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298 Cards in this Set
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Alpha 1 receptor:
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Gq: increase vascular smooth muscle contraction (increase blood pressure)
Qiss (kiss) and qiq (kick) till you're siq (sick) of sqs (sex) |
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Alpha 2 receptor:
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Gi: decrease sympathetic outflow, decrease insulin release
Qiss (kiss) and qiq (kick) till you're siq (sick) of sqs (sex) |
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Beta 1 receptor:
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Gs: increase heart rate, increase contractility, increase renin release, increase lypolysis, maintains aqueus humor formation
Qiss (kiss) and qiq (kick) till you're siq (sick) of sqs (sex) |
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Beta 2 receptor:
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Gs: vasodilation, bronchodilation, increase heart rate, increase contractility, increase glucagon release
Qiss (kiss) and qiq (kick) till you're siq (sick) of sqs (sex) |
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M1 receptor:
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Gq: CNS, enteric nervous system
Qiss (kiss) and qiq (kick) till you're siq (sick) of sqs (sex) |
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M2 receptor:
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Gi: decrease heart rate and contractility
Qiss (kiss) and qiq (kick) till you're siq (sick) of sqs (sex) |
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M3 receptor:
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Gq: increase exocrine gland secretions, increase gut peristalsis, increase bladder contraction
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D1 receptor:
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Gs: relaxes renal vascular smooth muscle
Qiss (kiss) and qiq (kick) till you're siq (sick) of sqs (sex) |
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D2 receptor:
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Gi: modulates transmitter release, especially in brain
Qiss (kiss) and qiq (kick) till you're siq (sick) of sqs (sex) |
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H1 receptor:
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Gq: increase nasal and bronchial mucus production, contraction of brhoncioles, pruritus, and pain
Qiss (kiss) and qiq (kick) till you're siq (sick) of sqs (sex) |
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H2 receptor:
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Gs: increase gastric acid secretion
Qiss (kiss) and qiq (kick) till you're siq (sick) of sqs (sex) |
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V1 receptor:
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Gq: increase vascular smooth muscle contraction
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V2 receptor:
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Gs: Increase H20 permeability and reabsorption in the collecting tubules of the kidney
Qiss (kiss) and qiq (kick) till you're siq (sick) of sqs (sex) |
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Gq receptors:
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H1, alpha1, V1, M1, and M3:
phsopholipase C-> lipids->PIP2 -> IP3 and DAG -> increase Ca and Protein Kinase 3 HAVe 1 M&M |
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Gs receptors:
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B1, B2, D1, H2, V2:
Adenylyl cyclase -> ATP -> cAMP -> Protein Kinase C |
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Gi receptors:
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M2, Alpha 2, D2:
Adenylyl cyclase -> cAMP decreases -> decrease in Protein Kinase C |
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Cholinergic drugs are?
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Bethanechol, Carbachol, Pilocarpine, Methacoholine
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Bethanechol?
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Postoperative and neurogenic ileus and urinary retention
Activates bowel and bladder smooth muscle |
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Carbachol:
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Glaucoma, pupillary contraction, and release of intraocular pressure
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Pilocarpine?
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Potent stimulator of sweat, tears, saliva
Contractsciliary muscle of eye (open angle), pupillary sphincter (narrow angle) |
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Methacholine?
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Challenge test for diagnosis of asthma
Stimulates muscarinic receptors in airway when inhaled |
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Anticholinesterase drugs are:
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Neostigmine, pyridostigmine, edrophonium, physostigmine, echothiophate
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Neostigmine:
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Postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of neuromuscular junction blockade
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Pyridostigmine:
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Myasthenia gravis (long acting)
Gets rid of MG |
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Edrophonium:
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Diagnosis of myasthenia gravis (short acting)
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Physostigmine:
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Glaucoma and atropine overdose
Phix atropine overdose |
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Echothiophate:
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Glaucoma
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Cholinesterase inhibitor poisoning:
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DUMBBELSS:
Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating and Salivation |
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Atropine, homatropine, tropicamide:
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Muscarinic antagonist
Used for eye (produces mydriasis and cycloplegia |
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Benztropine:
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Muscarinic antagonist
CNS, used for parkinsons Park my BENZ |
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Scopolamine:
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Muscarinic antagonist
CNS, used for motion sickness |
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Ipratropium:
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Muscarinic antagonist
Respiratory, used for asthma and COPD |
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Methoscopolamine, oxybutynin, glycopyrrolate
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Muscarinic antagonist
Genitourinary, reduce urgency in mild cystitis and reduce bladder spasms |
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What are the glaucoma drugs:
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Epinepherine (alpha antagonist)
Brimonidine (alpha antagonist) Timolol, betaxolol, carteolol (beta blockers) Acetazolamide (Diuretic) Pilocarpine, carbachol, physostigmine, echothiphate (cholinomimetics) Latanoprost (PGF2alpha) prostaglandin |
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Side effects of atropine:
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Hot as a hare
Dry as a bone Mad as a hatter Blind as a bat Red as a beet |
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Atropine effects:
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Eye: dilation, cycloplegia
Airway: decrease secretions Stomach: decrease acid secretion Gut: decrease motility Bladder: decrease urgency |
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Epinepherine moa and application:
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a1, a2, b1, b2
anyphylaxis, glaucoma, asthma, hypotension |
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Norepi moa and application:
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a1, a2 > b1
Hypotension (but decreases renal perfusion) |
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Isoproterenol moa and application:
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B1=B2
AV block (rare) |
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Dopamine moa and application:
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D1=D2 >B>alpha
Shock, (increase renal perfusion), heart failure |
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Dobutamine moa and application:
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B1 >B2
Shock, heart failure, cardiac stress testing |
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Pheynlepherine moa and application:
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A1 > A2
pupillary dilation, vasoconstriction, nasal decongestion |
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Albuterol/terbutaline moa and application:
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B2 >B1,
albuterol for acute asthma, terbutaline reduces premature contractions |
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Ritrodine moa and application:
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B2
Reduces premature uterine contractions |
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Amphetamines: moa and application:
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indirect general agonist, releases stored catecholamines
Narcolepsy, obesity, ADD |
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Ephedrine: moa and application:
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indirect general agonist, releases stored catecholamines
Nasal decongestion, urinary incontenince, hypotension |
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Cocaine, moa and application
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indirect general agonist, uptake inhibitor
causes vasoconstriction and local anesthesia |
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Clonidine, alpha methyldopa moa and application:
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centrally acting alpha 2 agonist, decreases central adrenergic outflow
hypertension, especially with renal disease |
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Phenoxybenzamine and phentolamine
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alpha blockers used for pheochromocytoma
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Prazosin, terazosin, doxazosin:
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alpha 1 selective blockers used for hypertension, urinary retention in BPH
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Mirtazapine:
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Alpha 2 selective blocker used for depression
toxicity: sedation, increase appetite |
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What primary hormone is increased or decreased in the following diseases?
