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106 Cards in this Set
- Front
- Back
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32-yr-old man renal transplant patient who is immunosuppressed has a positive India ink preparation:
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cryptococcal meningitis
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Bilateral ophthalmia neonatorum during the first week:
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N. gonorrhoeae
transmitted on the way through the cervix |
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Granulocyte colony stimulating factor (G-CSF):
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produced by fibroblassts
simulates neutrophil development in the bone marrow |
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Granulocyte/macrophage colony stimulating factory (GM-CFS):
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produced by macrophages and T cells
stimulates neutrophil & monocyte development in the bone marrow |
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T cells:
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60-70% of total lymphocyte count
markers: monoclonal antibody market studies for cluster designation (CD) types; immature T cells have nuclear enzyme terminal deoxynucleotidyl transferase (tdT) on their surface functions: type IV hypersensitivity; cytokines regulate B cells; defense against intracellular pathogens (e.g.,TB, protozoa) testing: mitogen assays: functioning T cells are specifically activated by phytohemagglutinin and concanavalin A; skin tests to evaluate cellular immunity: Candida is the main antigen used; absence of an immune indicates ANERGY or a lack of cellular immunity (e.g., AIDS) |
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Positive enzyme immunoabsorbent assay (EIA) test for HIV in a newborn:
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due to transplacental transmission of the IgG antibody from the infected mother
document HIV infection in newborn by detection of HIV RNA by PCR (best test) & p24 antigen capture assay |
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AIDS testing with enzyme immunoabsorbent assay (EIA):
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initial screening test
detects anti-gp120 antibody: sensitivity 99.5-99.8%; poor specificity due to low prevalence of HIV positivity in the general population |
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AIDS testing with western blot:
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confirmatory test for indeterminate of positive EIA
positive western blot: presence of p24 and gp41 antibodies and either gp120 or gp160 antibodies; combined positive predictive value of a positive EIA/western blot is 99.5% |
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AIDS tests for monitoring immune status:
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CD4T helper cell count
HIV RNA by PCR: best overall test to monitor viral burden |
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Non-AIDS difining infections:
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oral thrush
oral hairy luekoplakia (EBV glossitis) shingles (H.zoster) molluscum contagiosum (poxvirus) |
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Diagnosis of AIDS:
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HIV positive plus: CD4 T helper cell count: <200 cells/uL; specific malignancies: e.g., Kaposi's sarcoma; specific infections: e.g., P.carinti pneumonia (MC AIDS-defining disease
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AIDS miscellaneous infections:
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bacillary angiomatosis: due to Bartonella henselae: identify with silver stains; simulates Kaposi's sarcoma,
recurrent bacterial pneumonia: Streptococcus pneumoniae; infections encountered with CD4 T helper count 100-200 cells/uL; MC COD in AIDS infections encountered with CD4 T helper count <100 cells/uL: disseminated MAL: usually <75 cells/uL; Candida esophagitis; CMV retinitis/essophagitis; Toxoplasma encephalitis; Cryptosporidiosis: diarrhea; cryptococcal meningitis |
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Transplantation success requirements:
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ABO blood group compatibility; most important test
absence of preformed anti-HLA cytotoxic antibodies in the recipient's serum close matches for HLA-A, b and D loci between recipient and donor |
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Lymphocyte crossmatch:
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screens for recipient anti-HLA antibodies against donor lymphocytes
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Lymphocyte microcytotoxicity test:
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identifies HLA-A and B derived class T antigen profiles on recipient and donor lymphocytes using known test sera
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Mixed lymphocyte reaction:
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used for class II antigen (D loci) matching,
functional lymphocytes from the recipient and previously irradiated (killed) donor lymphocytes are mixed together with iritiated thymidine to detect the degree of compatibility between their D loci- increased radioactivity indicates incompatibility recipient's lymphocytes are irradiated (killed) and functional donor lymphocytes are reacted against the host's HLA-D loci to check for a graft versus host reaction (GVH) |
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Transplant donors:
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siblings are best source- chance of a sibling having another sibling with a O, 1, or 2 haplotype match is 25%, 50%, and 25%, respectively
parents are automatically a 1 haplotype match |
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Graft types:
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autograft: transfer of tissue from self to self: best survival
