Reading...
Play button
Play button
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;
110 Cards in this Set
- Front
- Back
|
Howel Jolly Bodies
|
DNA remnants seen in asplenia
|
|
|
pigmented iris hemartomas?
|
NF1
|
|
|
50 year old male with new unexplained skin yellowing and no other symptoms
|
pancreatic cancer in head of panceas ("Painless Jaundice")
|
|
|
trazadone mech
|
inhibits serotonin reuptake
|
|
|
famotidine mech
|
H2 blocker
|
|
|
fluvoxamine mech
|
SSRI
|
|
|
terbinafine mech
|
inhibits squalene epoxidase
(for onchomychoses) |
|
|
aneurysm causing eye to look down and out
|
poterior communicating artery
|
|
|
aneurysm causing bilateral loss of visual fields
|
anterior communicating artery
|
|
|
where do ciliated columnar cells stop in bronchial tree?
|
at respiratory bronchioles (stop things bigger than 2 micrometers)
smaller than that they are cleared by macrophages in alveoli |
|
|
dipalmitoyl phsophatidylcholine is what
|
surfactant
|
|
|
pneumonic for remembering where structures perforate the diaphragm
|
" I ate 10 eggs at 12"
T8- IVC T10- esophagus and vagus (vagus runs near the esophagus) T12- aorta (red), thoracid duct (white), azygous vein (blue) |
|
|
what measurement indicates fetal lung maturity
|
GREATER THAN 2
dipalmitoyl phosphatidylcholine (lecithin):shingomyelin ratio |
|
|
how does histimine cause bronchial constriction
|
by tissue edema of bronchi
|
|
|
functional reserve capacity vs. Expiratory reserve volume vs residual volume
|
FRC- ERV + RV
expiratory reserve volume- amount that can be expelled after tidal volume residual volume- amount that cannot be meauresed after ERV |
|
|
use what to determine fraction of air not exchanged in respiration (dead space)
|
dead space volume= Tidal volume X (PaCO2 - PexpirationCO2)/(PaCO2)
|
|
|
is T (taut) form of hemoglobin in tissues or in lungs?
|
tissues (low affinity)
T for Tissues |
|
|
why does fetal hemoglobin have higher affinity for oxygen
|
lower affinity for 2,3-Biphosphoglycerate
|
|
|
what agents can cause methemoglobinemia?
|
nitrates
primaquine/chloroquine dapsone sulfas metoclopramide treat with methylene blue, or cimetidine (reduces slowly) |
|
|
what is gene mutation seen in idiopathic pulmonary fibrosis
|
BMPR2
bone morphogenic protein receptor 2 |
|
|
how do following problems cause pulmonary HTN:
COPD L-->R shunt recurrent thromboemboli autoimmune disease |
COPD- parenchymal destruction
L-->R shunt- shearing stress, endothelial injury recurrent thromboemboli- decrease pulmonary vascular bed cross section) autoimmune- intimal fibrosis and medial hypertrophy |
|
|
hypoxemia vs hypoxia
|
hypoxemia- decrease in Pa02
hypoxia- decreased 02 delivery to tissues (hypoxemia, decreased CO, anemia, cyanide or CO poisoning) |
|
|
does 02 help in high V/Q or V/Q = 0?
|
high V/Q
because low v/q no air gets to blood |
|
|
4 paraneoplastic syndromes of renal cell carcinoma
|
PTH
epo ACTH renin |
|
|
is dyspnea onset early or late for chronic bronchitis? cyanosis?
|
dyspnea is late onset
cyanosis is early these findings are switched for emphysema |
|
|
pursed lips on exhalation seen in what disease
|
emphsyema (pink puffers with pursed lips)
|
|
|
epithelial plugs and crystals from lung tissue is
|
asthma (Charcot-Leydig Crystals, curshmann spirals)
|
|
|
what is pneumonic for eosinophilia
|
DNAAACP
drugs neoplasm allergy/asthma addisons acute interstitial nephritis collagen vascular diseases parasites |
|
|
theophylline mechanism, 2 toxicities
blocks action of what |
used for asthma, but not much because low theraputic index
phosphodiesterase inhibitor cardiotoxic and neurotoxic blocks adenosine |
|
|
5 actions of corticosteroids
|
trigger apoptosis
inhibit NF-kB (inhibit production of TNF-alpha) inhibit phospholipase A2 inhibit collagen synthesis stimulate lecithin production in fetal lungs |
|
|
zafirleukast and montelukast act where? what is difference in giving to patients?