Cushings Conn Addison Graves |
Cushings: increase cortisol
Conns: increase aldosterone Addisons: decrease of cortisol and aldosterone Graves: increase thyroid hormone |
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What is the function of MacConkey's agar?
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Crystal violet and bile salts in it; both inhibit the growth of gram (+), lactose is the only carbohydrate
Lactose fermenters take up neutral red and thus from pink colonies |
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What 5 classes of medications are used to treat glaucoma?
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alpha agonists, beta blockers, diuretics (Carbonic anhydrase inhibitors), cholinomemetics, PG F2alpha
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What is the cause of achalasia? How is it diagnosed?
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lose myenteric (aurebach's) plexus ,LES is unable to relax
Birds beak appearance with barium swallow |
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Compare the leading causes of death in ages 15-24 to those inages 25-64?
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15-24: injuries, homocide, suicide, cancer, heart dz
25-64: cancer, heart dz, injuries, suicide, stroke |
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Which glomerular disease would you expect to see the following changes?
anti-GBM antibodies: Kimmelstiel-wilson lesions Spike and dome appearance Tram track of subendothelial humps subepithelial humps |
Anti-GBM antibodies: Good pastures
Kimmelstiel-Wilson lesions: Diabetic nephropathy spike and dome: membrnous glomerulonephritis tram track: membranoproliferative subepithelial: acute poststreptococcal |
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What are the clinical uses for metronidazole?
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GET GAP on the Metro
Giardia, entomebia, trichomans Gardnerella, Anerobes, H. Pylori |
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What are the 2 most complications after an MI? What is dressler's syndrome?
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Cardiac arrhythmias (V. fib) and left ventricular failure (pulmonary edema)
Autoimmune dz that occurs weeks after an MI and cause fibrinous peridcarditis |
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What is the cause of Chrnoic granulomatous disease? What are the consequences of Chronic granulomatous disease?
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lack of NADPH oxidase activity which is critical for neutrophils and phagocytosis so neutrophils can't phagocytose things.
Consequences: susceptible to opportunistic infections (E. coli, staph aureus) |
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What is the WAGR complex?
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Wilms tumor
Anhirdia Genitourinary malformation Retradation |
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zero order elimination of drugs:
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linear elimination at a constant rate
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first order elimination of drugs:
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rate of elimination proportional to drug concentration (5--2.5-1.25)
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How to treat acidic and basic drugs?
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acidic: treat with NaHCO3 to trap in urine
Basic: treat with NH4Cl to trap in urine |
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What are the phases of a clinical trial?
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1: is it safe (sm. number of healthy volunteers)
2: Does it work (sm. number of disease patients) 3: Does it work better (treatment compared to another drug) |
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What are the classes of drug abuse potential?
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1: High abuse potential (Heroin, LSD)
2: High (triplicates): morphine 3: Moderate: hydrocodone 4: Low: metoprolol 5: Low: OTC drugs |
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What are the symptoms of excess parasympathetic activity?
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DUMBBELLS:
Diarrhea, urination, miosis, bronchospasm, bradycardia, excitation of skeletal muscle and CNS, Lacrimation, sweating and salivation |
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What are the direct acting cholinergic agonists?
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Bethanechol: post op and neurogenic ileus and urinary retention
Carbachol: Glaucoma, pupillary contraction, and release of intraocular pressure Pilocarpine: stimulator of sweat, tears, saliva Methacholine: challenge test for diagnosis of asthma |
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What are the indirect acting cholinergic agonists (anticholinesterases)?
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Neostigmine: post-op neurogenic ileus and urinary retention, Myasthenia gravis
Pyridostigmine: Myasthinia gravis (get rid of Myasthinia gravis) Edrophonium (diagnosis of Myasthenia gravis) Physostigmine: glaucoma and atropine overdose (fix atropine overdose) Echothiophate: glaucoma |
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What is myasthenia gravis:
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antibodies to acetylcholine receptor
ptosis (double vision) that worsens throughout the day, dx with tensilon test Associated with thymic hyperplasia, thymic atrophy, and thymoma |
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What drug regenerates acetylcholinesterases after organophosphate (insectisides) poisoning?
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atropine and pralidoxine (2-pam)
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What are the Muscarinic antagonists (inhibit parasympathetic activity)?
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atropine, homatropine, tropicamide: (produce mydriasis and cycloplegia)
Benztropine: CNS for parkinsons Scopolamine: CNS for motion sicknes Ipratropium: Respiratory for asthma, COPD Methscopolamine, oxybutynin, glycopyrrolate: Genitourinary, reduce urgency in mild cystitis Propantheline: GI for peptic ulcer treatment |
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What are the symptoms of inhibiting parasympathetic activity?
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Hot as a hare
Dry as a bone Red as a beet Blind as a bat Mad as a hatter |
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In what type of patient is atropine contraindicated?
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Alzheimers: pt will go dilirius
BPH Infants with hyperthermia Ilius or GI obstruction Glaucoma |
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A gardner presents with shortness of breath, salivation, miosis, and diarrhea: what caused this and what is the mechanism of action?
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parathion, it irreversibly inhibits cholinesterase
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What is the MOA of hexamethonium?
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Nicotinic antagonist (blocks both parasympathetic and sympathetics)
BPdecreases, Heart rate increases, CO decreases, Urine output decreases, GI motility decreases, pupil of the eye, mydriasis |
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What are the G protein 2nd messangers and their protein class?
