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78 Cards in this Set

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What is amitriptyline?
TCA - work by blocking reuptake of NE and seratonin
- Toxicity = the Tri-C's: Convulsions, Coma, Cardiotoxicity
What are the functions of the Golgi in protein modification?
- N-oligosaccharide modification = Asparagine
- Mannose-6-phosphate on Lysosomal proteins
- O-oligosaccharides added to = Serine & Threonine
in the vietnam war, NAM LOST, but Golgi lost his EYE
Which holosystolic murmur is heard best @ apex w/ patient in Left Lateral Decubitus
Mitral regurge
How does blood reach the SVC via the esophageal anastamosis in portal hypertension?
Via the Left Gastric Vein
What is Internuclear ophthalmoplegia?
MLF syndrome d/t lesion in the medial longitudinal fasciculus (MLF)
Medial rectus palsy when attempting a lateral gaze
seen in MS (think Ann Romney is a MiLF w/ MS)
How could systemic fungus treatment cause weakness & palpitations?
Amphotericin B is drug of choice
VERY Nephrotoxic (↓GFR & directly toxic to lumenal epithelium) → electrolyte abnormalities (palpitations; ↓K, ↓Mg lost in DT) & anemia (weakness)
What is Bacillary angiomatosis?
d/t Bartonella henselae (cat scratch)
found in Immunocompromised/HIV patients
Prz: Red-purple papular skin lesions (vascular proliferation); also found in viscera; can be fatal
- B. henselae → Cat Scratch (low fever, LA), bacillary angiomatosis, and endocarditis (culture negative)
What is a/w subperiosteal thinning and cystic degeneration?
Pirmary Hyperparathyroidism
How do you help prevent calculi formation in urine?
1) ↑ fluid (flow rate)
2) Citrate (will bind Ca and prevent it from ppt'ing)
What is the Papez circuit?
Neural pathway of limbic system involved in cortical control of emotion and memory; damaged in Wernicke encephalopathy (especially the mammillary bodies)
What cofactor is crucial for transamination reactions (like in urea cycle) b/w amino acids and α-keto acids?
B6 = Pyridoxal phosphate
What is the most common cause of septic arthritis?
1) Secxually active young adults = Gonorrhea
2) Kids/>50 y/o /IVDA = Staph aureus
What are the maternally transmitted infections to the fetus?
ToRCHHeS
- Toxo
- Rubella
- CMV
- HIV
- HSV2
- Syphilis
What are the common causes of meningitis in neonates?
1) GBS (agalactica - vaginal flora)
2) E. coli (vaginal flora)
3) Listeria monocytogenes
What causes a "blueberry baby"?
Either Rubella (German measles/Togavirus) or CMV (Herpesvirus)
What disease causes temporal encephalitis in neonates?
HSV2 - can also give the same herpetic lesions
What is sydenham chorea?
It's chorea d/t Rheumatic Fever (AI sequela of GAS pharyngitis or impetigo)
- anti-neuronal Ab's attack the caudate and subthalamic nucleus
What is the difference b/w scarlet fever and rheumatic fever?
Scarlet = Toxigenic (Sandpaper, Strawberry tongue)
Rheumatic = immunologic (ab's to M-Protein → Myocardium, Myelin, Marginatum, Polyarthritis)
What drugs cause Parkinsonism? What's the tx?
Causes:
1) Antipsychotics
2) Reserpine (Huntington's Drug - prevents loading of DA/EPI/NE into vesicles)
3) Metoclopramide (D2 R antagonist; tx's gastroparesis in DM and post-sx)

Tx = Antimuscarinics like Benztropine & Trihexyphenidyl (CONTRA = BPH and Angle Closure Glaucoma)
What anesthetic characteristics will make it have a SLOWER onset of action?
High solubility in blood (e.g. blood/gas partition)
High A/V concentration gradient [reflects the solubility in the tissue - so more needed to SATURATE the tissue and get your effect]
What is entacapone?
