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Flashcards in DIT Deck (236):
1

Kluver Bucy Syndrome clinical features and cause?

Disinhibited
Hyperdocility
Hyperorality
Hypersexuality
Curiosity

Caused by bilateral amygdala lesions

2

Order of human needs as described by Maslow

Self actualization
Esteem
Love and belonging
Safety
Physiological

3

Erikson's stages of development: infant

Basic trust vs. mistrust
birth-18 months

4

Erikson's: Toddler

Autonomy vs. shame
18 months-3 years

5

Erikson's preschooler

Iniitiative vs. guilt
3 years-5 years

6

Erikson's school-age child

Industry vs. inferiority
6-12 years

7

Erikson's adolescent

Identity vs. role confusion
12-18 years

8


Erikson's young adult

Intimacy vs. isolation
18-35 years

9

Erikson's Middle aged adult

Generativity vs. self absorption
35-55 years

10

Older adult

Integrity vs. despair
55 years to death

11

What structural motifs allow for proteins to bind to dNA

helix loop helix
helix turn helix
zinc finger
Leucine zipper protein

12

What are the different RNA polymerases in eukaryotes?

RNA polymerase I: rRNA
RNA polymerase II: mRNA
RNA polymerase III: tRNA

13

Treat ADHD

Methylphenidate and dextroamphetamine
(CNS stimulants, cause release of catecholamines at the synaptic cleft)

or

Atomoxetine (norepinephrine reuptake inhibitor)

14

conduct disorder vs. anti-social personality disorder

less than 18 yo

older than 18

15

Oppositional defiant disorder vs. conduct disorder

Deep down they know its wrong

16

Treatment for tourette

behavioral therapy
fluphenazine
pimozide
tetrabenzine

17

Characteristics of autism spectrum disorder

Living in his own world

early childhood

lack of responsiveness to others

poor eye contact

absence of social smile

impairments in commnication

peculiar repetitive ritualistic habitis

fascination with specific seemingly mundane objects

below normal intelligence

18

Rett disorder

similar presentation to autism spectrum disorder

x linked dominant, seen almost exclusively in girls (homozygous dominant die in utero)

Loss of milestones or developmental regression

Intellectual disability

Ataxia

Loss of verbal abilities

Hand wringing and hand to mouth gestures

19

Causes of transudative pleural effusion

CHF
Cirrhosis
Nephrotic syndrome
Pulmonary embolus
Fluid overload

20

How is emphysema from smoking different than alpha1-antitrypsin deficiency

Smoking-centriacinar

alpha1-antitrypsin deficiency-panacinar

21

Treatment of anorexia

Psychotherapy, nutrtional

22

Signs of bulimia

Enlarged parotid glands
Increased serum amylase
Erosion of enamel of teeth
Hypokalemic hypochloremic metabolic alkalosis

23

Hypokalemic hypochloremic metabolic alkalosis

Stomach puts bicarb into serum to buffer the acid reabsorption, which doesnt happen. so you get alkalotic.

Opposite to DKA, you get hypokalemic b/c the potassium goes into the cells.

Chloride follows H+

24

Treatment of bulimia

SSRI (fluoxetine) with psychotherapy

25

Criteria for anorexia

-Distorted body image
-Intense fear of gaining weight
-Refusal to maintain normal body weight, with BMI

26

Criteria for binge eating disorder

Episodes of binging with sense of lack of control

At least 3/5
-Eating faster
-Eating until uncomfortably full
-Eating large amounts when not hungry
-Eating alone
-Feeling badly about it

Marked distress or remorse
At least 1x/week for 3 months with no compensatory behavior

27

What are the different RNA polymerases in prokaryotes

Only one.
Makes 3 types of RNA

28

What enzyme is deficient in Lesch-Nyhan syndrome?

Treatment

HGPRT (hypoxanthine-guanine phosphoribosyltransferase)

Tx: Allopurinol [for hyperuricemia/gout but mental disorder still present]

29

Causes of an exudative pleural effusion

Pneumonia
Infection
TB
Cancer
Uremia
Connective tissue disease

30

Stages of Behavioral change

Precontemplation
Contemplation
Preparation/determination
Action/Willpower
Maintenance
Relapse

31

Alcohol action

GABA receptors (like benzodiazepine and barbiturates)

32

Alcohol withdrawal symptoms

agitation
anxiety
insomnia
tremor
formication
Deliirium tremens is severe

33

Delirium tremens

2-3 days after cessation of alcohol (often seen in post op)

seizures and extreme autonomic hyperactivity

34

Treatment of alcohol withdrawal

Benzodiazepines
Alcohol

35

Screening for alcoholism

CAGE
Cut back
Annoyance
Guilt
Eye-opener

36

Wernicke Korsakoff syndrome

Where does damage happen

Treatment

What to NOT DO

Thiamine (B1) deficiency

Wernicke encephalopathy (acute)
and
Korsakoff syndrome (long term consequence)

Damage to
-Medial thalamus
-Mammillary bodies of posterior hypothalamus

Tx: IV thiamine

DO NOT give glucose without thiamine first. because active thiamine is required for metabolism of glucose.

