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66 Cards in this Set

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How do enterococci develop resistance to Gentamycin?
Aminoglycoside resistance = Enzymes that modify them by transferring chemical groups (acetyl, adenyl, and PO4) so they can't bind ribosomes
what types of intracellular connection is responsible for BBB?
Tight junctions
What is demeclocycline?
It's a tetracycline that is an ADH antagonist; useful to Tx SIADH (along w/ water restriction)
Can also be the CAUSE of nephrogenic DI (antagonizes ADH @ the CD so can't concentrate the urine)
What is the short term and long term tx for atopic asthma?
1) Short term = M3 blocker (inhaled Ipratropium)
2) Long term = LTD4 R blocker (zafirlukast and montelukast)
What are the atypical pneumonias?
CML
Chlamydia
Mycoplasma
Legionella
What pnemonia has an xray finding of unilobar infiltrate & is a/w GI symptoms? What lab abnormalities would you find?
Legionella Pneumophila
Hyponatremia
Tx = Erythromycin
What disease causes a grey pharyngeal exudate in kids???
Diphtheria (corynebacteria diphtheriae)
What bacteria are grown on Thayer-Martin medium?
VCN medium for Neisseria spp
What bacteria are grown on Cysteine-tellurite agar?
Diphtheria (corynebacteria diphtheriae)
What bacteria are grown on Bordet-Gengou medium?
BORDETella pertussis = whooping cough
What is the prophylaxis for the mycobacteria?
TB = INH
MAC = Azythromycin
Leprae - n/a
What is the treatment for Mycobacterium avium complex?
Azythromycin, Rifampin, Ethambutol, Streptomycin (ARES for AVES)
Which type of rapidly progressive glomerulonephritis doesn't have deposits on immunofluorescense?
Wegener's (Type III - Pauci-immune)
a/w crescenting glomerulonephritis, c-ANCA and hemoptisis
(other RPGN's are Goodpastures [anti-GBM] and Immune-complex mediated)
What is Phytanic acid and how is it pathological?
It's a BCAA from Chlorophyll - accumulates in Refsum Dz (peroxisome dz so can't perform α-oxidation to break down Phytanic acid)
Leads to neurological disturbances
What is Zellweger syndrome?
Peroxisomal disorder (in the ß-oxidation of VLCFA's)
Infants can't properly from myelin in CNS leading to:
- Hypotonia
- Seizures
- MR
- Hepatomegaly
- Early death
How is cortisol involved in catecholamine synthesis?
Upregulates the activity of PNMT (Phenylethanolamine-N-methyltransferase) in the adrenal medulla that converts NE → Epi
What are the sources of Nitrogen atoms in Urea? What is the RLE of Urea cycle? What activates the enzyme?
1) N from NH3 and Aspartate
2) RLE = CPS 1 (carbamoyl phosphate synthetase I in mitochondria)
3) NAG (N-Acetylglutamate) stimulates it
What is Urea and where does it get its components?
Urea is NH2-(C=O)-NH2
The C=O is from CO2 and one of the NH2's is from NH4 (combined in the RLS into carbamoyl phosphate)
The other NH2 is from Aspartate
What is Mifepristone?
RU-486 is a progesterone receptor antagonist (stronger than real progestins so it helps w/ abortion)
What is Misoprostol?
An abortifacient that's a PG analog - stimulates uterine contraction and cervical dilation
Used in conjunction w/ Mifepristone
What psych meds affect chloride channels?
BEnzo's = Cl- FrEquEncy (shorter t1/2)
BArb's = Cl- DurAtion (longer t1/2) - not for insomniA
What drugs are a/w increased uric acid (and therefore gouty attacks)?
- Niacin (for dyslipidemia)
- Diuretics = Furosemide & Hydrochlorothiazide
- Cyclosporine (immune suppresent)
- Pyrazinamide (anti-TB)
What does TIBC indicate and what causes it to increase?
