Bbc Session 12

Front 1

Potential causes of metabolic alkalosis?

Back 1

loop diuiertics (K loss), insulin (K redistrbution), vomiting

Front 2

reqsiratory quotient

Back 2

CO2 release vs. O2 uptake, will be under 1 w/ hypoventilation, diabetes and fasting

carbs RQ is 1, poteins 0.8, fat 0.7

Front 3

Hb as a buffer

Back 3

takes up H ions in the blood, buffers ions in venous blood

Front 4

B-thalsemmia vs. alpha thalassemia Hb

Back 4

B thalsemial see HbF and HbA2 (usually a smaller component)

a thalsemmia- HbH or Hb bart, defect in alpha chain, 4 genes per person

Front 5

What causes a right shift in Hb O2 binding?

Back 5

Decreased affiinity

acidosis, increased CO2, 2,3-DPG, and temp

Front 6

gamma globulin in blood resposinpble for

Back 6

antibodies

decreased in agammaglobulinemia

Front 7

Largest resisitance in blood vessels is in the...

Back 7

arterioles

largest pressure is in the arteries

Front 8

The ductus venosis...

Back 8

connects the mbilical vein (only 1), to inferior vena cava

Front 9

Sites of action of...
carbonic anhydrase inhibtors
loops
thiazides

Back 9

carbonic anhydrase acts in proximal tubule, site of active resoprption (glucose, aas)and secretion (organic acids and protons)

Loops- NaCll resoption, thick ascending rtion impermeable to water

Distal tubule- K secretion and H secetion in exchange for Na, thiazides

CD- water permeability regulated by hormones

Front 10

Acid base in proximal tubule

Back 10

carbonic anhydrase converts water and CO2 to H and bicarbm 9.9% of filtered bicarb recovered, H is secreted and combines with tubular bicarb which is then transported back into peritubular space fom lumen

Front 11

GFR can be calculated by..

Back 11

inulin clearnance or creatine clearance, RBF can be calculated by PAH clearance

filtration fraciton = GFR/RPF

Front 12

Contraction of the afferent arteriole does this to GFR

Back 12

what is... decreases GFR

efferent arteriole contraction increases GFR

Front 13

Causes of hypertonic dehydration, hypertonic hydration

Back 13

excess sweating, diabetes insiduptus

hyperaldosteronism

Front 14

Atrial natiruretic peptide

Back 14

high extracellular volume, leads to atrial stretch ->natriuresis

Front 15

Renin released when

Back 15

NaCl delviery to macula densa is low or BP at JG cells is low

Front 16

Sites of GI absorption for... carbs, aa's, iron, vit B12, bile salts

Back 16

carbs- duodenum/jejunum
aa's- duodenum/jejunum
iron- duodenum
vit B12- terminalileum
bile salts- terminal ileum

Front 17

Cystinuria

Back 17

defect in basic aminoacid transporter

Hartnup dz is defect in neutral aminoacid transporter

Front 18

Important GI hormones

gastrin, secretin, CCK, GIP, somatostatin

Back 18

gastin-> H
Secretin -> bicarb in duodenum
CCK- enzymatic pancraetic secretion and gallbaldder contraction
GIP- stimulates insulin release
Soatostatin- inhbits HCl and enzyme secretion

Front 19

aldosterone released when...

Back 19

ang II, high K, somewhat ACTH

Disorders are Conn syndrome- too much

Addison- too little, hyponatremia, K retention, H retention

Front 20

Insulin metabolic effects

Back 20

liver- glycogen synthesis, decrease gluconeogensis, increased lipogenesis

muscle- increase glucose transport, glycolysis, increased AA uptake

fat cells- glucose tranport and glycerol synthesis to TGs, decrease lipolysis

Binds tyrosine kinase to activate ras, raf MAP kinase cascade
PHOSPHORYLATES

Front 21

FSH and LH functions in ovaries ant testes

Back 21

FSH- follicle maturation in ovaries, speramtogenesis in testes

LH- triggers ovulation, testosterone secretion in testes

Front 22

Important milestones

Back 22

chin up at 1 month, chest up at 2 months, sits alone and 7 months crwals on stomach at 8 months, stands holding something 10 months