37

Wernicke encephalopathy

Confusion
Nystagmus
Ophthalmoplegia
Ataxia
Sluggish pupillary reflexes
Coma and death if untreated

38

Korsakoff syndrome

Anterograde amnesia
Retrograde amnesia
Confabulation
Hallucinations

39

Long term treatment of alcoholism

-AA: is tried and true best relapse prevention

-Naltrexone (also opioid antagonst)

-Disulfiram [inhibits acetylaldehyde dehydrogenase]

-Topiramate [affects glutamate receptors, also used for migraine prevention and seizures]

-Acamprosate (campral) [also affects glutamate receptors]

40

Time frame for schizophrenia

>6 months

41

Time frame for brief psychotic episode

42

Time frame for schizophreniform

1-6months

43

Criteria for schizoaffective disorder

Psychotic symptoms for 2 weeks or more in absence of mood disorder

AND

A time period with BOTH psychosis and a major mood disorder episode at the same time

44

Positive symptoms of schizophrenia

Theory

delusions
halucinations
disorganized speech
Grossly disorganized/catatonic

Increased dopamine to mesolimbic system

45

Negative symptoms of schizophrenia

Theory

alogia
avolition
affective flattening
social withdrawal
thought blocking
poor grooming

Decreased dopamine to mesocortical

46

How long does a delusional disorder last?

>1 month

47

Characteristic finding for EM of dendritic cell with Langerhans cell histiocytosis

Birbeck granules, "Tennis rackets"

48

Low potency typical antipsychotics

Chlorpromazine
Thioridazine

49

SE of low potency typical antipsychotics

Anticholinergic SE
Block D2 dopamine receptors
Block muscarinic receptors
Block alpha1 receptors--> Hypotension
Block histamine receptors-->Sedation

50

High potency typical antipsychotics

Haloperidol
Fluphenazine
Loxapine
Thiothixene
Trifluoperazine

51

SE of high potency typical antipsychotics

Fewer anticholinergic,
EPS/Tardive dyskinesia
NMS

within first several days: acute dystonia and torticollis. Treat wtih antimuscarinic or anticholinergic drug (benztropine or diphenhydramine)

within first month: parkinsonism (bradykinesia, akinesia)

within 2 months: Akathisia (restlessness

Several months-years: Tardive dyskinesia (not an EPS). lip smacking. irrev.

52

SE Atypical antipsychotics

Fewer EPS
Fewer anticholinergic
Weight gain

53

Atypical antipsychotics

Olanzapine
Quetiapine
Risperidone
Aripiprazole
Clozapine

54

NMS symptoms

treatment

Deliirium and altered mental status
Autonomic instabliity
Muscle rigidity
Myoglobinuria
Hyperpyrexia

tx: Dantrolene [also used for malignant hyperthermia]
or dopamine agonist (bromocriptine)

55

Mech of atypical antipsychotics

block dopamine receptors
block serotonin receptors
block alpha-receptors:hypotension
block histamine receptors:sedation and wt gain. (especially olanzapine, also diabetes)

56

Clozapine

Strongest most effective atypical antipsychotics

But Agranulocytosis!! so need to check CBC weekly. Ergo third line antipsychotic.

57

Quetiapine

treat psychosis from parkinson meds

Lowest risk of EPS

58

Mania

>1 wk. distinct period of abnormally and persistently elevated, expansive or elevated mood.

SEveree enough to cause
-marked impairment in social or occupation function
-require hospitalization
-psychotic features

DIGFAST

59

DIGFAST

MANIA

Distractibility
Irresponsibility
Grandiosity
Flight of ideas
Activity/agitation
Sleep (decreased need)
Talkativeness/pressured speech

60

Hypomania (why different than mania)

same symptoms but less severe

>4 days

No marked impairment in social or occupational functioning!

61

Bipolar I disorder
Bipolar II disorder

1 manic episode

vs. Hypomanic episode and 1 episode of major depression

62

NT changes in Depression

Decreased Dopamine
Decreased Serotonin
Decreased NE

63

NT changes in Mania

Increased serotonin
Increased NE

64

Cyclothymic disorder

at least 2 years of mild hypomanic and mild depressive symptoms.

with no periods of normal mood longer than 2 months!