|
both block leukotriene receptors
montelukast can be given after 1 year old zafirlukast must wait until 5 |
|
|
what is inhaled treatment of choice for asthma
|
beclomethasone or prednisone
(corticosteroids, inhibit NF-kB and stop inflammation and production of TNF-alpha) |
|
|
chlorpheniramine mech
|
1st generation antihistimine
(sedating, along with anti muscarcinic and antiadrenergic effects) |
|
|
hydroxyzine
|
1st generation antihistimine
(sedating, along with anti muscarcinic and antiadrenergic effects) |
|
|
diphenhydramine
|
1st generation antihistimine
(sedating, along with anti muscarcinic and antiadrenergic effects) |
|
|
loratadine
|
1st generation antihistimine
(sedating, along with anti muscarcinic and antiadrenergic effects) |
|
|
eggshell calcifications of hilar lymph nodes indicate what? increase susceptibility to what?
|
indicate silicosis
(seen in foudnries, sandblasting, mines) silica can disrupt phagolysosomes and impair macrophages--> susceptible to TB |
|
|
shipbuilding, plumbing, roofing associated with what
|
asbestosis
|
|
|
calcified pleural plaques indicate
|
asbestosis
|
|
|
which pneumoconioses affect upper lobes? lower lobes?
|
upper- coal miners, silicosis
lower- asbestosis |
|
|
what sort of emphysema do healthy males get and what is complication
|
paraseptal emphysema, with bullae, bullae can rupture and cause spontaneous pneumothroax
|
|
|
in what respiratory condition do you see increased fremitus? what will resonance be?
|
lobar pneumonia
resonance will be dull |
|
|
in what respiratory condition does trachea deviate away from lung? toward lung?
|
away- tension pneumothorax
toward- bronchial obstruction (causing atelectasis (collapse) |
|
|
in what condition will a patient's lung sounds be hyperresonant?
|
tension pneumothorax (like an empty bottle with positive pressure)
|
|
|
person with swelling of face and upper extremities indicates what
|
superior vena cava syndrome, probably from lung cancer mass effect
|
|
|
what lung tumors are located centrally?
|
small cell and squamous cell, just like centriacinar emphysema, this is where smoking affects
|
|
|
what lung tumor is composed of small blue neuroendocrine cells?
associated with what gene? |
small cell carcinoma
L-myc |
|
|
enolase, chromogramin, synaptophysin are markers for
|
neurons, neuroendocrine cells
|
|
|
lung tumor with pleomorphic giant cells, anaplastic cells, and causes gynecomastia/galactorrhea
|
large cell carcinoma
|
|
|
BFDR for carcinoid tumor (of lung, colon, etc.)
|
bronchospasm
flushing diarrhea right-sided heart lesions |
|
|
what lung tumor can present as mucus secreting cells in alveoli
|
bronchoalveolar adenocarcinoma
|
|
|
which lung tumor can preset with done addition to diaphyses?
|
bronchoalveolar carcinoma (hypertrophic osteoarthropathy)
|
|
|
radon increases risk of what?
|
lung cancer
|
|
|
what is most common overall lung cancer
|
metastasis
|
|
|
lung cancer with hemorrhagic pleural effusions
|
mesothelioma
|
|
|
which pneumoconioses predispose to cancer?
|
only asbestosis!
silicosis and coal miner's DO NOT (just get pulmonary fibrosis) |
|
|
what muscles are used for intense inspiration?
expiration? |
diaphragm, external intercostals
anterior scalene, sternocleidomastoid NOT DIAPHRAGM, rectus abdominis, int./ext. obliques, transverse abdominis, internal intercostals |
|
|
a coal miner has what risk factor for lung cancer
|
RADON
not coal, coal and silica are not carcinogenic |
|
|
most common cause of pneumonia in kid less than 1 (but not neonate)
|
RSV
|
|
|
2 main viruses that cause intersitial pneumonia
|
RSV
adenovirus |
|
|
2 main bugs in lobar pneumonia
|
strep pneumo
klebsiella PhuK lobar pneumonia! |
|
|
4 bugs causing bronchopneumonia
|
acute inflammatory infiltrates from bronchioles into adjacent alveoli, patchy distribution
staph aureus, klebsiella (also in lobar), h flu, strep pyogenes |
|
|
3 most common lung metastases sites
|
Brain, bone, liver
("Bye Bye Lung") |
|
|
gram - rod in 80 year old with pneumonia, think about
|
E. Coli
|
|
|
what 2 amino acids are increased in growth?