TIBC = total iron binding capacity, an indirect measure of Transferrin (the transport protein of iron in the blood)
Increased in both Iron-Deficiency and Pregnancy/OCP use d/t increased production by the liver (in FeD, b/c it's trying to increase the chance of saturation; in OCP/Preg it's d/t Estrogen increasing hepatic protein productino all around)
What are the characteristics of aplastic anemia?
Triad:
1) Anemia = Low Hb
2) Thrombocytopenia
3) BM w/o hematopoietic cells
in person w/ normal renal fx, will have ↑EPO
What condition a/w chest pain that radiates to back accompanies lower BP in right arm than left?
Dissecting Aortic Aneurysm
The hematoma will expand and compress the proximal brachiocephalic trunk that feeds to the right extremity, reducing it's BP)
What is a Charcot-Bouchard pseudoaneurysm?
Small (1mm) pseudo-aneurysms that form in the small arteries that perfuse the basal ganglia & internal capsule d/t HTN induced hyaline arteriosclerosis; Can hemorrhage and cause sudden onset focal deficits (vs ischemic strokes that usually evolve over hours)
What is Kussmaul's sign?
Paradoxical INCREASE in JVD during inspiration (should decrease)
d/t Constrictive Pericarditis (most commonly d/t TB or SLE)
What causes a late systolic crescendo murmur w/ a midsystolic "click"?
Mitral valve prolapse (MVP)
most frequent
What cancer is a/w Arsenic and Vinyl chloride exposure and how do you ID it?
hepatic Angiosarcoma = highly lethal
has CD31 = PECAM1 (on endothelia that allows diapedesis)
What are the 2 non-selective α-blockers and what differentiates them?
1) Phentolamine = reversible/competitive (used for PHeo, MAOI crisis, cocaine OD)
2) Phenoxybenzamine = irreversible (used for Pheo)
What is the preferred Tx for combo Absent and Tonic-Clonic Seizures?
Valproate
What is GIlbert's Dz?
Problem w/ bilirubin conjugation and uptake by the liver - leads to mild jaundice and hyperbilirubinemia (unconjugated) in times of stress
What is pulsus paradoxus & what causes it?
Drop in Systolic BP >10mmHg during inspiration d/t
- Heart = severe tamponade, pericarditis
- Respiratory (obstructive) = Asthma, OSA, Croup
In determining the FF, what measurements can you substitute?
Clearances
GFR = CL of either INULIN (exact) or Cr (overestimate)
RPF = PAH
the clearances are the [urine]x(urine flow) divided by [plasma]
What gram negatives are oxidase positive?
1) the Comma Shaped Rods:
- Vibrio Cholera = Alkaline media
- Campylobacter jejuni = 42 degrees (HOT)
2) Pseudomonas = Non-Lactose Fermenting Rod
How do Galactose, Fructose, and Mannose enter glycolysis?
1) Galactose - phosphorylated→ Ga1P then mutased to G1P→G6P
2) Mannose - phosphorylated → M6P → F6P
3) Fructose bypasses the RLS of Phosphfructokinase 1 (PFK1) by going from F → F1P and then by Aldolase B → Glyceraldehyde and finally Triokinase → G3P
What is Lymphogranuloma venerium?
It's a dz caused by the L1-L3 serotypes of Chlamydia trachomatis
1) small papule emerges on genital mucosa
2) Inguinal lymph nodes become swollen, painful → coalesce, ulcerate, and rupture
What is HbF made from?
α2y2 (gamma chains can be stimulated by hydroxyurea so more HbF is made)
What drug for PSVT has the side effects of flushing, chest burning and SOB?
Adenosine - drug of choice (t1/2 of <10 seconds)
(chest burning and SOB are d/t bronchospasm; also causes hypotension and high grade AV block)
What drugs can be ototoxic?
AminoglYCosides (gentamycin)
CIsplatinum
saliCYlates
Loops = Furosemide e.g.
What is Thiopental?
IV anesthetic - Short acting Barbiturate (affects GABA-Cl durAtion)
- used for induction d/t its rapid action (1 min equilibration w/ brain tissue; 5-10 min rapidly REdistributed to muscle/fat)
What is first line tx for trigeminal neuralgia?
