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23 Cards in this Set
- Front
- Back
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Skeletal muscle sarcomere components
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"An Interesting Zoo Must Have Mammals"
Actin in I-band attaches to Z-line; Myosin in H-band attaches to M-line." |
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Smooth muscle contraction versus relaxation
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C: L-type voltage-gated Ca channel opens->Ca enters and binds calmodulin->activates Myosin-light-chain kinase (MLCK)->phosphorylates myosin aiding in contraction
**Ca=Contraction R: : NO activates guanylate cyclase->increase cGMP activates MLC phosphatase->dephosphorylates myosin aiding in relaxation |
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Muscle spindle system vs golgi tendon system
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MSS: feedback system that maintains muscle length
-->play role in stretch (myotatic) reflex and intrafusal fibers leading to contraction GTO: feedback system that monitors and maintains muscle force -->synapse on inhibitory interneurons leading to relaxation due to excess force |
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Aspirin
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Irreversibly inhibits COX 1/2 by covalent acetylation. Increases BT, no affect on PT, PTT. A type of NSAID
**pushes arachidonic acid down lipoxygenase pathway-->inc leukotrienes and aspirin-induced asthma Low dose--dec platelet aggregation Med dose--antipyretic High dose--anti-inflammatory Toxicity: GI ulcers, tinnitus; reye's syndrome; stimulates respiratory centers leading to hyperventilation and respiratory alkalosis |
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NSAIDS
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Reversibly inhibit both COX 1/2; dec PG synthesis
Indomethacin used to close PDA Toxicity: interstitial nephritis, GI ulcer (PGs protect muscosa), renal ischemia (PGs vasodilate afferent arteriole) |
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COX-2 inhibitor (celecoxib)
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COX 2 found in inflammatory cells and mediates inflammation and pain; drug spares COX-1 which helps maintain gastric mucosa
Also does not affect platelet aggregation which is a COX-1 mediated pathway |
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Acetaminophen
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Reversibly inhibits COX, mostly in CNS as it is inactivated peripherally.
Overdose produces hepatic necrosis; acetaminophen metabolite (NAPQI) depletes glutathione and is toxic. N-acetylcysteine is antidote which helps to regenerate glutathione. |
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Bisphosphonates-- "~dronate"
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Pyrophosphate analog that bind hydroxyapatite and inhibit osteoclast activity
Used for osteoporosis, paget disease of bone Toxicity: corrosive esophagitis and osteonecrosis of jaw (pts remain upright for 30 min after ingestion) |
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Chronic gout--
Allopurinol Febuxostat Prebenecid |
Allopurinol: inhibits xanthine oxidase; also used to prevent tumor lysis syndrome post-tx of lymphoma or leukemia
*rasburicase can also be used for TLS Febuxostat: inhibits xanthine oxidase Probenecid: inhibits reabsorption of uric acid in PCT (also inhibits penicillin secretion) |
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Acute gout--
NSAIDs (first-line) Glucocorticoids Colchicine |
Colchicine: stabilizes tubulin to inhibit microtubule polymerization and impair leukocyte/PMN chemotaxis
May see n/d and abdominal pain |
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TNF-a inhibitors
Etanercept Infliximab, adalimumab |
All predispose to infection and reactivation of latent TB-->TNF blockade prevents activation of M0's
Etanercept: TNF decoy receptor; used for RA, psoriasis, & ankylosing spondylitis Infliximab/adalimumab: anti-TNF-a monoclonal ab; used for IBD, and etanercept conditions |
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Achondroplasia
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Activating mutation in FGFR3 that inhibits chondrocytes; typically due to sporadic mutation although AD inheritance. Normal life span & fertility
Short limbs but axial skeleton and head are normal; contrasted to GH/IGF-1 deficiency where both axial and appendicular bones are proportionately short |
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"trabecular thinning"
"dense, brittle bones" "loss of total bone mass" "osteoid matrix accumulation" "subperiosteal thinning, cytic-like" "mosaic bone architecture" "persistence of primary unmineralized spongiosa in medullary canals" |
Osteoporosis
Osteopetrosis--marble bone disease Osteoporosis Osteomalacia Osteitis fibrosa cystica Paget disease Osteopetrosis |
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Osteoid osteoma versus Osteoblastoma
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"blasted aspirin didn't help"
Osteoid osteoma: benign osteoblastic tumor in children, often long bones, aspirin resolves pain Osteoblastoma: similar to OO, often in vertebrae; pains doesn't resolve with aspirin |
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RA--
Sx's Labs Tx |
Autoimmune inflammatory disorder, associated w/ HLA-DR4;
Pannus formation (DIP spared); rheumatoid nodules (fibrinoid necrosis); baker cyst; squishy joints Most of Rh-factor (anti-IgG ab); *anti-cyclic citrullinated peptide ab is more specific* Tx: NSAIDS, corticosteroids, **DMARDs (MTX, sulfasalazine, TNF-a ihibitors) |
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Reactive arthritis
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"Can't see, can't pee, can't climb a tree"
Conjunctivitis, uveitis Urethritis Arthritis Typically post-GI (Shigella, Salmonella, Yersinia, Campylobacter) or Chlamydia infections |
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Sarcoidosis
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Noncaseating granulomas
Elevated ACE Bilateral hilar adenopathy Hypercalcemia-->increased 1a-hydroxylase activity of M0's in granuloma-->inc vitamin D Asteroid bodies Mediated by CD4+ T-lymphocytes |
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Polymyalgia rheumatica versus Fibromyalgia
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PR: women >50yo; NO muscle weakenss, just pain/stiffness in shoulders and hips
Associated w/temporal (giant cell) arteritis; inc ESR F: women 20-50yo; widespread musculoskeletal pain associated w/insomnia |
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Polymyositis versus Dermatomyositis
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P: progressive symmetric proximal weakness; endomysial inflammation w/**CD8+ T cells
-->trouble climbing stairs, combing hair D: similar Sx's as P, but also malar rash, gottron papuls, shawl & face rash -->perimysial inflammation w/CD4+ T cells Findings: both have elevated CK, +anti-Jo-1, +anti-SRP, +anti-Mi-2 abs Tx steroids |
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Myasthenia gravis versus Lamber-eaton myasthenic syndrome
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MG: NMJ disorder, auto-abs to postsynaptic ACh receptor
Ptosis, diplopia, weakness worsens w/use **Thymoma AChE inhibitor reverses Sx's (edrophonium) LEMS: auto-abs to presynaptic Ca channels; proximal weakness, autonomic Sx's (dry mouth, impotence); weakness improves with use Associated w/small cell lung cancer |
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Albinism versus Vitiligo
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A: normal melanocyte number w/decreased melanin production; often due to decreased tyrosinase activity
V: autoimmune destruction of melanocytes |
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Pemphigus vulgaris versus Bullous pemphigoid
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PV: "V" splits epidermis->desmoglein abs; fish mouth->net like reticular pattern; affects oral mucosa
+Nikolsky sign (stroking-->blisters) BP: Not PV; hemidesmosomes, spares oral mucosa eosinophils, linear pattern at epidermal-dermal jxn |
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Basal cell carcinoma
Squamous cell carcinoma Melanoma |
BCC: most common skin cancer; pearly nodules w/telangiectasias; palisading nuclei
SCC: seen w/immunosuppression and arsenic exposure ontop of sunlight risks; chronic draining sinuses; histo shows keratin "pearls" M: +S-100, depth of tumor correlates w/risk of met; BRAF kinase mutation; ABCDE--asymmetry, borders, color, diameter, evolution |
