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Qs2 Flashcards

(103 cards)

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1
Q

Pyruvate kinase deficiency (glycolysis final enzyme)

A

Unable to maintain Na/K ATPase
Hemolytic anemia
RBC swelling/lysis

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2
Q

Hemiballismus is caused by lesion to what part of the basal ganglia?
What kind of stroke?

A

Subthalamic nucleus

Lacunar stroke

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3
Q

Open angle glaucoma
Risk factors
Presentation

A

More common; Bilateral
Over 40, black diabetes
Asx early; reduced peripheral vision later

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4
Q

Acute angle-closure glaucoma
Risk factors
Presentation

A

Emergency
Abrupt onset of pain, nausea, colored halos, rainbows around light
Red teary eye, hazy cornea, mid dilated pupil (not reactive to light, firm to palpation

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5
Q

Retroperitoneal Abdominal Structures

A DUCK PEAR

A 
Adrenal Glands
Duodenum (2,3,4 parts)
Ureters
Colon (descending and ascending)
Kidney
Pancreas
Esophagus
Aorta
Rectum
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6
Q

De novo pyrimidine synthesis RLS

A

CPS2

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7
Q

De novo purine synthesis RLS

A

glutamine PRPP amidotransferase

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8
Q

Glycolysis RLS

A

PFK1

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9
Q

Gluconeogenesis RLS

A

Fructose 1,6 bisphosphatase

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10
Q

Glycogen synthesis RLS

A

Glycogen synthase

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11
Q

Glycogenolysis RLS

A

Glycogen phosphorylase

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12
Q

TCA cycle RLS

A

Icocitrate dehydrogenase

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13
Q

HMP shunt RLS

A

glucose 6 phosphate dehydrogenase

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14
Q

Which cytokines inhibit Th1 cells?

A

IL-10

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15
Q

Flow of aqueous humor

A
  1. Formed in capillary bed of cilliary body
  2. Secreted into posterior chamber
  3. Flows between lens and iris diaphragm
  4. Into anterior chamber
  5. Reabsorbed by canal of schlemm
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16
Q

MOA of metoclopromide

A

Antagonist at dopamine 2 receptor
Serotonin agonist
Increase contractility in the GI tract

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17
Q

Landmark for pudendal nerve block

A

Ischial spine

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18
Q

RLS of carbohydrate digestion

A

Oligosaccharide hydrolases (intestinal brush border)

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19
Q

Vitamin deficiency from Hartnup disease

A

Tryptophan -> Niacin (B3) defciency -> pellagra

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20
Q

Pyruvate dehydrogenase complex cofactors

TLC for nobody

A 
Thiamine (B1, pyrophosphate, TPP)
Lipoic Acid
Coenzyme A
FAD (B2 riboflavin)
NAD (B3 niacin)
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21
Q

Why are alanine and glutamine levels high in blood?

A

They are good carriers of N

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22
Q

What happens in transamination?

A

Transfer of an amino group from an AA to a-ketoglutarate –> forming glutamate
Deaminated AA –> ketoacid (like pyruvate)

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23
Q

How are aminotransferases named?

A

Named by donor of amino group

Alanine aminotransferase converts alanine to pyruvate, forming glutamate

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24
Q

What is required by all aminotransferases (besides substrates)?

A

Pyridoxal phosphate (B6 derivative)

