• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/284

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

284 Cards in this Set

  • Front
  • Back
immunosuppressants:

cyclosporine + tacrolimus (FK506)

MOA
inhibit secretion of IL2

cyclosporine via calcineurin
tacrolimus via FK-binding protein
immunosuppressants:

azationprine (6MP) and mycophenolate mofetil

MOA
interfere w/ purine metabolism, block lymphocyte production
immunosuppressants:

muromonab-CD3 (OKT3) and sirolimus (rapamycin)

MOA
block signal transduction from IL2 binding to t-cell

muromonab via CD3 binding
sirolimus (rapamycin) via mTOR binding
immunosuppressants:

daclizumab

MOA
directly binds to IL2 on t-cell
Bacteriostatic mnemonic
ECSTaTiC about bacteriostatics.

Erythromycin, Clindamycin, Sulfamethoxazole, Trimethoprim, Tetracycline, Chloramphenicol

(all are protein synthesis blockers except TMP/SMX)
Bactericidal mnemonic
Very Finely Proficienct At Cell Murder

Vanco, FQs, Penicillins, Aminoglycosides, Cilastatins, Metronidazole

(all are membrane disrupters + FQ + AG)
ampicillin spectrum mnemonic
ampicilln HELPS kill enterococci

g+ and hemophilus, e. coli, listeria, proteus, salmonella, enterococci
what are the anti pseudomonal penicillins?
TCP - take care of pseudomonas

ticarcillin, carbenicillin, piperacillin

give w/ clavulanic acid
cephalosporins: mnemonic for 1st and 2nd generation
PEcK - proteus, ecoli, klebsiella

HEN PEcKS - PEcK + hemophilus, enterobacter aerogenes, neisseria, serratia
3g cephalosporins - common treatments, and exceptions
ceftriaxone for meningitis, ceftazidime for pseudomonas,

cant do LAME: listeria, atypicals, MRSA and enterococci
aztreonam
gets the TRIO of colorful g- rods

pseudomonas, klebsiella, serratia

wannabe aminoglycoside, g- only, good for pts who are allergic to penicillins and have renal failure.
imipenem/cilastatin, meropenem
g+cocci, g-rods, DOC for enterobacter

penicillin side effects + 50% of pts have seizures (lower in meropenem)
Vanco side effects
does NOT have much toxicity

Nephrotoxic, ototoxic, thrombophlebitis (red man syndrome)
30s vs 50s drugs, mnemonic
but AT 30, CCELL at 50

30S - AG, tetracyclines
50S - clindamycin, chloramphenicol, erythromycin, linezolid, lincomycin
Which protein synthesis inhibitors block translocation?
Macrolides prevent Movement of ribosomes.
Clindamycin causes ribosome to Cling to mRNA.
Lincomycin is just like erythromycin.
Which protein synthesis inhibitors block peptide bond formation?
ChloramPhenicol blocks Peptide bond formation via Peptidyltransferase.
Which protein synthesis inhibitors block initiation?
Aminoglycosides - A is the first letter, blocks intitiation which is the first step.
LinezolIDE - looks like aminoglycoside, has similar mechanism
Tetracycline mnemonic
TTC:
tRNA Tries but Cant bind to 30S
Aminoglycosides mnemonic
Mean GNATS canNOT kill anerobes.

gentamicin, neomycin, amikacin, tobramycin, streptomycin

nephrotoxicity, ototoxicity, teratogen
Tetracycline mnemonic
VACUUM THe BedRoom

Vibrio, Acne, chlamydia, ureaplasma urealyticum, mycoplasma, Tularemia, H. pylori, borrelia burgdorferi, Rickettsiae.

Doxy is okay for renal failure, do not give with divalent cations.
Erythromycin
Neiss Chicks Like My Mack

Neisseria, Chlamydia, Legionella, Mycoplasma, g+s

prolongs QT, increases GI motility, acute cholestatic hepatitis. inhibits cyp450
Chloramphenicol
Treats SHiN meningitis and rickettsia.

