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From Flashcardlet > 5/13 > Flashcards

5/13 Flashcards

1
Q

What is the Indx for Primidone? What is it metabolized to? Sdx?

A

Indx: anti-epileptic

Metabolized to phenobarbital and phenylethylmalonamide (PEMA)

Sdx: lethargy

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2
Q

Scalded Skin Syndrome

A

Staph Aureus infection that produces an exotoxin: exfoliatin.

Pts will have Nikolsky’s sign (skin slipping off w/ gentle pressure)

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3
Q

DES can mimic what disease?

A

angina pectoris

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4
Q

Where do craniopharyngiomas derive from?

A

Rathkes pouch (along with the ant pit)

Will present as a calcified mass in the head w/ brownish fluid collecting that is rich in cholesterol

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5
Q

What do BABR’s, Statins, and Fibrates do to total cholesterol levels?

A

Statins = decreases (by blocking HmG-CoA Reductase

BABR’s and Fibrates increase total cholesterol synthesis by increasing excretion of bile acids –> thus triggering production of more

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6
Q

Charcot-Bouchard pseudoaneurysm

A

An aneurysm in the middle of the brain due to hypertension

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7
Q

What occurs with aspirin OD?

A

hyperventilation (stimulated by medullary respiratory center) –> low CO2 and high blood pH. After a few hours this will be partially compensated for by a decreased HCO3 (metabolic acidosis)

After a few hours, aspirin will attack the mitochondria and uncouple oxidative phosphorylation and inhibit the citric acid cycle. This will result in an increased lactate, ketoacids, and pyruvate

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8
Q

What form does coccidioides immitis have in the lungs? Who is at risk?

A

Southern USA (arizona/california/new mexico)

Spherules containing endospores

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9
Q

What is the treatment of choice for neonatal listeria?

A

Ampicillin

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10
Q

What condition will show portal hypertension, splenomegaly, and varicosities at portal anastomoses but NO liver pathology?

A

Blockage of the portal vein

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11
Q

What do nerves S2-S4 innervate?

A

Perianal area, shaft of penis (head of penis = S3)

Groin = L1

pinky toe = S1

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12
Q

Clinical presentation of Whipple disease?

A

greasy stool, weight loss, ab discomfort, and joint pain

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13
Q

What are some common antigens that all enterobacteriaceae have?

A

All are GnRs, ferment glucose, and are ox(-)

All have somatic O ag
All have capsular (K) ag = virulence factor
motile ones have flagellar (H) ag

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14
Q

What are the different kinds of E.Coli and what diseases do they cause? What is the tx for serious e.coli?

A

EIEC: similar to shigella - invades mucosa and causes necrosis and inflammation = dysentery/bloody diarrhea

ETEC: watery travelers diarrhea - stable toxin causing no inflammation or invasion

EPEC: mucus-y child diarrhea - adheres to apical surfaces and flattens villi to prevent absorption

EHEC: O157:H7 - bloody diarrhea from cow meat. Causes HUS by causing endothelial swelling/lumen narrowing –> mechanical hemolysis/decreased renal blood flow and plt consumption. Labs show no fermetation of sorbitol (UNIQUE)

Tx of serous e.coli infections = Flouroquinolones or TMP-SMX

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15
Q

What is the unique characteristic of proteus mirabilis in the gut? What does this cause?

A

It is urease (+). This can cause increased ammonium and CO2 leading to ammonium phosphate stones causing staghorn calculi

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16
Q

What diseases can Klebsiella cause? what pt pops?

A

Diabetics and alcoholics

AAAA = aspiration penumonia, Abscess in lungs/liver, Alcoholics, and diAbetics

Causes UTI’s (could be nosicomial) and aspiration pneumonia (CURRENT JELLY SPUTUM)

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17
Q

What is the main cause of osteomyelitis in sickle cell pts?

A

salmonella

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18
Q

What are the characteristics of salmonella typhi?

A

typhoid fever - rose spots on belly w/ fever, HA, diarrhea.

It can remain in the gallbladder and cause a carrier state

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19
Q

What pathway does v.cholera activate?

A

Gs –> increases cAMP perminantly in the GI to excrete H20

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20
Q

Where is yersinia enterocolitica found?

A

pet poop, pork chitterlings, or milk

“Adenitis:” Causes bad GI stuff that can mimic Crohns or appendicitis

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21
Q

What is the tx for c.diff?

A

Metro

or, PO vanco

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22
Q

What is the triad of Rieters syndrome?

A

“Cant see, cant pee, cant climb a tree”

Conjunctivitus
Urethritis
Arthritis

Can also be associated with Shigella Flexneri (cause of diarrhea)

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23
Q

What are the most common causes of Salmonella?