Front 23

Freud vs. Piaget vs. Erikson

Back 23

Freud- uncoscios mental processes are the driving force motivating our behaviro

Piaget- develops in sequential stages

Erikson- ego develops in stages, each one characterized b a struggle

Front 24

Classical conditioning vs. operant

Back 24

classical- stimulus and response

operant- positive reinforcer and negative reinforcer

Front 25

Short intermediate and long acting insulins and uses

Back 25

short acting- regular insulin, insulin lsipro, aspart, glusiline, postprandial

intermeiate- NPH (humulin)

insulin glargine- long acting, can stay up for 24 hours, can mimic basal insulin tone

Front 26

Criteria for the betes

Back 26

fasting glucose over 126, random glucose of >200, serum glucose over 200 2 hours after a 75 gram oral glucose load or HbA1C over 6.5

Front 27

Metformin

Back 27

biguainde, inhibits glucose absorption, decerases glucose output by liver, increase glucose uptake in adipse tissue adn skeletal muscle

not for severe CHF, liver or renal failure

Front 28

Acarbose

Back 28

alphal-glucosidase inhibitor, prevents GI tract ability to degrade carbohydrates, making glucose less available for absoprtion

leads to flatulence though...

Front 29

Glitazones

Back 29

rosi/pioglitazone

work to lower blood sugar by increasing receptors and glucose transporters in fat and muscle, can cause weight gain edema, new onset heart failure, and hepatotoxicity

Front 30

Slufonureas and glinides

Back 30

Sulfonurylureas- increase calcium entry into eta islet cells by preventing K efflux -> depolarization of cell, leads to release of insulin

sulfonuryeas lose effective ness over time, 1st genend in amide, 2nd gen is glimerpiride, glynburide, glipidize

glinides- same thing don't lose effectiveness over time

Front 31

GLP-1 analogues and DPP-4 inhibitors

Back 31

GLP-1 analogs- decrease appetitie increase pancreatic sensitivity leading to increased insulin rlease, also decreased heaptic fat content leading to decreased TGs, senatide and liraglutide

-gliptans- DPP-4 inhibitors prevent breakdown of incretins (GLP-1 and GIP)

cause GI distrubance, contrainidcated in renal failure

Front 32

Familial lipoprotein lipase deficiency

Back 32

liprprotein lipase deficit/abnormality or apo CII defect, results in TGs and fatty acids being unable to enter adipose tissue, causing increased TGs and VLDLs, can't be degraded by liprotein lipase to form LDL so LDL and HDL is low, AR inheritance not atherogenic

Front 33

Familial hypercholesterolemia Type IIA and B

Back 33

II A- defect in LDL receptor

IIB- decreased affinitiy for LDL receptor d/t mutant apoprotein B100 (faciliates binding of LDL to receptor)

Can't be taken up by liver leading to elevated LDL and VLDL, AD and atherogenic

Front 34

Mutant apo E results in increased...

Back 34

chylomicrons, VLDLs, IDL, LDL and decreased HDL, important for hepatic uptake of chylomicron remnants

Front 35

Fmailial hypertryglyceridemia

Back 35

overproduction of VLDL associateed w/ glucose intolerance and hyperinsulinemia, AD, mildly atherogenic, increased risk for pancreatitis (similar to other lipidemias)

Front 36

Guidelines for hyperlipidemia treatment

Back 36

hyperTGs- over 150

hyperlipidemia occurs with LDL over 160 w/ 1 risk factor, 190 need to do meds, with more riksk facors do emds at 160, 130 can do lifestyle mods and exercise

with diabetes, MI, AAA, PVD need under 100 to avoid meds

Front 37

Niacin

Back 37

decreases hepatic uptake of FFAs, inhibits lipolysis o fat cells, increases HDL, decreases LDL, increase chylomircon and VLDL clearance leading to decreased TGs

Front 38

Clofibrate

Back 38

increase lipoprotein lipase activity, treat hyper TGs, can cause gallstoens d/t decrincreased cholesterol in bile, increase lipoprotein uptake in the liver, gemfibrozil, associated with myopathy and rhabomyolysis

