mean. CI = mean ± (Z x SEM), where Z is standard number and a CI of 95% is 1.96; CI = 99% is 2.58.
Sertoli cells release substance acting on paramesonephric ducts to prevent what structures in normal male fetus?
Mullerian inhibitory factor inhibits formation of: Fallopian tubes, Uterus, Proximal vagina.
TBI after motorcycle crash, neurosurgery resident orders phenytoin for seizure prophylaxis. What are the toxic side effects of phenytoin?
*“Mega FLINGHS” *
- Megaloblastic anemia
- Fetal hydantoin syndrome (gums, hair, messed up baby)
- Lupus like syndrome (SHIPP - Sulfazalazine, Hydralazine, Isoniazid, Procainamide, Phenytoin)
- Induces P450;
- Neurological Effects (SANDD) - Diplopia, Sedation, Ataxia, Nystagmus, Dizziness
- Gingival hyperplasia
- Hirsutism
- Stevens-Johnson syndrome - skin and mucous membranes ulcerate and slough off.
vaginismis
Reflex of the pubococcygeus muscle; Muscles in vagina to tense up suddenly; Common women in teens and early 20s; Tx: Relaxation.
What branchial arch derivative abnormality causes facial abnormalities by affecting Meckel’s cartilage?
What cranial nerves are affected in this abnormality?
What is the derivative of the branchial arches?
Meckel’s cartilage - 1st branchial arch
Cranial nerves: V2 and V3
- Mesoderm - muscles and arteries;
- Neural crest: Bones and cartilage (like meckel’s cartilage)
What popular non-benzodiazepine hypnotic is often avoided in the elderly because of the very undesirable side effect of confusion, to which elderly patients are very susceptible?
Zopidem; acts on same GABAa receptors. Be aware in elderly especially those w/ dementia or delerium.
You perform radial masectomy and exercise extreme caution as you dissect laterally along the serratus anterior muscle. You do this to avoid severing which motor nerve, resulting in what sequelae?
Long thoracic nerve, winged scapula
Young child weakness of extremities, has Arnold-Chiari II malformation with syringomyelia. What is syringomyelia? Symptoms commonly seen?
Arnold-Chiari II - herniation of cerebellum through the foramen magnum. Type I is mild, Type II more significant where you may see
Syringomyelia - Central canal of spinal cord is compressed; Dilation of canal distal to compression;
Dilated canal compressing tracts nearby (crossing fibers of spinothalamic tract, white commisure, could involve motor neurons of anterior horn);
Symptoms - loss of pain and temperature sensation; Sensation to touch unaffected; Cape-like distribution; ± Motor deficits (hand or arm weakness)
Young man presents with gynecomastia secondary to heavy marijuana use. Drugs that cause gynecomastia? Antifungals MOA? Diuretic drug MOA?
Ketoconazole - inhibits first step of steroid hormones synthesis (desmolase); Weak androgen receptor antagonist
Spironolactone - aldosterone antagonist and a potassium sparing diuretic -
- Increases conversion of testosterone to estradiol
- Blocks testosterone synthesis
- Antagonist of androgen receptors