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25
2 most important aminotransferase enzymes? What do they catalyze?
Alanine Aminotransferase Alanine + a-ketoglutarate Glutamate + pyruvate Aspartate Aminotransferase Glutamate + oxaloacetate a-ketoglutarate + aspartate
26
4 fates of pyruvate
Oxaloacetate Acetyl-CoA Lactate Alanine
27
What are indications for Dantrolene?
Malignant hyperthermia | Neuroleptic malignant syndrome
28
Etiology of Acute Pancreatitis | BAD HITS
``` Biliary Alcohol Drugs Hypertriglyceridemia and hypercalcemia Idiopathic Trauma (ERCP) Scorpion Sting ```
29
What cells release renin? | In response to what?
Juxtaglomerular cells | In response to decreased blood flow to kidneys
30
4 uses of NADPH
Synthesis of fatty acids and cholesterol Generation of oxygen free radicals Protects RBCs from oxygen free radicals Cytochrome P450
31
Which tissues use the PPP or HMP shunt?
RBCs Liver Adrenal Cortex Mammary Glands (during lactation)
32
Sx to Classic Galactosemia
``` Failure to thrive Intellectual disability Hepatomegaly Jaundice Infantile cataracts ```
33
Pancreatic insufficiency presentation
Diarrhea Steatorrhea Malabsorption and weight loss Deficiency of ADEK
34
Sx of serotonic syndrome
Muscle rigidity Hyperthermia Cardiovascular collapse
35
RLS for Ketogenesis
HMG-CoA synthase
36
What metabolic condition favors ketogenesis?
Production of acetyl CoA from B oxidation of fatty acids exceeds the oxidative capacity of the TCA cycle
37
What body tissues cannot use ketone bodies?
RBCs
38
What affect does liver metabolism of ethanol have on gluconeogenesis? What can happen to pt consuming much alcohol in a fasting state?
Cannot undergo gluconeogenesis when metabolizing ethanol. | Severe fasting hypoglycemia
39
Primary energy source if no food in 2 days?
Fatty acids
40
What is the mechanism for hypoglycemia from alcohol on an empty stomach? NADH shunts pyruvate --> Oxaloacetate --> Therefore pyr and oxa not available for
Lactate production Malate production Not available for gluconeogenesis
41
What kind of infections often precede Guillain-Barre syndrome?
Campylobacter or Herpes
42
Risk factors for Hepatocellular Carcinoma
``` Hep B and C Hemochromatosis a1-antitrypsin deficiency Hepatic adenoma Cirrhosis ```
43
Sx of TCA overdose
``` Convulsions Coma Cardiotoxicity Hyperpyexia (fever) Respiratory depression ```
44
What apolipoproteins are deficient in abetalipoproteinemia?
Apo-B 48 and apo-B 100
45
What gene is mutated in abetalipoprotenemia?
MTP gene
46
What are sx and tx of abetalipoproteinemia? | Blood smear?
Sx: Steattorhea, failure to thrive Tx: Vitamin E Smear: Acanthocytosis (spiked RBCs)
47
What is the substrate and RLS enzyme for cholesterol synthesis?
Substrate: Acetyl-CoA RLS: HMG CoA reductase (statins inhibit)
48
RLS for fatty acid synthesis?
Acetyl CoA carboxylase
49
RLS for fatty acid degradation (B-oxidation)?
Carnitine acyltransferase-1 | carnitine palmitoyl transferase-1
50
Where do fatty acid synthesis and degradation take place?
Synthesis: Cytosol Degradation: Mitochondria
51
ECG changes with MI?
ST elevation T wave inversion New LBBB New Q waves
52
Clinical features of neuroleptic malignant syndrome
``` Delirium Autonomic instability (tachycardia) Muscle rigidity Myoglobinuria Hyperpyrexia (fever) ```
53
What gland makes melatonin?
Pineal gland
54
RLS for urea synthesis?
CPS I
55
CPS I found where and N from where? | CPS II found where and N from where?
I: Mitochondria; ammonium II: Cytosol, glutamine
56
Sx of hyperammonemia
``` "Hepatoencephalopathy" constellation of sx Slurring of speech Somnolence Vomitting Cerebral edema Blurring of vision ```
57
Dermatologic findings of primary, secondary, and tertiary syphillis
1: Painless chancre 2: Maculopapular rash on palms and soles 3: Gummas
58
Anti-HTNs safe in pregnancy? | Hypertensive moms love Nifedipine
Hydralazine Methyldopa Labetalol Nifedipine
59
Secretory cells of GI tract G, I, S, D, Parietal cells
Gastrin, CCK, Secretin, Somatostatin, Gastric acid/IF
60
Mechanism of melanin
Tyrosinase deficiency or defect in tyrosine transport into cell Or lacking melanocytes (neural crest derivative)
61
Lens subluxation
Marfans (upward) and Homocystinuria (downward)
62