Front 39

Cholesytramine

Back 39

binds bile acids in gut, lvier has to synthesize more since no enterohepatic circulation

Front 40

Statins

Back 40

inhibit HMGCoA reductase, stop liver synthesis, requires increased uptake from bloodstream, decreases serum LDLs

hepatotoxicity, possible myopathy

Front 41

Histamine and gastric acid

Back 41

stimulate adenylate cyclase leading to increased cAMP, activates protein kinase, stimualting proton pump

cimetidine is an H2 blocker, anti-adrogenic, ranitidine,nizatidine adnd famotidine alsowork

Front 42

Pirenzipine

Back 42

anti-muscarnic specific to M1 receptor so only affects hydrogen ion secretion ins tomach, no affect on heart, eye or salivary glands

Front 43

sucralfate

Back 43

protets mucosa, forms gell over positively charged injured mucosa, can;t use with other antacids because it is only activated by low pH

Front 44

Bismuth

Back 44

inhibts pepsin, increasing mucus interaction with necrotic tissues, also kills H pylori

Front 45

round, flat, coin like plaques, feel greasy, look stuck on...

Back 45

seborrhiec keratosis, benign

Front 46

Major cause of skin lesions...

Back 46

SUN exposure

basal cell carcinoma pearly gray with tleangiectasias

Front 47

Pathogenesis of squamous cell carcinoma

Back 47

too much UV -> DNA damage, damge to Langerhans cells, malignant cells devlop and grow, #1 skin tumor on sun exposed sites in older adults

Front 48

Bowenoid papulosis vs. Bowen disease

Back 48

Bowenoid papulosis is pigmented papules on junk, in youner patietns, don't transition to squamous cell

Bowen disease- in genital region, associated with HPV, pearly grayt, some turn to SCC

Front 49

Pemphigus vs. pemphigoid

Back 49

pemhigoid is tense bullae, pemphigus is vesicles

pemphugis is anti-desmosomes between keratinocyrte junction

Front 50

rash preceded by herald patch, then scaling of plaques along trunk often with a Christmas tree pattern

Back 50

pityriasis (rosea)

Front 51

tinea versicolor

Back 51

hyperpigmented or hypopigmented scaly patches ontrunk, mixture of hyphae and spores (spaghetti and meatball

Front 52

See patient with Port-Wine stain on face, associated wtih...

Back 52

Cavernous hemangioma

associated with steurge weber, results in hemangiomeas and can e associated with the meninges leading to seizures

Front 53

Vitilog is associated with...

Back 53

anti-melanocyte antibodies, associated sometimes with other autoimmune diseases

Front 54

Mercury poisioning

Back 54

most commonly associated with parethesias, tremors, ataxia and blindness

Signs and sx of acute expsure- vomiting, dyspnea, cough, bleeding, gums and bleeding diarrhea

Front 55

Asbestos exposure

Back 55

can develop mesothelioma -> apical pleural thickening on CXR before development of mesothelioma

Front 56

Benzene exposure

Back 56

chronic leads to BMD, acute CNS depression

Front 57

Cyanide poisonin

Back 57

rapid weakness, confsion, excessive sleepiness, coma ->seizure ->death

Front 58

Special stains

Back 58

Ziehl-Neelsen- acid fast used for myocbacteriu (Tb)

India Ink0 negative staining, used fo cryptococcus

Giemsa- general blood smear stain

Congo red- stains amyoid red with apple-gren birefringenece

gram + if thick peptioglycn walls

Front 59

Cells walls in Gram +, gram _, mycopasma and chlamydia

Back 59

gram +- thick petidoglycan wall and techoic acid

Gram - thin petidoglycinae cintains lipopolysaccaride (endotoxin)

mycoplasma has none

chlamydiea has no peptidoglycan

Front 60

Important encapsulated bacteria

Back 60

strep pneumo, Neiserria, HiB

Front 61

Endotoxin

Back 61

lipopolysaccharie A, poor antigen, heat stable, actiaves complement, macrophages and Hageman factor

stimulates fevere, vasodilation, DIC respectiviely

Front 62

Tetanus toxin

Back 62

blocks glycine and GABA rlease on inhibitory interneurons of spinal cord, muscle spasms result