anemia, aplastic anemia, gray baby syndrome
Clindamycin
anerobic infections above diaphragm (bacteriodes, clostridium) and staph osteomyelitis

causes pseudomembranous colitis, fever, diarrhea
mtb tx
TB is RIPE for treatment

rifampin, inh, pyrazinamine, ethambutol
mai tx
treat mai ARSE

same as mtb tx but replace INH with azithromycin, pyrazinamide with streptomycin

rifampin, azithromycin, strepotmycin, ethambutol
Rifampin uses
mtb (w INH), leprosy (w dapsone), prophylaxis for meningococcemia and h. influenzae b exposure.
mechanism of resistance: penicillin, cephalosporins
b-lactam cleavage, or altered PBP in MRSA or penicillin resistant S. pneumo
mechanism of resistance: aminoglycosides
modificaiton by acetylation, adenylation, phosphorylation
mechanism of resistance: vancomycin
D-ala --> D-lac
mechanism of resistance: chloramphenicol
acetylation
mechanism of resistance: macrolides
alteration of rRNA near its binding site in ribosome
mechanism of resistance: tetracyclines
decreased uptake, increased efflux out of cell
mechanism of resistance: sulfonamides
altered bacterial dihydropteroate synthetase, decreased uptake, increased PABA synthesis
mechanism of resistance: quinolones
altered gyrase, reduced uptake
amphotericin / nystatin

moa
bind ergosterol, disrupting fungal membrane.

nystatin only topical, amphotericin is amphoterrible and doesnt cross bbb (give intrathecal)
azoles

moa
inhibit lanosterol -> ergosterol synthesis, inhibits hormone synthesis may cause gynecomastia, crosses BBB, inhibits cyp450
flucytosine moa
inhibits DNA synth by conversion to 5FU
caspofungin moa
inhibits cell wall synth by blocking b-glucan

cASPo for invasive ASPergillosis
terbinafine
inhibits squalene epoxidase (blocks lanosterol), for dermatophytes
griseofulvin
blocks microtubule function, disrupts mitosis, deposits in keratin

for dermatophytes

teratogenic, carcinogenic, headaches, induces CYP450
Amantadine
A man to dine takes off his coat. inhibits penetration / uncoating of virus (M2 protein), blocks influenza A, rubellA, may cause problems w/ cerebellA

lots of resistance to drug...
Zanamivir, oseltamivir (tamiflu)
inhibits neuraminidates, decreasing release of progeny in influenza A and B
Ribavirin
inhibits imp dehydrogenase, less guanine nucleotide synthesis

used for chronic hep C w/ interferon a
acyclovir
monophosphorylated active by viral thymidine kinase, triphosphorylated by cell enzymes, inhibits viral DNA polymerase by chain termination.

loss of thymidine kinase = resistance

similar to gancicyclovir which works in CMV as well.... (more toxic)
foscarnet
pyrophosphate analog doesnt need activation by viral kinase, for cmv in resistance cases.

nephrotoxicity looks like furosemide overdose - lose Ca K and Mg...
HIV protease inhibitors
-navir

navir TEASE a proTEASE

all have toxicity of GI intolerance, hyperglycemia, lipodystrophy, inhibit cyp450

indinavir has thrombocytopenia
NRTI that causes hypersensitivity reactions?
abacavir
NRTIs
haveudined with my nuclear family?

VUDINE - NRTI

zidovudine, didanosine, zalcitabine, stavudine, lamivudine, abacavir

ALL cause lactic acidosis and bone marrow suppression
NNRTIs
Nevirapine, Efavirenz, Delaviridine

Never Ever Deliver nucleosides. inhibit HIV reverse transcriptase

Cause rash, neuropathy
HIV drugs that cause pancreatitis and peripheral neuropathy
didanosine, zalcitabine, stavudine (nrtis)
safest RTI?
lamivudine
RTI used for pregnant women or occuational exposure?
ZDV, or AZT.
enfivurtide
fusion inhibitor, binds viral gp41, inhibits fusion w/ cd4 cells. blocks entry and replication

for pts not responsive to HAART
Antibiotics to avoid in pregnancy
SAFE Moms Take Really Good Care

Sulfonamides - kernicterus
AG - oto
FQ - cartilage
Erythromycin - acute cholestatic hepatitis
Metronidazole - mutagen
Tetracyclines - bone / teeth problems
Ribavirin - teratogen
Griseofulvin - teratogen
Chloramphenicol - gray baby
paclitaxel
anti breast cancer, stabilizes microtubules, they get stuck in metaphase
colchicine
macrophages need microtubules for chemotaxis, colchicine blockes their chemitaxis = no inflammatory response
vincristine, vinblastine
anticancer, no polymerization of microtubules
chediak higashi
microtubule polymerization defect results in poor phagcytosis, recurrent pyogenic infections, partial albinism, peripheral neuropathy
cytokeratin
epithelial cells
vimentin
connective tissue
desmin
muscle
gfap
neuroglia
neurofilaments
neurons
collagen synthesis: which step is defective in:

Scurvy
hydroxylation of pro and lys residues of preprocollagen in the ER. requires vitC
collagen synthesis: which step is defective in:

OI
defect in glycosylation of pro-alpha-chain in the ER, prevents formation of procollagen, the triple helix form
collagen synthesis: which step is defective in:

ehlers danlos
defect in cleavage of C-terminal end of procollagen, required for the formation of insoluble tropocollagen outside the fibroblast
collagen synthesis: which step is defective in:

Cu defiency
required for lysyl oxidase to cross link tropocollagen into covalently linked lysin-hydroxylysine cross linkage, making collagen fibrils
collagen synthesis: which step is defective in:

Zn deficiency
metalloproteinase / collagenases break down type 3 collagen and replace with type 1 collagen, this requires Zn (in healing of scars)
ADPKD
APKD1 gene is on chromosome 16. 16 letters in "polycystic kidney"
Familial adenomatous polyposis
APC gene is on chromosome 5, 5 letters in "polyp"
Huntington's disease
C's... Chorea, caudate atrophy, crazy, decreased acetylCholine and gaba, chromsome cuatro, CAG repeat, Cuarenta years old
Hereditary spherocytosis
AD, spectrin and ankyrin, increased MCHC
Familial hypercholesteremia IIa
AD, LDLR defect, MI at 19, chromosome 19
NF1
NF2
AD

NF1- von recklinghausen - chromosome 17, 17 letters
NF2- type 2, chromosome 22, 2 acoustic neuromas
Von Hippel Lindau
AD - VHL gene - 3 letters - chromsome 3. constant HIF hypoxia induced factor causes angiogenic growth factors
cystic fibrosis
AR - CFTR gene on chromosome 7, abnormal protein folding causes degradation of channel before reaching cell surface
X-linked recessive disorders mnemonic
Be Wise Fools GOLD Heeds Silly Hope

Bruton's agammaglobulinemia, Wiscott Aldrich, Fabrys, G6PD, Ocular albinism, Lesch Nyhan, Duchenne's MD (and beckers), Hunters Syndrome, Hemophilia A and B
Fragile X
X-linked, FMR1 gene, familial mental retardation. CGG repeat
Trinucleotide repeats mnemonic
Try Hunting for My Fried Eggs (X)

Huntington - CAG
MyoTonic dystrophy - CTG
FraGile X - CGG
Freidrichs - GAA - decrease in frataxin protein
Down syndrome quad screen results
increased bHCG, (inhibin A)
decreased aFP, estriol
Patau
13 fingaz, cleft Palate, holoProsencephaly, Polydactly, microPthalmia
Edwards
Election age 18, micrognathia, clenched hands head dz
Chromosomal inversions
Paracentric - does not involve centromere, does not go thru meiosis, "paralyzed" meiosis

Pericentric - involves centromere, goes thru meiosis

may decrease fertility
Cri du chat
chromosome 5 "cridu" 5 letters, microcephaly, mental retardation, high pitched crying mewin, epicanthal folds, cardiac defect
william syndrome
microdeletion of 7, 7 letters in william, elfin facies, hypercalcemia, verbal baller, extremely friendly, cardiac defect
22q11 deletion
CATCH 22

Cleft Palate, Abnormal Facies, Thymic aplasia, Cardiac Defect, Hypocalcemia (pth aplasia)

3rd and 4th pharyngeal pouch problems.

Velocardiofacial syndrome - palate, facial, cardiac
Water soluble vitamins mnemonic
The Rich Never Pan Pyrite Filled Creeks

B1 - Thiamine, B2 - Riboflavin, B3 - Niacin, B5 - Pantothenic acid, B6 - Pyridoxine, B9 - Folate, B12 - Cobalamin
B1 deficiency - enzymes affected
pyruvate dh
akg dh
bcaa dh
transketolase
B3 deficiency - causes of
derived from tryptophan, requires B6 for synthesis.

Hartnups syndrome, malignant carcinoid syndrome, INH treatment
B6 deficiency - processes effected
transaminations, decarboxylations, glycogen phosphorylase, cystathionine synthesis, heme synthesis, niacin synthesis, gaba synth

def caused by INH and OCP tx
B12 deficiency - enzymes affected
homocysteine + n-me-THF -> methionine + THF

methylmalonyl CoA -> Succinyl CoA
biotin def - enzymes affected
pyruvate carboxylase - gng
acetyl coa carboxylase - fa synth
propionyl coa carboxylase - ocfa oxidation
vitamin c functions
keeps Fe reduced, more absorption
hydroxylation of por lys for collagen
cofactor for dopamine b hydroxylase for DA->NE
drugs w/ disulfiram like reaction
inhibit acetaldehyde dh.

metronidazole, procarbazine, sulfonylureas, cephalosporins
mitochondrial reactions
fa oxidation, acetyl coa synthesis, TCA cycle, oxphos
cytoplasmic reactions
glycolysis, fa synth, hmp shunt, protein synth, steroid synth
reactions that occur in both cytoplasm and nucleus
HUGs take two.

