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60 Cards in this Set

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Describe the synthesis of estrogen by oocytes.

Begin with LH.
What is a normal lecithin to sphingomyelin ratio for a baby with mature lungs?
≥2.0
CGG repeats
Fragile X syndrome
Fragile X Syndrome:
Pathophys
Familial MR Gene 1 on X chromosome has inc'd number of CGG repeats

Leads to hypermethylation and subsequent gene inactivation

DOES NOT RESULT IN INC'D CHROMOSOMAL BREAKAGE/INSTABILITY
Define polyploidy.
When more than 2 complete sets of homologous chromosomes exist within an organism or cell.

Ex: Hydatidiform moles have 69 chromosomes (a factor of 23)
Define pleiotropy.
Occurrence of multiple phenotypic manifestations, often in different organ systems, as a result of a single genetic defect.
What is the Pygmalion effect?
Researcher's beliefs in efficacy of tx that can potentially affect outcome
What is Berkson's bias?
Selection bias created by selecting hospitalized patients as control group
Schizophrenia:
Presentation
How does it differ from a Schizophreniform Disorder?
Recurrent episodes of active psychosis and decline in functional capacity

Presentation includes hallucinations, delusions, disorganized thought, negative syx (blunted affect, social withdrawal, and anhedonia)

When above syx are present for 1-6 months, diagnosis is schizophreniform disorder.
Describe and explain the urinalysis findings of diabetic ketoacidosis.
Urine pH will decrease

HCO3- will be conserved in the body, and thus will be low in urine

H2PO4- is used to transport H+ out of body, so will be inc'd in urine
What are the 4 hypersensitivity reactions?

Describe and provide examples.
I: Immediate allergy (IgE)--atopic dermatitis, anaphylaxis, asthma

II: Cytotoxic, Ab-dependent (IgM or IgG)--autoimmune hemolytic anemia, thrombocytopenia, Erythroblastosis fetalis, Goodpasture's, Graves', Myasthenia gravis

III: Immune complex (IgG)--Serum sickness, RA, SLE, Hypersensitivity

IV: Delayed-type hypersensitivity, cell-mediated immune memory response, Ab-dependent (MEDIATED BY T CELLS)--CONTACT dermatitis, Mantoux Test (PPD), chronic transplant rejection, multiple sclerosis
Transdermal candida extra injected into pediatric patient.

48 hours later, patient returns with firm nodule.

What cell type responsible for this?
T lymphocytes
Which hypersensitivity reactions rely on B-lymphocytes?
Type I--asthma, anaphylaxis (IgE mediated)
Type II--antibody mediated (ABO incompatibility hemolysis)
Type III--immune complex (post-strep GN!!)
Describe the fates of pyruvate in aerobic and anaerobic conditions.

List enzymes necessary.
Pyruvate-->Acetyl-CoA in presence of Oxygen via PYRUVATE DH

Pyruvate-->lactate in lack of Oxygen vis LACTATE DH
Pyruvate dehydrogenase deficiency:
Dietary restrictions
Patients should restrict themselves to a ketogenic diet (as opposed to glucogenic, i.e., aa's that contribute to formation of pyruvate and then lactate. Don't want pts in lactic acidosis!)

Such aa's are lysine and leucine.
Glucogenic vs Ketogenic amino acids:
General
Glucogenic--produce intermediates of citric acid cycle or pyruvate

Ketogenic--produce acetoacetate or precursors

Ex: leucine, lysine are exclusively ketogenic and will not increase formation of lactic acid
Valsalva maneuver:
Therapeutic utility
Valsalva maneuver increases vagal tone and can be used to abolish paroxysmal SVT
DKA:
Treatment Protocol
-Bolus of short-acting regular insulin
-Infusion of insulin adjusted to blood glucose levels
-IV fluids and correct electrolyte imbalances
Rapid-acting vs Regular insulin:
Peak time of effect
Examples
Rapid-acting: Peak effect within 30 minutes-1 hour; ex: Lispro

Regular: Peak effect around 3 hours, ex: regular insulin
Intermediate insulin:
Peak time of effect
Example
Peak effect at 6-8 hours, lasts up to 16 hours

Ex: NPH, Lente
This insulin lasts 18-24 hours and does not peak.
Glargine (Lantus)
Apoptosis:
Extrinsic vs Intrinsic Pathways
Extrinsic: Death receptor, Fas, binds Fas-L-->produces protein called FADD-->activates caspases

Intrinsic: anti-apoptotic proteins Bcl2 and Bcl-x that reside in mitochondria replaced with Bak, Bax, Bim. Pro-apoptotic pathway allows for inc'd perm of mitochondria-->release of caspase-activating substances like cytochrome C.

CYTOCHROME C!
Vitamine E deficiency:
Effects
Presentation
Cause
Degeneration of spinocerebellar tracts, dorsal column, peripheral nerves
Mimics Friedreich ataxia bc same areas of CNS affected

Presentation: Ataxia, dysarthria, loss of position AND vibration sense
Chronic fatigue
Mild weight gain
Elevated creatine kinase
Hypothyroidism

Elevated creatine kinase due to hypothyroid myopathy
Hemiplegia
Aphasia
Brain CT hypodensity
Ischemic infarct
What cells are involved in repair of brain infarct?
Neutrophils followed by macrophages (MICROGLIA)

Macs phag debris, dead tissue

CNS repair by astrocytes that migrate to area of necrosis within 2 weeks

Will form cystic space surrounded by astrocytes (GLIOSIS)
Formula for flow of incompressible fluid through a cylinder.
Total Flow = Flow Velocity x Cross Sectional Area = Constant
Lactase:
Reaction catalyzed
Lactase:
Lactose ((galactosyl beta-1,4-glucose)-->Galactose + Glucose
Neisseria meningitidis:
Route of infection
Exposure to respiratory droplets or direct contact with respiratory secretions-->pilus-mediated adherence to, and penetration of mucosal epithelium-->circulation