65

Treatment of bipolar disorder

Lithium

Atypical antipsychotics
-Risperidone
-Aripiprazole
-Olanzapine

Antiepileptic
-Lamotrigine
-Valproic acid
-Carbamazepine

66

SE of lithium

sedation and dizziness
tremors
sick sinus syndrome
bradycardia
heart block
hypothyroidism
goiter
polyuria (blocking ADH action by blocking the luminal Aquaporin channels)-->Nephrogenic diabetes insipid
Ebstein anomaly

67

Ebstein anomaly

Tricuspid leaflets are displaced inferiorly into the right ventricle

Hypoplasia of the right ventricle

Tricuspid regurgitation or stenosis

Patent foramen ovale

68

Most common SE of lithium to occur rapidly (or any other time)

tremor

69

SSRI drugs

Fluoxetine
Paroxetine
Sertraline
Fluvoxamine
Escitalopram
Citalopram

70

SNRI drugs

Venlafaxine
Duloxetine
Desvenlafaxine

71

TCAs drugs

Desipramine
Nortriptyline
Imipramine
Amitriptyline
Doxepin

72

MAOI drugs

Tranylcypromine
Phenelzine
Isocarboxazid

73

MDD with seasonal pattern

>2 years
2 major depressive episodess
2 year time frame
No non-seasonal episode of MDD during the 2 years

74

SADPERSONS

Sex (males)
Age (45)
Depression
Previous attempt
Ethanol/drug use
Rational thinking (loss)
Sickness
Organized plan
No spouse/no social support
Stated future intent

75

SSRI

Citalopram
Fluoxetine
Paroxetine
Sertraline

76

serotonin syndorme

treatment

hyperthermia
hyperreflexia/myoclonus
autonomic instability
flushing
diarrhea
MSC


Tx:
-Cooling down
-Benzodiazepines
-Stopping the medications

-Cyproheptadine (serotonin antagonist, but not first line)

77

SNRIs

Desvenlafaxine
Venlafaxine
Duloxetine (also approved for neuropathic pain)
Milnacipran (only for fibromyalgia, not depression)

78

TCAs

Amitriptyline
Nortriptyline
Imipramine
Desipramine
Clomipramine
Doxepin
Amoxapine

79

TCAs and their uses

Imipramine-enuresis
OCD-clomipramine
Fibromyalgia-amitriptyline
Neuropathic pain-amitriptyline

80

TCA SE

and Tx

Convulsions
Coma
Cardiotoxicity
Respiratory depression
Hyperpyrexia
Confusion and hallucination

if CV toxicity-->Sodium bicarbonate (because trap the weak acid TCA in the urine and excreted)

81

MAOI

Tranylcypromine
Phenelzine
Isocarboxazid
Selegilene (not antidepressant, MAO-B just for dopamine for parkinsonism)

82

MAOI SE

Hypertensive crisis (tyramine ingestion).

83

Atypical antidepressants

Bupropion
Mirtazapine
Trazodone

84

Bupropion
use

mech

SE

Smoking cessation
antidepressant

inhibits reuptake of norepinephrine and dopamine

-Lowers seizure threshold
-stimulant (don't use at night)
-NO SEXUAL SE, so can use in lieu of SSRI

85

Mirtazapine
Mech

SE

alpha2 antagonist, promoting further norepinephrine release.
similar to SSRI except serotonin2 and serotonin3 receptor antagonist

SE:
-Sedation
Increased appetite
-Wt gain
-Dry mouth

86

Trazodone
Mech

Use

SE

inhibits serotonin reuptake

not for depression because would require too high dose. used for insomnia.

along with bupropion can be used as adjunct for SSRI or SNRI

SE:
-Sedation
-Priapism

87

Seronegative spondyloarthropathies

PAIR

Psoriatic arthritis
Ankylosing spondylitis
Inflammatory Bowel disease
Reactive arthritis (Reiter syndrome0

88

Hartnup disease

Deficiency of transporter for neutral AA (tryptophan)

Can't make niacin-->pellagra
Dermatitis
Diarrhea
Dementia
Death

89

Full saturation of glucose transporters

Begin spilling at 160
Fully saturated at 350

90

Psamomma bdoesis

Papillary adenocarcinoma
Serous cystadenocarcinoma of the ovary
Meningioma
Mesothelioma

91

lyti8c bone lesions on xray

multiple myeloma

92

What are the toxins for strep pyogenes

Streptolysin O-hemolysis on blod agar plates, oxygen labile

Streptolysin S-oxygen stable

Streptococcal pyrogenic exotoxins type A, B, and C- erythrogenic toxins

93

What is HUS

Hemolytic uremic syndrome

O157:H7 serotype E. coli

Hemolytic anemia
Thrombocytopenia
Acute renal failure

94

How are organic anions secreted in the proximal convoluted tubule?