Front 63

Diptheria toxin

Back 63

inhbits protein synthesis by modfying elongaciton offactor 2 leads to psuedomembranous formation in throat, myocarditis and arryhmias, peripheral neuritis/neuropathy

Front 64

Toxic Shock syndrome toxin

Back 64

binds to class II MHC direcctly without intracellular processing (superantigen), produced by staff, induces inflammartory cytkines leads to fever, rash, dequamaiton and diarrhea then drop in BP then shock

Front 65

Cholera toxin

Back 65

binds to gangliosides stimulates gs protein actiaves adenylate cyclase leads to excess cAMP causing secretion of cholide ions and water leading to watery diarrhea

Front 66

pertussis toxin

Back 66

nhbits Gi in ciliated resp tract cells and lymphocytes

lymphocytes- inhibition of chemokne receptors leading to lymphocytosis

inhbition of ciliary movement -> ciliated epithelial death

Front 67

Facultative anearobes

Back 67

use oxygen when aavailable but will use other stuff if not, possess enzymes for deactivation ROS

Front 68

Obligate aerobes

Back 68

mycobacteriu, bacillus anthrais, nocardia, pertussis, psedomonas, neiserria

Front 69

Microaerophillic (tolerate low levels of O2)

Back 69

brucella, campylobacter, strep, spirochetees (treponema, borrelia)

Front 70

Obligate anearobes

Back 70

clostridium, actinomyces, bacteroides

Front 71

Most common causes of...

sinusitis

bronchitis and rhinits

ICU pneumonia, community acquired, nursing home

Back 71

sinusitis- strep pneumo also otitis media

bronchiutis and rhinits- rhinovirus

nursing home- klebsiella, ICU- psuedomonas, community - strep pneumo

Front 72

Diarrhea causes

Back 72

adults- norwalk, kids rotavirus, bloody cam jejuni, parasitic, entamoeba histolytica

Front 73

ETEC vs. EHEC vs. EPEC vs EIEC vs. EAEC

Back 73

ETEC- watery diarrhea, travelers, fecal oral

EHEC0 shig-like toxin, bloody diarrhea, O157:H7 assoicated with HUS

EIEC- WBCs, blood in stool

EAEC- stacked brick pattern in culture, watery diarrhea

EPEC- severy watery diarrhea, adheres to bowel wall

Front 74

Subtypes of staph

Back 74

staph auerus- skin infections, scalded skin syndrome, ostomyelitis

epidermidis- prosthetic heart valvels

saprphyticus- staghorn calculus, UTI

Front 75

M protein

Back 75

virulence factor of group A beta hemlytic strep (progenes)

interferes with phagocyte infestion, can be rheumatognic or nephritogenic

(causes post-strep GN or rheumatic fever)

Front 76

Streptolyin O

Back 76

anitigenic will always be + in rheumatic fever even post infection, used to dx autoimmune post strep problems

Front 77

virulence factors of neiserria meningitditis vs. gonorrheae

Back 77

both have IgA protease only meningitidis is encapsulated

gonorhea can cause gonogcocal arthritis and tenosynovitis

meningitis can call Waterhouse-friedrischsen syndrome

Front 78

Bacillus anthracis

Back 78

spores ersist in soil, liberated by herbiovres grazing

toxin has edema factor, protective antigen and lethal facotr which blocks messenger system needed for cell growth

x-ray findings widened mediasinum

Front 79

Corynebacterium diphtheriae

Back 79

has diphtheria toxin only if infected by phage, pseudomembrane of throat, fever, moarditis and paralysis

chinese character formation

Front 80

Listeria

Back 80

Chinese character formation from unpasteruized dary or undercooked meats, watery diarrhea, fever, myalgia but can be bad for neonates

Front 81

Gas gangrene

Back 81

dt alpha-toxin in clostrium perfingnes, germination of spores that multiply in tissue, tx is debridement and pen G and clindamycin