What is the most common cause of food poisoning causing issues 1 hour after eating picnic food?

A

Poultry, eggs, turtles

Staph Aureus (preformed toxin makes you sick quickly)

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24
Q

What drugs cause photosensitivity?

A

i SAT for the Photo

S: sulfas
A: amiodorone
T: tetracycline

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25
Q

What drugs should a pt with a sulfa allergy avoid?

A

All sulfas
Diuretics: Loops, Thiazides, CA inhibitors (acetazolamide)
Celecoxib
Probenecid

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26
Q

Why shouldnt pregnant women use SMX for their UTI’s? What should you use instead?

A

b/c it can cause kernicterus in babies

Use Nitrofurantoin instead: it is reduced by bacterial proteins to a reactive intermediate that inactivates bacterial ribosomes

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27
Q

What diagnostic labs are seen in Giardia infection?

What is the tx of Giardia?

A

Trophozoites/Cysts in the stool

Metro

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28
Q

What are the uses of Metronidazole?

A

“GET GAP on the metro”:
Giardia
Entomoeba hystolitica
Trichomonas

Gardnerella Vaginalis
Anaerobes (Clostridium, bacteroides, actinomyces)
h. Pylori

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29
Q

How do you make the diagnosis of E. Histolytica infection?

A

Serology (check for Abs against it)

Trophozoites (w/ RBCs in cytoplasm) in stool

Liver abscess w/ flask shaped ulcers

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30
Q

How do you make the diagnosis of Cryptosporidium infection?

A

OOcytes (cysts) in stool that stain acid fast

AIDS pts are very susceptable (watery diarrhea)

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31
Q

How do you make the diagnosis of Toxoplasmosis infection?

What is the tx?

A

Serology

Tx: sulfa + pyrimethamine + folinic acid

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32
Q

How do you make the diagnosis of N. Fowleri infection?

What is the tx?

A

You can see amoebas in the spinal fluid

Tx: Amphotericin B

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33
Q

What is the tx for Trypanosoma Rhodesiense and Gambiense?

How are they acquired?

A

Tsetse fly bite –> african sleeping sickness

Tx: Suramin (if its in the blood) or Melarsoprol (if it is in CNS)

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34
Q

What is the tx for Trypanosoma Cruzi?

How is it acquired?

A

Reduviid bug poops in a bite on your skin and you scratch it in –> megacolon, megacardia, megacolon

Tx: Nifurtimox (CDC delivered only!)

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35
Q

What is the tx for Leishmania Donovani?

How is it acquired?

A

Sandfly bite –> hepatosplenomegaly and fever w/ pancytopenia (maybe self limited ulcers)

Dx: macs contain amastigotes (de-flagellated bugs)

Tx: Na+-Stibogluconate

36
Q

What are the treatments for the different malarias?

A

Start with Chloroquine, if resistant, use mefloquine

If life threatening = use quinidine

Add Primiquine if its vivax/ovale

37
Q

What type of malaria is shaped like a banana?

What is the malaria cycle?

A

P. Falciparum (the worst one)

Anopheles mosquito injects sperozoite into blood

It invades a hepatocyte (early –> late schizant) and becomes a merozoite

The merozoite ruptures the hepatocyte and goes to infect an RBC

Inside the RBC (early –> late schizant) the merozoite becomes a trophozoite (LOOKS LIKE DIAMOND RING) and then a merozoite again –> releases

Once released, fever and chills are triggered

38
Q

What is babesiosis? What is the vector that causes this?

Dx and Tx?

A

Babesiosis = fever, hemolytic anemia via babesia protozoa

Its is transfered by ixodes (lyme disease) ticks in Northeastern US.

Dx: blood smear/ring cross (tetrad) inside RBCs

Tx: Clindamycin and Quinine

39
Q

What is the Dx labs for Tichomonas Vaginalis?

A

Motile Trophozoites (unique twitching via flagella) on wet mount

Will also have green discharge from vag

40
Q

How do you get Trichonella spiralis? Clx? tx?

A

Undercooked pork

Myositus, eosinophilia, periorbital edema

Tx: Bendys

41
Q

How do you get Enterobius Vermicularis? Clx? tx?

A

= Pinworm, you eat food contaminated w/ the eggs, or spread fecal oral.

Anal Pruritis

Tx: Bendys (dx with scotch tape test)

42
Q

How do you get Ascaris Lumbricoides? Clx? tx?

A

= Giant roundworm. Fecal-oral

Can cause GI problems, or eosinophilic pneumonia

Tx: Bendys

43
Q

How do you get Strongyloides Stercoralis? Clx? tx?