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alpha 1 (q) inc. vasc sm. muscle
alpha 2 (i) dec. symp. outflow Beta 1 (s) inc. heart rate and contractility Beta 2 (s) vasodilation, bronchodilation M1 (q) CNS, enteric nerv. system M2 (i) Decrease heart rate M3 (q) Inc. exocrine gland secretion D1 (S) relaxes renal vascular sm ms D2 (i) Modulates transmitter release H1 (q) Inc. nasa & bronchial mucus production H2 (s) Inc. gastric acid secretion V1 (q) Inc. vascular smooth muscle contraction V2 (s) inc. H2O permeability and reabsorption in collecting tubules |
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What are the direct acting sympathomimetics?
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Epi: alpha 1, alpha 2 B1, B2 (anaphylaxis, glaucoma, asthma)
NE: alpha 1, alpha 2 (hypotension) Isoproternol: B1=B2 (AV block) Dopamine: D1=D2 (shock increases renal perfusion) Dobutamine: B1>B2 (cardiogenic shock, HF) Phenylephrine: alpha 1>alpha2 (pupillarry dilation, vasoconstriction) Albuterol, terbuatline: B2>B1 (asthma, premature contractions) Ritodrine: B2 (reduces premature contractions) |
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What are the indirect sympathomimetics?
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Amphetamine: (narcolepsy, obesity, ADD)
Ephedrine: (nasal decongestion, urinary incontinence) Cocaine: (vasoconstriction) |
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How does clonidine and alpha methyldopa work?
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Centrally acting alpha 2 agonist, decreases central adrenergic outflow
For HTN, especially with renal dz (no decrease in blood flow to kidney) |
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What drug is given as a nebulizer for asthma?
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albuterol
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What is the DOC for anaphylaxis?
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Epinepherine
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What is the most common first line agent for patients in cardiogenic shock?
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Dopamine
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What is the most common first line agent for pts in septic shock?
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Norepi
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Given SubQ for asthma?
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terbutaline
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What are the nonselective alpha blockers?
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Phenoxybenzamine and Phentolamine
used for pheochromocytoma Toxicity: orthostatic hypotension and reflex tachycardia |
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What are the alopha 1 selective blockers?
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prazosin, terazosin, doxazosin
used for HTN, urinary retention in BPH Toxicity: 1st dose orthostatic hypotension, dizziness, headache |
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What is the alpha 2 selective blocker?
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mirtazapine used for depression
Toxicity: sedation, increase serum cholesterol, increase appetite |
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What drugs do you give someone after an MI?
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MONA: morphine, 02, nitro, asprin
statin, beta blocker, ace or arb |
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What is glaucoma? What are the 2 different kinds of glaucoma?
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increased intraocular pressure
Open angle: blocked canal of schlemm (starts peripherally) Acute angle-closure: obstruction of angle (medical emergency) diagnosis with cup:disk ration greater than 1:2 |
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drugs to treat glaucoma?
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Alpha agonists: epi and brimonidine
Beta blockers: timolol, carteolol Diuretics: acetazolamide Cholinomimetics: Pilocarpine, carbachol, physostigmine Prostaglandin: PGF2alpha |
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What does the radial nerve innervate and what is seen if it is damaged?
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Triceps: can''t extend forearm, loss of triceps reflex
Loss of sensation of posterior arm Loss of Wrist extension (WRIST DROP) Innervates the BEST: Brachioradialis, extensor of wrist and fingers, supinator and triceps Satruday night palsy or using a crutch: compression of radial nerve |
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What does the ULNAR nerve innervate and what is seen if it is damaged?
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innervates interosseus muscles
Get claw hand Cannot flex DIP joint of 4th and 5th digits, atrophy of interosseus muscles and inability to extend the interphalangeal joints when trying to straighten fingers |
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What does the Median nerve innervate and what is seen if this nerve is damaged.
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Innervates most of thumb
Get Bishops hand (lateral 1/2 of flexor digitorum) APE hand (can't oppose thumb) |
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what are the encapsulated bacteria?
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Strep pneumoniae, HIb, N. meningitidis, and Klebsiella
A splenic pts should be vaccinated against these agents. |
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Where are B cells found in the lymph node?
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Follicle
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Where are T cells found in the lymph node?
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Paracortex (not well developed in DiGeorge syndrome)
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What is innate immunity?
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Response to pathogens that is fast and nospecific. No memory. Consists of neutrophils, macrophages, dendritic cells and complement
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What is adaptive immunity?
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receptors that recognize pathogens undergo VDJ recomination during lymphocyte development. Response is slow on first exposure but memor response is faster and more robust. Consists of T cells, b cells, and circulating antibody. (vaccine is an example)
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Helper T cell surface proteins?
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CD4, TCR, CD3, CD28, CD40
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Cytotoxic T cell surface proteins?
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CD8, TCR, CD3
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B cell surface proteins?
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IgM, IgD, CD 19,20,21
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IL 1?
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Secreted by macrophages. Induces fever
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IL 2
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Secreted by Th1 cells. Stimulates growth of helper and cytotoxic T cells
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IL-3?
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secreted by activated T cells. stimulates bone marrow
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IL 4
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Secreted by Th2 cells. promotes growth of B cells. Enhances class switching to IgE and IgG
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IL 5
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Secreted by Th2. Enhances class switching to IgA (in nose)
Snot producer |
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IL 6
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Secreted by Th cells and macrophages. Stimulates production of acute phase reactants and immunoglobulins
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IL 8
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Major chemotactic factor for neutrophils (secreted by macrophages)
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IL 10
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Secreted by regulatory T cells. Inhibts actions of Activated T cells
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IL 12:
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Secreted by B cells and macrophages. Activates NK and Th1 cells
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How do etanercept and infliximab work?
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Recombinant form of human TNF receptor that binds TNF, Anti-TNF antibody
Used for RA, psoriasis, ankylosing spondylitis, chrons disease |
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IgG isotype
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Main antibody in secondary response. Most abundant. Fixes complement, crosses the placenta., opsonizes bacteria, neutralizes bacterial toxins and viruses. Half life of 21 days
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IgA isotype
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Prevents attachment of bacteria and viruses to mucous membranes, does not fix complemtn. Monmer or dimer. Found in secretions. Picks up secretory copmonent from epithelial cells before secretion.