Heme synthesis, Urea Cycle, Gluconeogenesis
rate limiting enzyme:

glycolysis
PFK1

+ insulin, F26bp, AMP
- citrate
rate limiting enzyme:

gluconeogenesis
F16BPase

+ glucagon
- F26bp
rate limiting enzyme:

TCA cycle
isocitrate dehydrogenase

+ ADP, Ca
- NADH
rate limiting enzyme:

Glycogen synthesis
glucokinase

+ insulin
rate limiting enzyme:

Glycogenolysis
glycogen phosphorylase

+ glucagon
- insulin
rate limiting enzyme:

HMP shunt
G6P dehydrogenase

+ NADP+
rate limiting enzyme:

De novo purines
glutamine PRPP amidotransferase

-AMP, GMP
rate limiting enzyme:

de novo pyrimidines
CPS2

+PRPP
-UTP
rate limiting enzyme:

urea cycle
CPS1

+NAG
rate limiting enzyme:

fatty acid synth
Acetyl coa carboxylase

+citrate, acetylcoa
rate limiting enzyme:

fa oxidation
carnitine acyltransferase

-malonyl coa
rate limiting enzyme:

ketogenesis
hmg-coa synthase
rate limiting enzyme:

cholesterol synthesis
hmg coa reductase

-cholesterol
Heme synthesis
ALA synthase
Bile acid synthesis
7 alpha hydroxylase
4 places you use NADPH
1. respiratory burst
2. anabolic processes (fa+steroids)
3. glutathione reductase
4. CYP450
hexokinase vs glucokinase:

feedback inhibition
only hexokinase has feedback inhibition by g6p
glucokinase deficiency
results in maturity onset dm or gestational dm because its rate limiting step toward insulin release from b cells
pyruvate kinase - regulation
+F16BP
-alanine, ATP
pyruvate DH - regulation
- ATP, NADH, acetylcoa
arsenic poisoning
inhibits lipoic acid, needed in akgdh,pdh, leads to vomiting, rice water stools, garlic breath
PDC / akgDH cofactors mnemonic
Tender Loving Care For Nobody

Thiamine, Lipoic acid, CoA, FADH2, NADH
PDC deficiency
backup of ala and pyr, lactic acidosis, can be acquired in alcholics 2/2 B1 deficiency

tx: give ketogenic aa, (lys, leu)
akg DH and pdc - what regulates them?
both are inhibited by ATP, NADH, and their products (succinyl coa and acetyl coa)
oxphos - inhibitors of complex 1
amytol (barbiturate), rotenone (tick poison), mpp (metabolite of MPTP)
oxphos - inhibitors of complex 3
antimycin A
oxphos - inhibitors of complex 4
arsenic, CN-, CO, H2S, N3-

this step converts 1/2O2-> H2O
oxphos - inhibitors of complex 5 (atp synthase)
oligomycin, macrolide causing lactic acidosis
oxphos - uncoupling agents
2,4DNP, aspirin, thermogenin

cause leaking membrane in mitochondria
can odd chain fatty acids make glucose?
yes, they release propionyl coa, which becomes succinyl coa and enters TCA cycle, to OAA which goes into gluconeogenesis. even chains only make acetyl coa, which is before the block on isocitrateDH in the fasting state, so cannot make glucose.
respiratory burst
NADPH oxidase takes gives electron from NADPH to O2, SOD takes superoxide radical and makes hydrogen peroxide, myeloperoxidase takes h202 and makes HClO. bacteria dies.
neutralizing h2o2
catalase uses GSH to turn H2O2 into H2O, G6PD makes NADPH from G6P, which is used in GSH reductase to replenish GSH
infantile cataracts:
hurlers vs galactosemia vs fructose intolerance
hurlers is 2 years after birth, galactosemia is 2 weeks after birth, fructose intolerance is 6 months after birth
what tissue-specific enzyme deficiency causes osomotic problems in diabetics?
sorbitol dehydrogenase, which converts sorbitol to fructose in normal tissue.

schwann cells, lens, retina, kidneys have aldose reductase but no sorbitol dh, and are therefore sites of osmotic damage in DM
Urea cycle mnemonic
Ordinarily Careless Crappers Are Also Frivolous About Urination

Ornithine, Carbamoyl phosphate, Citrulline, Aspartate, Arginosuccinate, Fumarate, Arginine, Urea