Alpha ketoglutarate/Organic anion antitransporter.

Alpha ketoglutarate is brought into cell by Alpha ketoglutarate/Na+ cotransporter.

Na/K ATPase sets up gradient

95

How are organic cations secreted into the proximal convoluted tubule?

3Na2K ATPase, sets up electrical gradient.

Organic cation/H+ cotransporter

96

What are the Tubular Fluid/Plasma concentrations of various substances along the proximal tubule?

PAH steepest

Creatinine and Inulin linearly up

Urea

Chloride

Potassium and sodium along the 1.0 line (slightly above , potassium slightly hgiher)

Phosphate below,

Amino acids and Glucose very much lower

97

What class of drugs inhibits the Na+/2Cl-/K+ symporter int he thick ascending limb and what is the result

Loop diuretics, leading to isotonic H2O secretion

98

Where does PTH act on the kidney?

Early distal tubule: increase Ca2+/Na+ exchange-->Calcium reabsorption

Early proximal convoluted tubule: Inhibits Na+/PO4 cotransport-->Phosphate excretion

99

What are the 2 types of cells composing the collecting duct and the last segment of the distal tubule? What do they do?

Principal cells:
-Reabsorb H2O and Na+
-Secrete K+

Intercalated cells:
-Secrete H+ or HCO3-
-Reabsorb K+

100

What are the two types of intercalated cells

Alpha cells-->Secrete H+
Beta cells--> Secrete HCO3-

101

What are the potassium sparing diuretics?

Aldosterone antagonists
-Spironolactone
-Eplerenone

Inhibit epithelial Na+ channels
-Triamterene
-Amiloride

102

What effect does aldosterone have on the principal cells and intercalated cells

Principal cells: reabsorption of Na+ and secretion of K+

Intercalated cells: Stimulates the secretion of H+

103

What happens at the thick ascending limb?

H2O impermeable

Ca2+ and Mg2+ are reabsorbed

Na/2Cl/K cosymporter is inhibited by loop diuretics

104

What are the uses for mannitol

Drug overdose, increased ICP, increased intraocular pressure (use for acute close angle glaucoma)

105

What are the uses for acetazolamide

Chronic glaucoma, urinary alkalinization,metabolic alkalosis, altitude sickness, pseudotumor cerebri

106

What are the loop diuretics

Furosemide
Bumetanide
Torsemide
Ethacrynic acid (not a sulfa drug)

107

SE to Furosemide

OH DANG!

-Ototoxicity
-Hypokalemia
-Dehydration
-Allergy
-Nephritis
-Gout

ototoxicity and nephrotoxicity when given with aminoglycoside

108

Uses for thiazides

-HTN
-Idiopathic hypercalciuria (unless serum is also high as n hyperPT)
-Nephrogenic diabetes insipidus

109

SE of thiazides

Hypokalemia
Hyponatremia
Hyperglycemia
Hyperlipidemia
Hyperuricemia
Hypercalcemia

-Sulfa allergy!

110

Treatment of central DI

Intranasal desmopressin

111

Treatment of nephrogenic DI

Hydrochlorothiazide (increase proximal reabsorption)

Indomethacin (2nd line or adjunct), inhibit prostaglandin synthesis and decrease renal blood flow and renal output

112

Treatment for nephrogenic DI lithium induced

Amiloride, blocks the sodium channels that lithium uses to enter the prinicpal cell

113

Causes of increased anion gap metabolic acidosis

MUDPILES
Methanol
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tablets or isoniazid
Lactic acidosis
Ethylene glycol
Salicylate

114

Causes of normal anion gap metabolic acidosis

HARD-ASS
Hyperalimentation
Addison disaease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion

115

what nerve runs with anterior interosseous artery

anterior interosseous nerve

116

What nerve runs with posterior interosseous artery

deep branch of the radial nerve

117

what nerve runs with the posterior circumflex artery

axillary nerve

118

what nerve runs with the suprascapular artery

suprascapular nerve

119

What nerve rusn with the thoracodorsal artery

thoracodorsal nerve

120

what nerve runs with the deep brachial artery

radial nerve

121

what nerve rusn with the dorsal scapular nerve

dorsal scapular nerve

122

what nerve runs with the lateral thoracic artery

long thoracic nerve

123

what nerve runs with the ulnar artery

ulnar nerve

124

what nerve runs with the brachial artery

medial nerve

125

what causes a rash on the palms and soles

secondary syphilis
rocky mountain spotted fever
coxsackie A virus
Kawasacki disease