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IgM isotype:
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Produced in the primary response to an antigen. Fixes complement but does not cross the placenta. Antigen receptor on the surface of B cells. Monomer on B cell or Pentamer.
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IgD isotype:
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Unclear function. FOUnd on the surface of many B cells and in serum
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IgE isotype:
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Mediates immediate (type 1) hypersensitivity by inducing the release of mediators from mast cells and basophils when exposed to allergen. Mediates immunity to worms by activating eosinophils. Lowest concentration in serum.
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Type 1 hypersensitivity:
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Anaphylactic and atopic: free antigen cross-links IgE on presensitized mast cells and basophils triggering release of vasoactive amines (histamines)
Scratch test (5 minutes) |
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Type 2 hypersensitivity:
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Antibody mediated: IgM, IgG bind to fixed antigen on "enemy" cell leading to lysis by compelement or phagocytosis
Direct and Indirect coombs test |
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Type 3 hypersensitivity:
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Immune complex: antigen antibody complex activate complement which attracts neutrophils, neutrophils realease lysosomal enzymes
Immunoflourescent staining |
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Type 4 hypersensitivity:
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Delayed: sensitized T lymphocytes encounter antigen and then release lymphokines
Tb test |
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What is Bruton's agammaglobulinemia?
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X-linked (Boys)
B cell deficiency-defective tyrosine kinase gene thus low levels of all Ig's Recurrent Bacterial infections after 6 m Remember B's |
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Thymic aplasia (DiGeorge syndrome)
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3rd and 4th pouches fail to develop from endoderm
thus no thymus (no T cells) and no PTH's so low calcium which causes tetany Congenital defects in heart/great vessels Recurrent viral, fungal, protozoal infections 90% have 22q11 deletion |
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Severe Combined Immunodeficiency (SCID)
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Defect in early stem cell differentiation
Caused by at least 7 different gene defects (adenosine deaminase deficiency) Presentation triad: Severe recurrent infections, Chronic diarrhea, Failure to thrive No thymic shadow on newborn x-ray |
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X-linked immunodeficiencies?
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Wiscott-Aldrich
Bruton's Agammaglobulinemia Chronic Granulomatous dz Hyper IgM syndrome WBC |
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Wistkott Aldrich?
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WAITER
Wiskott Aldrich Immunodeficiency Thrombocytopenia and purpura Eczema Recurrent pyogenic infections no IgM vs capsular polysaccharides of bacteria low IgM, high IgA |
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Ataxia telangiectasia?
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IgA deficiency
Cerebellar ataxia, and pooor smooth pursuit of moving target with eyes Telangiectasias of face at 5yo Inc. cancer risk (lymphoma) Radiation sensitivity Inc. alpha fetal protein >8mo |
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Selective immunoglobulin deficiencies?
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IgA deficiency is most common
Most appear healthy Recurrent sinus and lung infections possible anaphylaxis to blood transfusions and blood products |
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Chronic Granulomatous Disease?
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lack of NADPH oxidase activity (causes impotent phagocytes)
Susceptible to encapsulated organisms (klebsiella, S.Aureus, E.coli) Dx (-) Nitroblue tetrazolium dye Prophylactic TMP-SMX |
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Chediak-Higashi disease?
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Defective LYST gene (lysosomal transport)
Defective phagocyte lysosome->giant cytoplasmic granules in PMN's are diagnostic Presentation triad: Partial albinism Recurrent respiratory tract and skin infections Neurologic disorders |
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Job's syndrome (hyperimmunoglobulin E syndrome)
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Deficient INFgamma-> PMNs fail to respond to chemotactic stimuli
High levels of IgE and Eosinophils Presentation triad: Exczema, Recurrent cold S. Aureus abscesses Course facial features (broad nose, prominent forehead, doughy skin) Also can have 2 rows of teeth |
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Case-control study?
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Compares a group of people with disease to a group without. Asks what happened?
Uses odds ratio |
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Cohort study?
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Compares a group with a given risk factor to a group without to assess whether the risk factor increases the likelihoood of disease. Asks what will happen.
Uses relative risk |
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Cross sectional study?
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Collects data from a group of people to assess frequency of disease at a particular point in time. Asks, what is happening?
Uses disease prevalence. |
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Age development at 3 mo?
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roll over
Laugh, squeal Hands together |
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Age develpment at 6 mo?
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Sit up
Single syllables Pass a cube Feed themselves some |
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Age development at 12 mo?
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Stand and walk
1-3 words pass a cube feed themselves |
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Age development at 15 mo?
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Walk backward, run
6 words 2 cube tower Fork and spoon |
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Age development at 18 mo?
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Climb stairs and kick a ball
Combine words 4 cube tower Brush teeth with help |
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Age development at 2yrs?
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jump up
half understandable 6 cube tower washes/dries hands Start toilet training (b/w 2-3) |
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Age development at 3 yrs?
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jump forward
completely understandable copy circle or line make cereal, brush teeth, dress and board games |
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Age development at 4 yrs?
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hop on one foot
Copy a cross (make stick figure) |
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Age development at 5 yrs?
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copies a square and button clothes
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What are kubler ross grief stages?
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Denial, anger, bargaining, grieving, acceptance
Death arrives bringing grave adjustments |
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What are the stages of sleep and the associated wave lengths?
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Awake: beta
Awake (eyes closed): Alpha 1: Light sleep (theta) 2: Deeper sleep (sleep spindles and K complexes) 3-4: Deepest, sleepwalking (Delta) REM: dreaming (beta)` |
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What are the 1st generation cephalosporins and what do they treat?
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cefazolin, cephalexin (Ph.D)
Treat Gram (+), PEcK Proteus, E.coli, Klebsiella |
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What are the 2nd generation cephalosporins and what do they treat?
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cefoxitin, cefaclor, cefuroxime
Treats HEN PEcKS H.flu, Enterobacter, Neisseria, Proteus, E.coli, Klebsiella, Serratia |
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What are the 3rd generation cephalosporins and what do they treat?
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ceftriaxone, cefotaxime, ceftazidime
Treats gram (-) |
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What are the 4th generation cephalosporins and waht do they treat?
