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80 Cards in this Set

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Which part of the RAAS pathway takes place in the lungs?

Ang I > Ang II via ACE

Where do femoral hernias occur in relation to the femoral vessels?

In Hesselbach's triangle, which is medial to the femoral vein, lateral to the pubic tubercle, and inferior to the inguinal ligament

rasburicase

recombinant version of urate oxidase - it catalyzes the conversion of uric acid to allantoin, which is much more soluble than uric acid, and thus can be used to tx hyperuricemia in cases such as tumor lysis syndrome

alkaptonuria

AR deficiency of homogentisate oxidase blocks the metabolism of phenyalanine and tyrosine at the level of homogentisic acid, thereby preventing the conversion from tyrosine to fumarate

single genital ulcer, indurated and painless

syphillis

penicillins are structural analogs of ____________

D-Ala-D-Ala

what is the cause of rapid plasma decay of thiopental?

redistribution of the drug to other tissues throughout the body, not metabolism

how do you calculate number needed to treat?

NNT = 1 / ARR




ARR = event rate in control group - treatment group

how do you calculate relative risk reduction?

RRR = ARR / event rate in control group

intellectual disability, gait abnormalities, eczema, and musty body odor

PKU

histology of medullary thyroid cancer

arises from parafollicular calcitonin secreting C cells; uniform polygonal or spindle shaped cells with extracellular amyloid deposits

phentolamine

alpha 1 blocker - causes vasodilation

what determines ventricular contraction rate in AF?

dependent on transmission of abnormal impulses through the AV node - the AV nodal refractory period regulates the number of impulses that reach the ventricle

DOC for arsenic poisoning

dimercaprol (chelating agent) - it displaces arsenic from sulfhydryl groups of enzymes

abdo pain/distension, bloody diarrhea, fever, and signs of shock in setting of untreated UC - what is suspected and what test would you do?

toxic megacolon - plain abdo X ray

DRESS syndrome

drug reaction with eosinophilia and systemic symptoms (DRESS) - occurs 2-8 wks following exposure to high risk drugs such as anticonvulsants, allopurinol, sulfonamides, and antibiotics

entacapone vs tolcapone

both are COMT inhibitor that prevents degradation of levodopa - entacapone only works peripherally while tolcapone works both peripherally and centrally




tolcapone is associated with hepatoxicity

what drug is given to tx pts with bradycardia following an inferior MI?

atropine - blocks vagal influence on SA and AV node and is effective in increasing HR




*side effects due to muscarinic blockade (may precipitate acute angle closure glaucoma)

Drug (and its mech) used to tx C. diff infection aside from metronidazole or vancomycin - particularly helpful in pts with recurrent infection

fidaxomicin - macrocyclic antibiotic that inhibits the sigma subunit of RNA polymerase, impairing protein syn and leading to cell death; oral drug with minimal systemic absorption and bactericidal activity

when/how is RCC usually detected?

usually detected incidentally at an advanced stage

most common site for mets in RCC

lungs


clear cell carcinoma (subtype of RCC)

how is diastolic heart failure characterized?

normal or near normal left ventricular ejection fraction and EDV in the setting of increased LV filling pressures

what can lead to diastolic dysfunction?

conditions that decrease LV compliance such as impaired myocardial relaxation (e.g. from ischemia), or increased ventricular wall stiffness (i.e. from amyloid deposition or hypertrophy)

where does blunt aortic injury (i.e. from MVC) most often occur?

most often at the isthmus, which is tethered to the ligamentum arteriosum (which is relatively fixed and tethered unlike most of the adjacent descending aorta)

most often at the isthmus, which is tethered to the ligamentum arteriosum (which is relatively fixed and tethered unlike most of the adjacent descending aorta)

anastrozole, letrozole, exemestane

aromatase inhibitors; superior/equivalent to tamoxifen in the tx of breast cancer

which hormone is responsible for metabolic changes in the mother during pregnancy? what are the changes?

human placental lactogen; glc + AAs shunted towards fetus while FFAs, ketones, and glycerol provide energy to the mother

what causes maternal insulin resistance during pregnancy?