126

Causes of Nephritic syndorme

-Acute poststreptococcal glomerulonephritis
-Rapidly progressive glomerulonephritis
-Berger disease (IgA glomerulonephropathy)
-Alport syndrome

127

Causes of Nephrotic syndrome

Focal segmental glomerulosclerosis
Membranous nephropathy
Minimal cahnge disease
Amyloidosis
Diabetic glomerulonephropathy

128

What can present as boh nephritic and nephrotic

Diffuse proliferative glomerulonephritis

Membranoproliferative glomerulonephritis

129

What is associated with IgA nephropathy? also what is the other name for IgA nephropathy

aka Berger disease

Seen with Henoch-Schonlein purpura

130

When does IgA nephropathy present

with URI or acute gastroenteritis

131

What is cause for Alport syndrome

Mutation in type IV collagen leading to thinning and splitting of the glomerular basement membrane. Most commonly x linked

132

Presentation for Alport syndrome

Cant See, cant Pee, cant hear high C

Glomerulonephritis
Deafness
Eye problems

133

If kidneys and lungs are attacked (Hematuria/hemoptysis).. you should think of

Goodpasture syndrome
and
Granulomatosis with polyangiitis (Wegeners'

134

What are the possible causes of Rapidly progressive (crescentic) glomerulonephritis

Goodpasture syndrome

Granulomatosis with polyangiitis

Microscopic polyangiitis

Lupus

135

What is notable about minimal change disease?

What causes it.

Treatment.

Effacement of foot processeses

Most common cause of nephrotic syndrome in children, triggered by infxns or immunizations

Tx: Corticosteroids

136

causes of membrano-proliferative glomerulonephritis

Hepatitis b
Hepatitis C
Lupus
Subacute bacterial endocarditis

137

sign of membrano-proliferative glomerulonephritis

Tramtrack appearance of GBM splitting caused by mesangial ingrowth

Subendothelial immune complex deposits with granular IF

138

sign of membranous nephropathy

Spike and dome appearance with subepithelial deposits

139

signs of diabetic glomerulonephropathy


eosinophilic round acellular nodules within the glomeruli (Kimmelstiel noduels)

Nonenzymatic glycosylation of GBM, increased permeability and thickening

Nonenzymatic glycosylation of efferent arterioles, increased GFR, mesangial expansion

140

Linear pattern of IgG deposition on IF

Goodpasture syndrome

141

Lumpy bumpy deposits of IgG, IgM, and C3 in the mesangium

Poststreptococcal glomerulonephritis

142

Deposits of IgA in the mesangium

IgA nephropathy

143

Anti-GBM antibodies, hematuria, hemoptysis

Goodpasture syndrome

144

Nephritis, deafness, cataracts

Alport syndrome (xlinked mutation in type IV collagen)

145

Crescent formation in the glomeruli

rapidly progressive glomerulonephritis

146

Wire-loop appearance on LM

Diffuse proliferative glomerulonephritis

147

Nephrotic syndrome associated with HIV

focal segmental glomerulosclerosis

148

Nephrotic syndrome associated with Hep B

Membranoproliferative glomerulonephritis

149

EM:spiking of the GBM due to subendothelial depostis

Membranous nephropathy

150

nodular hyaline deposits in the glomeruli

Kimmelstiel wilson onodules (diabetic nephropathy)

151

Glomerulonephritis plus pulmonary vasculitis

Granulomatosis with polyangiitis
Goodpasture syndrome

152

What nerve most likely damaged in fibular neck fracture

deep peroneal nerve

153

RBC cast

glomerular damage

154

WBC cast

acute pyelonephritis

155

Bacterial cast

pyelonephritis

156

Epithelial cell cast

ATN (acute tubular necrosis), toxic ingestions

157

Waxy cast

Chronic renal failure

158

Hyaline cast

nonspecific, can be normal, often in concentrated urine samples

159

Fatty cast

nephrotic syndrome

160

Granular cast

ATN, acute tubular necrosis, chronic renal disease

161

What are the different types of kidney stones in order of occureance

Calcium (80%) (oxalate or phosphate or both)
Ammonium magnesium phosphate (15%)
Uric acid (5%)
Cystine (1%)

162

which kidney stone type is radiolucent (not seen on xray). but seen on CT or ultra sound