It's a COMT inhibitor used in Parkinson tx
- Prevents PERIPHERAL degradation of L-DOPA (just like carbidopa, a DDI, prevents the transformation to DA peripherally as well)
- Increases the amount of L-DOPA that reaches the brain untouched
What is tolcapone?
Like entacapone, it's a COMT inhibitor used in Parkinson tx.
UNLIKE entacapone:
- it acts CENTRALLY and PERIPHERALLY
- is a/w Hepatotoxicity
What drugs help prevent degradation of Parkinson Tx?
1) COMT Inhibitors = Entacapone (periph) and Tolcapone (CNS/Periph)
2) MAO Inhibitors = Selegiline (CNS) prevent breakdown of DA
What is Dantrolene?
It's a specific type of Ca-channel blocker = Ryanodine R blocker
Prevents release of Ca into the cytoplasm of muscle fibers from the SR
Used in Tx of Malignant Hyperthermia (Halothane induced massive release of Ca into muscle cytosol by sensitive Ryanodine R's; results in massive ATP use and production → Heat → Rhabdomyolysis → ↑ K+, Myoglobin, Creatine Kinase
What is the most potent chemotactic eicosanoid?
LT B4
What is Bromodeoxyuridine?
It's a Thymidine analog used in the grading of brain tumors
High uptake would indicate lots of cells undergoing S-phase and therefore ready to proliferate - this would indicate high grade tumor and poor prognosis
Which negatively charged amino acid is replaced in hemoglobinopathies like sickle cell?
GLUTAMATE = glutamic acid
- in HbS - substitute VALINE (neutral)
- in HbC - substitute LYSINE (positive)
What is haptoglobin?
Plasma protein that binds free Hb so it's not renally excreted
Levels are decreased in patients w/ hemolytic anemia
How does hypertriglyceridemia cause acute pancreatitis?
Direct Tissue Toxicity
- High TG's (>1000 mg/dL) → High FA's & overwhelm the ability of albumin to bind
- High [FA] injures acinar cells and pancreatic capillaries
How does Rb regulate cell cycle?
It's responsible for G1 → S transition
- in Go it is ACTIVE (unphophorylated) so it binds up E2F transcription factor
- When growth factor stimulates the cell, CDK4 is activated, which phosphorylates Rb (making it inactive) thus releasing E2F to transcribe
What is Pioglitazone?
It's a Thiazolidinedione (TZD) used to improve insulin sensitivity
- Major SE is hepatotoxicity
What acid base changes are seen in high altitude exposure (for about a week)?
Chronic Respiratory Alkalosis
- drop in O2 increases respiratory drive (peripheral sensors) thus blowing off more CO2
- w/in 48 hours, kidney compensates for alkalosis by excreting HCO3 and making the body a little more acidotic
- pH mildly elevated; PaO2 ~ 60; PaCO2 ~ 20; HCO3 ~ 15
What bone disease shows spongiosa filling medullary canal w/ no mature trabeculae?
Osteopetrosis
What bone disease shows osteoid matrix accumulation around the trabeculae?
Rickets (vitamin D deficiency)
Which chemicals stimulate receptors that utilize the JAK/STAT signaling pathway?
Receptor activates Janus Kinase (JAK) which activates Signal Transducers and Activators of Transcription (STATs);
- Cytokines
- hGH
- PRL
- IL-2
Which chemicals stimulate receptors that utilize the MAP Kinase pathway?
RTK's stimulate MAP Kinase which activates Ras protein:
- Insulin
- EGF
- PDGF
What is Fexofenadine?
2nd Generation Anti-H1
What is Promethazine?
1st Generation Anti-H1
like diphenhydramine, chlorpheniramine, and hydroxyzine
What is the helicotrema?
It is the apex of the cochlea (near the end) that picks up low-frequency sounds
- high frequency is picked up closer to the base of the cochlea, near the round and oval windows
How can a mid-diastolic murmur (heard best @ apex) lead to hoarseness?