Front 82

foul smelling, watery diarrhea, pseudomembranes

Back 82

C diff d/t clindamycin, cephalosporing, sampillins

Toxin B causes actin destruction leading to enterocyte death

Front 83

Salmonella vs. shigella

Back 83

salmonella high infectious dose, motile, can be typhi subtype, bradycardia rose spots on abdomen, constipation, or regular, diarrhea with or without blood

shigella low infectious dose, shiga toxin inhibits protien stnthesis elading to enterocyte death and prs

Front 84

Campylobacter jejuni

Back 84

from domestic animal sources, watery, foul smelling diarrhea, severe abd pain, associated with Guillain Barre

Front 85

Bacteroides fragilis

Back 85

inhavit colon, normal flora of vag too

most common cause of serious anerobic infection, abscesses and intraabdominal infections (self acquired)

Front 86

Yersinia pestis

Back 86

low infectious dose, from rodents, tx is streptomycin, otherqise death tuh oh

human to human form is worse, get endotoxin causing DIC and cutaneous hemorrhages and shock

Front 87

Brucella

Back 87

unpasteruized dairy products leads to undulating fever, fluo-like aches and painins, temp high in afternoon normal in the morning, paraplegia or nerve deafness or death by endocarditis, if untreated

Front 88

Fransciella ularenesis

Back 88

tularemia- can cause and atypical npneumonia with ough, dyspnea, 30% moerlity unless treated with streptomycin, granulomas form and lympadenopathy if gotten via rabbit or tick vectors

Front 89

Bortdetella pertussis

Back 89

obligate aerome, gram neg, pertssis toxin causes whooping couhg, only colonizes resp tract, treatmen is eryhtromycin, 1-2 weeks of rhinoorhea, malaise, fever, URI

Front 90

Atypical pneumonia, air conditioning ducts, gram neg rod, intracellular catalase +

Back 90

legionella, eryhtromycin

atypical pneumonia, iarrhea, hyponatremia

Front 91

Ghon complex

Back 91

ghon focus with calcified tubercles in middle or lower lung, perihilar lymph node calcided by granulomas

Front 92

Most morbidity of TB is due to..

Back 92

reactivation leading to lesions and cavity formation with weight loss, low fever, night sweats

tx is isonizid, ehtmbutol, pyrazinamide, rifampin

Front 93

Some one gets too familiar with armadillos

Back 93

leprosy, tx is dapsone + rigamipin in only granuolmas, if nodular skin lesions and stuff falling off need dapsone, clofazime and rigampin for two years

Front 94

Mycobacterium avium intracellularly

Back 94

can't tell diff between this and TB, but more rapid proression, common in immunesuppressed, therapy resistant

Front 95

Actinomyces and nocardia

Back 95

actinomyces- water and soil, normal oral flora, can form sulfur granules bright yellow pus drining from abscesses, amp or Pcn

nocardia- rows in soil, form sinnuses, problem for immunocomrpomised, mimics TB, TMP-SMX

Front 96

Borrelia burgdorferi

Back 96

tixodes deer tick, eryhtmea migans and athralgias followed by neurologic proelems and arthralgia then can progresse to CNS disease, diangosed by antibodies, tx is doxycycline

Front 97

Borrelia recurrentis

Back 97

cause relapsing fever every 8 days, carried by lice, tetracycline

Front 98

chlamydia life cycle

Back 98

exist outside cell in iner elemebrary body, becomes active in cell as reticulate body, can cause lyphogranuloma vneereium, painless papule that ulcerates and heals spontaneously tx is doxycline except in kids erythromycin

Front 99

Bird poop, has parrots. guy has pneumonia with hepatitis

Back 99

Chlyamdia psittacci, tetracyline

Front 100

Rickketsia

Back 100

DOC is doxycycline

causes thypus, with lice and mite vectors, small rodents, rash starts and wastes and spreads peripherally

Front 101

Aburpt fever, headache, chills, rash on extremities spread to trunk, patient wen hiking in appalachia

Back 101

rickettsia rickettsiae, high affinity for endothelium ledaing to endothelial damage and vasculits, shock, thrombosis