Uric acid

163

Calcium kidney stones treatment

causes

thiazides and citrate

hypercalciuria
-cancer
-increase pth
-ethylene glycol (calcium oxalate)
-increased vitamin c (Calcium oxalate)

164

ammonium magnesium phosphate causes

how can it present

tx

urease positive bugs (proteus mirabilis, staphylococcus, klebisella) that hydrolyze urea to ammonia leading to urine alkalinization.

can present as staghorn calculi

tx: eradiction of underlying infxn and surgical removal of stone

165

Cystine stone presentation and treatment

Can form staghorn calculi

tx: alkalinize urine

166

Wilms tumor

most common renal malignancy of children 2-4 yo

Hematuria, large flank mass

Deletion of WT1 or WT2 on chr 11

assoc with WAGR complex

167

WAGR complex

Wilms tumor
Anidiridia (lack of iris)
Genitourinary malformation
Retardation

168

Transitional cell carcinoma

most common tumor of urinary tract system (can occur in renal calycyes, renal pelvis, ureters, bladder)

Painless hematuria (no casts) suggests bladder cancer

Risks:
-Phenacetin
-smoking
-Aniline dyes
-Cyclophosphamide

169

drug induced acute interstitial nephritis features

fever
rash
eosinophilia
azotemia

170

thyroid like appearance of kidney

chronic pyelonephritis

171

Cholinesterase inhibitor poisoning presentation

DUMBBELSS

Diarrhea
Urinatin
Miosis
Bronchospasm
Bradycardia
Excitation
Lacrimation
Sweating
Salivation

172

Blocking parasympathetic presentation

DUMBBeLSS (skeletal muscle and CNS excitation are mediated by nicotinic receptors)

Hot as a hare
Dry as a bone
Red as a beet
Blind as a bat
Mad as a hatter

173

1st aortic arch forms what

Part of maxillary artery (Branch of external carotid)

[1st arch is maximal]

174

2nd aortic arch forms what

Stapedial artery and hyoid artery

175

3rd aortic arch forms what

Common carotid artery and proximal part of internal carotid artery

176

4th aortic arch forms what

On left, aortic arch; on right, proximal part of right subclavian artery

177

6th aortic arch forms what

Proximal part of pulmonary arteries and (on left only) ductus arteriosus)

178

Branchial clefts derived from what

derived from ectoderm

aka branchial grooves

179

Branchial arches derived from what

derived from mesoderm (muscles, arteries) and neural crest (bones, cartilage)

180

Branchial pouches derived from what

derived from endoderm

181

Branchial cleft derivatives

1st cleft-->external auditory meatus

2-4 clefts form temporary cervical sinuses obliterated by proliferation of 2nd arch mesenchyme

182

1st branchial arch

Cartilage
-Meckel cartilage: Mandible, Malleus, incus, spheno-Mandibular ligament

Muscles
-Muscles of Mastication (temporalis, masseter, laterla and medial pterygoids), mylohyoid, anterior belly of digastric tensor tympany, tensor veli palitini)

Nerves
-CN V2, and V3 (chew)

183

Abnormality in 1st branchial arch

Treacher Collins syndrome (mandibular hypoplasia, facial abnormalities)

184

2nd branchial arch

Cartilage
-Stapes, styloid process, lesser horn of hyoid, stylohyoid ligament

Muscles
-Muscles of facial expression (Stapedius, Stylohyoid, platySma, belly of digastric)

Nerves
-CN VII (facial expression, smile)

185

abnormality in 2nd branchial arch

Congenital pharyngocutaneous fistula (persistence of cleft and pouch-->fistula between tonsillar area and lateral neck)

186

3rd branchial arch

Cartilage
-Greater horn of hyoid

Muscles
Stylopharyngeus, innerv by the glossopharyngeal nerve

Nerves
CN IX (stylopharyngeus) swallow stylishly

187

4-6th branchial arches

Cartilage
-Thyroid
-cricoid
-arytenoids
-corniculate
-cuneiform

Muscles
4th: most pharyngeal constrictors, cricothyroid, levator veli palitini

6th: all intrinsic muscles of larynx except cricothyroid

Nerves
4th: -CN X (superior laryngeal branch), simply swallow

6th: -CN X (recurrent laryngeal pbranch) [speak]

188

clinical consequence of a glycolytic enzyme deficiency

Hemolytic anemia (no ATP for Na/K ATPase resulting in RBC swelling and lysis)

189

Rate limiting step in glycolytic pathway

phosphofructokinase-1

190

How does insulin or glucagon control glycolytic pathway

Glucagon receptor, Adenyl cyclase, PKA, then the phosphorylation of the PFK-2/FBP-2 complex causes FBP-2 action

results in decreased Fructose-2,6 bisphosphate


Conversely, increased insulin to glucagon ratio decreases AC, decreases PKA, hypophosphorylates the enzyme complex resulting in greater PFK-2,

results in increased Fructose-2,6 bisphosphate, resluting in sitimulated PFK-1 to go through glycolytic pathway

191

what part of basal ganglia if lesioned causes hemiballismus and how

subthalamic nucleus lesioned in a lacunar stroke.

