Block 1 Flashcards by gabrielle thro

Vomitting reflex can be activated by either _____ or _____ stimuli

Humoral or neuronal

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Area postrema in the _______ has chemoreceptor trigger zone that can respond to may nerotrnsmitters, drugs, or toxins

Fourth ventricle

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The _________ in the 4th ventricle has chemoreceptor trigger zone that can respond to many neurotransmitters, drugs, or toxins

Area postrema

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The _____ receives information from teh area postrema, gastroinestinal tract via the vagu nerve, vestibular system ,and central nervous system.

Nucleus tractus solitarius (NTS)

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The nucleus tractus solitarius is in what area of the brain

Medulla

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Neurons from the nuclus tractus solitarius project to other medullary nuclei and coordinate the _______ process

Vomitng

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5 major receptors involved in stimulating the vomiting reflex in the area postrema an adjacent vomiting center nuclei are _____, ______, ______, ______, _______

M1 muscarinic
D2 dopaminergic
H1 hitaminic
5-HT3 serotonergic
Neurokinin 1 (NK1) receptors

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5-HT3 receptor antagonists (odansetrno) and dopamine receptor antagonists (metoclopramid) are particularly helpful for ________ induced vomiting.

Chemotherapy-induced vomiting

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When 5-ht3 receptor antagonists and dopamine receptor antagonists do not control symptoms, _____ receptor antagonists can be consdered; they prevent both aute and delayed emesis associated with chemotherapy.

Nk1 receptor antagonists (prevent substance P release)

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In galactose metabolism, lactose is first broken down into ______ and _______

Galactose and glucose

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Galactose is phosphorylated to galactose-1-phosphate by the enzyme_______

Galactokinase (GALK)

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Excess galactose from a galactokinase (GALK) deficincy is converted to _______-

Galactitol

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Excess galactose is converted to galactitol, an osmotic agent that causes _____

Cataracts

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Excess glactose is converted to galactitol which spills into the urine, causing urine to test positive for a ________substance

Reducing

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Which presents more seriously: a glactokinase (GALK) deficiency or a galactose -1-phosphate uridyl transferaase (GALT) defeciency

GALT
(GALK deficiencies may only present as cataracts while GALT deficiencies present in early noenates as lethargy, vomiting, and failure to thrive)

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The mode of inheritence for glucose 6 phosphate- dehydrogenase (G6PD) deficiency is _____

X linked recessive

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G6PD deficienct causes episodic bouts of hemolysis when red blood cells experience __________

Increased oxidative stress

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How is glucose transported into the cells of most tissues

Facilitated diffusion via glucose transporter proteins (GLUT)

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Transmembrane glucose transporter proteins (GLUT) are steroselectiveand have preference for ___- glucose

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There are _____ codons for amino acids but only ____ amino acids

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More than 1 ________ can code for a particular amino acid

Codon

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The ______ hypothesis sates that the first 2 nucleotide positions on the mRNA codon require tradition base pairing with their complementary nucleotides on tRNA whereas the third “______“nucleotide position may undergo less stringent base pairing

Wobble

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DNA polymerases are the primary enzymes responsible for DNA synthesis, which occurs ____ -> _____ direction

5’ –> 3’

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Prokaryotes such as E. Coli have __ major DNA polymerases

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High fidelity DNA replication is accomplished by the _________ proofreading exonucleas activity of all 3 DNA polyermases in prokaryotes

3'-->5'

High fidelity replication i accomplished by the 3'-->5' "proofreading" ________ activity of all 3 DNA polymerases in prokaryotes

Exonuclease

DNA polymerase __ is unique as it is the only prokaryotic polymerase that also has 5'-->3" exonuclease activity

DNA polymerase I is uniqueas it is the onl prokaryotic polymerase that also has ___________ exonuclease activity

5'-->3'

5'-->3' exonuclease activity functions by removing the ______ created by RNA primase and repair damaged DNA sequences

RNA primer

Warfarin is a ______ antagonist that inhibits epoxide reductase in the liver, thereby preventing gamma carboxylation ________ dependent clotting factors

Vitamin k

Warfarin is a vitamin k antagonist that inhibits _________ in the liver

Epoxide reductase

Vitamin K dependent clotting factors include:

II, VII, IX, X

What effect does Warfarin have on INR

Prolongs the INR

How does change in dietary intake of vitamin K induce risk of subtherapeutirc or supratherapeutic INR while on warfarin therapy?

Increase in dietary vit K intake --> increased availible vit K which counters inhibitory effect of warfarin on epoxide reductase --> subtherapeutic INR

How to antibiotics alter warfarin activity?