syngeneic graft (isograft)- graft between identical twins allograft- graft between unrelated individuals xenograft: transplant of tissue from one species to another; e.g., pig heart transplant |
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Corneal transplants:
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best overall allograft survival rate
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HLA haplotypes and disease:
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familial predisposition to disease: weak penetrance; disease is not invariable; usually requires exposure to an environmental factor (e.g., virus),
HLA-A3: hemochromatosis HLA-B8/DR3: celiac disease HLA-B27: ankylosing spondylitis HLA-DR2: multiple sclerosis HLA-DR3/DR4: type I insulin-dependent diabeties mellitus HAL-DR4: rheumatoid arthritis |
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Examples of type I hypersensitivity reactions:
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atopy: familial predisposition (multifactorial inheritance) to develop an allergic reaction
examples: eczema (face, flexor/extensor surfaces); hives; seasonal conjunctivitis; seasonal rhinitis; asthma; hypersensitivity to bee/wasp/hornet stings Rx of anaphylactic reactions- sc. administration of aqueous epinephrine 1:1000 dilution |
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Examples of type II cytotoxic hypersensitivity reactions:
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involves antibody reactions with or without complement
warm autoimmune hemolytic anemias and cytopenias Rh/ABO hemolytic disease of newborn cells/helminths coated by specific IgG/IgE antibodies, respectively (without complement) are destroyed by cells (e.g., NK cells/eosinophils, respectively) with low affinity IgG/Ige Fe receptors myasthenia gravis: anti-acetylcholine receptor antibodies Grave's disease: igG thyroid-simulating Ig directed against TSH receptor |
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Examples of type III immunocomplex (IC) hypersensitivity reactions:
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circulating ICs (antigen + IgG/IgM) deposit in target tissue (e.g., glomerulus, small vessel)--> activate complement system--> chemotactic agents recruit neutrophils/macrophages that damage the tissue
pathogenesis of localized IC reactions (Arthus reactions)- first antigen exposure results in antibody production --> second exposure to antigen deposited in tissue leads to antigen-antibody ICs --> complement system activation --> neutrophil/magrophage damage of tissue examples: serum sickness: Rx of rattlesnake envenomations with use of horse serum antitoxins; SLE glomerulonephritis (GN): anti-DNA + DNA ICs; post-streptococcal GN: anti-bacterial antigen antibodies + bacterial antigen ICs; Henoch-Schonlein purpura: anti IgA antibodies against IgA; rheumatoid arthritis: IgM antibodies against IgG (rheumatoid factor), clinical example of an Arthus reaction: Farmer's lung: antigen is thermophilic actinomycetes |
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Examples of type IV T cell-mediated hypersensitivity reactions:
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antibody-independent cellular immune reations involving CD4 helper T cells (DRH reactions) and CD8 cytotoxic T cells
types of DHR reactions: allergic contact dermatitis: poison ivy, nichel; skin tests: tuberculin sensitivity, patch test in contact dermatitis; granulomas, pathogenesis of cytotoxic T cell reactions: cytotoxic T cells normally interact with class I antigens on nucleated cells --> alteration of class I antigens on target cells activates cytotoxic T cessl to release perforins that destroy the cell; examples: neoplastic/virally infected cell, foreign antigens in a transplant cell |
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Parasitology terms:
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definitive host: host that harbors the adult, or sexual stage of the parasite
intermediate host: host that harbors the larval, or asexual stage of the parasite protozoa: amebae; ciliates; flagellates; sporozoa helminths include: nematodes: roundworms, cestodes: tapeworms, trematodes: flukes |
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Allopurinol:
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inhibits xanthine oxidase
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Isoniazid:
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causes pyridoxine deficiency leading to peripheral neuropathy and sideroblastic anemia
MOA - INH is nicotinic acid derivative that inhibits synthesis of mycolic acid in mycobacteria cell wall |
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Effect of aspirin on kidney:
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decrease PGE2 synthesis (vasodilator) leading to unopposed AT II effect
renal pappillary necrosis |
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Methotrexate:
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blocks dihydrofolate reductase - macrocytic anemia due to folate dificiency
S phase inhibitor leucovorin rescue interstitial fibrosis in lungs |
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Peripheral neuropathy and cancer drug:
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vincristine
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Dapsone:
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sulfone that inhibits synthesis of folic acid by M. Ieprae
may precipitate hemolytic anemic in G6PD deficiency may produce methemoglobinemia nephrotic syndrome peripheral neuropathy |
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Heparin:
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MCC of thrombocytopenia in hospital: type II hypersensitivity reaction
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Acute Rx for coumarin overdose when bleeding is life-threatening:
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fresh frozen plasma best choice
use IM vitamin K for less serious bleeds |