A

Transferred via larvae in soil penetrating the skin (feet)

Can cause asthma, anemia, diarrhea, vomiting

Tx: Ivermectin

44
Q

How do you get Ancylostomas (Necator, Duodenale, Americanus)? Clx? tx?

A

Transferred into feet from soil

Anemia by sucking blood in GI

Tx: Bendys

45
Q

Which worms infect via GI route?

A

You will get sick if you EAT these:

Enterobius
Ascaris
Trichonella

46
Q

Which worms infect via skin?

A

Dont walk in the SANd

Strongyloides
Ancyclostomas
Necator

47
Q

What is the typical clinical presentation of cysticercosis?

A

It comes from eating undercooked pork (Taenia solium)

Will occur as new onset neuro symptoms in an immigrant
looks like “swiss cheese” in your brain

48
Q

What is the typical presentation of Schistosoma infection?

A

Liver/spleen inflammation

If S. Haematobium –> Egyptian immigrant with hematuria (can cause squamous cell carcinoma of bladder)

49
Q

What is the best drug to use for flukes or tapeworms

A

Praziquantel

50
Q

What areas of the brain are involved in the limbic system?

A 
Septal N
Mammillary bodies
Fornix
Hippocampus
Cingulate Gyrus
51
Q

What cancers cause the most mortality in men and women?

What have the highest incidence?

A

Mortality = lung in both

Incidence =
M: Prostate, Lung, Colon
W: Breast, Lung, Colon

52
Q

What effect does phosphoylating RB have on the cell cycle?

A

It stops Rb from binding (sequestering) E2F and allows the cell cycle to take place (G1–>S phase)

Rb = tumor suppressor gene responsible for retinoblastoma and osteosarcoma

53
Q

What are common tumor suppressor genes?

A 
RB
p53
BRCA 1 and 2
NF1 
NF2 (acoustic schwannomas)
APC

You need 2 hits for all of these to = cancer (1 hereditary and 1 sporatic)

54
Q

What are common proto-oncogenes?

A 
abl = CML (tyrosine kinase)
c-myc = Burkitts (T.F)
n-myc = Neuroblastoma (T.F.)
HER2/neu = Breast/Ovarian (Tyrosine kinase)
bcl-2 = follicular lymphoma
ras = colon cancer (a GTPase)
ret = MEN 2A + 2B + papillary CA of thyroid (tyrosine kinase)
c-kit = GIST
BRAF = melanoma
55
Q

What cancers are associated with a mutation of K-RAS

A

colon, lung, pancreas

56
Q

What are the most common cancers associated with ionizing radiation?

A

AML, CML, and Thyroid CA

57
Q

What is Li Fraumini syndrome?

A

(AD) A genetic inheritance of p53 mutation leading to multiple tumor types (sarcomas, breast, brain, and adrenal are most common)

58
Q

What cancers are associated with tuberous sclerosis?

A

Cardiac Rhabdomyoma
Giant cell astrocytoma
Renal Angiomyolipoma

59
Q

What cancers are associated with Pagets disease?

A

2* Osteosarcoma and Fibrosarcoma

60
Q

What cancer is associated with Plummer Vinson Syndrome?

A

Squam CA of esophagus

61
Q

What is the MOA of Bevacizumab?

A

VEGF M-Ab - inactivates it and cuts off cancers blood supply

62
Q

Most common tumors to metastasize to the brain, liver, and bone?

A

Brain = lung>breast>Genitourinary

Liver = Colon»stomach>pancreas

Bone = Prostate/Breast > lung

Liver and Lung are the most common metz after a local lymph no

63
Q

What are the causes of cachexia in cancer pts?

A

TNF-a

also IFN-y, and IL-6

64
Q

What CA’s are Lambert-Eaton, PTHrP, and Erythropoietin elevation associated with?

A

Lamb = Small Cell Lung (caused by Abs to the presynaptic Ca channels on the NMJ –> weakness will get better with use (opposite of My.Grav.)

PTHrP = SqCC of Lung

EPO = Renal Cell Carcinoma

65
Q

What tumor markers are associated with Ovarian Cancer, Melanoma, Hairy Cell Leukemia, and Pancreatic Adenocarcinoma?

A

Ovarian = CA-125

Melanoma = S-100 (+ BRAF)

Hairy = TRAP

PA = CA-19-9

66
Q

What are the recommendations for breast, cervical, and colon cancer screening tests?

A

Breast: Mammogram every 2 yrs btwn 50-75

Cervical: Pap smear every 3 years starting at 21 (or 3 yrs after sex onset) until 65yo.