MS = the murmur → LA hypertrophy and enlargement → impinging (and leading to neurapraxia) of the recurrent laryngeal nerve = Ortner syndrome
Which drugs activate PPARα?
TZD's like pioglitazone → complex increases transcription of adiponectin → increased insulin sensitivity
What is the most common small vessel vasculitis in children?
HSP = Henoch-Schonlein purpura (IgA-complexes)
- palpable purpura on the butt
- GI → Upper and lower bleeding (hematemesis/bloody diarrhea)
- Renal = IgA (Berger)
- Joints = mirgratory arthralgias/arthritis
What stains w/ Wright-Giemsa?
Bugs and Reticulocytes: Borrelia, Chlamydia, Plasmodium, and Trypanosomes
What is Imipramine?
A TCA Antidepressant
Which diseases are a/w spelunking?
1) Virus = Rabies (rhabdovirus)
2) Fungus = Histoplasmasmosis
What drug combo can have additive negative chronotropic effects that lead to SEVERE bradycardia and hypotension?
1) ß-blockers (like atenolol)
2) Non-DHP Calcium Channel Blockers (Verapamil, Diltiazem)
What's the difference b/w the Dihydropyridine and Non-DHP Calcium channel blockers?
1) DHP's (Nifedipine) are anti-hypertensives acting primarily on vasculature (↑Peripheral dilation) -- NOTE: leads to reflex Tachycardia
2) Non-DHP's (Verapamil/Diltiazem) slow conduction thru the AV node (useful for AFib w/ a rapid ventricular response)
What is Ticlopidine?
It's an ADP antagonist used to prevent platelet aggreagation; Usually you would use clopidogrel + aspirin (blocks TXA2 release) because it can cause neutropenia (manifests as fever and mouth ulcers)
What drugs give Disulfiram-like effects?
Metronidazole
Cephalosporins
Procarbazine (Hodgkins)
Sulfonylureas (DM - First generation)
What symptoms are exlusive to Grave's Dz vs other hyperthyroidism?
1) Exophthalmos
2) Pretibial myxedema
3) Edema of the Eye = Periorbital and Conjuctival
Patients w/ CGD are at risk of infection by which organisms?
SPANS:
Staph aureus
Pseudomonas cepia
Aspergillus
Nocardia
Serratia marcenescens
What does the sodium cyanide-nitroprusside test detect?
Sulfhydryl groups, as in cystine
- Cyanide converts Cystine → CystEine
- Nitroprusside binds CystEine rutning it purple
What is ristocetin?
It's a drug that is used to test for vWB factor dysfunction. If present, it will catalyze vWF to bind w/ platelet Gp1b-IX
What does the Prussian blue stain detect?
Intracellular iron
- Can differentiate b/w lipofuscin or hemosiderin (both golden yellow/brownish cytoplasmic granules)
What is a/w renal failure, pulmonary symptoms (cough, dyspnea, hemoptysis), and upper respiratory symptoms (epistaxis, mucosal ulceration, chronic sinusitis)??
ANCA-associated RPGN
What drugs lead to increased lithium levels?
1) Hydrochlorothizides (result in ↑Na resorption in PT - and lithium along w/)
2) ACE-I's
3) NSAIDS
What is the genetic difference b/w Lynch syndrome (HNPCC) and Sporadic adenocarcinoma?
HNPCC = DNA Mismatch Repair gene mutations (MLH1, MSH2, MSH6, PMS2)
Sporadic Colon Adenocarcinoma = Proto-Oncogenes & Tumor Suppressors (APC, K-ras, p53, and DCC)
What is endothelium-derived relaxation factor?
NO
Cholinergic receptors on endothelia promote the release of NO → muscle cells where they activate Guanylate Cyclase (↑cGMP) → activates Ca pumps and causes Ca efflux from cells → muscle relaxation w/o Ca
What amino acids are exclusively ketogenic? Both Keto and glucogenic?