Nitrogens in urea are from NH4 and Aspartate, and Carbon is from CO2.
ammonia effect on metabolism
depletes akg, inhibiting TCA cycle. treat w/ benzoate or phenylbutyrate
ammonia intoxication
tremor, slurring, somnolence, vomiting, cerebral edema, blurred vision
CPS1 vs CPS2
CPS1 - urea cycle, in mitochondria, gets N from ammonia and aspartate

CPS2 - pyrimidine synthesis, cytosolic, N from glutamine
Phe derivatives
tyrosine, dopa, dopamine, NE (vitc), epi(sam) , melanin, thyroxine
trp derivatives
niacin (b6), melatonin, serotonin (both BH4)
his derivatives
histamine (b6)
glycine derivatives
porphyrin, heme (both b6)
arg derivatives
NO, urea, creatine (sam)
glu derivatives
gaba (b6), glutathione
breakdown products

DA
NE
Epi
DA - HVA
NE - VMA
Epi - metanephrine
PKU causes
deficiency in phe hydroxylase, tetrahydrobiopterin, dihydropterin reductase
albinism causes
tyrosinase deficiency, defective tyr transporters, lack of neural crest cell migration
homocystinuria causes
1. cystathionine synthase def (tx: dec met, inc cys, inc b12 and B9)
2. dec affinity of cystathionine synthase for B6 (tx:inc B6 in diet)
3. homocysteine methyltransferase deficiency (needs b12)

retarded marfans w/ stroke, MI and bone problems

all of them, inc cys, dec met
MSUD
def in aketacid dh, decrease intake of I Love Vermont maple syrup

Ile, Leu, Val
Niemann Pick vs Tay Sachs
NP has no HSM, but has foam cells. Tay SaX (hexosaminidase, GM2 ganglioside) has onion skin lysosomes. Both have cherry red spot and progressive neurodegeneration.
Fabrys enzyme, accumulated substrate, findings
XR - alpha galactosidase, ceramide trihexose, peripheral neuropathy, angiokeratomas, cardio / renal dz.
Krabbe's dz
galactocerebrosidase, galactocerebroside accum, optic atrophy, globoid histiocytic cells
Metachromic leukodystrophy
central and peripheral demyelination, arylsulfatase a def, cerebroside sulfate accumulates
Hurlers vs Hunters
X marks spot w/ hunters, hurlers has corneal clouding, hurLers enzyme is alpha L idurinase, hunters is iduronate sulfatase, both accum heparan sulfate and dermatan sulfate
carnitine deficiency
cant transport LCFA into mitochondria, toxic accumulation. weakness hypotonia, hypoketotic hypoglycemia
acyl-coa dehydrogenase deficiency
increased dicarboxylic acids, decreased glucose and ketones
ketone bodies
made in prolonged starvation or drunkness when depletion of OAA (from too much NADH or depletion) stalls krebs cycle, shunts glucose and FFA toward production of ketone bodies for muscle and brain. RBC (no mito) and liver cannot use ketone bodies.
zellweger syndrome
cannot break down vlcfa, phytanic acid accumulates, cant for myelin. hypotonia + seizures, hepatomegaly, retardation and death as child
apoproteins of:

VLDL
B-100 - Binds to LDL receptor, mediates VLDL secretion
C-II - cofactor for LPL
E - mediates Extra (remnant) uptake
apoproteins of:

IDL
B-100 - Binds to LDL receptor, mediates VLDL secretion
E - mediates Extra (remnant) uptake
apoproteins of:

LDL
B-100 - Binds to LDL receptor, mediates VLDL secretion
apoproteins of:

Chylomicrons
B48 - mediates chylo secretion
A-IV - activates LCAT(?)
C-II - cofactor for LPL
E - mediates Extra (remnant) uptake
apoproteins of:

HDL
AI and AII - activate LCAT
familial dyslipidemias:

type 1
hyperchylomicronemia, elevated TG and chol due to LPL deficiency or altered ApoC2.

pancreatitis, HSM, eruptive xanthomas (no risk of atherosclerosis)
familial dyslipidemias:

type 2a
familial hypercholesteremia, increased LDL and cholesterol, AD, deficient LDLR, causes accelerated atherosclerosis, achiles xanthomas and corneal arcus
familial dyslipidemias:

type 3
liver cannot remove chylomicrons or VLDL remnants from blood due to def in E3 and E4, inc TG and cholesterol. (Looks like type 1)
familial dyslipidemias:

type 4
hypertriglyceridemia, increased VLDL and TG, hepatic overproduction of VLDL, causes pancreatitis

tx w/ fibrates, which increase PPARalpha, increasing LPL and tg lysis...
bronchopulmonary segments - triad and diad
tertiary segmental bronchus, bronchial and pulmonary arteries at center