Carbamazepine
also FLT for all the types of partial seizures (simple, complex, tonic-clonic)
Stops rapid firing of neuron by lengthening the inactivation of Na channels
What is fenfluramine?
It's an appetite suppressant (fenfluramine, dexfenfluramine, and phentermine) that if used for more than 3 months can lead to secondary pulmonary hypertension
What causes hyaline membranes in the alveoli of an adult?
This is ARDS - diffuse alveolar damage leads to increased capillary permeability and protein-rich leakage into the alveoli
e.g. Pancreatitis releasing lipases and amylases into the vasculature
What forms the GTP needed to phophorylate Oxaloacetate to PEP in gluconeogenesis?
In the TCA cycle, SuccinylCoa → Succinate generates GTP
(enzyme = succinyl-Coa synthase / succinate thiokinase)
What kidney problem shows as diffuse increased thickness of GBM w/o cellularity increase, "spike and dome" appearance on silver stain, and has granular deposits on IF?
Membranous Glomerulopathy
What enzymes does lead poisoning affect?
1) ALA Dehydratase
2) Ferrochelatase
LEAD = ferroche-L-atas-E, A-la D-ehydratase
What causes Isolated systolic hypertension?
Decreased compliance (increased stiffness) of the aorta and its proximal branches
Male w/ delayed puberty and anosmia?
Kallmann's syndrome = failure of GnRH neurons to migrate from outside CNS to hypothalamus (d/t KAL-1 or FGF-1)
What infection is a/w myocarditis?
Cocksackie B
What are the Class 1A Antiarrhythmics?
Double Quarter Pounder (Intermediate, prolonged AP)
-Disopyramide
-Quinidine
- Procainamide
What are the Class 1B Antiarrhythmics?
Lettuce, Tomato, Mayo (Weak, shortened AP)
-Lidocaine
-Tocainide
-Mexiletine
What are the Class 1C Antiarrhythmics?
MOre Fires Please (Strong, no change to AP)
-Moricizine
-Flecainide
-Propafenone
What is "Holiday Heart Syndrome"?
AFib precipitated by binge drinking
What do an absence of P waves on EKG signify?
AFib d/t loss of coordinated atrial contraction
What is triamterene?
K+ Sparing diuretic - blocks Na channels in DT and CD
Which diuretic has been shown to decrease mortality in heart failure patients?
Spironolactone (Aldosterone antagonists) - prevents neurohormonal effects of aldosterone on the heart (remodeling and fibrosis)
A lesion of what nerve causes Trendelenburg sign?
Superior Gluteal (innfervates gluteus medius and minimus) and causes "gluteus medius limp"
How can you tell the difference b/w a benign or malignant carcinoid tumor?
Benign won't have clinical symptoms b/c excess seratonin, bradykinin, and PG's are metabolized by liver.
Mets to the liver will result in the classic symptoms
What is Berkson's Bias?
Selection bias created by selecting hospitalized patients as your control.
What kind of mole is triploid?
PARTIAL mole (complete are diploid)
What kind of irregular RBC's are a/w DIC on PB smear?
Schistocytes d/t damage squeezing through the microemboli in small vessels
What are Acanthocytes?
RBC's w/ irregularly spaced surface projections - extreme ones are called Spur cells and a/w abetalipoproteinemia
What are Teardrop cells?
RBC's a/w myelofigbrosis; they must squeeze out of the fibrous marrow which gives them characteristic teardrop shape
What are the layers of the testicle?
From outside in:
- external spermatic fascia (from external oblique fascia)
- cremasteric spermatic fascia (from internal oblique fascia)
- internal spermatic fascia (from transversalis fascia)
- tunica vaginalis (from peritoneum) --> is the location of hydrocele formation
What are the types of RNA polymerase in eukaryotes?
RNA polymerase I = rRNA (nucleolus)
RNA polymerase II = mRNA
RNA polymerase III = tRNA, snRNP, and 5C rRNA
I and III are constitutively active, while II is under regulatory control