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195 Cards in this Set
- Front
- Back
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What are 5-HT3 antagonists used for
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Anti-emetic
(ondansterone) |
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Vitamin E toxicity
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bleed on warfarin - dec synthesis of Vit K dependent cofactors
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What type of cardiomyopathy results from acute MI
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dilated
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Delusional disorder
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Nonbizarre
Greater than one month |
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No spleen - effect on platelets and rbcs
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Thrombocytosis - platelets normally sequestered in spleen are still.in circulation
Nucleated rbcs |
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Selenium
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Antioxidant that neutralizes peroxide
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Marajuana
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Dry mouth
Inc HR conjunctival injection |
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Delusional disorder
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Nonbizarre
> 1 month |
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No spleen:
- platelets - RBCs |
thrombocytosis (platelets normally sequestered in spleen are now in circulation)
Nucleated RBCs |
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DiGeorge: cardiac probs
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Aortic arch abnormalities
Tetrology of Fallot |
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Gram + rods
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Listeria
Bacillus Corynebacterium Clostridium Mycobacterium |
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Agar:
- mycoplasma - mycobacterium Stain: - acid fast |
mycoplasma - Eaton's
mycobacterium - Lowenstein-Jensen acid fast: Ziehl-Nielson |
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Top 3 UTI
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E. coli
S. saprophyticus Klebsiella |
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Silver stain
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PCP
Legionella |
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B. pertussis: agar
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Bordett-Gengou
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Treat digitalis toxicity
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lidocaine
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Organisms --> staghorn calculi
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Proteus
Staphylococcus Klebsiella |
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Dapsone:
1. MOA 2. Clinical 3. Toxicity |
1. like sulfonamides - PABA analog
2. Leprosy, PCP 3. hemolysis (G6PD), methemoglobinemia |
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G6PD deficiency --> hemolysis
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IS PAINeD
INH Sulfonamides Primaquine Aspirin Ibuprofen Nitrofurantan Dapsone |
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Which fungus is encapsulated
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Cryptococcus = encapsulated yeast
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MOA:
1. spironolactone 2. Triamterene, Amiloride |
1. Inhibit Aldosterone
2. Inhibit Na+ channels |
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Epydidimitis:
<35 >35 |
<35: Nisseria/Chlamydia
>35: E. coli/Pseudomonas |
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diagnose Acromegaly
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inc IGF-1
fail to dec glucose following oral glucose tolerance test |
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Why jaundice and kernicterus in Crigler-Najjar
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Unconjugated bilirubin is insoluble --> can't excrete in urine, builds up in tissues and brain
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Charcot-Marie tooth
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Can't produce myelin sheath
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MTB:
- cord factor - sulfatides - wax d |
Mycolic acid --> virulence:
cord (serpentine) - inactivate PMN, damage mitochon, inc TNF sulfatides - inhibit fusion of phagolysosome Wax D - activate cellular immunity |
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Renal papillary necrosis
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1. Diabetes (ischemia)
2. Acute pyelonephritis (abscess formation) 3. Chronic Aspirin (free radicals --> damage medulla, dec RBF --> ischemia) 4. Sickle cell anemia Slough renal papillae Hematuria Proteinuria |
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Drug induced interstitial nephritis:
- drugs - findings |
NSAIDs, penicillin derivatives, sulfonamides, rifampin, diuretics
pyuria (eosinophils), azotemia 1-2 weeks after drug fever, rash, tenderness Drug= haptens --> hypersensitivity |
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Causes of hematochezia
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1 diverticulosis
2 angiodysplasia (confirm with angiography) |
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Most common fistula, complication
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Colovesicle - pneumaturamia - can rupture - perotinitis
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Most common cause pneumaturia
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Divertucular disease
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Malignancy of polyp
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Size
Villous Dysplasia |
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What does a colonic polyp do
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Bleed
Secrete mucous Obstruct |
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Pseudopolyp
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Residual mucosa that's bloody, inflamed, friable, with freely hanging mesentery
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To where do carcinoid tumors usually metastasize
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Liver
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Most common source of jaundice
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Hep a
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Spontaneous perotinotis
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Adult - cirrhosis - e. Coli
Kid - nephritic syndrome, ascites - s. Pneumonia |
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Copper level in Wilsons
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Decreased - just free copper is high but total is low
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Effect of p450 inducing drugs on calcium
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Speed vit d metabolism - Dec ca2+
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Effect of fiber on estrogen
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Prevents recycling in bile - excretion
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Marantic endocarditis -
Similar to... Associated with... |
Rheumatic fever (Sle all over the place)
Paraneoplastic - mucous producing cancers (colon cancer) |
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Effect of prostglandins on uterine tone
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PGI2 - dec uterine tone
PGE2 - inc uterine tone (misoprostol) |
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Effects of PGE2
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dec vascular tone (vasodilate kidney, maintain PDA)