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cefepime
Increase activity against pseudomonas as well as gram (+) organisms |
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If someone is allergic to penicillin what can you give them that will act the same (not a cephalosporin)
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Aztreonam (inhibts cell wall synthesis)
Used for gram (-) rods |
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How does vancomycin work and what is it's toxicity?
|
inhibits cell wall mucopeptide formation by binding D-ala D-ala
causes diffuse flshing "red man syndrome" |
|
|
What are the aminoglycosides and how do they work. What are they used for?
|
Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin
They inhibit formation of initiation complex and cause misreading of mRNA. Use for gram (-) rods Nephrotoxic, Ototoxic, Teratogen |
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|
What are the tretracyclines and how do they work? What are they used for?
|
Tetracycline, doxy, demeclocycline, minocycline
Bind to 30s and prevent attachment of aminoacyl-tRNA (can't take with milk) VACUUM THe Bed Room Vibrio, acne, chlamydia, ureaplasma, urealyticum, mycoplasma, Tularemia, H. Pylori, Borrelia, Rickettsia |
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|
What are the macrolides and how do they work? What are they used for?
|
Erythromycin, azithromycin, clarithromycin
Inhibit protein synthesis by blcoking translocation, bind to the 23S rRNA of the 50 S ribosomal subunit URI's, pneumonias, STD's |
|
|
How does Clindamycin work?
|
Blocks peptide bond formation at 50S ribosomal subunit.
Treats anaerobic infections. BUY at 30, CCELL at 50 CLEan (50) TAg (30) |
|
|
What is the mechanism of action of floroquinolones?
|
Inhibit DNA gyrase (topoisomerase 2)
Ciprofloxacin, norfloxacin, olfloxacin Used for Gram (-) rods of urinary and GI tracts Hurts attachments to long bones (tendonitis) |
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|
metronidazole?
|
Forms toxic metabolites in the bacterial cell that damage DNA.
GET GAP on the Metro. Giardia, Entamoeba, Trichomonas, Garnerella vaginalis, Anaerobes, H. Pylori |
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Voluntarily choosing not to think about a piece of bad news?
|
suppression (mature)
|
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|
Indiana jones using comedy to express feelings of discomfort?
|
Humor (mature)
|
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|
arsonist donates money to the fire department?
|
-altruism (mature)
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using ones aggression to succeed in business ventures
|
sublimation (mature)
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|
realistically planning for future inner discomfort?
|
anticipation (mature)
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|
consciously postoponing an inner conflict until after a big project is completed?
|
suppression (mature)
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redirecting impulses to a socially favorable object?
|
sublimation (mature)
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not acknowledging a piece fo bad news, as though it as never said?
|
Denial (immature)
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|
Involuntary withholding of a feeling from conscience awareness?
|
repression (immature)
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a veteran that can describe horrific war details without any emotion?
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isolation (immature)
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|
a child abusre was himself abused as a child?
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identifcation (immature)
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|
man yells at his family when he has a bad day at work?
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displacement (immature)
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homosexuals chooisng to become priests?
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reaction formation (immature)
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using intellectual processes to avoid affective expression?
|
intellecutalization (immature)
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belief that people are either all good or all bad?
|
splitting (immature)
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expressing aggression through passivity, masochism, and turing against self
|
passive-aggressive (immature)
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believing an external source is responsible for an unacceptable inner impulse?
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projection (immature)
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changing ones character or personal identity to avoid emtional distress?
|
-disscotiatoin (immature)
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returning to an earlier level f maturation to avoid the conflict at the current maturation level, stressed children wet the bed?
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regression (immature)
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offering an explanation for an unacceptable attitutde/belief/behavior
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rationalization (immature)
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a thoguht that is avoided is replaced by an unconscious emphasis on the opposite?
|
reaction formation (immature)
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|
converting mental conflicts into bodily symptoms?
|
somatization (immature)
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temporarily inhibiting thinking but continuing to build more tension?
|
blocking
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avoiding interpersonal intimacy to resolve conflict and obtain gratification?
|
schitzoid fantasy (immature)
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|
extreme forms can result in multiple personalities?
|
dissosciation (immature)
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|
chronically giving into an impulse to avoid tenstion from an unexpressed unconscious wish; tantrums?
|
acting out (immature)
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|
what is anaclitic depression?
|
depression in an infant attributable to continued spearation from caregiver- results in failure to thrive
|
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|
what is autism?
|
severe communication problems and difficulty forming relationships. Repetitive behavior, unusual abilities, and usually below normal intelligence
|
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What is aspergers?
|
a milder form of autism, involving problems with social relationships and repetitive behavior.
|
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What is Rett's disorder?
|
X-linked disorder only seen in girls. Loss of development and MR appearing at age 4. Hand wringing.
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|
Neurotransmitter changes seen with dz?
|
Anxiety: inc. NE, Dec. GABA and Ser
Depression: Dec. NE and 5-HT Alzheimers: Dec. Ach Huntingtons: Dec. GABA and Ach Schizophrenia: inc dopamine Parkinson's: dec. Dopa, inc. Ach |
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|
Schizophrenia?
|
1-6 mos schizophreniform disorder
<1 month: brief psychotic disorder Schizoaffective disorder= schizophrenia plus a Major depressive, manic or both episode |
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|
What are the positive and negative symptoms of schizophrenia?
|
Must have 2 or more of either positive or negative symptoms
(+): delusions, hallucinations, disorganized thought, disorganized or catatonic behavior Negative: flat affect, social withdrawl, lack of motivation, lack of speech or thought |
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Keeping schizo straight:
|
schizoid < schizotypal (odd thinking) < schizophrenic (greater odd thinking) < schizoaffective (schizophrenia and mood disorder)
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|
What are the anitpsychotics?
|
neuroleptics:
blick dopamine D2 receptors (excess dopamine effects connected with schizophrenia) Extrapyramidal side effects (acute dystonia, akinesia, akathisia, trardive dyskinesia) |
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|
What are the atypical antipsychotics:
|
clozapine, olanzapine, risperidone
Block 5-HT and Dopamine receptors Useful for + and - symptoms of schizophrenia Clozapine may cause agranulocytosis (weekly WBC monitoring) |
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Which is used more atypical or nueroleptics for schizophrenia:
|
atypicals bc they don't have the extrapyramidal side effects
|
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|
What is mania?
