Week 8 Flashcards
what effect can diabetes have on the GI?
In some cases of longstanding diabetes, the enteric nerves supplying the small intestine may be affected, leading to abnormal motility, secretion, or absorption. This leads to symptoms such as central abdominal pain, bloating, and diarrhea. Delayed emptying and stagnation of fluids in the small intestine may lead to bacterial overgrowth syndromes, resulting in diarrhea and abdominal pain.
Metclopropamide and cisapride may help to accelerate the passage of fluids through the small intestine, whereas broad-spectrum antibiotics will decrease bacterial levels.
How to differentiate gout or pseudo gout with septic arthritis?
Obtain athrocentesis
gout - yellow, parallel, needle shaped
pseudogout - rhomboid, parallel is blue
*could see neutrophils from acute inflammation*
vs septic arthritis, likely to see culprit!
S. aureus, Strep or N. gonorrhea
what area of the brain does the ACA supply?
Stroke here –>
anterior-medial surface (could see in a midsaggital cut)
lesion –> contralateral lower limb paralysis and loss of contralateral lower limb sensation
viral particle with wheel like shaped?
What symptoms could this cause in a young child/infant?
double-stranded RNA, segmented, naked w/icosahedral capsid
Disease - #1 cause of severe infantile gastroenteritis that leads to watery diarrhea
ABG metabolic ketoacidosis?
METABOLIC acidosis –> bicarbonate will be low
increased anion gap
INC H+ / hyperventalation will compensate (decreasing PCO2)
** insulin normally shifts potassium in - lack of, plus acidosis, shifts potassium out of cell –> hyperkalemia but depleted totaly body K+ ..and eventually will be lost in urine –> part of treatment includes giving potassium
Recurrent vomiting ABG?
vomiting = expelling hydrogens –> metabolic ALKALOSIS
HCO3- INC
pH increased
Anion gap is normal
K+ decreased (in alkalosis, K+ shifts into the cells –> decreased K+)
what are the calories per gram of fats, proteins and carbs?
fats: 9 calories/gram
proteins: 4 calories/gram
carbs: 4 calories/gram
alcohol: 7 calories/gram
*Calories = Kcal = 1000 calories
What murmur could be described as brisk with a rapid fall?
aortic regurg
leukocytes vs lymphocytes vs myeloid cells?
leukocytes = white blood cells (not RBCs)
Lymphocytes = T cells, B cells, Natural killers (part of innate)
Rest are myeloid origin - includes: of myeloblast origin:neutrophils, basophils, eosinophils, monocyte/macrophage
Anestetics - what does it mean to have increased/decreased blood vs lipid solubility?
drugs with DECREASE solubility in BLOOD –>
rapid induction and rapid recovery
drugts with INCREASE solubility in LIPIDS–>
increase potency = 1/MAC (minimal alveolar concentration-in inhaled; amt required to prevent 50% of its subjects from moving in response to noxious stimuli)
what is pseudocholinesterase?
glycoprotein enzyme made by the liver to hydrolyze/deactive exogenous choline esters
ppl with a defect in this enzyme have higher levels of succinylcholine –> neuromuscular blockade by succinylcholine neurmuscular blocks
provide artificial ventilation until pt wakes up; no further medical complications have been noted
where are the most actively dividing cells in the GI found?
base of crypt
Fluoroquinoloes (-floxicans) should not be taken with what other drugs?
do not take with anti-acids!
(aluminum hydroxide, calcium carbonate, magnesium hydroxide)
*Tetracyclines also should not be taken wtih milk, anti-acids or iron containing preparations because it will decrease the bioavailability of the drug in the gut
polycystic kidney disease with clear kideny damaged ABG?
INC in BUN, INC in creatine, with a ratio <15 –> intrinsic renal failure –> metabolic acidosis
low pH and low bicarb
low PCO2 to compensate
What marker should be used to monitor heparin?
an increase of tihs marker could be an indication of what?
use PTT (partial thrombinplastin time-intrinsic pathway)
Heparin induced thrombocytopenia (HIT) = development of IgG antibodies against heparin boudn platelet factor 4
Ig-heparin-PF4 complex activates platelets –> thrombosis and thrombocytopenia
No neutrophils at infection site, yet enough in the blood + mulitple skin and mucosal infections?