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Cyclophosphamide:
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hemorrhagic cystitis
transitional cell carcinoma activated (not metabolized) in the liver |
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Captopril:
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bradykinin side-effects include cough and angioedema - ACE normally degrades bradykinin
cough not seen with losartan |
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Drug used to climinate calcium in patient with hypercalcemia:
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loop diureetic
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Drug used to remove calcium from urine in a calcium stone former:
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hydrochlorothiazide
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S-phase drug used in treatmente of acute lymphoblastic leukemia:
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methotrexate
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ACE inhibitors:
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block in AT II (works as vasoconstrictor of efferent arteriole in glomerulus) by ACE inhibitor removes important control for maintaining intrarenal blood flow causing potential for renal failure (particularly with bilateral renal artery stenosis)
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Nephron site of action of thiazides:
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Na +/C1* pump in cortical thick ascending limb
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Vitamin given in Rx of TB:
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pyridoxine (B6) - used up when using isoniazid,
risk of peripheral neuropathy & sideroblastic anemia |
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Antihypertensives increasing blood lipids:
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Beta-blockers
thiazides |
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H. pylori:
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Rx - amoxicillin + clarithromycin + proton pump blocker
prevention - proton pump blocker + bismuth |
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HMG-CoA reductase inhibitors:
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statin drugs block CH synthesis
hepatocytes compensate by up-regulation of LDL receptor synthesis leading to increased clearance of IDL and LDL remnants derived from VLDL |
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ACE inhibitor effect of plasma renin activity:
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increases due to decrease in AT II and aldosterone
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Drugs affecting tubulin in mitotic phase:
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vinca alkaloids
paclitaxel |
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Use of aqueous epinephrine in shock:
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1:1000 dilution subcutaneously
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Treatment of acetaminophen overdose:
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acetylcysteine to replace used up GSH - neutralizes acetaminophen free radicals formed in the liver cytochrome system
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MOA of loop diuretic:
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blocks Na+-K-2C1* cotransport pump in the thick ascending limb in the renal medulla
also blocks calcium reabsorption - used in the Rx of hypercalcemia |
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Isotretinoin:
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always order a pregnancy test in females
put patients on BCP |
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Hair loss in a woman - ? drug:
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oral contraceptives - predictable side effect
estrogen causes hair to be at same stage of development may also occur after delivery |
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Group of drugs has the highest association with urticarial and maculopapular lesions:
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amoxicillin
TMP/SMX ampicillin/penicillin rashes are the MC adverse reaction to drugs, with maculopapular rashes leading the list most drug reactions involving skin are not type I hypersensitivity hisstamine-related, however, those involving penicillin are usually type I hypersensitivity |
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CD4 helper T cell count for prophylaxis against PCP:
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<200 cells/uL-Rx with TMP/SMX
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CD4 helper T cell count for prophylaxis against toxoplasmosis:
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<100 cells/uL- Rx with TMP/SMX
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CD4 helper T cell count for prophylaxis against MAI:
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<50-100 cells/uL-Rx with clarithromycin
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Drugs involved in folate metabolism:
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phenytoini blocks intestinal conjugase - polyglutamate to monoglutamate
BCP & alcohol block uptake of monoglutamate in the jejunum methotrexate / TMP-SMX block dihydrofolate reductase |
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Drug induced SLE:
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procainamide
hydralazine |
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Ace inhibitors:
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increase in renin & ATI, but a decrease in ATII and aldosterone
aldosterone eventually increases, hence the addition of spironolactone to keep aldostrerone suppressed --> increases longevity in CHF |
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Botulism toxin:
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blocks the release of acetylcholine - diagram may be given of neurotransmitter synthesis & must locate the block
