April 1 - Cardio, Psych, Derm

Question 1

Embryologic development of venous system

Answer 1

Three systems during development
1. Umbilical veins: connnect to placenta; degenerate
2. Vitelline veins: drain yolk sac; become portal system, including SMA, etc
3. Cardinal veins: become systemic circulation
In fetus, all drain to the sinus venosus (primitive part of heart)

Question 2

Wolff-Parkinson-White syndrome: EKG findings, pathophys, complications

Answer 2

EKG: short PR interval (QRS comes right after P wave), delta wave (early activation of ventricle via bypass tract)

Pathophys: extra bypass tract that can conduct in both directions between atria and ventricles. Sets up for AV re-entrant tachycardia in which loop occurs through bypass tract and AV node

Complication: A fib can be life threatening because can conduct to ventricles through bypass tract. Need to avoid meds that slow AV node conduction as they increase flow through bypass tract

Question 3

Myocardial ischemia: timing and effects

Answer 3

ATP decreases and results in loss of contractility within 60s of total myocardial ischemia.

Ischemis less thatn 30 mins reversible but with prolonged myocardial dysfunction for a few days after restarting blood flow

Ischemia longer than 30 mins results in large decrease in ATP with loss of cell homeostasis and irreversble injury

Question 4

Risk factors for aortic dissection

Answer 4

HTN is single number one risk factor

Question 5

NO synthase

Answer 5

Converts arginine + NADPH + O2 to NO

Question 6

Brachiocephalic vein

Answer 6

External jugular drains scalp and lateral face to R subclavian vein. R subclavian vein drains arm and dumps to brachiocephalic.

IJV drains brain, neck, face and dump into brachiocephalic.

R lymphatic duct also drains to brachiocephalic

Question 7

Other condition associated with congenital QT prolongation

Answer 7

Sensorineural deafness

Question 8

Phenoxybenzamine

Answer 8

Irreversible alpha1 and alpha2 antagonist used to treat pheochromocytoma

Question 9

Phentolamine

Answer 9

Reversible competitive alpha antagonist used to catecholamine induced HTN crisis

Question 10

Fenoldopam

Answer 10

Peripheral D1 agonist that causes vasodilation, esp of renal artery, leading to diuresis and natriuresis.

Question 11

Cilostazol

Answer 11

Decreases platelet activation and causes direct arterial vasodilation. Used in PAD

Question 12

Segmented viruses

Answer 12

Orthomyxoviruses, reoviruses, bunyaviruses, arenaviruses

Question 13

Burkitt lymphoma translocation

Answer 13

t(8;14) c myc and IgH

Question 14

Calcineurin inhibitors; names, MOA, ADRs

Answer 14

Names: cyclosporine and tacrolimus

MOA: inhibit calcineurin, preventing activation of NFAT and production of I-2

Use: Autoimmune disease and transplants

ADRs: DDIs through CYP metabolism. Nephrotoxicity (constricts renal vessels) leading to HTN. Increased uric acid, hyperglycemia. Cyclosporine also causes gingival hyperplasia and hirsutism

Question 15

Sirolumus: MOA, ADRs

Answer 15

Also called rapamycin

MOA: Inhibits mTOR, decreasing response to IL-2, decreasing B and T cell proliferation

ADRs: marrow suppression, hyperlipidemia, hyperglycemia

Question 16

Methotrexate: MOA, ADRs

Answer 16

MOA: Inhibits dihydrofolate reductase. Prevents conversion of dUMP to dTMP, which requires THF.

ADRs: myelosuppression that is reversible with leucovorin/folinic acid. Stomatitis/mucositis. Abnormal LFTs

Question 17

Cyclophosphamide: MOA, use, ADRs

Answer 17

MOA: alkylating agent that causes cross linking of DNA, inhibiting DNA replication

ADRs: myelosuppression, hemorrhagic cystitis (decreased with hydration and mesna), SIADH

Use: vasculitis, glomerulonephritis, chemo

Question 18

Infliximab: MOA, use, ADRs

Answer 18

MOA: anti-TNF monoclonal
Use: RA and Crohns disease
ADR: can reactivate TB

Question 19

Etanercept: MOA

Answer 19

Decoy receptor for TNF alpha

Question 20

Linezolid: use and ADR

Answer 20

Antibiotic that treats resistant gram positive bugs. Has MAOI activity and can precipitate serotonin syndrome in someone on SSRI

Question 21

Alcoholism pharmacotherapy

Answer 21

1. Disulfiram
2. Naltrexone: blocks rewarding/reinforcing effects of alcohol and decreases cravings, only one that can be initiated while still drinking
3. Acamprosate: modulates glutamate transmission at NMDA receptor

Question 22

Fluphenazine

Answer 22

High potency first gen antipsychotic, similar to haloperidol

Question 23

Thioridazine

Answer 23

Low potency first gen antipsychotic, similar to chlorpromazine

Question 24

TCAD- how cause arrhythmias

Answer 24

Cause QT prolongation and QRS widening at high dose by blocking Na+ channels. Leads to arrhythmias

Question 25

Transferance vs displacement

Answer 25

Transference: Shifting of emotions or desires associatied with person from PAST to person in PRESENT Displacement: Expressing unacceptable feelings meant for someone else in present life to someone safer

Question 26

Akathisia

Answer 26

Extrapyramidal side effect. Restlessness, inability to sit still, occurs days to weeks after starting antipsychotic.

Question 27

Tourette disorder diag criteria and treatment

Answer 27

Both multiple motor and 1+ vocal tic (grunting, throat clearing, yelling, etc). Lasts over a year and onset before age 18 Treatment: antipsychotics, alpha agonists, behavioral therapy

Question 28

Schizophreniform vs schizophrenia

Answer 28

Phreniform: 1-6mos Phrenia: over 6 mos

Question 29

Narcolepsy diag test

Answer 29

Low hypocretin-1 in CSF

Question 30

Chronic lymphedema complication

Answer 30

Angiosarcoma 10 yrs later

Question 31

Bullous pemphigoid vs pemphigus vulgaris

Answer 31

Bullous pemphigoid: ABs against hemidesmosomes | Pemphigus vulgaris: ABs against desmosomes

Question 32

Intraductal papilloma

Answer 32

Most common cause of bloody nipple discharge. Papillary cells around fibrovascular core.

Question 33

Fibrocystic change

Answer 33

Diffuse small cysts +/- metaplasia. Cyclic breast pain

Question 34

Fibroadenoma

Answer 34

Small firm mobile mass. Proliferation of stroma and ducts. Stroma can compress ducts to slits.

Question 35

Perineal body

Answer 35

Separates urogenital and anal triangles. Midline epidiotomy goes to it

Question 36

Tuberous sclerosis

Answer 36

Auto dom. Renal angiomyolipomas, brain hamartomas, cardiac rhabdomyomas, ash leaf patches

Question 37

Alkaptonuria

Answer 37

Tyrosine metabolism disorder (Can't convert tyrosine to fumarate). Deficient homogentisic acid dioxygenase. Black color to urine, black pigment on collagen, arthropathy in adulthood

Question 38

Malformation

Answer 38

Intrinsic cell or tissue defect leads to chain of downstream effects.

Question 39

Deformation

Answer 39

Caused by extrnisic mechanical forces

Question 40

Disrupation

Answer 40

Breakdown of previously normal tissue

Question 41

Theophylline intoxication

Answer 41

Seizures, tachyarrhthmia