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0525 Flashcards

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1
Q

high levels of what contribute to insulin resistance in overweight pts?

A

FFA and serum TGs

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2
Q

what is the most significant factor contributing to bone density in healthy pts?

A

genetic differences.

ex: caucasians have lower bone mass than africans.

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3
Q

topical vit D analogs treat?

A

psoriasis- inhibit keratinocyte proliferation, stimulate keratinocyte differentiation

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4
Q

vagus nerve effect on lungs

A

bronchoconstriction and increased mucus secretion (M3)– both increase airflow resistance and work of breathing

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5
Q

salmonella component that is antiphagocytic?

A

Vi antigen (special capsule, Vi stands for virulence)- protects bact from opsonization and phagocytosis

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6
Q

hand weakness

A

injury of lower trunk of brachial plexus (C8-T1 affects intrinsic mm. of hand)

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7
Q

sudden upward stretching of arm at shoulder damages?

A

lower trunk of brachial plexus

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8
Q

centriacinar emphysema localizes to?

A

upper lobe

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9
Q

panacinar emphysema localizes to?

A

lower lobe

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10
Q

INH and liver

A

directly hepatotoxic- acute MILD hepatic dysfunction

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11
Q

glucocorticoid action

A

CATABOLIC- cause muscle weakness, skin thinning, impaired wound healing, osteoporosis, immunosuppression.

BUT also increases liver protein synthesis for gluconeogenesis and glycogenesis.

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12
Q

how do glucocorticoids contribute to hyperglycemia?

A
  1. increase liver prot synthesis for gluconeogenesis.

2. peripheral antagonism of insulin effects.

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13
Q

which cytokines mediate systemic inflamm response?

A

IL-1, IL-6, TNF-a…

stimulate acute phase proteins, including fibrinogen, CRP, ferritin, complement, etc.

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14
Q

increased fibrinogen causes RBCs to…?

A

form stacks (rouleaux) that sediment at a faster rate- increased ESR

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15
Q

dystonia

A

prolonged, repetitive muscle contractions that force body parts into abnormal, sometimes painful movements/postures

*basal ganglia

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16
Q

myoclonus

A

sudden, brief, sometimes severe/shock-like muscle contraction (ex: hiccups)

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17
Q

short-term TX of RA

A

glucocorticoids (unfavorable side effects) good for anti-inflammatory effects until disease-modifying agents like MTX can take effect

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18
Q

lung involvement with scleroderma

A

pulmo HTN due to damage to arterioles.

accentuated P2 of S2.
signs of right heart failure.

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19
Q

hamartoma

A

excessive growth of tissue that is native to the organ involved.

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20
Q

most common site for hamartoma

A

LUNGS- benign tumors consisting of mature hyaline cartilage + adipose tissue + fibrous tissue + smooth muscle

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21
Q

ureaplasma urealyticum

A

part of mycoplasma genus.
lacks peptidoglycan cell wall.
contains cholesterol in single phospholipid layer.

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22
Q

TX against mycoplasma

A

anti-ribosomal agents: tetracycline, erythro

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23
Q

MRSA drug resistance

A

to all beta-lactam ABx due to altered penicillin-binding protein in peptidoglycan wall that does not bind beta-lactams effectively.