used to treat LES spasm in achalasia |
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A child who ingests 30 adult aspirins will most likely develop:
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an increased anion gap metabolic acidosis
children, unlike adults, do not commonly develop a mixed metabolic acidosis and respiratory alkalosis Rx is to preform gastric lavage & add activated charcoal & to produce an alkaline urine for increased excretion of the acid |
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Tamoxifen:
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weak estrogen that acts as an antagonist in breast tissue (estrogen competes with tamoxifen for binding to the receptor, and partial agonist in uterus (can produce endometrial hyperplasia)
also protects against osteoporosis & can be used in women who have ERA positive tumors can be used in treating progestin-resistant endometrial cancer complications: flushing (menopausal symptoms), vaginal bleeding, potential for endometrial hyperplasia/cancer |
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Acetaminophen:
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analgesic & antipyretic but not an anti-inflammatory agent
inhibits prostaglandia synthesis in the CNS very week cyclooxygenase inhibitor MC drug causing acute fulminant hepatitis converted into free radicals in the liver - * glutathione inactivates the FRs, * acetylcysteine treatment replaces GSH |
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Drug for bacterial carrier states (S.aureus, N.meningitidis, H.influenzae):
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rifampin
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Single dose drug for GC and Chlamydia:
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azithromycin
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Rx of malignant hypertension:
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nitroprusside
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Estrogen effects:
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Estrogen
Lipid effects prevents osteoporosis thrombogenic increases liver synthesis of transcortin & thyroid binding globulin increases liver synthesis of sex hormone (testosterone or androgen) binding globulin cancer risk |
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Iron toxicity:
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clinical setting - accidental overdose of ferrous sulfate in children
S/S of iron |
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Organophosphate poisoning:
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MOA: irreversible block of acetylcholine esterase (non competitive inhibitor); accuulation of acetylcholine at synapsis/myoneural junctions
source: pesticides Initial autonomic system overactivity: excessive lacrimation/salivation, fecal incontinence, constrited pupils Nicotinic effects later in toxicity: muscle weakness/paralysis; muscle fasciculations, Low serum & RBC cholinesterase (pseudocholinesterase) Rx: atropine Rx of choice; pralidoxime (2-PAM) also may be used |
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Rx of hypertension (HTN):
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weight reduction is the most important factor in lowering BP
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Antidotes used in unconscious patients:
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dextrose - R/O possible hypoglycemia from insulin overdose
naloxone - possible opiate overdose intravenous thiamine - glucose may precipitate Wernicke's encephalopathy in alcoholics with thiamine deficiency |
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Intravenous drug abuse (IVDA):
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MC localized infection is skin abscesses due to Staphylococcus aureus
HBV MC systemic infection HIV, infective endocarditis: MC tricuspid and aortic valve; S. aureus MCC, tetanus: complication of "skin popping" |
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Heroin:
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derived from poppy plant
usually "cut" with some agent (e.g., quinine, talc) - granulomatous reactions occur in skin / lungs from the cutting agents, non-cardiogenic pulmonary edema: frothing from the mouth is common focal segmental glomerulosclerosis: hypertension + nephrotic syndrome Rs: naloxone, a morphone derivative with a high affinity for opioid binding sites of the mu receptor type |
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Meperidine:
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MC DOA in health professionals, 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydro-pyridine (MPTP): by-product of attempted synthesis of meperidine; produces irreversible Parkinson's: cytotoxic to neurons in nigrostriatal dopaminergic pathways
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Cocaine:
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MC COD from DOA in United States,
MOA: blocks uptake of neurotransmitters dopamine/NOR by presynaptic axon, predisposes to: sudden death; acute myocardial infarction (AMI); stoke; pulmonary edema; ventricular arrhythmias; myocarditis, S/S: hypertension/sinus tachycardia, psychosis/seizure activity, mydriasis |
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Amphetamines:
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MOA: release catecholamines from presynptic terminals,
examples of amphetamines: dextroamphetamine; Rx obesity; methylphenidate: Rx ADHD and narcolepsy; methamphetamine; "ice" is street form of the drug, hallucinations: drug that most simulates schizophrenia |
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Marijuana:
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MC illegal DOA used in United States,
