March 29 Flashcards by Caleb Liberman

Anti arrhythmic that can cause 2nd degree AV block

diltiazem and verapamil

also cause constipation, bradycardia

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Polycythemia vera

intense itching after hot shower, facial plethora (reddish complexion), splenomegaly

increased: RBCs, WBCs, Platelets

JAK2 mutation –>

JAK is an cytoplasmic receptor tyrosine kinase; EPO receptor signal transduction –> JAK2 –> clonal proliferation of myeloid cells

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Cytoplasmic tyrosine kinase

aka non-receptor tyrosine kinase

JAK2/STAT

implicated in polycythemia vera, primary myelofibrosis, myeloproliferative disorders

prolactin, IL-2, IL-6, IFN, GH, EPO

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Intrinsic receptor tyrosine kinases

receptors for insulin, insulin-like growth factor, and epidermal growth factor (EGFR)

think growth factors: IGF-1, FGF, PDGF, EGFR

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Glucagonoma

rare pancreatic alpha cell tumor
causes DM and necrolytic migratory erythema

necrolytic migratory erythema - painful and pruritic rash @ face/groin/extremities

“crusting and scaling at the borders with central areas of brownish induration” + superficial necrolysis

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VIPoma

WDHA

Watery Diarrhea Hypokalemia Achlorhydria

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Dog Bite

Pasteurella multocida

gram negative cocobacillus

mouse smell on culture

mouse-like odor = indole+

cellulitits at site of bite

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Fight Bite (human)

Eikenella corrodens

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Cat Bite

Pasteurella multocida (cellulitis) 
Bartonella henselae (lymphangitis)

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Autosomal Dominant Polycystic Kidney Disease

85% due to mutation PKD1 @ Chr16
15% due to mutation PKD2 @ Chr4

associated with berry aneurysm (–> subarachnoid hemorrhage), mitral valve prolapse, hepatic cysts

tx: ACEi or ARB

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most common cause of bacterial meningitis in adults

Strep pneumo

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Transtentorial aka Uncal Herniation

ipsilateral mass lesion (hemorrhage or brain tumor) esp @ temporal lobe

first sign is impingement on CN III –> fixed dilated pupil (ipsilateral) + ptosis + down and out gaze

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Hereditary Orotic Aciduria

defect in uridine 5’-monophosphate synthase –> elevated orotic acid levels - defect in pyrimidine synthesis

delayed developmental milestones and megaloblastic anemia

Uridine supplementation

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Ligamentum Flavum

thickening can cause central spinal stenosis and compression of nerve roots –> pain/numbness/paresthesia

located between cord and spinus processes

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posterior rostral pons at the lateral floor of the fourth ventricle

locus ceruleus

produces norepinephrine

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Rifampin

inhibits DNA dependent RNA polymerase

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hippocampus and cerebral arterioles with patchy red deposits that turn green under polarized light

Alzheimers

beta amyloid plaques

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Crohns

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mediated by Th1 –> granulomatous inflammation

hyperemic and edematous bowel, cobblestone appearance, non-caseating granuloma, transmural inflammatory infiltrate

risk of kidney stone due to hyperoxaluria

Risk Factors for Nephrolithiasis

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Low fluids
Low Calcium
High Oxalate (spinach)
High ProteinHigh Sodium
High Fructose

Gout –> hyperuricosuria
Crohns –> hyperoxaluria
hyperPTH –> hypercalciuria

low urinary citrate (chronic metabolic acidosis like diarrhea)

Myocardial hibernation

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chronic myocardial ischemia causes decreased metabolic rate and function of myocardium

@ reperfusion/revascularization the hibernating myocardium improves contractility and LV function!

Fluphenazine

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DA antagonist

treatment for Tourette syndrome

tics are often temporarily suppressible and often preceded by an urge to make movement/noise

extrapyramidal side fx

Diverticula

True vs False
Traction vs Pulsion

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True = all layers Mucosa-Submucosa-Muscularis-Serosa (Meckel’s)

False = Psuedo - no muscularis (Zenker’s)

Pulsion are caused by increased intraluminal pressure @straining for BM

Most adult diverticulum are false and pulsion

TB treatment that must be activated by mycobacterial catalase peroxidase

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INH

activated by intracellular catalase peroxidase - mechanism of resistance

Halothane hepatitis

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acute hepatitis post-op due to halogenated inhaled anesthetics like desflurane

elevated AST, ALT and bilirubin + centrilobular necrosis

D-alanine-D-alanine

structurally similar to penicillin what vancomycin binds to

Ree-Sternberg cells

CD15+ and CD30+ Hodgkin lymphoma peak in 20y/os and 60y/os B-cell lymphoma associated with EBV infection

Opioid OD

miosis, decreased RR, decreased HR, decreased BP, decreased bowel sounds give naloxone

"watershed" area of kidney

proximal tubules ischemia --> acute tubular necrosis (increased serum Cr and BUN but normal ratio) straight portion of proximal tubule and thick ascending limb of Henle are most susceptible to hypoxia b/c they have active (ATP) transport of ions = increased O2 demands

Muddy brown casts

Acute Tubular Necrosis (most often due to cardiogenic shock)

Erosion vs Ulcer

Erosion stays in mucosa and muscularis mucosa ulcers go deeper: mucosa-muscularis mucosa-submucosa and even muscularis propria

Placental abruption

seperation of placenta from uterus while baby is still in utero --> DIC DIC of pregnancy mediated by tissue factor (from placental injury) --> activation of coag cascade

Familial hypocalciruic hypercalcemia

autosomal dominant disorder to Calcium-sensing receptors (which are transmembrane GPCR) - high serum calcium required to activate defective calcium sensors - raised set point of calcium induced regulation (inhibition) of PTH

Fenoldopam

D1 agonist for HTN crisis vasodilator (esp at coronary, pheripheral, renal, splanchnic) promotes natriuresis

NNRTIs

Efavirenz Nevirapine (CYP inducer) Delavirdine

Integrase Inhibitors

-TEGRAVIRs Dolutegravir Elvitegravir

Penetration Inhibitors

Enfuviritide binds GP41

Attachment Inhibitors

Maraviroc binds CCR5

Hormone Sensitive Lipase

converts TG - -> glycerol --> gluconeogenesis --> glucose - -> free fatty acid --> lipolysis --> ketones

Aortic Dissection

severe retrosternal chest pain that radiates to the back inciting event: tear in aortic intima HTN is primary risk factor HTN ==> medial hypertrophy --> reduced blood flow --> medial degeneration --> aortic enlargement and increased wall stiffness --> increased wall stress --> tear --> dissection

Paroxysmal nocturnal hemoglobinuria

mutated PIGA gene --> decreased GPI --> decreased surface proteins: ``` CD55 = DAF (decay accelerating factor) CD59 = MAC inhibitory protein ``` without these you get too much complement-mediated hemolysis symp: hemolytic anemia, hemoglobinuria, thrombosis (hepatic, portal cerebral veins), pancytopenia hemosiderosis - iron deposition in the kidney due to chromic hemolysis --> PCT dysfunction

Schiller-Duval body

yolk sac tumors resemble glomeruli

congenital hypothyroidism

generally due to thyroid dysgenesis (agenesis, hypoplasia, ectopy) symp: lethargy, poor feeding, constipation, hypotonia, umbilical hernia, protruding tongue, large fontanelle

Hemochromatosis

Autosomal recessive, abnormally high iron uptake liver disease, hepatomegaly, abd pain, hyperpigmentation "bronze diabetes" = DM, pigment cirrhosis, and hepatomegaly

March 29 Flashcards

(43 cards)