|
distinct abnormality of abnormally and persistenly elevated, expansive, or irritable mood lasting at least 1 week:
Need 3 or more of DIG FAST: deistractibility, irresponsibility, grandiosity, flight of ideas, increase in goal directed activity, decrease need for sleep, talkativeness |
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How do you characterize major depressive episodes?
|
SIG E CAPS
sleep disturbances, loss of interest, guilt, loss of energy, loss of concentration, change in appetite/weight, psychomotor retardation, suicidal ideations, depressed mood Must have 5 for at least 2 weeks Dysthymia ismilder form lasting at least 2 years |
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Cyclothymic disorder is?
|
milder form of bipolar disorder for at least 2 years
|
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|
What is generealized anxiety disorder?
|
unconrollable anxiety for at least 6 mos. that is unrelated to a specific person, situation, or event.
treat with benzo or buspirone |
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What is adjustment distorder?
|
emotional symptoms (anxiety, depression) causing impariment following an identifiable psychosocial stressor (divorce) and lasting < 6 mos
|
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|
What is factitious disorder?
|
consciiously creates symptoms in order to assume "sick role" and to get medical attention (primary gain)
|
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|
What is munchausen's syndrome?
|
chronic history of mutiple hospital admissions and willingness to receive invasive procedures
|
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|
What is munchausen's syndrome by proxy?
|
illness in a child is caused by the parent. Motivation is to assume a sick role by proxy
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Conversion disorder is?
|
motor or sensory symptoms (paralysi, pseudoseizure) that suggest neurologic or physical disorder, but test and physical exam are negative; often follows an acute stressor, patient may be unconcerned about symtpoms
|
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What is pain disorder?
|
prolonged pain that is not explained completely by illness
|
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What is hypocondriasis?
|
preoccupation with and afear of haing a serious illness in spite of medical reassurance
|
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|
Somatization disorder is?
|
variety of complaints in multiple organ systems with no identifiable underlying physical findings
|
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|
pseudocyesis is?
|
false belief of being pregnant associated with objective physical signs of pregnancy
|
|
|
What are the cluster A personality disorders?
|
Odd or eccentric
Paranoid: distrust and suspiciousness Schizoid: avoidant Schizotypal: interpersonal awkwardness, odd beliefs Scary Street People |
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|
What are cluster B personality disorders?
|
Dramatic, emotional, erratic
Anitsocial: disregard for and violation of rights of others, criminality Borderline: unstable mood and interpersonal relationships (splitting) Histrionic: excessive emotionality, attention seeking, sexually provacative Narcissistic: grandiosity, entitlement Have been a Nuesence |
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|
What are cluster C personality disorders?
|
Anxious, fearful
Avoidant: sensitive to rejection OCD: preoccupation with order Dependent: submissive and clinging, low self-confidence |
|
|
What are the fetal landmarks?
|
Day 0: implantation
Week 1: implantation (blastocyst) Week 2: Bilaminar disk (epi and hypoblast) Week 3: Gastrulation, primitive streak, notochord begin to form Week 3-8: Neural tube formed (need Folic acid) Week 4: Heart begins to beat (4 chambers) Week 8: fetal movement Week 10: genitalia have male/femal characteristics |
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|
What are the rule of 2's for 2nd week?
|
2 germ layers (epi and hypoblast)
2 cavities (amniotic and yolk sac) 2 components to placenta (cytotrophoblast, syncytiotrophoblast) |
|
|
What are the rule of 3s fro3rd week
|
3 germ layers (endo, ecto, mesoderm)
|
|
|
What are the rule of 4's for the 4th week?
|
4 heart chambers
4 limb buds grou |
|
|
What cells are derived from ectoderm?
|
Surface: adenohypophysis, lens of eye, epithelial linings of skin, ear, eye, and nose, epiderms
Neuroectoderm: Neurohypophysis, CNS, oligodendrocytes, astrocytes, pineal glands Neural crest: ANS DRG, melanocytes, chromaffin cells of adrenal medulla, pia and arachnoid, cranial structures, thymus, aorticopulmonary septum |
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|
What cells are derived from endoderm?
|
Gut tube epithelium and derivatives (lungs, liver, pancreas, parathyroid, follicular cells)
|
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|
What cells are derived from mesoderm?
|
Dura mater, connective tissue, muscle, bone, CV structures, lymphatics, blood, urogenital structures
Mesodermal defects: VACTERL, vertebral, anal atresia, cardiac defects, tracheo-esophageal fistual, renal defects, limb defects |
|
|
What makes up the umbilical artery
|
2 arteries (retrun deoxygenated blood) and 1 umbilical vein (oxygenated blood)
urachus remvoes nitrogenous waste from fetal bladder |
|
|
Truncus arteriousis forms what?
|
ascending aorta and pulmonary trunk
|
|
|
Bulbus cordis forms what?
|
smooth parts of left and right ventrical
|
|
|
Primitive ventrical forms what?
|
Trebeculated parts of left and right ventricle
|
|
|
Primitive atria forms what?
|
Trabeculated left and right atrium
|
|
|
fetal erythropoiesis:
|
Yolk sac (3-8 wk)
Liver (6-30 wk) Spleen (9-28 wk) Bone marrow (28 wk onward) |
|
|
What are the aortic arch derivatives?
|
1st: Maxillary artery
2nd: Stapedial artery + hyoid artery 3rd: common carotid artery 4th: aortic arch on L, proximal part of right subclavian on R 6th: proximal part of pulmonary arteries and ductus arterious |
|
|
what defect is associated with 22q11 syndrome?
|
truncus arteriousis and tetralogy of fallot
|
|
|
what defect is associated with down syndrome?
|
ASD, VSD, AV septal defect
|
|
|
What defect is associated with turners syndrome?
|
coarctation of aorta
|
|
|
What defect is associated with Marfans syndrome?
|
Aortic insufficiency (late complication)
|
|
|
What defect is assocated with offspring of diabetic mother?