MOA: contains the psychoactive stimulant TRIANGLE9-tetrahydrocannabinol (THC); THC binds to receptors in substantia nigra, globus pallidus, hippocampus, cerebellum; derives from leaves/flowering tops of hemp plants (Cannibis sativa); hashish is extracted resin of marijuana that has 5-10 times the potency of the parent compound; high lipid solubility: THC is present in urine for more than a week, Clinical uses: cancer: decreased N/V in cancer patients; lower intraocular pressure in glaucoma; analgesia, S/S of marijuana use: reddening of conjunctiva; euphoria; delayed reastion time: engineer driving a train involved in a crash with an oncoming train was found to have THC metabolites in his urine |
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LSD (lysergic acid diethylamide):
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MOA: erot alkaloid that binds to D2 dopamine receptors in the brain; also blocks 5-HT2 serotonin receptor in peripheral tissue,
Predisposis to chromosomal breakage leading to congenital defects, S/S of LSD toxicity: hallucinations; flashbacks |
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PCP (phencyclidine):
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Angel dust,
MOA: reacts with opioid-like sigma receptors & subtypes of glutamate receptors (antagonist); initially introduced as a dissociative anesthetic: separates bodily functions from the mind without a loss of consciousness, S/S of PCP toxicity; agitation/violent behavior; coma with the eyes open; impervious to pain |
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Use of Beta-blocker in Rx of Grave's disease:
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Thyroid hormones normally upregulate synthesis of beta-receptors that interact with catecholamines & produce many of the symptoms of thyrotoxicosis,
Giving beta-blockers, blocks the beta-receptors, hence blocking the adrenergic symptoms of thyrotoxicosis |
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Electrolyte changes when giving insulin:
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drives glucose into the cell along with potassium & phosphate
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Central & neophrogenic DI:
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Both have low UOsm & increased POsm,
Central DI shows > 50% increase in UOsm with administration of vasopressin, Nephrogenic DI shows <50% increase in UOsm with vasopressin |
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Respiration changes with increasing altitude:
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Respiratory alkaloisis, hypoxemia due to decreased atmospheric pressure not a decrease in % oxygen in air,
Increase in 2,3 BPG right shifts the ODC |
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Inhibin:
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Synthesized in Sertoli cells in seminiferous tubules,
Negative feedback with FSH, Increased if seminiferous tubules are destroyed, Normal if Leydig cells are destroyed, since testosterone has a negative feedback with LH |
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Calculations:
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Alveolar ventilation - PAOx = PiO2 - PACO2/R, where PiO2 equals % oxygen x 713) and R is the respiratory quotient that normally equals o.8, subtract PaO2 from PAO2 and you have the A-a gradient,
Fick's equation for cardiac output - cardiac output mL/min = oxygen consumption divided by oxygen in pulmonary vein - oxygen in pulmonary artery |
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Placental anatomy/physiology:
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Maternal surface has slightly bulging areas called cotyledons, which are covered by a layer of deciua basalis,
Fetal surface is entirely covered by the chorionic plate - chorionic vessels converge with the umbilical cord, which is composed of 2 umbilical arteries (venous blood returning from the fetal heart) and 1 umbilical vein (carries ocygenated blood from the placenta), Chorionic villus / umbilical cord - * chorionic villi project in the intervillous space, which contains maternal blood from which oxygen is extracted: spiral arteries from the uterus empty into the space, * chorionic villi are lined by trophoblastic tissue: outside layer is composed of syncytiotrophoblast; synthesized bCG and human placental lactogen (growth hormone of preganccy) and inside layer is composed of cytotrophoblast: clear cells, the interior of the chorionic villus has fetal blood vessels, which coalesce to form the chorionic vessels that converge with the umbilical cord, The umbilical cord contains 2 umbilical arteries (contains deoxygenated blood exiting the fetal heart & returning to the placenta) and 1 umbilical vein (contains oxygenated blood) |
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hCG:
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Has luteinizing hormone activity,
Keeps corpus luteum of pregnancy synthesizing progesterone until 8-10 wks and then placenta takes over that function |
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Atrial natriuretic peptide:
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mediated by guanylate cyclase, increased if left or right atrium is volume overloaded
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Most effective nephron site for acid excretion:
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proximal tubule of the kidney
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Nephron site for DH effect:
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collecting tubule
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Nephron site for greatest of free water/most susceptible to ischemia:
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thick ascending limb in the medulla
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Constriction of the efferent arteriole:
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increases the GFR & decreases renal plasma flow
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Causes of metabolic acidosis
Increased AG Lactic acidosis |
End-product anaerobic glycolysis.