LIkely to be leukocyte adhesion deficiency type 1 -defect in LFA1-integrin CD18 protein on phagocytes –> impaired migration and chemotaxis
Auto recessive
also associated with: absent pus formation, impaired wound healing and delay umbilical cord separation (>30days)
person with hemochromatosis is at increased risk for what disease processes?
HCC
also results in HF and testicular atrophy
primary is autosomal recessive
secondary could be do to excessive transfusions
Atelectasis-
what is it? what does it cause and what could precipitate it?
atelectasis = alveolar collapse –> bronchial obstruction
on lung exam: decreased breath sounds, dull to percussion, decreased fremitus, and if there is tracheal deviation, it wil be towards the affected side
causes:
- compression (usually an accumulation of fluid/blood/air that physically compress/collapse the adjacent lung) examples are pleural effusions from HF, typically reversible
- Resportion (when air is blocked from reaching the alveoli) examples are obstruction of bronchus by mucopurulent plug; typically reversible
- Contraction (occurs when local or generalized fibrotic changes in the lung/pleura hamper expansion and increase elastic recoil during expiration) example radiation therapy; typically irreversible
fingershaped fibrovascular core with benign squamous cell epithelium on vocal cords or epligottis?
think HPV 6
Dry tap?
think: aplastic anemia (hypocellular) or myelofibrosis (fibrotic)
myelofibrosis–> tear drop cells
=obliteration of bone marrow due to increase fibroblast activity in response to proliferation of monoclonal cell lines
see tear drop RBC and immature forms of the myeloid line (ie-nucleated erythrocytes)
often associated with massive splenomegaly
NOT associated with the philadelphia chromosome but in 30-50% of the cases with a JAK2 mutation
left lower sternal border holosystolic murmur?
ventricular septal defect
leukamoid reaction:
acute inflammatory response to infection
increase WBC with increase neutrophils and increase precursors such as band cells (left shift)
increase LAP (leukocyte alkaline phosphatase - in contrast to CML which as a decrease LAP)
melanoma - what affects its prognosis?
significant risk for metastasis
DEPTH correlates with risk
pulmonary hypertension is mostly idipathic but can be secondary to..
fibrosis
fibrosis –> deoxygenation –> vasoconstriction via endothelin-1
tx: bosentan (endothelin-1 antagoinst –> decreasing vascular resistance), PDE inhibitors, prostaglandin analogs (PGI1 - epoprestinol, iloprost)
*pulmonary sclerosis is the most common cause of death in people with scleroderma*
Overview of MS pahtogen:
Autoimmune with destruction of oligodendrocytes
hypersensitivity reaction type IV
thought of CD4+ T activated by myelin basic protein
related with HLA-DR2
What HTN drug should be avoided in bilateral renal stenosis
ACE inhibitors (-prils)
it can increase the progression to renal failure by further decreasing GFR
one of the tale-tell sign of renal stenosis when PT has high blood pressure with INC renin and INC aldosterone; hypokalemia and metabolic alkalosis+ giving ACE inhibitor further increases serum renin!
Olser-Weber-Rendu syndrome-
clinical presentations:
aka: hereditary hemorrhagic telangiectasia
Autosomal Dominant
inherited blood disorder of blood vessels
branching skin lesions (telangiectasias), reccurent epistaxis, skin discoloration, AV malformations, GI bleeding and hematuria
pulmonary AV shunting –> shortness of breath
Drug-induced interstitial nephritis:
presentation
causative agents
=tubulointerstitial nephritis
pyuria, often with eosinophils and azotemia occuring after administration of drugs that act as haptens –> hypersensitivity
associated with: fever, joint pain, rash, CVA tenderness, hematuria (or could be asymptomatic)
biopsy: inflammatory infiltrates
Nephritis occurs 1-2 weeks after certain drugs: diuretics, penicillin derivatives, PPI, sulfonamides, rifampin
but can occur months after NSAID use
underventilated but well perfused area of lung –>?
physiologic shunt
which vibrio could cause cellulitis?
vibrio vulfinuclus
factor that leads to vasoconstriction in the lungs with lack of ventilation?