inc pain inc uterine tone inc temperature (stim by IL-1, IL-6, TNF) mucus barrier in stomach, inhib gastric acid secretion (misoprostol dec NSAID induced gastritis) |
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B5 deficiency
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alopecia
adrenal insufficiency |
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2 methods to return to normal after muscle contraction
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SR - Ca2+ ATPase
Ca2+/Na antiporter |
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Heme malignancy --> what kind of anemia, why
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normochromic, normocytic
(dec RBCs - BM replacement by tumor and hypersplenism) |
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Anterior spinal artery occlusion
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Spare DC-ML & Tract of lisseur
Lose pain and temp |
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Terminate pregnancy
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Mifeprestone - anti-progestin
Misoprostol - PGE2 |
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Pigment stones
Biliary sludge |
Black- chronic hemolysis
Brown - infection Sludge - hypomotility (dec weight, spinal cord injury, parenteral nutrition, octreotide) |
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How long until metabolic compensation
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48 hours
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Therapy for SS - prevent dehydration
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Guardos - Ca2+ dependent K+ channel - regulate transport of H2O through RBC membrane
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Hydroxyurea - mechanism for CLL
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dec DNA synth
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Auer rod
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Fused azurophilic (lysosomal) granules - contain myeloperoxidase
MPO: myeloid cells |
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TdT
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Add nucleotides to VDJ region --> Ab diversity
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subarrachnoid hemorrhage - treat vasospasm with
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Ca2+ channel blockers
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Meniere's disease: what kind of damage, why
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inc endolymph in inner ear --> distension of endolymph system --> vestibular AND cochlear damage
- lose cochlear hairs - sensorineural hearing losee |
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MS: dx
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MRI gold standard
oligoclonal bands in CSF (IgG) = diagnostic |
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BTK =
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tyrosine kinase (Bruton's agammaglobulinemia)
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CVID
- develops... - mechanism.. |
20s-30s
autoimmune |
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ADA deficiency - why is there a problem
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Build up adenosine --> inhibits ribonucleotide reductase --> can't make more & can't break it down
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Leukocyte adhesion deficiency - missing...
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LFA-1 integrin (CD18)
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Silicosis
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upper lobes
eggshell calcifications of hilar lymph nodes bad m-phages --> TB |
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Asbestosis
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lower lobes
calcified pleural plaque |
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Caplan's
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pneumoconioses + rheumatoid nodules
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Adenocarcinoma of lungs
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tall columnar cells
multiple densities short, plump villi (Mesothelioma has long slender villi) |
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Coin lesion in lungs
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Hamartoma (cartilage, adipose, ...)
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See afib, think...
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Graves
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location of pancoast tumor
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superior sulcus (groove from subclavian vessels)
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smoking during pregnancy
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vasoconstriction, bronchospasm
dec growth preterm labor ADHD |
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citrate effect on renal stones
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Binds Ca2+ --> prevents renal stones from forming
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contraindication of etanercept, adalimumab, infliximab
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+ PPD - can reactivate TB
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cryptococcus virulence
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capsule - antiphagocytic
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tamulosin
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a1 antagonist
treat BPH inhibit smooth muscle contraction (selective for prostate a1 > vascular a1) little effect on bp |
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a1 blockers
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prazosin
terazosin doxazosin HTN, urinary retention in BPH orthostatic hypotension |
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a2 blocker
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mirtazapine (inc release of serotonin and NE)
depression sedation, inc cholesterol, inc appetite |
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Reserpine:
-clinical -side effects |
HTN, Huntington's
deplete NT's --> severe depressione |
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Block:
tyrosine --> dopa --> dopamine |
1. metyrosine
2. carbidopa |
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Age of premature menopause
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<35
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SSRI antidote
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cyproheptadine (5-HT2 receptor antagonist)
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duloxetine
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SNRI, also used for diabetic peripheral neuropathy
Block reuptake NE>serotonin --> side effect HTN |
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Tyramine: MOA
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release stored catecholamines
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ciliary muscle/process
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Process - epithelium produces aqueous humor (block with B-blocker)
Muscle - accommodation (M3 agonist) |
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Glaucoma emergency
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pilocarpine - very effective at opening canal of schlemm
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effects of cholinergic agonists on glaucoma
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contract sphincter --> trabecular meshwork more accessible
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Latanoprost
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PGF2a - inc outflow of humor
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Mucor and Rhizopus - prolif in...
