Dit Week 2 Monday

Front 1

Why do the kidneys retain fluid in heart failure pts?

Back 1

CHF: low LV contractility leads to low CO which causes an increase renin-angiotensin-aldosterone, increased renal Na+ and H2O reabsorption, and increased systemic venous pressure. This increases preload,and increases CO (compensation).

Front 2

What would you expect to see in nephritic disease?

Back 2

Nephritic = inflammatory; involves glomeruli; hematuria and RBC casts; azotemia, oliguria, hypertension, and proteinuria (<3.5/day)

Front 3

What would you expect to see in nephrotic disease?

Back 3

NephrOtic: massive proteinuria (>3.5 g/day, frothy urine), hyperlipidemia, fatty casts, edema; associated with thromboembolism and increased risk of infection

Front 4

In which kidney disease would you expect to find anti-GBM antibodies?

Back 4

(immunoflourescence)
Goodpastures

Front 5

In which kidney disease would you expect to find Kimmelstiel-Wilson lesions?

Back 5

(light microscope)
diabetic glomerulonephropathy *NEG glycosylation of GBM leads to thickening, NEG of efferent arterioles which causes GFR increases leading to mesangial expansion, GBM thickening (LM), nodular glomerulosclerosis (kimmelstiel-wilson lesion)

Front 6

In which kidney disease would you see a "spike and dome" appearance on electron microscope?

Back 6

Membranous glomerulonephritis; diffuse capillary and GBM thickening, SUBEPITHELIAL DEPOSITS; SLE’s nephrotic presentation; most common cause of adult nephrotic syndrome

Front 7

In which kidney disease would you expect to see a "tram track" of subendothelial humps on electron microscope?

Back 7

MPGN: subendothelial ICs with granular IF; usually progresses slowy to chronic renal failure, Type I (tram-track) associated with HBV > HCV; type II (“dense deposits”); C3 nephritic factor

Front 8

In which kidney disease would you expect to see subepithelial humps on electron microscope?

Back 8

Acute poststreptocococcal glomerulonephritis; most frequently seen in children; peripheral and periorbital edema; resolves spontaneously

Front 9

What is the rate-limiting enzyme for pyrimidine synthesis?

For purine synthesis?

Back 9

Pyrmidine synthesis: carbamoyl phosphate synthetase II

Purine: glutamine-PRPP amidotransferase

Front 10

Compare the mechanism of action of zileuton to that of zafirlukast.

Back 10

Zileuton: 5-lipoxygenase pathway inhibitor; blocks arachidonic acid to leukotrienes (bronchoconstriction);

Zafirlukast: blocks leukotriene receptors; especially good aspirin-induced asthma

Front 11

Km is the substrate concentration at one-half Vmax. Vmax is the maximum velocity of a reaction. How does a competitive antagonist affect Km and Vmax?

How does a noncompetitive antagonist affect Km and Vmax?

Back 11

Competitive antagonist: increases Km; no effect on Vmax

Noncompetitive: do not effect Km; decrease Vmax

Front 12

What are the different types of epithelial cell junctions?

Back 12

Tight junctions (zona occludens; prevents diffusion across paracellular space; composed of claudins and occludins);

zona adherens (intermediate junction – below zona occludens,, cadherins connect to actin, CADherins are Ca-dependent adhension molecules),

macula adherens (desmosomes – discrete, small sites of attachment; cadherins connect to intermediate filaments);

gap junctions (allows adjacent cells to communicate for electric/metabolic functions)

hemidesmosome – connects cells to underlying extracellular matrix

integrin – maintains integrity of basement membrane; binds to laminin in BM

Front 13

What structures are injured in an unhappy triad knee injury?

Back 13

This common football injury consists of damage to MCL, ACL, and lateral (not MEDIAL) meniscus

Positive anterior drawer sign indicates tearing of the ACL

Abnormal passive abduction indicates a torn MCL

Front 14

What is the definition of low birth weight? What complications are associated with low birth weight?

Back 14

Low BW is less than 2.5 kg; associated with greater incidence of physical and emotional problems; caused by prematurity or intrauterine growth retardation; complications: infections, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and persistent fetal circuation

Front 15

In which types of infections are macrolide antibiotics a good choice?

What is the most common cause of non-adherence to macrolide antibiotics?

Back 15

erythro, azithro, clarithryo
mech: inhibit protein synthesis by blocking translocation (binds to 50S); bacteriostatic;
uses: treats URIs, pneumonias, STDs- gram positive cocci, (mycoplasma, legionella, Chlamydia, neisseria)
Adverse: Major noncompliance: GI toxicity, prolonged QT (especially erythro); increases serum concentration of theophyllines and oral anticoagulants

Front 16

Which branchial pouch gives rise to the middle ear cavity and eustachian tubes?

Back 16

1st pouch

Front 17

Which brachial pouch gives rise to the superior parathyroids?

Back 17

4th pouch

Front 18

Which brachial pouch gives rise to the inferior parathyroids?

Back 18

3rd pouch

Front 19

Which brachial pouch gives rise to the thymus?

Back 19

3rd pouch

Front 20

Which brachial pouch gives rise to the mastoid air cells?

Back 20

1st pouch

Front 21

Which brachial pouch gives rise to the epithelial lining of the palatine tonsil?

Back 21

2nd pouch

Front 22

What are the clinical manifestations of Addison’s disease?

What is the cause of Addison’s disease?

Back 22

Chronic Adrenal insufficiency due to adrenal atrophy or destruction by disease (autoimmune, TB, metastasis)
Mech: primary deficiency of aldosterone and cortisol
Sx: hypotension (hyponatremic volume contraction), skin hyperpigmentation (due to MSH, a by product of increased ACTH from POMC
Disease involves adrenal atrophy and absence of hormone production; involves all 3 cortical divisions

Front 23

Where would you expect to find type I collage?

Back 23

BE (SO TOTALLY) COOL, READ BOOKS

Bone, skin, tendon, Bone

Front 24

Where would you expect to find type II collagen?

Back 24

cartilage (hyaline), vitreous body, nucleus pulposus

Front 25

Where would you expect to find type III collagen?

Back 25

reticulin (skin blood vessels)

Front 26

Where would you expect to find type IV collagen?

Back 26

basement membrane or basal lamina

Front 27

What are the side effects of the cGMP inhibitors (sildenafil, vardenafil, tadalafil)?

Back 27

mech: causes increased cGMP, smooth muscle relaxation in the corpus cavernosum, increased blood flow and pencil erection
use: treat erectile dysfunction
Adverse: “Hot and sweaty” but then headache, heartburn, hypotension (with nitrates)

Front 28

What are 4 examples of obligate aerobic organisms?

Back 28

NAGGING PESTS MUST BREATHE; nocardia, pseudomonas aeruginosa, mycobacterium tuberculosis, and bacillus; use an O2-dependent system to generate ATP; reactivation of M. tuberculosis in apex (highest PO2)

Front 29

are the three symptoms of pellagra?

What are the causes of pellagra?

Back 29

Cause: Niacin deficiency
Sx: diarrhea, dermatitis, dementia
Deficiency from: Hartnup disease (decreased tryptophan absorption), malignant carcinoid syndrome (increased tryptophan metabolism), and INH (decreased vitamin B6) which is needed to do synthesis from tryptophan; vitamin B3 in corn not absorbable unless treated , so excess untreated corn in diet can lead to pellagra