KETOGENIC = Leucine & Lycine
KETO & GLUCOGENIC = Isoleucine, Phenylalanine, Tryptophan
What disorder prevents gluconeogenesis (the final step) in the liver?
Von Gierke's = Type 1
- will have SEVERE fasting hypoglycemia, ↑↑ glycogen in liver, ↑ lactate in blood, hepatosplenomegaly
What bacterial toxins are encoded in a lysogenic phage?
ABCDE:
- A = shig-A like (SLT) of E. coli (E157:H7)
- B = Botox
- C = Cholera
- D = Diphtheria
- E = Erythrogenic toxin (GAS)
What is fluticasone?
It's a Corticosteroid (inhaled) used in the LONG TERM treatment of chronic asthma
What is the potential risk of treating CMV in someone on HAART?
CMV is treated w/ Ganciclovir which interferes w/ host cell DNA synthesis (leading to neutropenia, anemia, thrombocytopenia, and↓ renal fx)
Zidovudine (ZDV aka AZT) binds/inhibits some DNA polymerases too, leading to possible bone marrow suppression (anemia, granulocytopenia)

They both can impair hematopoiesis, so this combo increases risk of neutrorpenia and anemia
What is the most common primary immunodeficiency?
Selective IgA deficiency
- Recurrent sinopulmonary infections (HiB and S. pneumonia)
- GI (diarrhea) d/t viral, bacterial, and G. lamblia
- Anaphylactic response to transfusions (recognize IgA's as foreign)
What are the main side effects a/w Nicotinic acid?
Niacin administration leads to flushing, warmth, and itching d/t Prostaglandins. Prophylactic ASA can be used beforehand to prevent these SE's.
What is hyperacusis and what causes it?
Increased sensitivity to sound d/t paralysis of the stapedius muscle (d/t stapedius (CN VII) injury)
The stapes can then oscillate more widely.
Commonly seen in Bell's palsy = peripheral facial nerve palsy
What is cold enrichment?
Laboratory culturing technique used to test for Listeria monocytogenes b/c it can multiply at 4ºC (thus it can contaminate refrigerated foods: dairy, undercooked meats, and unwashed veggies)
Why does the blood in the pulmonary veins have a higher pO2 than in the LA?
D/t mixing w/ the deoxygenated bronchial veins that empty in to the LA - drops from 104 (equilibrated w/ the alveoli) to about 100 mm Hg
Systolic crescendo, decrescendo murmur @ base of the heart?
Aortic stenosis (most commonly d/t degenerative (senile) calcification of the aortic valve leaflets)
What is the most effective long-term treatment for someone w/ HTN and CHF? Why?
ACE-I's - prevent the A-II mediated LV hypertrophy and remodeling
For acute, symptomatic relief, then use a diuretic
What passing structures could be damaged by a mid-shaft fracture of the humerus?
Radial nerve (goes through the radial groove)
Deep Brachial artery (runs w/ radial n)
What enzyme is a/w activating pro-carcinogens?
Microsomal monooxygenase aka Cytochrome P450
What does having a low Vd (3-5 L) tell you about a drug?
It is basically "trapped" in the plasma compartment (3 L) d/t to:
- HIGH molecular weight
- HIGH protein plasma binding
- HIGH charge
- HYdrophilicity
What skin condition is a/w Celiac dz?
Dermatitis herpetiformis
What is Cladribine?
It's a purine analog used in HCL
Special b/c it resists ADA breakdown
What cytokines and hormones contribute to insulin resistance?
TNF-α, Catecholamines, Glucocorticoids, and Glucaon activate Serine & Threonine Kinase activity.
These serine kinases inactivate the IRS (insulin receptor substrates) as well as directly affect the intracellular tyrosine kinase portion of the insulin receptors
What is the BRAF protein kinase a/w?
Melanoma (melanocyte proliferation) Mutation = V600E (valine replacing glutamate)
What are Type I and Type II errors?
Type I = probablity of seeing a difference when there is no difference
Type II = probability of not seeing a difference when there really is one