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vessel walls --> necrosis of tissue --> black eschar (biopsy)
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osteopetrosis - defect in...
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carbonic anhydrase I
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Pagets: heart probs
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high output heart failuredue to inc vascularity in bone --> AV shunt
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IL-6, IL-1, TNFa - how do they affect temp setpoint
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inc PGE2 --> HTH --> inc temp
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Ebstein's
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Lithium
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Neuroblastoma --> urine findings
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catecholamines in urine
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Fat embolus
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Long bone fx, liposuction
microvessel occlusion --> CNS, pulm probs, hypoxemia platelets adhere to fat --> thrombocytopenia --> petechiae |
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Amniotic fluid embolus
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thrombogenic, DIC
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IC antiarrhythmics
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Flecainide, Encainide, Propefenone
Prolong depolarization, no effect on QT Use in SVT, Wolff-Park-White |
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Ankylosing spondylitis: pulm?
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Enthesopathies --> involve costovertebral and costosternal joints --> limit chest mvmt, hypoventilation
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Phase 4 at AV node
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dec slope: adenosine, ACh
inc slope: catecholamines |
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adenosine
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dec slope of phase 4 --> dec HR
SVT flushing, hypotension 15 seconds |
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defect in renal tubular AA transporter:
- location - diagnose |
PCT
cyanide-nitroprusside test - detect cysteine in urine by binding sulfhydryl groups --> turn purple |
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SAH: what to use for vasospasm
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Ca2+ channel block - Nimodipine
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Medullary sponge kidney
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dilated collecting duct --> kidney stones
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Langerhans: which cell line
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myeloid
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Dermatitis herpetiformis: findings
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IgA ICs
PMNs pruritic) |
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Bartonella: 2 diseases
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Cat scratch (lymphadenopathy)
Bacillary angiomatosus (immunocompromised) |
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Reyes: assoc viruses
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VZV
influenza B |
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Atopic dermatitis (2 things)
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spongiosis
PRURITIC! (hallmark) |
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psoriasis: changes
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acanthosis (inc stratum spinosum)
dec str granulosum |
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Actinic keratosis
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hyperkeratosis (inc keratin)
sandpaper, pearly gray inc str corneum with nuclei (hyperparakeratosis) |
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lichen planus
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lymphocytes at dermal-epidermal jxn
HEP C |
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What mutation protects against HIV
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CCR5 (M-phage)
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aortic stenosis: age of calcification
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bicuspid - 6th decade
calcific - 7th decade |
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MCC V-Fib in young person
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HCM
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how to diagnose CHF in pathological ventricular pertrophyhy
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ventricles secrete ANP (BNP)
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Initiator:
abdominal aortic aneurysm aortic dissection arteritis |
intimal streak (atherosclerosis)
intimal tear medial inflammation |
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sleep apnea: sequella
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chronic sympathetic stimulation, inc NE --> pulm HTN, rt heart failure
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effect of NO on Ca2+
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inc Ca2+ efflux --> relax vasculature
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GIP
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glc --> K cells --> GIP --> insulin
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COPD resp drive
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driven by hypoxia (no longer CO2)
supplement O2 too quickly --> dec resp drive, coma |
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receptors:
- NE - Isoproterenol |
NE: a1, a2 > B1
vasoconstrict --> dec HR, dec bp Isoproterenol: B1=B2 inc HR --> dec BP |
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omalizumab
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anti IgE antibody for mast cells (asthma)
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corticosteroids: MOA
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dec NF-KB --> dec TNFa and dec synth of all cytokines
1st line chronic asthma |
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pulsus parvus
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aortic stenosis: pulses weak compared to heart sounds
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Theophylline: toxicity
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vomit, diarrhea
seizures tachycardia |
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conn's syndrome: effects of alkalosis
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neg chg on albumin --> dec Ca2+ --> tetany
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B2 deficiency
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Corneal vascularization
Chelosis |
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B6 deficiency
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Convulsions
Irritable Peripheral neuropathy Sideroblastic anemia |
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Chronic bronchitis - obstruction located in...