What does S-adenosyl-methionine do and for what production is it necessary? What is it made from?
Methyl donor Phosphocreatine and Epinephrine (from NE) ATP and Methionine
63
Regeneration of methionine requires which vitamin cofactors?
Folate a B6?
64
Glaucoma pathogenesis
Blockage at canal of Schlemm Aqueous humor not reabsorbed Increased pressure Optic nerve atrophy
65
Aortic dissection presentation, CXR; Tx
Tearing chest pain radiating to back CXR: Mediastinal widening Tx: Beta blockers
66
What enzymes require Zinc?
Carbonic anhydrase | Lactate dehydrogenase
67
Where does mercury (poison) accumulate?
Brain and kidney
68
Where (2) do you see acrodynia (peeling of fingertips)?
Mercury poisoning and Kawasaki disease
69
From where is an infant likely to get iron poisoning?
Prenatal or iron-fortified vitamins?
70
Zinc deficiency sx
``` Delayed would healing Decreased immune response Acrodermatitis enteropathica Anorexia/diarrhea Growth retardation Decreased mental function Infertilitiy ```
71
Hypocalcemia sx
Tetany and neuromuscular irritability Chvostek's sign (tap cheek -> face spasm) Trousseau's sign (tighten bp cuff -> carpal spasm)
72
Bluish-colored lines on gingivae
Lead poisoning (Burton's lines)
73
Which cytokine inhibits Th2 cells?
Interferon-gamma
74
Bacillus anthracis skin sx
Black eschar (necrotic) with edematous ring
75
Common causes of ARDS
``` Shock Infection Toxic gas inhalation Acute pancreatitis Aspiration Heroin overdose High concentrations of O2 ```
76
R occulomotor nerve damage: what is the light reflex? (Efferent defect)
R eye does not respond to light in either eye | L eye constricts with light in either eye
77
Ddx for eosinophilia DNAAACP
``` Drugs Neoplasm Atopic Disease (allergy, churg-straus) Addison's (primary adrenal insufficiency Acute interstitial nephritis Collagen vascular disease Parasites ```
78
What substances act on smooth muscle light chain kinase; how does this affect bp?
Dihydropyridine CCBs Epinephrine Prostaglandin E2 Vasodilation -> decrease BP
79
Enzymes that require thiamine (B1) | ATP
Pyruvate dehydrogenase (glycolysis -> TCA) a-ketoglutarate dehydrogenase (TCA) Transketolase (HMP shunt) Branch-chain ketoacid dehydrogenase
80
INH can cause what vitamin deficiencies?
INH inhibits B6 and B3
81
What vitamin deficiencies can cause megaloblastic anemia?
B9 (folate) | B12
82
Vitamin deficiency: convulsions + irritability
Vitamin B6 (GABA production)
83
Where is B12 absorbed in gut?
Terminal ileum
84
Which vitamins are used in oxidation/reduction reactions?
B2 | B3
85
Which vitamins are used in carboxylation reactions?
Biotin | K
86
Which vitamins are required for DNA synthesis?
B9 | B12
87
Most common vitamin deficiency in US
B9 folate
88
Dilated cardiomyopathy, edema, polyneuropathy
Wet Beri Beri (B1 def)
89
Hypersegmented neutrophils
Megaloblastic anemia
90
Derivatives of first branchial arch
M's and T's Muscles: Mastication, Mylohyoid, Tensor tympani, Tensor veli palatini Nerves: Maxillary and mandibular of trigeminal
91
Which AAs found in Elastin?
Glycine and Proline
92
MOA of adenosine as an anti-arrhythmic?
Increases outward K current Hypopolarization of cells Decreases intracellular Ca2+
93
2 yo girl has increased abdominal girth, failure to thrive, skin/hair depigmentation
Kwashiorkor
94
Enzyme deficiency in fructose intolerance?
Aldolase B
95
Enzyme deficiency in essential fructosuria
Fructokinase
96
Classic galactosemia
Galactose-1-phosphate uridyltransferase
97
Thyoid cells with optically clear nuclei
Papillary carcinoma of thyroid
98
Branching rods with oral infection
Actinomyces israelii
99
Eczema, recurrent infection, thrombocytopenia
Wiskott-Aldrich syndrome | "WAITER"
100
Hemosiderinuria and thrombosis
Paroxysmal nocturnal hemoglobinuria PNH
101
Derivatives of 2nd branchial arch
"S" CN 7: Facial expression Stapedius and Stylohyoid
102
``` Antidote for Opioids Benzodiazepines TCAs Heparin Warfarin Theophyline ```
``` Opioid: Naloxone, Naltrexone Benzodiazepine: Flumazenil TCA: Sodium Bicarbonate Heparin: Protamine Warfarin: Vit K/Fresh Frozen (immed) Theophyline: B-Blockas ```
103
How does hyperKalemia affect T waves?
Tall peaked T waves | low K: low flat t waves

DIT Qs (3 decks)

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