|
arginine and histidine
|
|
|
which two AAs are increased in histones
|
arginine and lysine, makes sense because basic so have positive charge in serum so will bind to DNA
histidine is basic too, but neutral at body pH |
|
|
what cofactors are needed for:
Phe--> tyrosine tyrosine-->dopa (dihydroxyphenylalanine) dopa-->dopamine dopamine-->NE NE-->Epi |
phenylalanine-->tyrosine & tyrosine-->dopa - BH4 (dihydropterin reductase) and NADP
dopa-->dopamine - B6 dopamine-->NE - Vitamin C NE-->Epi - SAM |
|
|
what enzyme does carbidopa inhibit?
|
inhibits dopa decarboxylase (L-dopa--> dopamine)
used in decarboxylations |
|
|
where is vitamin C used in phenylalanine metabolism?
B6? |
vit 6- dopamine--> NE (dopamine beta hydroxylase)
B6- dopa-->dopamine (dopa decarboxylase) |
|
|
melanin comes from what precusor
|
L-dopa
|
|
|
2 things tryptophan can be converted into, what are necessary cofactors
|
tryptophan--> niacin (using B6)
tryptophan--> serotonin (using BH4) |
|
|
what is needed for histidine to histimine
|
B6
|
|
|
Glycine used in what synthesis, and what enzyme is necessary
|
glycine--> porphyrin (using B6) --> heme
|
|
|
3 things arginine can be turned into
|
creatine (remember histidine and arginine used for growth)
urea nitric oxide (lots on Ns) |
|
|
glutamate turns to GABA by what enzyme, and what is needed
|
glutamate decarboxylase, B6 is needed
|
|
|
eczema, musty body odor, MR, seizures
2 defects that can cause it? how treat? screen how long after birth, treat by when |
PKU
defect in phenylalanine hydroxylase, or production of tetrahydobiopterin cofactor Rx: tyrosine becomes essential (give more), decrease Phe, give BH4 if needed screen 2-3 days (to get elevated levels), treat within 2-3 weeks to avoid brain damage |
|
|
does maternal PKU have effects?
|
yes, can cause growth, cardiac, and mental retardation in child
|
|
|
brown sclera, brown connective tissue, dark urine upon standing?
deficiency? complication? |
Alkaptonuria
homogentisic acid oxidase (can't degrade tyrosine) bad arthralgias because homogentisic acid is toxic to cartilege |
|
|
3 possible defects resulting in albinism
|
tyrosinase deficiency (AR)
defective tyrosine transporters lack of migration of neural crest cells |
|
|
marfanoid like symptoms, homocysteine in urine:
what 3 problems (2 enzyme deficiencies) and treatments |
cysteine becomes essential in homocysteinuria
cystathionine synthase deficiency decreased cystathioninine synthase use of pyrodoxal phosphate RX- give lots of B6 homocysteine methyltranferase defciciency -dec. methionine, increase B12 and folate to drive reaction toward cysteine conversion- still need to give cysteine too!) |
|
|
homocysteinuria mortal complication?
|
can get MI, stroke from increased atherosclerosis
|
|
|
hereditary metabolic disorder causing kidney stones? what is problem, treatment?
|
Cystinuria
cant excrete COLA (cysteine, ornithine, lysine, arginine) in PCT excess cysteine makes cystein kidney stones alkalinize urine with acetazolamide |
|
|
MR and diaper smells like burned sugar:
what is problem what is built up 2 components to treatment |
Maple syrup urine disease
alpha-ketoacid dehydrogenase leucine (most), isoleucine, and valine build up because can't be excreted Rx: diet restriction, thiamine (cofactors to help enzyme) |
|
|
Hartnup disease:
what is problem what is lost what develops |
problem is that neutral amino acids cant be absorbed in kidney or intestinal epithelial cells
tryptophan lost into urine causes pellagra |
|
|
hereditary defect that can also be induced by alcoholics with B1 deficiency
|
pyruvate dehydrogenase deficiency
|
|
|
alanine is main transporter of amine groups from muscel to liver. What does it get its amino group from? who does it give it to in the liver?