Note: N. meningitidis produces an IgA protease that facilitates survival of organism in mucosa by destroying IgA ab's
Cat scratch fever:
Cause
Effects
Bartonella

Can also present with bacillary angiomatosis, culture negative endocarditis
How does HIV-1 become resistant to anti-retroviral drugs?
Pol gene mutations result in resistance fo HIV reverse transcriptase inhibitors and HIV protease inhibitors
Cardiac AEs of TCAs

Treatment?
TCAs have quinidine-like effect:
QRS and QT prolongation
Due to inhibition of fast Na+ channels

Tx: Sodium bicarb to correct QRS prolongation, reverse hypotn, tx ventricular dysrhythmias
Treatment for benzodiazepine toxicity.
Flumazenil
Blastomyces (broad based budding)
Coccidoides--large spherule filled w/endospores
Most common cause of sudden cardiac death in young, healthy individual.
Hypertrophic cardiomyopathy resulting in ventricular tachycardia that deteriorates to ventricular fibrillation
Enoxaparin:
Drug Class
MOA
LMWH
Binds and activates anti-thrombin III, which binds to factor Xa and stops it from converting prothrombin to thrombin
This structure supplies the ovary with nerves and vessels.
Suspensory ligament
Round ligament:
Locations
Uterus (contains artery of Sampson; rarely source of major bleeding during surgery)
Liver
This structure supplies contains the uterine artery.
Transverse cervical ligament
Fenoldopam:
MOA
Dopamine-1 receptor agonist-->arteriolar dilation and natriuresis

Leading to dec'd systemic vasc resistance and bP reduction

Also improves renal perfusion
Which penicillins are resistant to peniciliinase?

Use?
Nafcillin
Methicillin
Oxacillin

Use to tx Staph aureus (not not MRSA), ex: folliculitis, abscesses
Dec'd compliance in LV (mitral in question stem)-->inc'd risk pulmonary edema
This molecule has 220 times more affinity for hemoglobin than does oxygen.
Carbon MONOxide
Treatment of CO poisoning.
100% or hyperbaric oxygen
Spontaneous hemarthroses
Easy bruising
Hemophilia A
Hemophilia A:
Pathophys
Presentation
Treatment
Factor VIII deficiency

(A--ATE--EIGHT)

Presents with spontaneous hemarthroses, bleeding after dental procedures, easy bruising

Tx: Desmopressin
Desmopressin:
MOA in Hemophilia
Other uses
Stimulates release of Factor VIII and vWF from ENDOTHELIAL cells (temporarily increases plasma FVIII by 2-3 times)

Desmopressin is a synthetic analog of ADH, so used in tx of diabetes insipidus to inc reabsorption of water in collecting tubules
Goodpasture Syndrome:
Pathophys
Light vs Immunofluorescence findings
Goodpasture: Anti-GBM Abs react with Collagen Type IV on GBM

Light findings: Glomerular crescent formation

Immunofluorescence: Linear deposits of IgG and C3 along BM
Functional Mitral Regurgitation:
What is it?
Cause?
Heart murmur in absence of valve lesion

Dilatation of LV in response to inc'd preload can result in fnal mitral regurgitation--eliminated by preload reduction and reduced by afterload reduction (diuresis!)
Describe the breakdown of glucose to pyruvate.

RLS?
Glucose
Glucose 6-phosphate
Fructose 6-phosphate
**VIA PFK-1 (RLS)**
F-1,6-Bisphosphate
-->-->Pyruvate
Describe the breakdown of galactose to pyruvate.

RLS?
Galactose
Galactose 1P
Glucose 1P
Glucose 6P
Fructose 6P
**VIA PFK-1 (RLS)**
F-1,6-bisphosphate
-->-->Pyruvate
Which monosaccharide does not require PFK1 for metabolism to pyruvate?

How does this affect rate of glycolysis?
Fructose

Rapidly metabolized bc bypasses PFK-1--the RLS of glycolysis
Filtration Fraction:
Equation, Subequations
Normal Value
FF = GFR/RPF
Normal = 0.2 or 20%

GFR can be calculated by: creatinine OR inuline clearance, or Starling equation

Cx = Ux * V/plasma [ ]

Starling:
GFR = Kf ((Pg - Pb) - (πg - πb))

Where P = hstatic P
Where π = oncotic P
Where G = Glomerular Capillaries
Where B = Bowman's space

RPF:
Use clearance of PAH
FF = [(200 x 1.0) /2] / [(100 x 1.0) / 0.2] = 100/500 = 0.2 = 20%
Leuprolide:
MOA
Effects
Use
GnRH hormone administered in constant levels; used to dec both T and DHT levels

When GnRH administered constantly and not in pulsatile fashion:
-Initial increase in release of FSH/LH-->initial increase in T and DHT

But then results in suppression of pituitary release of gonadotropins, causing dec'd DHT and T
This drug causes a discordant decrease in DHT compared to T.
Finasteride bc inhibits T-alpha reductase
Rickets:
Histologic hallmark
Unmineralized osteoid matrix, widened osteoid seams

note: there is normal architecture unlike osteoporosis
Osteoporosis:
Histologic hallmark
Trabecular thinning with few interconnections (abnl architecture)
What determines whether a coronary artery plaque qill cause ischemic myocardial injury?
Rate at which occludes the involved artery

A slowly developing occlusion will allow for formation of collaterals that could prevent myocardial necrosis

A thin fibrous