hPL, GH, estrogens, progesterone, and glucocorticoids

by which method would two non-fragmented, ds-DNA genome viruses exchange genetic information?

recombination - the exchange of genes between two chromosomes via crossing over within homologous regions

effects of dobutamine on CVS

B1 agonist:




- positive ionotropic effect


- weakly positive chronotropic (increased HR) effect (leads to increased myocardial O2 consumption)


- increases conduction velocity (can lead to arrthymias)

decreased intestinal absorption of lysine, arginine, ortnithine, and cysteine

cystinuria - defective transporter leads to impaired renal/intestinal absorption of cysteine, ornithine, lysine, and arginine (COLA)

HbA vs HbA2

HbA - a2B2




HbA2 - a2d2

which type of Hb is increased in beta thalassemia?

HbA2

pathogenesis of hypercalcemia in sarcoidosis

in granulomatous diseases, activated T cells secrete IFN-gamma, which increases the 1-alpha hydroxylase (activates vit D in kidneys) in macrophages

how is CO maintained in aortic regurgitation?

increase in LV EDV in association with eccentric left ventricular hypertrophy

how many subunits does myoglobin consist of?

it is monomeric, as opposed to hemoglobin which is tetrameric

what can result with incomplete obliteration of the vitelline duct?

1. Vitelline duct/fistula: connection b/w intestinal lumen and umbilicus


2. Meckel diverticulum


3. Vitelline sinus: partial closure of duct with patent portion open at umbilicus


4. Vitelline duct cyst: central portion of duct remains with fibrous bands connecting it to the ileum and abdo wall

which drug can be used to combat the abdominal side effects of the drug physostigmine?

excessive cholinergic stimulation of the gut can be controlled with scopolamine; selective musc receptor antagonist that won't effect skeletal muscle receptors (which uses nicotinic receptors)

pilocarpine

nonselective muscarinic receptor agonist used to tx glaucoma (contraction of iris sphincter and ciliary muscles)

initial painless ulcer on genitals > wks later painful inguinal nodes that coalesce, ulcerate, and rupture




intracytoplasmic inclusion bodies on histo

lymphogranuloma venereum (chlamydia trachomatis); the ulcers are called buboes

how can you differentiate LGV from Haemophilus ducreyi (chancroid) or Klebsiella inguinale (donovanosis) clinically?

- LAD lesson common in granuloma inguinale (donovanosis) - Donovan bodies on histo are diagnostic


- chancroid - initial papule is tender unlike initial lesion in LGV which is painless



pathogenesis of the disease that results in hemolytic anemia, pancytopenia, and hypercoaguability

PNH - absence of GPI which anchors CD55/CD59 to RBC membrane, inhibiting complement deposition; without these surface proteins, MAC forms and lyses RBCs; thrombotic complications result from prothrombotic factors released by hemolysis

immunologic mechanism responsible for hyper acute graft rejection

preformed IgG antibodies (such as anti-ABO blood group or anti-HLA) against graft in recipient's circulation - results in arterial fibrinoid necrosis and capillary thrombotic occlusion

which two factors are the main drivers of angiogenesis?

VEGF and FGF

drug induced lupus has been linked to drugs that are metabolized in what way?

N-actetylation by the liver - slow acetylators are at greater risk for developing drug induced lupus

when is vertical diplopia most noticeable to the patient?

when the affected eye looks towards the nose, as when walking down the stairs or reading

what is the most likely cause of an isolated vertical diplopia?

trochlear nerve palsy (usually traumatic or idiopathic)

pathogenesis of dyspnea in LV CHF

back up of blood into pulmonary veins/capillaries > increased hydrostatic P > transudation of fluid into interstitial space > decreased lung compliance

how is compliance defined and what are the common causes?

lung's ability to stretch during inhalation; pulmonary fibrosis, insufficient surfactant, or pulmonary edema

where are the receptors for thyroid hormone located?

nucleus

where are the receptors for steroid hormones located?

cytoplasm - they migrate to the nucleus once activated

what are the role of each of the subtypes of histones: H1, H2A, H2B, H3, and H4?