veins and lympatics at the borders.
which is more common for aspiration, right or left mainstem bronchus?
right, its wider and more vertical then the left
pulm artery association w/ mainstem bronchi
RALS - Right anterior, left superior.
aspirate a peanut, upright vs supine...
upright - lower portion of right inferior lobe
supine - superior portion of right inferior lobe
crossing of diaphragm - esophagus, aorta, ivc
I(vc) 8, 10 eggs (vagus too), aat 12 (azygous and thoracic duct too)
diaphragm pain referral
c345 sends it to shoulder
inspiratory muscles during exercise
inSpiratory - external intercostals, Scalenes, Steromastoids

inspire w/ externals
expiratory muscles during exercise
for muscles of abdominal wall and internal intercostals.

expire w/ internals
why is kallikrein in lungs?
activates BK, activates plasmin, kills clots
what makes hemoglobin go from R to T?
increased Cl-, H+, CO2, 2,3BPG, temperature
right shift hb curve mnemonic
CADETs face right

CO2, Acid/Altitude, DPG, Exercise, Temperature
what is diffusion limited?
O2 in emphysema, fibrosis, CO. Gas does not equilibrate by the time it blood reaches end of capillary. exercise kind of makes O2 diffusion limited.
Pulm HTN genetic cause
inactivation of BMPR2 (TGF beta related gene normally inhibits vasc smooth muscle proliferation)
Pulm Vasc resistance eq.
PVR = (Ppulm art - P L atrium) / CO
alveolar gas equation

and

A-a gradient
PAO2 = 150 - PAco2 / 0.8

A-a gradient = PAO2-PaO2 = 10-15mmHg

increased in hypoxemia, shunting, V/Q mismatch, fibrosis (diffusion block)
what causes hypoxemia w/ normal A-a gradient?
high altitude and hypoventilation
what causes hypoxemia w/ high A-a gradient?
V/Q mismatch, shunting R->L, diffusion block
zones of lung:

PA>Pa>Pv
zone 1, apex

V/Q = 3 dead space
zones of lung:

Pa>PA>Pv
zone 2, middle

V/Q b/w .6 and 3
zones of lung:

Pa>Pv>PA
zone 3, base

V/Q = .6 shunt
do you give 100% O2 to pt w/ shunt or dead space?
100% O2 helps physiologic dead space (blood flow obstruction)
do you give O2 if there is a shunt?
you shunt give O2 to pt w/ a shunt (airway obstruction, pulmonary edema, pneumonia)
terbafine mnemonic
that black chick squalene is more than fine, she's terba-fine
changes in PaO2 and PaCO2 during exercise
no changes in PaO2 and PaCO2, but PvCO2 increases..
prevention of DVT
heparin
chronic bronichitis or emphysema...

early onset cyanosis or early onset dyspnea?
CB = early onset cyanosis due to shunting, you shant give O2 for shunt
extrapulmonary restrictive lung dz's
poor muscular effort - myasthenia gravis and polio
poor structural apparatus - scoliosis, obesity
interstitial lung dz's
characterized by poor diffusion capacity - ARDS, NRDS, pneumoconiosis, sarcoidosis, IPF, goodpastures, wegeners, histiocytosis x, drugs
drugs causing pulm fibrosis
bleo, busulfan, amiodarone
asbestosis, coal miners or silicosis?

increased TB risk
silicosis impairs mphage phagolysosomes - eggshell calcification in hilar lymph nodes
physical finding:

lung hyperresonance?
tension pneumothorax
physical finding:

increased fremitus
lobar pneumonia
physical finding:

tracheal deviation toward lesion
bronchial obstruction
physical finding:

tracheal deviation away from lesion
tension pneumothorax
physical finding:

decreased everything
pleural effusion -


decreased breath sounds + dullness to percussion + decreased fremitus, no deviation of trachea
lung cancer - mets vs primary?

presents w/ cough
primary
lung cancer - mets vs primary?

presents w/ dyspnea
mets
lung cancer complications mnemonic
SPHERE of complications
SVC syndrome, pancoast tumor, hemoptysis, endocrine (paraneoplastics), recurrent laryngeal n., effusions (pericardial or pleural)
lung CA,

central w/ cavitation
sq cell ca
lung CA,

PTHrP
sq cell ca
lung CA,

MCC in nonsmokers
adenoca, MCC in females, both bronchial and bronchioalveolar due to Clara cells - type 2 pneumocytes
lung CA,