192

Open angle glaucoma presentation

Risk factor

Risk factor:
>40,
black,
diabetes

Common, insidious form, bilateral
early: asymptomatic
late: areas of reduced/absent vision; contraction of visual field (peripheral to central)

193

acute angle closure glaucoma

emergency
abrupt onset of pain, nausea, colored halos, rainbows around light

red teary eye with hazy cornea and fixed, mid dilated pupil (not reactive to light), that is firm to palpation

194

What are the retroperitoneal abdominal structures

SAD PUCKER
A DUCK PAIR

Adrenal glands
Duodenum (2,3,4 parts)
Ureters
Colon (descending and ascending)
Kidneys
Pancreas (not tail)
Esophagus (south of diaphragm)
Aorta
Rectum

195

Gluconeogenesis enzymes

1. Pyruvate carboxylase (with biotin)
2. PEP carboxykinase

3. Fructose-1,6-bisphosphatase

4. Glucose-6-phosphatase

196

where can gluconeogenesis take place?

Hepatocytes
Kidney
Intestinal epithelium

197

Gibbs free energy equation

deltaG=deltaH-T*deltaS


H=energy/enthalpy (heat change in constant pressure rxns)

S=entropy/disorder/randomness

198

pathway of aqueous humor

ciliary body production
posterior chamber
anterior chamber,
reabsorbed by canal of schlemm

199

metoclopramide mechanism

antagonist at the dopamine D2 receptor
Serotonin agonist

increases contractility in the GI tract

200

What are the 2 functions of debranching enzyme

transferase 4-alpha-D-glucanotrasnferase (brings 3 of the 4 to the end of the other strand)

alpha-1,6 glucosidase (cleaves off remaining as glucose)

201

What are the glycogen storage diseases and their mechanism?

-McArdle (deficiency in glycogen phosphorylase) aka Glycogen storage disease type V

-Von Gierke disease (deficiency in glucose-6-phosphatase) aka Glycogen storage disease type I

-Cori's disease (deficiency in alpha-1,6-glucosidase) aka Glycogen storage disease type III

-Pompe disease (deficiency of alpha-1,4 glucosidase in the lysosomes) aka Glycogen storage disease type II

202

McArdle disease (type V)

Mech

presentation

life expectancy

Mech: (glycogen buildup-->osmotic, lyse)


Rhabdomyolysis
-Myoglobinuria
-Renal failure
Muscle cramping

Normal life expectancy

203

Von Gierke disease (Type I)

mech

presentation

treatment

Mech: (liver, enterocytes, kidney) cannot share glucose

Severe fasting hypoglycemia
Hepatomegaly
Enlargement of the kidneys
Elevated serum lactate
Elevated uric acid
Hypertriglyceridemia

tx: feed patient frequently, overnight give cornstarch

204

Cori disease (Type III)

mech

presentation

Mech: (defect in debranching enzyme. cannot break alpha1,6 linkages). like milder von gierke

milder hypoglycemia
no elevation in lactate levels
no elevation in uric acid

205

Pompe disease (Type II)

Mech

Presentation

Mech: (Deficiency of alpha-1,4 glucosidase in the lysosomes)

2 forms:
*Infantile form
-severe muscle weakness
-cardiomegaly and heart failure
-shortened life expectancy

*Adult form, some activity but less than normal
-No cardiac involvement
-Gradual onset of skeletal muscle weakness
-Diaphragm weakness
-Respiratory failure

206

Limiting rate enzyme for
De novo pyrimidine synthesis
De novo purine synthesis
Glycolysis
Gluconeogenesis
Glycogne synthesis
Glycogenolysis
TCA cycle
Hexose monophosphate shunt


Carbamoyl phosphate synthetase-2
Glutamine PRPP amidotransferase
Phosphofructokinase-1
Fructose-1,6-bisphosphatase
Glycogen synthase
glycogen phosphorylase
isocitrate dehydrogenase
Glucose-6-phosphate dehydrogenase

