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Flashcards in Other Deck (36):
1

Hirshprung Disease

absence of ganglia that regulate peristalsis
(problem w/ neural crest cell migration)

2

Spore-forming bacteria

Bacillus anthracis & cereus, clostridium perfringens, botulinum & tetani, & Coxiella burnetti

3

Drugs that INDUCE cytochrome P450

=> decrease effectiveness of the metabolized drug
1. Phenobarbitol/all barbiturates
2. Rifampin
3. Carbemazepine
4. Phenytoin
5. Griseofulvin *also: chronic EtOH abuse

4

Drugs that INHIBIT cytochrome P450

=> decreased metabolism of cyp450 dependent drugs
1. Cimetadine
2. Fluoxetine
3. Antibiotics: Isoniazid, Erythromycin
4. Antifungal/virals: Ketoconazole, Ritonavir
5. Grapefruit juice

5

Case:
HIV + patient, with diffuse neuro Sxs (headache, stiff neck, fever...).
What is the DDx (& assoc. treatment)?

#1. Toxoplasmosis (w/ ring-enhancing lesions on MRI)
Tx: pyrimethamine & sulfasiazine
#2. Primary CNS Lymphoma (B cell infiltrate & EBV DNA in CSF)
#3. Cryptococcus (diffuse)
Tx: Amphotericin B

6

Bacteria that causes infective endocarditis and is associated with colon cancer

Streptococcus BOVIS

7

Case:
Patient presents w/ mitral regurgitation and history of chorea in childhood.
Cause?

Strep pyogenes => Rheumatic fever!
= molecular mimicry problem after resolved strep infection.
Acutely: fever, chorea
Chronic/long-term: mitral regurgitation OR mitral stenosis

8

Causes of Renal Papillary Necrosis

(Sx = gross hematuria, w/ a predisposing factor below)
1. Sickle cell disease OR trait
2. Diabetes
3. Severe obstructive pyelonephritis
4. Analgesic nephropathy (ie: NSAIDs)

9

Bacillary Angiomatosis vs. Kaposi's Sarcoma

Bacillary angiomatosis: benign, capillary skin papules.
- w/ AIDS, from bartonella.
Kaposi's Sarcoma: malignant, endothelial on skin OR mouth/GI/Resp.
- w/ HHV-8 & HIV

10

Sturge Weber disease

Congenital disease of capillaries.
- "port wine stain" on face
- ipsilateral leptomeningeal angiomatosis => intracerebral AVM
- seizures, early glaucoma

11

"Monday Disease" for Nitroglycerin exposure

develop tolerance during week of exposure (less vasodilation), but LOSE tolerance over weekend
=> tachycardia, dizziness, headache w/ re-exposure

12

Meds for lowering lipids
(class name, biggest effect, major SEs)

All decrease LDL.
#1. Statins: (--l HMG CoA reductase) decrease LDL *rhabdomyolysis
2. Niacin: increase HDL, *flushing, hyperglycemia/urate
3. Bile acid resins: block bile reabs. *gallstones
4. Ezetimibe: block cholesterol reabs.
5. Fibrates: upreg. LPL = decrease TGs! *myositis, LFTs up, gallstones

13

Niacin Deficiency

"3 Ds" --> Diarrhea, Dementia, Dermatitis
= Vit B3 def., common in EtOH abuse
* needed as coenzyme for NAD & NADPH

14

Kussmaul Sign

= paradoxical RISE in JVP during inspiration,
indicates Constrictive Pericarditis
(also likely to hear "pericardial knock" later than S3)

15

Signs and causes of Infectious Arthritis

"STD"
S- Synovitis, T- tenosynovitis, D- Dermatitis
*often migratory, asymmetric Sxs!
Causes: S. aureus, Strep, Gonorrhea ("gonococcal arthritis")

16

Potential causes of avascular necrosis/osteonecrosis

1. trauma
2. high-dose corticosteroids
3. alcoholism
4. sickle cell disease
*usually @ femoral head.

17

Disease associated with Elevated ACE serum levels

Sarcoidosis!
(wide-spread, immune-mediated non-caseating granulomas)

18

Secondary causes of hypoxia => clubbing

1. Lung disease (esp. supurative): lung cancer, TB, CF, bronchiectasis, pulm. HTN, empyema, etc.
2. Heart disease: tetralogy of fallot/other congen. heart defects, bacterial endocarditis
3. Other: IBD (crohns/Ulc. colitis), hypERthyroidism, malabsorption

19

#1 most noxious toxin of Clostridium perfringens

Lecithinase, aka: "Alpha toxin" or Phospholipase C
-> splits phospholipid molecs
=> cell lysis & RBC hemolysis, edema, tissue necrosis