Endothelin-1
Bosetan = endothelin antagonist, used in pulmonary hypertension
what is the result and cause of glycogen deficiency in the vaginal epithelium
glycogen deficiency can result from estrogen due to premature ovarian failure or menopause
this results in –> flattening of the labial folds and vaginal rugage which can cause dyspareuria
How do RBC accomodate for low blood oxygenation levels?
RBCs don’t have a mitochondria thus can’t produce tons of ATP via the citric acid cycle
BUT they have the enzyme bisphosphoglycerate mutase which is able to convert 1,3 bisphos to 2,3 bisphos; this step bypasses the ATP-generating step of glycolysis
this increases in hypoxia and chronic anemia
2,3-BPG allosterically decreases hemoglobins affinity for oxygen thus increasing oxygen delivery at the periphery
what contributes to slow phase 4 of cardiac pacemaker cells:
what drugs prolong phase 4?
- closure of K+ channels
- slow inward Na2+ flow through funny channels
- opening of T-type Ca2+ channels
Acetycholine and adenosine prolong phase 4, reducing the rate of spontaenous deoplarization in cardiac pacemaker cells
what is the major determinant of symptom severity in pt with tetrology of fallot?
the degree of right ventricular outflow obstruction, determines how much deoxygenated blood is delievered to the systemic system, thus determing the degree of right to left intracardiac shunting and cynosis
note- the degree of RVOT obstruction is dynamic and can increase sudenly –> cyanosis / tet spells
can be triggered by: hyperventilation, dehydration, idiopathic
what type of trauma is common with posterior and anterior urethral injuries in men?
mgmt?
Posterior urethra includes the prostate and mebraneous segment; the membraneous segment is more likely to be injured due to its lack of surrounding supporting tissue
– pelvic injury
anterior urethra includes the bulbous and penile segment;
– straddle injuries
if urtheraly injury is suspected, foley is contraindicated as it may worsen the injury; do a retrograde urethrogram to assess injury
where is the center related to acute nausea post chemotherapy?
stimulation of the chemoreceptor trigger zone, which lies in the area postrema of the dorsal medulla near the 4th ventricle
this area received blood from fenestrated blood vessels / no BBB thus allowing it to sample chemicals circulating in the blood
Name the function of RB:
one of the regulators of the G1 –> S transition
active RB = HYPOphosphorylated (ie- resting cells in Go phase)
inactive RB = HYPERphosphorylated
when the cell is stimulated by growth factor, activation of cyclin D, cyclin E and the corresponding cyclin kinases 4 and 6, occur –> hyperphosphorylation of the RB protein = inactivation –> release of E2F transcription factor allowing the cell to progressin from G1 –> S
if RB is active (hypophosphorylated) in binds to E2F stopping the transcription of genes necessary for G1 –> S thus cell division
what is p27?
cell cycle inhibitor
acts during G1 phase by inhibiting cyclin-dependent kinases
normal tissue contains high levels of p27 while malignant tissues contain low levels
where does meningitis colonize?