The gut flora produces vit K. Gram negative antibiotivs wipe out gut flora --> decreased vit K --> supratherepeutic INR (increases effect of warfarin)

Increased cytochrome P450 2C9 activity _______ warfarin activity

Decreases | Warfarin is metabolized by cytochrome P450 2C9

_______ and ______ drug class are used as antiemetics in motion sickness while ______, ______, and ________ are used as antiemetics in chemotherapy induced emesis

Antimuscarinics (anticholiergics) and Antihistamines | Dopamine receptor antagonists, setotonin receptor antagonists, and neurokinin 1 receptor antagonists

Chronic lung transplant rejection is marked by _____ ____ ______ in the walls of the small airways

Lymphocytic inflammation

_____ lung transplant rejection is marked by submucosal lymphocytic inflammation in the walls of the small aiways

Chronic

Chronic lung transplant rejection is marked by submucosal lymphocytic inflammaion int he walls of the __________

Small airways

In chronic lung transplant rejection, ingrowth of granulation tissue into the lumen leads to ______

Airway obstruction and obliteration: bronchiolitis obliterans

Chronic lung transplant rejection presents ______ after transplant

Month - years

_______ rejection usually ocurs the first day of transplantation

Hyperacute

Hyperacute rejection is caused by preformed host antibodies against _________ or ______

Donor ABO or human leujocyte antigens (HLA)

Histology of hyperacute rejection of lung transplant shows "_________": fibrinoid necrosis with heorrhage and ischemia

White graft reaction

_______ rejection to lung transplant usually occurs within 6 months of transplat

Acute

Acute rejection of lung transplant is typically caused by _____________ to donor human leukcyte antigens

Cell mediated immune response

Histology of acute rejection of lung transplant generally shows ______________ in small blood vessels of the lung which can expand to include alveolar walls

Perivascular mononuclear infiltrates

The most important opsonins (coating proteins) are ________ and ______

Immunoglobulin G and complement C3b

On a table displaying test results and disease status, which axes is disease always on?

X axis

Equation for positive predictive value

PPV = TP/(TP + FP)

Equation for negative predictive value

TN/ (TN + FN)

What study design compares two groups (treatment and a control) in the future for outcome of interest

Clinical trial

What study design compares 2 groups (one with risk factor and one without the risk factor) in the future for disease incidence

Prospective cohort

What study desing reviews past records and compares 2 groups (one has risk factor and other does not) on disease incidence

Retrospective cohort

What study design compares 2 groups (diseased cases and nondiseased controls) in the past to compare risk factor frequency

Case-control

Which study design looks at 2 groups (one with risk factor and other without risk factor) in the present to compare disease prevelance

Cross- sectional

Endurance training can cause a systolic murmur due to ______

Eccentric left ventricular hypertrophy

Strength training can cause what changes to the left ventricle

Concentric left ventricular hypertrophy

Coronary dominance is determined by the coronary artery that:

Supplies blood to the posterior descending artery

The PDA originates in most people (right dominant) from the ______ . In left dominant people, the PDA originates from the _______

Right coronary artery | Left circumflex artery

Involvement of the ________ artery during M.I. Can cause varying degrees of AV block

AV nodal artery (most commonly a branch of the right coronaryartery although can also arise from left circumflex in left dominant)

What is an atheroma

An atherosclerotic plaque

What is released from platelets, activated macrophages, and enothelial cells to trigger smooth muscle cell recruitment from the media and proliferation of the intima?

Growth factors (platelet derived growth factor (PDGF)

Platelet derived growth factor has what effect in the vessels during formation of atherosclerotic plaque

Trggers smooth muscle cell recruitment and proliferation in the intima

A holosstolic murmur at the apex with radiation to the axilla is consistent with _____

Mitral regurge

A _______ murmur at the apex with radiation to the _____- is consistent with mitral regugitation

Holosystolic | Axilla

What extra heart sound is sometimes heard in mitral regurge

Why is an S3 sometimes heard in mitra regurgitation

Blood flowing back into left atria increases left atrial pressure --> more blood reentering let ventricle during systole

Amphotericin B binds ______ to exert antiungal effects

Ergosterol

How does amphotericin B cause toxicity in human tissues

It also binds cholesterol to some degree (suppose to bind ergosterol)

List 3 important adverse effects of amphotericin B

Nephrotoxicity Hypokalemia Hypomagnesemia

Diptheriae has diptheria toxin which inhibits host cell protein synthesis how?