Colon: Colonoscopy every 10yrs starting at 50 till 75 (if there is a hx of colon cancer, start it 10 years before the family member got it.)

67
Q

What are the 5 main things MTX can be used to treat?

A
  1. RA (immuno stuff)
  2. Leukemias
  3. Choriocarcinomas
  4. Ectopic Pregnancy
  5. Abortion-induction
68
Q

5-FU

A

MOA: blocks thymidylate synthase (pyrimidine analog which complexes folic acid)

Clx: Colon CA, Basal cell CA, SqCC prevention

Can be rescued with thymidine (NOT leucovorin)

69
Q

Cytarabine

A

MOA: Pyrimidine analog –> blocks DNA polymerization (similar to acyclovir/gancyclovir)

70
Q

Azathioprine and 6-MP

A

MOA: Purine analogs, activated by HGPRT and block PRPP Synthetase

Metabolized by xanthine oxidase, so allopurinol will increase tox

71
Q

Dactinomycin

A

MOA: Intercalates DNA
Indx: Wilms Tumor, Ewings Sarcoma (onion skin bone growth)

72
Q

Doxorubicin and Daunorubicin

A

MOA: generates free radicals & intercalates DNA

Cardiotoxic (cause dilated heart) so you can use Dexrazoxane to chelate iron and prevent cardiotoxicity

73
Q

Bleomycin

A

MOA: free radical formation –> causes DNA strands to break
Indx: Testicular CA
Tox: Pulmonary FIbrosis

74
Q

Cyclophosphamide

A

MOA: Covalent X linkage of DNA
Tox: Hemorrhagic cystitis which can be prevented by pretreating with Mesna.

Can also cause increased risk of transitional cell CA of bladder

75
Q

Nitrosoureas (-Mustines)

A

MOA: Cross BBB and cause CNS problems (can tx brain tumors)

76
Q

Busulfan

A

MOA: Alkylates DNA
Tox: Pulmonary Fibrosis

77
Q

Vincristine and Vinblastine

A

MOA: Block polymerization of microtubules
Tox: Neurotox (cristine), BM suppression (blastine)

78
Q

Paclitaxel

A

MOA: Hyperstabilizes microtubules in M phase
Indx: Breast/Ovarian CA

79
Q

Cisplatin and Carboplatin

A

MOA: Cross link DNA
Indx: Teste CA
Tox: Nephrotoxicity w/ acoustic nerve damage

80
Q

Etoposide and Teniposide

A

MOA: Block topoisomerase II
Indx: Teste CA

81
Q

Hydroxyurea

A

MOA: Blocks Ribonucleotide Reductase

82
Q

What are the effects and side effects of an inhaled anesthetic? (isoflourane)

A

Main goal: CNS depression via increasing GABA (an inhibitor) and affect K channels in neuronal membranes and keep them hyperpolarized.

Side effects:
Cardio: depression w/ increased atrial and ventricular pressures. Results in hypotension and decreased C.O.

Resp: Depress. Decrease Vt and minute ventilation causing hypercapnia and suppress mucociliary clearance –> can cause post surg atelectasis (N.O. does not do this.)

*use halothane and sevoflurane in asthma pts as these bronchodilate.

Brain: decrease vasc resistance, thus increasing cerebral brain flow –> increased ICP

Kidney: decrease GFR and RPF while increasing vasc resistance

Liver: decreased blood flow

83
Q

Slow plaque growth in a vessel can result in compensatory collateral growth and thus spare the myocardium of necrosis and scarring despite vessel occlusion

A

A dense lipid core in a plaque predisposes it to rupturing

84
Q

What accounts for the fact that blood in the left atrium has a lower PO2 than blood in the pulmonary capillaries?

A

The admixture of deoxygenated bronchial blood with the oxygenated blood (shunting)

85
Q

What are the differences in function and diagnostic utility between Rf and anticitrullinated peptide Abs in R.A.?

A

Rf = auto antibodies to the Fc portion of IgG, they are not very clinically specific; can occur in healthy people

Anti-Citrullinated Peptides (Anti CCP) are antibodies to citrullinated peptides. These have a high diagnostic criteria for RA. TRUST THESE

86
Q

What are the effects of Adenosine and Acetylcholine on cardiac pacemaker action potentials?

A

Both act on phase 4

Adenosine: activates K channels and prolong K flow causing membrane potential to be (-) for more time. It also blocks L-Ca++ channels which prolongs the time taken to reach threshold. –> decrease HR

ACh also opens K channels and slows inward Ca++ and Na+ during phase 4

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