mucosal epithelium of the nasal pharynx
transmission is droplet or direct contact with respiratory secretions
colonize via pilus mediated adhesionso the mucolsa epithelium –> invade –> gain access to the vasculature where they spread hemotogenously
recombo between silent and expressed pili genes –> antigenic variation that makes vaccines difficult to target
also have an IgA protease that inhibits mucosal antibodies
Diffuse esophageal spasms (DES)
pathogen
sx
imaging
Most likely nvolved impaired inhibitory neurotransmission within the esophageal myenteric plexus –> inappropriate contraction of the esophagus –> disorganized non-peristaltic contractions
sx: food bolus is inefficiently propelled towards the stomach –> intermitten solid/liquid dysphagia, chest pain, heartburn, food regur
monometry shos disorganized non-peristaltic contractions
corkscrew esophagus on barium esophagroam
mgmt of febrile seizures
acetaminophen or ibuprofen for comfort
most common neurologic disorder affecting children
rf: high temps, family hx
exclude CNS infections
minimally increase risk of developing nonfebrile seizures
use: antipyrecs can dec fever and improve pt comfort by inhibiting prostaglandin synthesis; decrease prostaglandin E2 –> reduce thermoregulatory set point in the hypothalamus, thus lowering body temp
do not prevent future sezures though!
With which of the congenital adrenal hyperplasia would a pt have increase bp?
11b- hydroxylase (due to weak mineralcorticoid of 11- deoxycorticosterone) w/ ambiguous genitalia in females
17a- hydroxylase (increased aldosterone production)
all pt phenotypically female; affected individuals do not undergo puberty (no sex steroids), develop hypertension, hypokalemia
what are common initial symptoms of MS?
Manifest with various self-limiting neurological sx, usually in pt 20-30 y/o
most common initial sx: optic neuritis, internuclear opthalmoplegia, sensory deficits
*symptoms usually worsen with heat exposure (hot shower, streneous activity) –> fatigue; due to decreased axonal transmission associated with increased heat, also may lead to episodes of worsening neurological deficits
affected areas demonstrate myelin breakdown/demyelinaiton
chronic demyelinating dx affecting the white matter of CNS
NK Cells:
- derived from lyphoid stem cells
~10% of lymphocytes circulating
large cells with cytoplasmic granules containing perforins, granzymes –> apoptosis
Do not directly lyse cells
responsible for destruction of cells with decreased or absetn MHC class I on their surface
CD 16 or CD56
do not req. thymus for maturation; found in athymic pt
have no antigen-specific activitys; dont req antigen for activation and do not ahve memory ability
activated by interferon-gamma, IL12
Benzos vs barbituates
Benzos - increase FREQUENCY of chloride channel opening
Barbs - increase DURATION of chloride channel openning
N gonorrhea tx?
must treat for both N gonorrrhoeae and Chlamydia trachomatis
N. gonorrhea: ceftriaxone
C. trachomatis: doxycycline or azithromycin (macrolide - erythromycin
how does chronic rejection affect the lungs?
**rejection of lung transplant differs from rejection of an intra-abdominal organ-which is primary vascular obliteration**
In lung transplant, the immune system affects the small airways –> inflammation of the small bronchiles= bronchiolitis obliterans syndrome
-inflammation and fibrosis of the bronchiolar wall –> narrowing and obstruction of the affected bronchioli
*major cause of mortality in lung transplantation
sx: dyspnea and wheezing
note: pulmonary and bronchial vessels are the main targets of acute rejection- perivascular infiltration with lymphocytes, macrophages, plasma cells is characteristic
primary platelete problem
+ megakaryocytes??
immune thrombocytopenia
antibodies directed against G11b/IIIa
–> splenic macrophage consumption of the immune complex
commonly due to viral illness
Labs: megakaryocytes
Tx: steroids, IVIG, splenectomy for refractory
increase in hydrostatic pressure in bowman’s space?
something beyond the bowman’s capsule that is pushing up pressure…
ie) BPH
When a renal artery is blocked, what are the effects?
renal is not being perfused and is not filtering –>
blood pressure is going to increase (depends how much the other kidney is working)
The affected kidney is not “sensing” that blood is coming through / sense “low blood pressure” –> activate the RAAS system –> increased renin, increased aldosterone –> greater increase to the bp, total peripheral pressure is increased
(think of this case with low renal perfusion from stenosis or fibromuscular dysplasia, CHF, ect..)
chronic gastritis –>
mucosal inflammation often leading to atrophy, (hypochlorydia –> hypergastrinemia) intestinal metaplasia, hyperplasia of enterochromaffin cells
increase risk for cancer