20

Metabolism mech for drugs associated with drug-induced lupus

(example drugs: hydralazine, procainamide)
N-Acetylation by the Liver (phase II)
*slow acetylators have greatest risk of developing drug-induced lupus.
*anti-histone Ab = most specific for drug-induced Lupus

21

Triad of Sxs/complications in Congenital Rubella infection

1. "white pupils" (= congenital cataracts)
2. Sensorineural hearing loss
3. PDA/congen. heart defects
*prevent by vaccinating NON-pregnant women of child-bearing age!
(w/ live attenuated vaccine)

22

toxins of Pseudomonas aeruginosa

* gram + rod => "ecthyma gangrenosum" (purple cut. lesions, esp. if lacking humeral immunity)
1. Exotoxin A --l protein synthesis
2. Elastase --> blood vessel destruction
3. Phospholipase C --> degrades cell membranes
4. pyocyanin: makes ROS

23

Odds Ratio vs. Relative Risk calculations

Odds ratio: (#Tx & disease/#Tx & no disease)/(#disease and NO Tx/#no Tx & no disease) = "(AxD/BxC)
aka: (%Tx w/ outcome)/(%not Tx w/ outcome)

Relative risk: (#Tx & outcome/all Tx)/(#noTx & outcome/all NOT Tx)

24

mycobacterium avium

Mycobacterium (not TB),
causes disease in healthy OR immunosuppressed pts.
Sxs: hepatosplenomegaly & elevated AlkPhos, fever, weight loss, diarrhea... *clear chest Xray (vs. granulomas if TB)
**grows best at 41C! Prophylactic Tx w/ azithromycin (esp. if CD4 <50)

25

Amino acids with 3 titratable protons
(=> 3 points distinct points on titration)

(7) Histidine, Lysine, Arginine,
Aspartic acid, Glutamic acid,
Cysteine, tyrosine.

26

Fetal development timeline & landmarks
(week 1, 2, ...)

wk 1: hCG secretion begins (can confirm on urine test)
wk 2: BiLaminar disc (epiblast/hypoblast)
wk 3: TriLaminar/gastrulation (endo/meso/ectoderm)
wk 4: 4 limb buds, heart beats
wk 8: fetal mvmt, wk 10: genitalia formed (complete @ wk 12)

27

Fetal "triple test" components and significance

1. AFP: increases w/ # wks => likely dating error if abnormal
2. hCG: high => twins, hydatidiform mole, or choriocarcinoma
3. Estriol: low = placental insufficiency

28

Major Tissues that originate from surface ectoderm (5)

1. Epidermis
2. Ant. Pituitary (Adenohypophysis)
3. Parotid, sweat, & mammary glands
4. sensory organs of ear
5. epithelial lining of mouth

29

Major tissues that originate from the Neuroectoderm (3)

1. Brain/CNS (includes spinal cord)
2. Retina & optic nerve
3. pineal gland

30

Major tissues originating from Neural Crest (6)

1. PNS
2. Melanocytes
3. Chromaffin cells of adrenal medulla
4. Parafollicular ("C") cells of thyroid
5. skull bones, 6. Aorticopulmonary septum

31

Major tissues that originate from the Mesoderm (6)

1. Muscle *includes heart!
2. bone
3. CT & dermis
4. serous lining of body cavities (peritoneum, spleen)
5. Blood & lymphatics
6. Testes/ovaries

32

Major tissues derived from Endoderm (~2)

1. gut epithelium
2. "Lumenal epithelium" => Lungs, Liver, gallbladder, pancreas, paraT, thymus...

33

Deformation vs. Malformation

Deformation = EXtrinsic disruption of dvpt, AFTER embryonic period
vs.
Malformation = INtrinsic disruption, DURING embryonic period

34

"Fetal Hydantoin Syndrome"

= results of phenytoin (teratogen).
=> microcephaly & dysmorphic craniofacial features, hypoplastic fingernails & distal phalanges, AND cardiac defects, mental retardation
(*similar to carbemazepine effects)

35

Effects on Fetus of Nicotine vs. Cocaine vs. EtOH
...vs. Diabetes vs. Vitamin A excess

Nicotine: IUGR (small), placenta problems, ADHD, preterm labor
Cocaine: fetal addiction, placental abruption
EtOH: major birth defects & mental retardation (FAS)
*Diabetes: caudal regression, heart & neural tube defects
* VitA: cleft palate & heart defects

36

Reyes Syndrome

mitochondrial damage in Children given ASPIRIN for viral infections.
=> fatty liver, hypoglycemia, vomiting, hepatomegaly, coma

*beta oxidation blocked by revers. inhibition of mitochondrial enzymes