world 45 Flashcards
what are the two most common causes of right-to-left intracardiac shunts in CRYPTOGENIC STROKE
ATRIAL SEPTAL DEFECT (ASD)
PATENT FORAMEN OVALE (PFO)
when does one see a PARADOXICAL EMBOLIS
PATENT FORAMEN OVALE (PFO)
conditions that raise the RIGHT ATRIAL PRESSURE above the left atrial pressure (VALSALVA) can produce a transient right-to-left shunt across the PFO that may result in paradoxical embolization
foramen ovale is patent in 25% of adults (compared to0.1% w/ ASD)
what is the best test for hypo/hyperthyroidism
TSH
initiation of transcription is governed by the binding of transcription factors to the regulatory region of the gene. Transcription factor II D binds where
TATA promotoer sequence located ~25 bases upstream form the coding region of the gene
elongation factors facilitate what in tRNA
tRNA binding and the TRANSLOCATION steps of protein synthesis
chicks with anti-phospholipid antibody are at greater risk for what complications
VENOUS or ARTERIAL THROMBOEMBOLIC DISEASE
- DVT
- PE
- ischemic stroke/TIA
ADVERSE PREGNACNY OUTCOMES
- unexplained embryonic or fetal loss
- premature birth due to placental insufficiency or preeclampsia
chicks with anti-phospholipid antibody have what lab findings
LUPUS ANTICOAGULANT EFFECT- paradoxical aTT prolongation NOT REVERSED on plasma mixing studies
ANTICARDIOLIPIN antibody
ANTI-BETA-2-GLYCOPROETIN-1 antibody
attenuated S2 heart sound indicated what
PULMONARY HYPERTENSION
what is seen in CREST syndrome
Calcinoshs Raynauds phenomenon Esophageal dysmotility Scleodactyly Telangiectasias
PULMONARY HTN develop due to damage to pulmonary ARTERIOLES (attenuated heart sounds and cor pulmonale)
what causes limited and systemic sclerosis
increased DEPOSITION of COLLAGEN in TISSUES (thought to be triggered by monoclonal T cell in the affected tissues that secret a variety of cytokines (TGF-beta), which increase collagen and ECM proteins by fibroblasts)
earliest damage is seen in SMALL ARTERIOLES and CAPILLARIES
pt with PYRUVATE DEHYDROGENASE DEFICIENCY gets build up of PYRUVATE which gets shunted to lactate via lactate dehydrogenase, resulting in potentially life-threatening lactic acidosis. how is this disease manged
KETOGENIC DIET (high fat, low card diet w/ moderate levels of protein) and LYSINE and LEUCINE are the only truly ketogenic
LYSINE and LEUICINE can provide energy for these peeps in the form of ACETYL-CoA without increasing lactate production
how does AML present
adults (65)
pancytopenia (fatigue form anemia, bruising/bleeding from thrombocytopenia, infection from possible functional neutropenia despite leukocytosis)
white count around 15,000 at presentation
over 20% blasts
urinary concentration of creatine and inline remain equal to what
filtered load of the substance regardless of the serum concentration
what is cystitis cā path in the glomerulus
filtered at glomerulus w/ no active reabsorption
metabolized by renal tubular cells, which results in variable urinary excretion
appears in urine at level low serum concentration
what are PAH concentrations like at differed filtered amounts
urinary exertions exceeds total filtered amount always because its actively secreted
what are the possible causes of HYPOXIA with a NORMAL A-a gradient (b/w 5-15)
ALVEOLAR HYPOVENTIALTION
INSPIRATION of AIR at HIGH ALTITUDE
the normal A-a gradient indicates that the low PaO2 is due directly to low PAO2
what causes an increased A-a gradient
thickening of alveolar capillary membranes (alveolar hyaline membrane disease)
right-to-left shunt
V/Q mismatch (pneumonia, COPD)
L2 nerve rood radiculopathy results in what
sensory loss: upper anteromedial thigh
weakness: hip flexion (iliopsoas)
L3 nerve rood radiculopathy results in what
sensory loss: lower anteromedial thigh
weakness: hip flexion (iliopsoas), hip adduction, knee extension (quads)
L4 nerve rood radiculopathy results in what
sensory loss: lower anteromedial thigh, knee, medial calf and foot
weakness: hip adduction, knee extension (quads), PATELLAR reflex
L5 nerve rood radiculopathy results in what
sensory loss: buttocks, poterolateral thigh, anterolateral leg, dorsal foot
weakness: foot dorsiflexion and inversion (tibialis anterior), eversion (peroneus), and toe extension (extensor digitorum braves)
S1 nerve rood radiculopathy results in what
sensory loss: buttons, posterior thigh and calf, lateral foot
weakness: HIP EXTENSION (gluteus maximus), knee flexion (hamstrings), foot plantar flexion (gastrocnemius), ACHILLES refelx
a postitive straight leg raise test (pain elicited in the supine patient when the left is held straight while raised off the examining table) is a sign of what
SCIATIC NERVE ROT (L4-S3) IRRITATION
most sensitive for intervertebral disc herniation causing sciatica
whats going on in hemochromatosis
AR
excessive intestinal iron absorption and accumulation within parenchymal tissues that result in end organ damage
MISSENSE mutation in HFE gene (C282Y)
enterocytes and hepatocytes sense false low iron levels
- increased divalent metal transporter 1 internal iron absorption
- decreased hepsiden synthesis- increasing ferroportin expression and promotes iron secretion into circulation