|
terminal bronchiole (hypertrophy of mucus secreting glands) - Reid index >50%
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NSAIDS: what type of asthma
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extrinsic
inc leukotrienes |
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Vd 4-8:
|
only plasma
- high MW - bound to carrier proteins - charged (hydrophilic) |
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Idiopathic pulmonary fibrosis
|
Injury and healing --> high collagen
Subpleural cystic airspace enlargement (honeycomb lung) |
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Death in marfans
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Aortic dissection
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Calcified aortic valve: marker of
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preceding cell injury and necrosis
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Hyperchylomycronemia:
- defect - signs |
dec LPL (degrades TGs)
pancreatitis, xanthomas, hepatosplanomegaly |
|
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Sarcoidosis: second most common place hit
|
Face: uveitis, parotiditis
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Most common non-infectious cause of granulomatous hepatitis
|
Sarcoidosis
|
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SVC: 2 causes
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- mediastinal mass - bronchogenic carcinoma
- Non-Hodgkin lymphoma (right next to perihilar + paratracheal lymph nodes) |
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pulsus paradoxus - also seen in
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asthma, COPD, pulmonary embolism (limit compensatory increased RV filling on inspiration)
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Cushing reflex
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inc ICP --> constricts arterioles --> cerebral ischemia --> inc bp, reflex bradycardia
Can result from epidural hematoma 1. HTN 2. bradycardia 3. resp depression |
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Amyloid:
1. senile cardiac 2. Isolated atrial amyloid 3. Diabetes mellirus II 4. Dialysis associated 5. primary systemic amyloidosis |
1. transthyretin - AF
2. natriuretic peptide (can lead to A-fib) 3. Amylin (AE) 4. B-microglobulin (MHCI protein) 5. Ig light chains - multi organ deposition |
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Pyrzinamide: works where
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Inside phagolysosome at low pH --> kills MTB inside M-phage
|
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M. leprae rx
|
Rifampin, dapsone, clofazimine (binds DNA of leprae)
|
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Rheumatoid lung disease
|
pulmonary fibrosis
Lymphocytic interstitial inflammation |
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Effect of tension pneumothorax on heart rate & bp
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Inc pressure in chest cavity --> dec systemic venous return --> dec CO --> inc HR, dec BP
|
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Sildenafil:
1. MOA 2. side effects |
1. dec PDE --> inc cGMP
2. headache, flushing dec blue-green color vision + nitrates --> hypotensive |
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effects & clinical:
1. dopamine 2. dobutamine |
1. D1=D2>B>a
inc renal flow, inc CO, then dec shock (inc renal perfusion), heart failure 2. B1>B2 inc contractility --> inc CO, dec filling pressures (use in heart failure, cardiac stress testing) |
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subdural hematoma: time course
|
veins --> develops slowly
|
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MI:
2-4 4 hours 12-24 hours Day1-3 Day7-10 Day10-14 2 months |
2-4: no visible changes
4 hours - start neutrophils, necrosis, edema, hemorrhage, wavy fibers 12-24 - contraction band necrosis Day 1-3 - PMN infiltrate Day 7-10 - M-phage phagocytosis Day 10-14 - Fibrovascular granulation, neovascularization 2 months - scar |
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Atropine overdose
|
Physostigmine
-crosses BBB - inc risk for cataracts |
|
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Atropine contraindicated in...
|
glaucoma
|
|
|
drug of choice for both type of glaucoma
|
pilocarpine (miosis --> free entrance to canal of schlemm)
(inc tone of trabecular meshwork --> good for narrow angle) |
|
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Indication for atropine
|
bradycardia
(can be used in MI - RCA occluded --> knock SA node --> bradycardia) |
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Atropine contraindicated
|
Glaucoma (relax constrictor muscle - narrow angle --> obstruct canal of schlemm)
|
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All antimuscarinics: contraindicated...