Diptheria toxin inactivates EF-2 via ribosylation

What toxin in Pseudomonas aeruginosa inhibits host cell protein synthesis and how

Exotoxin A inactivates EF-2 via ribosylation (same as diptheriae toxin)

Staph aureus' enterotoxin, a superantigen, is responsible for what symptom of staph

It acts locall on GI tract to cause vomiting

Staph aureus' TSS toxin, a superantigen, leads to what symptoms

TSS toxin stimulates T cells --> wide spread cytokine release and shock

C. Dif's cytoxin B leads to what changes in the intestine

Actin depolymerization --> cell death Necrosis of colonic surfaces Pseudomembrane formation

B pertusis' pertussis toxin disinhibits adenylate cyclase via ____ , increasing cAMP

Gi ADP ribosylation

What is the effect of pertussis toxin increasing cAMP production in host cell?

Increased histamine sensitivity and phagocyte dysfunction

V. Cholerae's cholera toxin activates adenylate cyclase via ______, increasing cAMP production in host cells

Gs ADP ribosylation

What is the result of cholera toxin increasing cAMP production in host cells

Secretory diarrhea, dehydration, and electrolyte imbalances

What is the most common cause of malaria in non african countries

Plasmodium vivax

How is the latent liver phase of plasmodium vivax treated

Primaquine

Verrucous, skin colored genital lesion = _________ (anogenital warts)

Condylomata acuminatum

What virus causes condylomata acuminatum

HPV (specifically types6 and 11)

HPV infects ___________ cells through small breaks in the skin or mucosal surfaces

Basal epithelial cells (specifically stratified squamous epithelium (found in anal canal ,vagina, and cervix)

Infants can aquire respiratory papillomatosis via passage through the birth canal of mothers infected with HPV leading to warty growths on _______ which can lead to weak cry, hoarsness, and stridor

True vocal cords (only part of respiratory tract with stratisfied squamous epithelium)

Positive hepatitis B surface antibody, Negative hep B surface antigen, Negative hep B core antibody reflects what in the patient regarding post or present Hep B infection/vaccination?

Immunization against hep B with no prior hep B infection

CMV is defferentiate from mononucelosis by what negative test result?

CMV is heterophile antibody (Monospot) negative

How might CMV present in immunocompromised patients with reactivated infection?

Severe retinitis , pneumonia, esophagitis, colitis, hepatitis

What is the most common indicator of obesity related restrictive lung disease? (On pulmonary function test)

Reduction in ERV (expiratory reserve volume: maximum volume of air that can be expired after a normal tidal expiration)

What is the ERV on a pulmonary function test

Expiratory reserve volume: max volume of ir that can be expired after a normal tidal expiration

How does perfusion change as you approach the apex of the lung compared to ventilation?

They both decrease but the ventilation only decreases slightly while the perfusion decreases more dramatically --> increased V/Q

What is the diagnosis of a patient with a heavy smoking history, exertional dyspnea, and dilated airspaces on CT scan?

Centriacinar emphysema

Smoking induced emphysema involves oxidative injury to respiratory bronchioles and activation of ____________

Resident alveolar macrophages

Cigarette smoke ctivates resident alveolar macrophages causing inflammatory recruitment of nutrophils. Nutrophils and activated macrophages release ______ that degrade extracellular matrix

Proteases such as elastave but also cathepsins, and metalloproteinases

Where does the protease-antiprotease imbalance lead to irreversible airspace dilation in emphysema?

Distal to the terminal bronchioles

Panacinar emphysema is due to what deficiency?

Alpha-1 antitrypsin deficiency

Centriacinar emphysema is due to what?

Cigarette smoke

INR equation

INR = (PT test/PT normal) ^ ISI (international sensitivity index)

Prothrombin time tests which coagulation pathways

Extrinsic pathwa

What factors are in the extrinsic coagulation pathway and tested in PT?

VII, II, V, X, and fibrinogen

Vitamin K gamma carboxylation is required for ativation of what coagulation factors

II, VII, IX, X

Does aspiring effect INR?

No, it causes prolonged bleeding time but does not increase INR

Name the phospholipid in surfactant

Dipalmitoyl phosphatidylcholine

Inferior epigastric artery is a branch of what artery?

External iliac artery

What stain is used for malaria

Giemsa stain

How is the measles rash described

Maculopapular Starts on face and descends Spares palms and feet

What virus has a vesicular rash

Herpes/chicken pox

Why is a HBV infection required for hepatitis D infection

HBV provides the surgace antigen for HDV envelope

Why are patients not instructed to take nitrates at night?

Decreases tolerance

How to calculate odds ratio>

Set up a 4 x 4 with the disease on x axis | AxD)/BxC

Block 1 Flashcards

(112 cards)