SIADH / ACTH / eaton lambert
small cell, small blue neuroendocrine cells
lung CA,

psammoma bodies
mesothelioma
lung CA,

pleomorphic giant cells
large cell carcinoma, pleomorphic giant cells w/ leukocyte fragments in cytoplasm
H1 antagonist toxicity
sedation, antimuscarinic, anti alpha adrenergic (H1, M3 and alpha1 are all Gq)

H1 blockers are really Gq blockers...
theophylline mechanism
inhibits PDE, increases cAMP like Beta2 agonist

blocks adenosine (Gi)
ZilEuton vs zafirlukast / montelukast
ZilEuton blocks leukotriene Enzyme, lukasts block receptor
bosentan - whats it used for, and mechanism?
pulm htn, comp antagonizes endothelin-1, a vasoconstrictor
macula densa: when does it release adenosine?
increased NaCl levels release adenosine -> afferent constriction, decrease GFR
body water - 60-40-20 rule
60% of body weight is TBW, 40% is ICF, 20% is ECF (1/4 plasma, 3/4 interstitial)
when does PAH clearance rate approximate RPF and GFR?
RPF at low concentrations, GFR at high concentrations because carriers get saturated.
filtered load equation
FL = GFR x Plasma concentration
increased plasma protein concentration. effect on FF?
NC to RPF, decrease GFR, therefore decrease FF
free water clearance
Ch2o =V - Cosm

Cosm = (Uosm / Posm) * V

Ch20 = V(1-Uosm/Posm)
excretion rate
Excretion rate = Ux*V
PTH effect on proximal tubule
inhibits Na+/PO4 cotransport, increases phosphate excretion
PTH effect in distal tubule
Increases Na+ / Ca+ exchange, increase Ca+ reabsorption
AT2 effect on proximal tubule
Increases Na+/H+ exchange, leading to contraction alkalosis (BP down, aldosterone up, Na H exchange up, bicarb up
carbonic anhydrase proximal tubule mechanism
releases H+ into tubule, making HCO3 into H2O and CO2, which diffuses back into cell. Then it makes it back into bicarb and pumps it out into blood.
what determines metabolic rate of kidney?
GFR, because main metabolic function of kidney is NaK pump, so increase GFR = increased NaK pump work...
Which substances concentrations increase in proximal tubule (TF/P)?
PAH > Cr > Inulin > Urea > Cl- > K+ Na+ (1:1)

secreted except (K Na)
Which substances concentrations decrease in proximal tubule (TF/P)?
Glucose < amino acids < bicarb

all are reabsorbed
ANP renal effects
released from atria 2/2 inc volume, relaxes vascular smooth muscle by cGMP, increasing GFR and blocking renin / aldosterone effects
renin vs ANP
renin inc GFR, inc Na reabsorption

ANP inc GFR, dec Na reabsorption
JG cells
modified smooth muscle of afferent arterioles, defect stretch, make store and secrete renin to decrease GFR (save sodium), raise bp
3 stimuli for JG cells renin release
1. dec BP
2. dec Na + delivery to macula densa
3. inc sympathetic tone (beta1)
hyper / hypoosmolarity:

effect on potassium?
HYPERosmolarity causes HYPERkalemia, and vice versa
winter's formula
figure out respiratory compensation to metabolic acidosis:

Pco2 = 1.5bicarb+8

Pco2 should increase .7mmHg per 1mEg/L bicarb
winters formula:

pCO2 > bicarb
metabolic acidosis also has primary respiratory acidosis
winters formula:

bicarb > pCO2
metabolic acidosis also has primary respiratory alkalosis
anion gap metabolic acidosis mnemonic
MUDPILES - methanol, uremia, dka, paraldehyde / phenformin. iron / inh, lactic acidosis, etylene glycol, salicylates
non-anion gap metabolic acidosis
Dont Sniff Chloroform Rags

diarrhea, sniffing glue, chloremia, renal tubular acidosis
metabolic alkalosis
peeing, vomiting, burping and aldosterone

diuretics, vomiting, antacids, hyperaldosterone
hypokalemic acidosis
RTA 1 (distal) and 2 (proximal).
RTA 1 vs RTA 2
1. distal, cant excrete H+, alkaline urine, more Ca stones
2. proximal, cant absorb HCO3. hypophosphatemia rickets

both have low K+ high H+
RTA 4
HYPERkalemic, 2/2 hypoaldosteronism, low urine pH due to less buffering capacity. Cong. adrenal hyperplasia
Renal tubular acidosis
hyperchloremic, non anion gap metabolic acidosis
Renal tubular acidosis
hyperchloremic, non anion gap metabolic acidosis
Renal tubular acidosis
hyperchloremic, non anion gap metabolic acidosis
Renal tubular acidosis
hyperchloremic, non anion gap metabolic acidosis
nephritic syndrome - tetrad mnemonic
lucas HAPOpuro has glomerolonephritis.