207

what enzyme catalyzes the rate limiting step in carbohydrate digestion

oligosaccharide hydrolases at brush border

208

what enzymes are involved in the TCA cycle that we should know

Citrate synthase
Isocitrate dehydrogenase (RLS)
alpha-Ketoglutarate dehydrogenase (TLC For Nobody cofactors same as PDH)

209

What cofactors are needed for pyruvate dehydrogenase

TLC For Nobody
(same as for alpha-ketoglutarate dehydrogenase)

Thiamine (B1)
Lipoic acid
Coenzyme A (B5)
FAD (B2)
Niacin (B3)

210

Uncoupling agents

Thermogenin
Aspirin
2,4-DNP (dinitrophenol)

211

Disruptions in mitochondrial electron transport

Complex 1 (NADH reductase): Amytal/Rotenone/MPP
Complex III (Cytochrome b+c1): Antimycin A
Complex IV (Cytochrome a+a3): CN/N3-/CO/H2S
H+ATPase: Oligomycin A

212

What are the nitrogen carriers in the blood

alanine and glutamine

213

required cofactor of all aminotransferases

Pyridoxal phosphate (deriv of vitamin B6)

214

what are the 2 most important aminotransferases and what do they catalyze

-Alanine aminotransferase (alanine and alpha-ketoglutarate goes to glutamate and pyruvate)

-Aspartate aminotransferase (glutamate and oxaloacetate goes to alpha-ketoglutarate and aspartate)

215

causes of acute pancreatitis

BAD HITS
biliary causes
alcohol
Drugs
hypertriglyceridemia/hypercalcemia
idiopathic
trauma (ERCP)
scorpion sting

216

enzymes for red cells to detoxify hydrogen peroxide

Glutathione peroxidase
Glutathione reductase
Glucose-6-phosphate dehydrogenase

217

enzymes for production of ROS

NADPH oxidase
Superoxide dismutase
Myeloperoxidase

218

oxidative substances

Anti-malarial drugs (primaquine and chloroquine)
Nitrofurantoin
Dapsone
Sulfonamides
Isoniazid
Naphthalene
Fava beans
Ibuprofen
High dose ASA (Aspirin)

219

Glucose-6-phosphate dehydrogenase deficiency presentation

Hemolytic anemia
Heinz bodies
Bite cells

220

Prophylaxis for all malaria species except P. falciparum

Chloroquine
(safe during pregnancy also)

221

Prophylaxis for resistant strais of P. falciparum

Atovaquone-proguanil recommended
Mefloquine is alternative drug

222

Tx for P.vivax/ovale

Chloroquine plus primaquine

223

Tx for P. falciparum

Chloroquine sensitive: Chloroquine without primaquine

Chloroquine resistant: quinine sulfate and doxycycline

224

Essential fructosuria cause

presentation

Deficiency in Fructokinase

builds up in blood and spills into urine. BENIGN. just can't use fructose as a energy source

225

Fructose intolerance

Mech

Presentation

Tx:

Deficiency in Aldolase B. Buildup of Fructose 1-P, end up inhibiting glycogenolysis and gluconeogenesis. cannot correct fasting hypoglycemia.

Hypglycemia and vomiting (esp after consuming fructose or sucrose)

Tx: decrease intake of fructose and sucrose

226

Galactokinase deficiency mechanism

presentation

lack of galactokinase. accumulation of galactitol (accumulates in blood and urine)-->cataracts

227

Classic galactosemia mech

presentation

Treatment

deficiency of Galactose-1-phosphate-uridyltransferase

hepatomegaly, jaundice, failure to thrive, intellectual disability

tx: exclude lactose and galactose

228

Lactase deficiency

lactose passes into the colon, bacteria consume.

-gas
-bloating, cramping, flatulence
-osmotic diarrhea

tx: supplement lactase in diet
avoid dairy products

229

rate limiting step ofpentose phosphate pathway

G6PD

230

what tissues use the pentose phosphate pathway

RBC
liver
Adrenal cortex
Mammary glands

(reducing reactive oxygen species, and for making cholesterol and fatty acids)

231

tx iron overdose

Dferoxamine

232

tx Mercury, Gold, Arsenic

Dimercaprol (BAL)

233

tx Acetaminophen overdose

N-acetylcysteine

234

tx: copper overdose

penicillamine

235

tx: lead posoning

EDTA (Ethylenediamine tetraacetic acid)
or
Succimer

236

Associations with primary biliary cirrhosis

Can have IBS (like UC)

Cholangiocarcinoma
Gallbladder carcinoma
Colorectal carcinoma (huge risk when you have BOTH PSC AND UC)