*susceptible to vancomycin

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24
Q

amphotericin B TOX

A
  1. acute infusion-related rxn: fever, chills, rigors, hypotension.
  2. dose-dependent nephrotox: decreased GFR.
  3. electrolyte abn: hypomagnesemia, kalemia.
  4. anemia: suppressed EPO synth.
  5. IV site thrombophlebitis
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25
anabolic steroids
i.e. methyltestosterone = ANDROGEN. promote follicular epidermal hyperproliferation and excess sebum production to cause ACNE.
26
drugs that cause acne
androgens. EGFR inhibitors. lithium.
27
what keeps intracellular calcium concentrations low in skel mm?
Ca-ATPase pump in SR membrane- sequesters calcium soon after it binds troponin C.
28
ryanodine receptor
facilitates calcium release from SR into intracellular fluid when skel muscle cell membrane is depolarized
29
urge incontinence (overactive bladder syndrome)
due to uninhibited bladder contractions (detrusor instability). treat with antimuscarinic (M3) drugs to decrease contractions and sense of urgency, increase bladder capacity.
30
BRAF mutation
protein kinase involved in signaling pathways for melanocyte proliferation. seen in 40-60% of MELANOMA. V600E (valine replaced by glutamate).
31
breast mass: solid sheets of pleomorphic, high-grade cells with central necrosis
comedocarcinoma (DCIS)
32
what causes hypercalcemia in sarcoidosis?
increased extra-renal formation of 1,25-OH2 vit D by activated macrophages. (activated T cells secrete IFN-g to increase 1-alpha hydroxylase activity) *high levels suppress PTH secretion
33
chloride shift in RBCs
bicarb (made from CO2 by carbonic anhydrase) diffuses OUT of RBC. Cl ions diffuse INTO RBC to maintain electrical neutrality. *responsible for high RBC Cl content in venous blood
34
what causes retraction (dimpling) of overlying skin in invasive breast cancer?
infiltration of Cooper's (suspensory) ligament
35
what causes orange peel appearance (peau d'orange) in breast cancer?
blockage of lymphatic drainage by tumor- lymphedema, pitting, and thickening of skin.. *common in inflammatory breast cancer
36
what vessel is often damaged by femoral neck fracture (displaced fracture)?
MEDIAL femoral circumflex artery. injury = avascular necrosis of femoral head.
37
trochanteric anastomosis
1. superior gluteal a. 2. inferior gluteal a. 3. medial femoral circumflex. 4. lateral femoral circumflex.
38
lepromin skin test
Mycobacterium leprae Ags are injected intradermally. POSITIVE: tuberculoid leprosy (strong CD4+ Th1 cell-mediated response). NONREACTIVE: lepromatous leprosy (weak cell-mediated response).
39
where are ketones produced?
liver mitochondria- FA breakdown. | then released into circulation to peripheral tissues.
40
what tissues metabolize ketones?
1. skel mm. 2. cardiac mm. 3. renal cortex. 4. brain (in starvation). converted to acetyl coA in mito.
41
why can't liver use ketone bodies?
liver lacks THIOPHORASE (succinyl CoA-acetoacetate CoA transferase) needed to converted acetoacetate into acetoacetyl CoA
42
why can't erythrocytes use ketone bodies?
lack mitochondria
43
fructose 2,6-bisphosphate
allosterically inhibits fructose-1,6-bisphosphatase (gluconeogenesis). allosterically activates phosphofructokinase-1 (glycolysis).
44
what increases fructose-2,6-bisphosphate levels levels?
insulin
45
where do all rxns of pentose phosphate pathway occur?
cytoplasm
46
lipoic acid is a cofactor for...?
mitochondrial enz: 1. PDH (def: lactic acidosis). 2. alpha-ketoglutarate DH in TCA. 3. branched chain ketoacid DH (def: MSUD).
47
what inhibits lipoic acid?
arsenic- rice water stool, garlic breath, vomiting
48
accumulated homogentistic acid
due to deficient homogentistic acid oxidase (tyrosine degradation)- ALKAPTONURIA. causes pigment deposits in conn tissues: darkened sclera, ear cartilage, arthritis, ankylosis
49
myeloperoxidase
neutrophil enzyme that catalyzes hydrogen peroxide + chlorine into hypochlorite (BLEACH)
50
cholecystectomy
no gallbladder to store bile so bile is constantly released into duodenum
51
normal handling of dietary lipids
digestion in duo. | absorption in jejunum.
52
what prevents hemorrhagic cystitis from cyclophosphamide tx?
MESNA (2-mercaptoethanesulfonate)- sulfhydryl compound that binds acrolein metabolite in urine
53
CF vs Kartagener
both cause recurrent infxs and infertility but only Kartagener is assoc with situs inversus
54
most common cause of SVC syndrome
bronchogenic carcinoma (mediastinal mass) #2: non-Hodgkin lymphoma
55
SVC sx
impaired venous return from upper body- facial swelling, headache, visual disturbances. dilated vessels of neck and trunk.
56
TX of enterobiasis (pinworm)
perianal pruritus + Scotch tape test. mebendazole/albendazole. Pyrantel Pamoate in Pregos.
57
gummas
necrotizing granulomas that occur on skin, mucosa, SQ tissue, bone and within organs in TERTIARY SYPHILIS
58
positive VDRL and pleocytosis in CSF (LUMBAR PUNCTURE)
= NEUROSYPHILIS (tertiary)
59
condyloma lata
large gray warty growths of secondary syphilis
60
toxic component of LPS
lipid A: activates macrophages (IL-1, TNF-a) for septic shock
61
vasopressin at V2 receptor
increases permeability of luminal membrane of inner medullary collecting duct to water and urea (increased REABSORPTION)
62
complete vs. partial central DI
complete: more than 50% rise in urine osmolality with vasopressin admin. partial: indicates that some vasopressin is present but not enough for normal kidney function.
63
nonoxidative rxns of HMP shunt
transketolase and transaldolase
64
unexplained oral thrush (Candida) in otherwise healthy person =
possible HIV infx
65
elevated HbA2
beta thal minor (trait) and intermedia | beta globin chain underproduction causes decreased HbA1 synth
66
most pronounced intestinal changes in celiac
duo and prox jejunum
67
matched V/Q defect (ventilation defect is anatomically matched by perfusion defect)
indicates lung collapse or consolidation
68
what parts of kidney suffer first with hypoxia?
proximal tubules and | thick ascending loop Henle

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