|
transposition of great vessels
|
|
|
Branchial arch 1:
|
M's and T's
Meckel's cartilage, Mandible, Malleus, incus, spehoMandibular, Muscles of mastication (temporalis, Masseter, lateral and Medial pterygoids, Mylohyoid) Nerve: mandibular and Maxillary (V2, and V3) |
|
|
Branchial arch 2 derivatives:
|
Stapes, Styloid process, Stylohyoid ligament, Stapedius, Stylohyoid (S's)
Nerve Seven, Facial |
|
|
Branchial arch 3 derivatives:
|
Greater horn of hyoid
Stylpharyngeus Nerve: glossopharyngeal |
|
|
What is the Male geintal embryology steps?
|
SRY gene on Y chromosome codes for testis-determining factor. Mullerian inhibiting substance secreted by testes suppresses development of paramesonephric ducts. Increased androgens lead to development of mesonephric ducts.
|
|
|
What does the mesonephric (wollfian) duct give rise to?
|
SEED: male internal structures
Seminal vesicles, Epididymis, Ejaculatory duct, and Ductus deferens |
|
|
What does the paramesonephric (mullerian) duct give rise to?
|
Develps into fallopian tube, uterus, and part of vagina
|
|
|
What is a yeast with pseudohyphae in culture at 20 degrees C and germ tube formation at 37 degrees C?
|
Candida
Causes thrush esophagitis in immunocompromised, endocarditis in IV drug users, vaginitis, and diaper rash Treatment: Nystatin (swish and swallow) |
|
|
Crytpococcal causes?
|
meningitis. Found in soil, pigeon droppings. Culture on Sabourauds agar and stains with India ink. Soap bubble lesions in brain.
|
|
|
Pneumocystis jiroveci (PCP) causes ?
|
interstitial pneumonia. Ground glass in both lungs. Immunosuppression predisposes to disease. Methenamine silver stain of lung tissue. Treat with TMP-SMX.
Start prophylaxis with CD4 drops below 200. |
|
|
Aspergillus fumigatus causes?
|
allergic bronchopulmonary aspergillosis, lung cavity aspergilloma (fungus ball). Mold with septate hyphae that branch at a V shaped 45 degree angle.
|
|
|
Mucor and Rhizopus cause?
|
Mucormycosis. Mold with irregular nonseptate hyphae branching at wide angles (> 90). Disease mostly in DKA and leukemic pateints.
|
|
|
What does Giardia lamblia cause?
|
Giardiasis: bloating, flatulence, foul-smelling diarrhea (seen in campers/hikers)
Txt with metronitdazole |
|
|
What does trichomonas vaginalis cause?
|
Vaginitis: foul smelling greenish dishcarge, itching and burning.
Txt with metronidazole |
|
|
Trypanosoma cruzi:
|
Chaga's disease (dilated cardiomyopathy, megacolon, megaesophagus)
transmitted by reduvidd bug Treat with Nifurtimox |
|
|
Leismania donovani causes?
|
Visceral leishmaniasis: spiking feveres, hepatosplenomegaly, panyctopenia
transmitted by the sandfly Txt with sodium stibogluconate |
|
|
Plasmodium causes?
|
Malaria: cyclic fever, headache, anema, splenomegaly:
|
|
|
What factors increase contractility?
|
catecholamines, increase in intracellular calcium, decrease in extraceullar sodium, Digitalis (increase intraceullar sodium, resulting in increase calcium)
|
|
|
What factors decrease contractility?
|
Beta blockade, heart failure, acidosis, Hypoxia/hypercapnea, Non-dihydropiyridine calcium channel blockers (verapamil)
|
|
|
What are the classes of antiarrythmics?
|
No Bad Boy Keeps Clean
Na blockers, Beta blockers, k blockers, Ca blockers |
|
|
What are the class 1A Na channel blockers/
|
Class 1A: Quinidine, Procainamide, Disopyramide, Amiodarone
Increase AP duration and Increase effective refractory period (ERP) used for reentrant and ectopic SV and ventricular tachycardia |
|
|
What are the class 1B Na channel blockers?
|
Lidocaine, Mexiletine, Tocainide
Affect ischemic or depolarized purkinje and ventricular tissue. |
|
|
What are the class 1C Na channel blockers?
|
Flecainide, encainide, propafenone
No effect on AP duration. Useful in V tachs that progress to VF and in intractable SVT |
|
|
What are the Class 2 antiarrhythmics?
|
Beta blockers
Decrease cAMP, decrease Calcium currents. Suppress abnormal pacemakers by decreasing the slope of phase 4 |
|
|
What are the Class 3 antiarrhythmics?
|
K blockers: sotalol, ibutilide, amioderone
Increase AP duration, Increase ERP Need to check PFT's, LFT's, TFT when using amioderone |
|
|
How does adenosine work?
|
increases the amount of K going out of cells: hyperpolarizing the cell
DOC for AV nodal arrhythmias Potent vasodilators |
|
|
What are the Herpesviruses?
|
Enveloped, DS-linear virus
HSV-1 (oral) HSV-2 (genital) VZV (chicken pox, shingles) EBV: mononucleosis CMV HHV-6 roseola HHV-8 (kaposi's sarcoma |
|
|
What are the Hepadnavirus?
|
Enveloped, DS partial ciruclar
HBV (acute or chronic hepatitis) |
|
|
What are the Adenovirus?
|
Non-enveloped, DS-linear
Febrile pharyngitis (sore throat) Pneumonia Conjuctivitis "pink eye" |
|
|
What are the Parvoviruses?
|
Non-enveloped, SS linear
B-19 (aplastic crises in sickle disease, slapped cheeks, fifths disease) |
|
|
What are the Papillomaviruses?
|
Non-enveloped, DS circular
HPV: warts, CIN, cervical cancer (16,18) |
|
|
What are the Polyomyavirus?
|
Non-enveloped , DS circular
JC virus: PML in HIV |
|
|
What are the poxvirus?
|
Enveloped, DS-linear
Smallpox, molluscum contagiosum |
|
|
What are the Non enveloped (naked) DNA viruses?
|
PAPP
Parvo, Adeno, Papilloma, Polyomavirus |
|
|
What are the Non enveloped (naked) RNA virsues?
|
CPR
Calcivirus, Picornavirus, Reovirus |
|
|
What are the DNA viruses?
|
HHAPPPPy viruses
|
|
|
What are the picornaviruses?