HTN, azotemia, proteinuria, oliguria (and hematuria)
glomerulonephritis after URI
either PSGN (lumpy bumpy subepithelial immune complexes, granular IF, IgG+C3) or Berger's dz (IgA+C3 in mesangium)
diffuse proliferative GN
MCC of death in SLE, (MPGN also)
rapidly progressive GN
goodpastures (anti BM IgG), wegeners (c-anca), or microscopic polyarteritis (p-anca)
membranous GN
MC adult nephrotic, in SLE, tumors, drugs

spike and dome, (subepithelial IgG+C3)
Focal segmental GS
IVDA and HIV, poor prognosis
Membranoproliferative GN type 1
subendothelial IC, tram track (HBV associated)
Membranoproliferative GN type 2
subendothelial IC, dense deposits (C3 nephritic factor)
Membranous GN - things that cause it
Drugs - penicillamine
Infections - HBV HCV
Systemic dz - SLE, DM
Cancer - lung / colon
which renal stones do you treat by acidifying urine?
Ca and Struvite (MAP magnesium ammonium phosphate), the radiopaque ones
which renal stones do you treat by alkalinizing urine?
uric acid and cystine stones, the radiolucent ones
WAGR syndrome
Wilms tumor, Aniridia, Genital malformations, Retardation
Transitional cell CA causes
PSAC problems
phenacetin, smoking (shistosoma), aniline dyes, cyclophosphamide
diffuse cortical necrosis
acute infarction of both cortices of kidneys, post pregnancy DIC or vasospasm
drug induced interstitial nephritis vs ATN
DIIN is allergies to sulfa drugs, ATN is direct toxicity of AG, myoglobin, toxins (epithelial detachment muddy casts)
renal papillary necrosis causes
santa cruz pd
sickle cell, chronic pyelonephritis, phenacetin, DM
ARF:

Urine osmol >500, Urine Na <10, FeNa<1%, BUN/Cr>20
prerenal azotemia

no renal failure, perfusion problem, normal osmol, Na, low GFR raises BUN/Cr
ARF:

Urine osmol <350, Urine Na >20, FeNa>2%, BUN/Cr<15
renal azotemia - 2/2 ATN, ischemia, toxins - patchy necrosis, fluid backflow - granular casts - impaired BUN reabsorption
ARF:

Urine osmol <350, Urine Na >40, FeNa>4%, BUN/Cr>15
postrenal azotemia - stones, bph, neoplasia, congenital - only if bilateral
ARFs

BUN / Cr < 15
renal / ATN
ARFs

Uosm > 500, FeNa<1%
prerenal
ARFs

Uosm < 350, FeNa>2%
w/ renal tubular cell casts = renal
w/o casts = postrenal
Fanconi's causes
wilsons, cisplatin, expired tetracycline

dec prox tubule reabsorption of everything. looks like DI
Electrolyte imbalances:

disorientation, stupor, coma
hypo Na
Electrolyte imbalances:

hypokalemia, hypovolemia, increased aldosterone
hypo Cl-, secondary to metabolic alkalosis
Electrolyte imbalances:

U wave on ECG, flattened T waves, arrythmias, paralysis, weakness
hypo K+
Electrolyte imbalances:

Tetany, NM irritability
hypo Ca+2
Electrolyte imbalances:

NM irritability, arrhymias
hypo Mg+2
Electrolyte imbalances:

bone loss, osteomalacia
hypo PO4
Electrolyte imbalances:

irritability, delirium, coma
hyper Na
Electrolyte imbalances:

accompanies anion gap acidosis
hyper Cl
Electrolyte imbalances:

peaked T waves, wide QRS, arrhythmias
hyper K
Electrolyte imbalances:

delirium, renal stones, abdominal pain
hyper Ca
Electrolyte imbalances:

delirium, decreased deep tendon reflexes, cardiopulmonary arrest
hyper Mg
Electrolyte imbalances:

renal stones, metastatic calicification
hyper PO4
diuretics causing gout mnemonic
Fuckin Elbow Hurts
furosemide, ethacrynic acid, HCTZ
loops side effects mnemonic
OH DANG!
Ototoxic, hypokalemia, dehydration, allergy (sulfa), nephritis, gout
HCTZ mnemonic
hyperGLUC
glycose, lipidemia, uricemia, calicemia
K sparing diuretics mnemonic
the potassium STAys

spironolactone, triamterene, amiloride
ACEi mnemonic
CAPTOPRIL
cough, angioedema, proteinuria, taste changes, hypOtension, pregnancy problems, rash, increased renin, lower AT2