Overproduction: alcoholism; shock; phenformin-like drugs. Decreased metabolism: chronic liver disease |
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Causes of metabolic acidosis
Ketoacidosis |
Liver conversion excess acetyl CoA into AcAc and Beta-OHB.
Overproduction: diabetic ketoacidosis: alcoholism; starvation |
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Causes of metabolic acidosis
Renal failure |
Retention phosphoric & sulfuric acid
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Causes of metabolic acidosis
Salicylate poisoning |
Excess salicylic acid.
Overstimulation respiratory center may produce primary respiratory alkalosis as well. |
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Causes of metabolic acidosis
Ethylene glycol (antifreeze) |
Converted into glycolic & oxalic acid by alcohol dehydrogenase.
Calcium oxalate crystals in renal tubules produce renal failure. Rx with IV alcohol (competes with ethylene glycol for metabolism by alcohol dehydrogenase). |
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Causes of metabolic acidosis
Methyl alcohol (solvent) |
Converted into formic acid by alcohol dehydrogenase.
Damage to optic nerve with potential for blindness. Rx same as ethylene glycol. |
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Causes of metabolic acidosis
Normal AG Diarrhea |
Lose HCO3 in stool.
Isotonic loss Na+ and loss in K+. |
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Causes of metabolic acidosis
Type I distal RTA |
Dysfunctional aldonsterone-mediated H+/K+ ATPase pump in collecting ducts.
HCO3 not regenerated, Excess H+ combines with C1 to form HC1, Urine pH>5.5 (decrease acid in urine). Causes: drugs (e.g., amphotericin); BJ protein, RX: increase HCO3 intake. |
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Causes of metabolic acidosis
Type II proximal RTA |
Low threshold for HCO3 reclamation in proximal tubule (e.g., 15 mEq/L vs 24 mEq/L).
Urine pH>5.5 (lost HCO3). Causes: acetazolamide (blocks carbonic anhydrase); heavy metals (Pb and Hg). Rx: thiazide (produces volume depletion, which increases renal threshold for reclaiming HCO3). |
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Examples of Acid-Base Disorders
Patient: 24-yr-old woman with barbiturate overdose |
uncompensated acute respiratory acidosis (HCO3 <30 mEq/L)
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Examples of Acid-Base Disorders
Patient: 55-yr-old smoker with chronic bronchitis |
partially compensated chronic respiratory acidosis
HCO3 >30 mEqL) |
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Examples of Acid-Base Disorders
Patient: 35-yr-old woman with a pulmonary embolus |
acute respiratory alkalosis
(HCO3 > 18mEq/L) |
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Examples of Acid-Base Disorders
Patient: 29-yr-old man with acute gastritis and vomiting |
partially compensated metabolic alkalosis
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Examples of Acid-Base Disorders
Patient: 32-yr-old man drank antifreeze |
partially compensated metabolic acidosis
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Examples of Acid-Base Disorders
Patient: 4-yr-old child with salicylate intoxication |
mixed blood gas disorder with primary metabolic acidosis & primary respiratory alkalosis.
NOTE: pH is normal because both conditions are primary disorders; this is not full compensation |