|
PERCH
Poliovirus: polio-salk/sabin vaccine Echovirus: aseptic meningitis Rhinovirus: common cold Coxsackievirus: aseptic meningitis HAV: acute viral hepatitis A |
|
|
What are the Reoviruses?
|
Reovirus: colorado tick fever
Rotavirus: #1 cause of fatal diarrhea in children (seen especially in winter) |
|
|
What are the Caliciviruses?
|
Norwalk virus and HEV
|
|
|
What are the flaviviruses?
|
HCV
Yellow fever, Dengue, St. Louis encephalitis, West Nile virus |
|
|
What are the Togaviruses?
|
Rubella, Eastern and western equine encephalitis
|
|
|
What are teh Retroviruses?
|
HIV, HTLV (T cell leukemia)
|
|
|
What are the Paramyxoviruses?
|
Parainfluenza: croup
RSV: Rubeola (measles) Mumps |
|
|
What are the Rhabdoviruses?
|
Rabies
|
|
|
What are the essential amino acids?
|
Ketogenic: leu, lys
Glucogenic/ketogenic: Ile, Phe, Tyr, Thr Glucogenic: Met, Val, Arg, His |
|
|
What are the acidic amino acids?
|
Asp and Glu (negatively charged at body pH)
|
|
|
What are the basic amino acids?
|
Arg, Lys, and Histamine
Arg is most basic His has no charge at body pH |
|
|
What are the amion acid derivatives?
|
phenylalanine to Tyrosine which goes to Thyroxine and Dopa, Dopa goes to Melanine and Dopamine, Dopamine goes to NE and Epi
|
|
|
What are other amino acid derivatives?
|
Tryptophan to Niacin and Serotonin, Serotonin goes to Melatonin
Histidine goes to Histamine Glycine goes to porphyrine which goes to Heme Glutamate goes to GABA (requires B6) and Glutathione |
|
|
What is Phenylketonuria?
|
Decrease phenylalanine hydroxylase or decrease tetrahydrobiopterin cofactor
Findings: mental retardation, growth retradation, musty body odor Txt: decrease phenylalanine (nutrasweet) and incease Tyrosine in diet |
|
|
What is alkaptonuria?
|
Congenital deficiency of homogentisic acid oxidase in the degradative pathway of tyrosine. Resulting alkapton bodies causing urine to turn black on standing. Connective tissue also turns black.
|
|
|
What is albinism?
|
Defect in tyrosinase (inability to synthesize melanine from tyrosine) or defective tyrosine transporters (decrease amounts of tyrosine and thus melanin)
|
|
|
What is homocystinuria?
|
1: cystathionine synthase deficiency (txt: decrease Met, Inc Cyst, and increase B12 and folate in diet)
2: decrease affinity of cystathionine synthase for pyridoxal phosphate (txt: incrase vit. B6 in diet) 3: homocysteine methyltransferase deficiency Findings: mental retardation, tall stature, kyphosis, lens subluxation |
|
|
What is maple syrup urine disease?
|
Blocked degradation of branched aminoe acids (Ile, Val, Leu) due to decrease alpha ketoacide dehydrogenase.
I Love Vermont maple syrup |
|
|
What are the major apolipoproteins?
|
A1: Activates LCAT
B100: Binds to LDLreceptor and mediates VLDL secretion C2: Cofactor for lipoprotein lipase B48: Mediates chylomicron secretion E: mediates extra (remnant) uptake |
|
|
What is Adenosine deaminase deficiency?
|
ADA deficiency can cause SCID.
SCID is a severe combined (T and B) immunodeficiency |
|
|
What is Lesh-Nyhan syndrome?
|
Purine salvage problem owing to absence of HGPRT, which converts hypoxanthine to IMP and guanine to GMP.
Findings: retardation, self-mutilation (biting of lips), aggression, hyperuricemia, gout |
|
|
What are some DNA repair defects?
|
UV light: xeroderma pigmentosum
x-rays: ataxia telangectasia radiation: blooms syndrome cross-linking agents: fanconi's anemia |
|
|
What are the eukaryotic RNA polymerases?
|
1: rRNA (nucleolus)
2: mRNA (nucleoplasm) 3: tRNA (nucleoplasm) Real Mean Trucks |
|
|
What is seen in 17 alpha hydroxylase deficiency?
|
decrease sex hormones, decrease cortisol, increase mineralcorticoids
Hypertension, hypokalemia, phenotypically female but no maturation (1 in the first number = HTN, 1 in second number = masculinization) |
|
|
What is seen in 21 hydroxylase deficiency?
|
Decrease cortisol (increased ACTH), decrease mineralcorticoids, increase sex hormones
Masculinization, female pseudohermaphroditisim, Hypotension |
|
|
What do you see in 11 Betahydroxylase deficiency?
|
decrease cortisol, decrease aldosterone and corticosterone, decrease sex hormones, masculinization, Hypertension
|
|
|
What is the function of cortisol?
|
Anti-inflammatory
Gluconeogenesis, lipolysis, protelysis Decrease immune function Maintain blood pressure Decrease bone formation |
|
|
What is conn's syndrome?
|
Primary hyperaldosteronism
HTN, hypokalemia, metabolic alkalosis, and low plasma renin |
|
|
What is addison's disease?
|
primary deficiency of aldosterone and cortisol due to adrenal atrophy or destruction by disease causing hypotension and skin hyperpigmention
Adrenal atrophy, absence of hormone production |
|
|
What is the difference between pheochromocytoma and Neuroblastoma of the adrenal gland?
|
Pheochromocytoma is seen in adults and Neuroblastomas in kids
|
|
|
What are the symptoms of pheochromocytoma?
|
Pressure (elevated BP)
Pain (headache) Perspiration (diaphoresis) Palpitations (tachycardia) Pallor (pain) |
|
|
What is MEN type 1 (wermers syndrome)?
|
Pancrease, Pituitary and Parathyroid
|
|
|
What is MEN type 2 a?
|
Pheochromocytoma, Parathyroid and Medullary carcinoma
|
|
|
What is MEN type 2b?
|
Pheochromocytoma, Medullary carcinoma, and oral and intestinal ganglionuromatosis
|