|
Narrow angle glaucoma - prevent contraction of pupillary constrictor
|
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Hexamethonium - how is it different from pancuronium
|
Pancuronium - competitive at just NMJ
Hexamethonium - antagonist at ALL nicotinic junctions (sympathetic and parasympathetic ganglions) |
|
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Nicotinic effects of sarin
|
muscle twitching, fasciculations, weakness, flaccid paralysis
|
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What type of channel does memantidine block
|
NMDA - Ca2+
|
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Where does tetani toxin work
|
Renshaw cells in spinal cord - inhibit glycine and GABA release
glycine & GABA: inc Cl- entry through postsynaptic ionotropic receptor --> hyperpolarize & prevent AP) |
|
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sulfacrate MOA
|
binds to ulcer crater, allows regeneration of mucus barrier. Needs H+ to work --> don't use with PPI
|
|
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Fibrates: MOA
|
activate PPARg --> inc LPL --> inc TG clearance
|
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Side effect of propylthiouracil and methimazole
|
agranulocytosis, aplastic anemia
|
|
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Promote heart in shock
|
Isoproterenol > Dobutamine > Dopamine
|
|
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Dapsone: toxicity
|
G6PD hemolysis
methemoglobinemia |
|
|
MCC thrombocytopenia in a hospital
|
heparin
|
|
|
Nitrofurantoin
|
Urinary tract antiseptic
G6PD hemolysis |
|
|
Cyclophosphamide
- activated? - causes |
- activated in liver
- transitional cell carcinoma (and hemoragic cystitis) |
|
|
Clonidine: MOA
|
PRESYNAPTIC a2 agonist --> prevent release of NE
also activate imidazole receptors in CNS |
|
|
Resp alkalosis and then metabolic acidosis
|
Salicyclate intox
|
|
|
Drug used for Wilm's tumor
|
actinomycin D (dactinomycin)
|
|
|
6-MP and 6-TG: which can be given with allopurinol
|
6-TG
|
|
|
Drugs to avoid in pregnancy
|
GRRAS
Griseosulfan Retinoic acid, Ribavirin Aminoglycosides (ototoxicity) Sulfur (kernicterus) |
|
|
Aminoglycosides: resistance
|
transferase enzymes - inactivate drug
|
|
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Macrolides: resistance
|
Methylate 23s binding site
INducable resistance to clindomycin |
|
|
Chloramphenicol: resistance
|
plasma encoded acetyltransferase that inactivates the drug
|
|
|
Which B-blocker can cause dyslipidemia
|
Metoprolol
|
|
|
MC side effect of imunosuppresant drugs
|
Squamous cell carcinoma
|
|
|
EEG in patient with absence seizure
|
3/sec spike and wave discharge
|
|
|
Theophylline - metabolism
|
P450 (rev by phenytoin)
|
|
|
Biggest concern of iron poisoning in a child
|
Hemorrhagic gastritis
Liver necrosis |
|
|
Whiteout in CXR - diffuse alveolar infiltrate
|
PCP`
|
|
|
Hyaline membrane in RDS & ARDS
|
- necrotic Type II pneumocytes
- fibrin from fibrinogen |
|
|
How is ARDS different from RDS
|
Neutrophils initiate
1. destroy cells in lungs --> surfactant decreases --> collapse (massive atalectasis) 2. hyaline membranes - neutrophils make for leaky capillaries --> protein and fibrinogen gets out --> hyaline membranes |
|
|
Most common cause of ARDS
|
septic shock (ie. E. coli from indwelling catheter) --> ARDS --> DIC --> death
|
|
|
How to obtain:
1. spontaneous pneumothorax 2. tension pneumothorax |
1. rupture subpleural bleb (scuba diver comes up too quickly)
2. Knife injury |
|
|
Pneumonia in alcoholic/drug user
|
KiSS
Klebsiella S. pneumonia Staphylococcus |
|
|
Postviral
|
Staphylococcus
H. influenza |
|
|
Total body sodium:
- high - low |
high - indentations on skin, dependent pitting edema
low - tongue dry |
|
|
Cladribine
1. use 2. special |
purine analog
1. Hairy cell 2. resistant to ADA |
|
|
Cyclophosphamide:
1. activation 2. mechanism |
1. activated by P450
2. Covalently link DNA at guanine N-7 |
|
|
Toxicity of hydroxychloroquine
|
retinopathy
maculopapular rash |
|
|
3 glucocorticoids used in asthma
and a side effect |
Flunisolide
Beclomethasone Prednisone Rinse mouth - oral candidiasis |
|
|
Three drugs that cause seizures
|
Buproprion
Isoniazid (without pyroxidine) Imipenim my BRain IS IN a seizure |
|
|
In which phase of the cell cycle
1. Bleomycin 2. Etoposide |
1. G2 - damages DNA, prevent repair
2. late S to G2 - inhibits ability of top II to reseal double strand DNA breaks |
|
|
Toxicity of etoposide
|
Secondary leukemia
(etOOOOPS!oside) |
|
|
What to use for wilm's tumor and rhabdomyosarcoma and Ewing's sarcoma
|
Dactinomycin (kids ACT out)
|
|
|
What drug is used in CHF to improve morbidity
|
Spironolactone
|
|
|
Excess of which ion can decrease DTRs
|
Mg2+
|