|
gets it from glutamate in muscle (making alpha-ketoglutarate) and gives to alpha-ketoglutarate in liver, making glutamate again
|
|
|
what amino acids take part in the urea cycle? what compound leaves?
|
aspartate added to citrulline
fumarate leaves arginine left, gives NH3 from aspartate to NH3 becomes ornithine, which is converted with ornithine transcarabmoylase back into citrulline |
|
|
what enzymes of urea cycle are in the mitochondria?
|
carbamoyl phosphate synthetase 1and ornithine transcarbamoylase
|
|
|
increased orotic acid with hyperammonemia and low BUN?
inheritance? treatment? |
Ornithine transcarbomylase deficiency
X-LINKED RECESSIVE Rx- phenylbutyrate |
|
|
what is treatment for liver failure induced hyperammonemia and how does it work
|
lactulose
broken down by colonic bacteria and forms acids that bind NH4+ and excrete it in the gut |
|
|
fatty acid synthesis:
occurs where what is rate limiting step, and what cofactor does it need |
cytosol
Acetyl-CoA carboxylase, using BIOTIN (makes malonyl-CoA, eventually palmitate) |
|
|
where does fatty acid beta oxidation occur, and what is the rate limiting enzyme?
|
occurs where products will be used (acetly-coA for TCA or ketones) in the MITOCHONDRIA
rate limiter is getting acyl-coA into the mitochondria - CARNITINE ACYLTRANSFERASE |
|
|
newborn with weakness, hypotonia, hypoketoic hypoglycemia?
|
carnitine deficiency (fatty acids cant get into mitochondria to be broken down to ketones or acetyl-CoA)
|
|
|
disease state with decreased glucose, decreased ketones, but increased DICARBOXILIC ACIDS
|
acyl-coA dehydrogenase deficiency
|
|
|
how does high fiber lower cholesterol
|
binds to cholesterol and inhibits it reabsorption in intestine
|
|
|
familial dyslipidemias:
-blood shows increased chylomicrons, what is disease and what is complication? |
hyperchylomicronemia
elevated TGs and cholesterol problem with lipoprotein lipase or CII (cofactor for lipoprotein lipase) high TGs- can cause pancreatitis high cholesterol- atherosclerosis |
|
|
person with tendon xanthomas has what?
inheritance |
hypercholesterolemia due to defective LDL-R
AUTOSOMAL DOMINANT |
|
|
what is function of chylomicrons?VLDL? LDL?
HDL? |
chylomicrons- take TGs and cholesterol from intestine to liver (most lost to tissues on the way due to lipoprotein lipase
VLDL- gives TGs to tissues from liver LDL- gives cholesterol to tissues from liver (endocytosis) HDL- takes up esterified cholesterol (from LCAT) |
|
|
lipoprotein A1 fxn
B100 B-48 C2 |
A1- activates LCAT (put A1 on the cat)
B-100- binds LDL-R B-48- on chylomicrons C2- lipoprotein lipase cofactor |
|
|
infant with failure to thrive, steatorrhea, spiky red blood cells ataxia, accumulation in enterocytes has what problem? rx?
|
abetalipoproteinemia (no B-100 or B-48, so can't secrete chylomicrons)
AR Rx- vitamin E |
|
|
does steroid synthesis take place in cytoplasm or mitochondria?
|
cytoplasm
|
|
|
3 metabolic processes that take place both in cytoplasm and mitochondria
|
gluconeogenesis
urea cycle heme synthesis |
|
|
Cyclosporine mech and side effect
|
inhibits Calcineurin (Cyclosporine = calcineurin) which blocks production of IL-2
nephrotoxic (can be solved by mannitol diuresis) |
|
|
precurosor of 6-MP
|
azathioprine
|
|
|
immunosuppressant that may prevent nephrotoxicity with mannitol diuresis
|
cyclosporine
|
|
|
ab that binds to CD3 on T cells
|
muromonab
|
|
|
ab that binds to IL-2 receptor
|
daclizumab
|
|
|
inhibits inosine monophosphate dehydrogenase
|
mycophenylate
|
|
|
2 drugs that inhibit mTOR
|
Tacrolimus and sirolimus
|
|
|
what immunosuppressant can be used for lupus nephritis
|
mycophenylate
|