H1: facilitates packaging of nucleosomes into more compact structures




H2A, H2B, H3, and H4: two of each form the 8 histones that make up the nucleosome core

what type of anemia is caused by HUS-TTP?

microangiopathic hemolytic anemia

which reflexes are diminished/preserved in sciatic nerve injury?

ankle reflex diminished; patellar preserved

compression of L5 vs S1

both result in sciatica




L5: posterior and lateral thigh and leg pain shooting to inner foot




S1: pain strictly in posterior thigh and leg/foot; weak plantar flexion; diminished ankle jerk

which anti-hyperlipidemic drug can precipitate gout?

niacin

what is seen on muscle biopsy in Pompe disease (acid alpha-glucosidase deficiency)?

enlarged lysosomes containing PAS (+) material - glycogen accumulation in lysosomes

why is the decrease in GFR less pronounced than the decrease in RPF in severe dehydration?

because compensatory mechanisms leading to aff arteriolar dilation and eff arteriolar constriction bring GFR nearer to normal

what is the infectious source of schistosomiasis?

snails

why can long term use of PPIs lead to osteoporosis?

insoluble calcium requires an acidic environment for absorption so acid-suppressing medications can interfere with the process

what morphological changes take place in chronic transplant rejection?

vascular wall thickening and luminal narrowing; interstitial fibrosis and parenchymal atrophy

high levels of what are thought to induce insulin resistance in overweight individuals?

FFA and TGs

what effect does CO have on PaO2?

None - PaO2 reflects Amt of O2 dissolved in plasma and CO has no effect on this; CO decreases the O2 content of the blood by decreasing the amt of Hb available for binding




remember that O2 content = O2 carried by Hb + PaO2

what drug is used to dilate the eye and which receptors does it act on?

phenylephrine is an alpha 1 agonist that causes contraction of pupillary dilation muscles

what does stimulation of B2 receptors of the uterus lead to? which drugs do this?

uterine relaxation (tocolysis) - ritodrine, terbutaline

hallmark of asbestosis

localized pleural thickening with calcification, particularly of pleura of posterolateral mid-lung zones and diaphragm

For PCR, the oligonucleotide sequence of the ___________ must be known in order to make the primers

flanking regions

which type of virus acquires its envelope by budding from the host nuclear membrane as opposed to the host plasma membrane?

herpesviruses (including CMV)

How is ovulation induced pharmacologically in pts with PCOS?

Menotropin acts like FSH and triggers development of ovarian follicle. Ovulation is then induced by admin of beta-hCG, which mimics the LH surge due to similar structural subunits

what gives rise to the collecting system of the kidneys?

ureteric bud

what gives rise to the glomeruli, Bowman's space, proximal tubules, loop of Henle, and DCT?

metanephric blastema (mesoderm)

thyrotoxicosis, tenderness over thyroid gland, increased ESR, and markedly reduced radioactive iodine uptake - what is it/what causes it?

subacute granulomatous (de Quervain's) thyroiditis - possibly caused by viral infection

what causes the findings in subacute granulomatous thyroiditis?

thyrotoxicosis is caused by release of stored thyroid hormones secondary to thyroid inflammation; it does not cause increased production of TH, which is why iodine uptake is decreased

characteristic histologic findings in de Quervain's

mixed, cellular infiltration with occasional multinucleate giant cells

how does radiation cause cell death?

1. ds-DNA breakage


2. Formation of free radicals

which enzymes are inhibited in lead poisoning?

ALA dehydratase (ALA > PBG)




Ferrochelatase (protoporphyrin IX > heme)

what does it mean if a drug has a high blood/gas partitioning coefficient?

- highly soluble in blood


- a large amt is needed to saturate the blood


- equilibration with the brain is slow


- onset of action is slow

what part of the lungs are affected in chronic rejection?

small airways, causing bronchiolitis obliterans (inflammation and fibrosis of bronchiolar walls)

which drug is used to tx CMV retinitis?

ganciclovir