Rapid Review: Lab/Diagnostic Findings and Clinical Presentations; and MISC! Flashcards Preview

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Flashcards in Rapid Review: Lab/Diagnostic Findings and Clinical Presentations; and MISC! Deck (596):
1

Anticentromere antibodies

Scleroderma (have excessive fibrosis and collagen deposition throughout the body; 2 types. the type associated with anti-centromere antibodies is the Crest type: CREST syndrome = Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia)

2

Antidesmoglein (epithelial) antibodies

Pemphigus vulgaris (blistering)

2

List the 4 most important pharmacokinetics equations: (Vd, Cl, LD, MD)

1) Vd = (amount of drug given)/([drug] in plasma)2) Cl = (Vd X 0.7)/t1/23) LD = Css X Vd4) MD = Css X Cl

2

List the 4 most important pharmacokinetics equations: (Vd, Cl, LD, MD)

1) Vd = (amount of drug given)/([drug] in plasma)2) Cl = (Vd X 0.7)/t1/23) LD = Css X Vd4) MD = Css X Cl

3

Anti-glomerular basement membrane antibodies

Goodpasture's syndrome (glomerulonephritis and hemoptysis)

3

competitive vs noncompetitive inhibitors:1) Resemble substrate?2) Overcome by increased [S]?3) Bind active site?4) Effect on Vmax?5) Effect on Km?6) Pharmacodynamics: effect on potency? efficacy?

Competitive inhibitors:1) Yes2) Yes3) Yes4) Vmax does not change5) Km increases6) decreased potency (increased Km, decreased potency); no effect on efficacyNoncompetitive inhibitors:1) No2) No3) No4) Vmax decreases5) Km does not change6) decreased efficacy (decreased Vmax, decreased efficacy); no effect on potentcy

3

competitive vs noncompetitive inhibitors:1) Resemble substrate?2) Overcome by increased [S]?3) Bind active site?4) Effect on Vmax?5) Effect on Km?6) Pharmacodynamics: effect on potency? efficacy?

Competitive inhibitors:1) Yes2) Yes3) Yes4) Vmax does not change5) Km increases6) decreased potency (increased Km, decreased potency); no effect on efficacyNoncompetitive inhibitors:1) No2) No3) No4) Vmax decreases5) Km does not change6) decreased efficacy (decreased Vmax, decreased efficacy); no effect on potentcy

4

antihistone antibodies

drug-induced SLE. drugs:
1) hydralazine - treats severe HTN (1st line for HTN in pregnancy, with methyldopa), CHF
2) isoniazid (INH) - treatment and prophylaxis for Mycobacterium tuberculosis
3) phenytoin - anti-epileptic
4) procainamide - anti-arrhythmic

4

Zero-order elimination

rate of elimination of drug is constant, regardless of the plasma concentration; Cp decreases linearly with time.Examples = PEA: Phenytoin, Ethanol, Aspirin

4

Zero-order elimination

rate of elimination of drug is constant, regardless of the plasma concentration; Cp decreases linearly with time.Examples = PEA: Phenytoin, Ethanol, Aspirin

5

Anti-IgG antibodies

Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere deformity)

5

First-order elimination

Rate of elimination is proportional to drug concentration (a constant fraction of the drug is eliminated per unit time); the plasma concentration decreases exponentially with time.

5

First-order elimination

Rate of elimination is proportional to drug concentration (a constant fraction of the drug is eliminated per unit time); the plasma concentration decreases exponentially with time.

6

antimitochondrial antibodies (AMAs)

Primary biliary cirrhosis (female>male; autoimmune disease of liver - get slow progressive destruction of bile canaliculi, so bile builds up in liver = cholestasis, and damages tissue over time, leading to scarring, fibrosis, cirrhosis; portal hypertension)

6

Phase I vs Phase 2 metabolism:Which phase do geriatric patients lose first?

Phase I: -reduction, oxydation, hydrolysis-usually yields slightly polar, water-soluble metabolites (often still active)-cytochrome P-450Phase II:-GAS: Glucuronidation, Acetylation, Sulfation-usually yields very polar, inactive metabolites (renally excreted)*Geriatric patients lose phase 1 first

6

Phase I vs Phase 2 metabolism:Which phase do geriatric patients lose first?

Phase I: -reduction, oxydation, hydrolysis-usually yields slightly polar, water-soluble metabolites (often still active)-cytochrome P-450Phase II:-GAS: Glucuronidation, Acetylation, Sulfation-usually yields very polar, inactive metabolites (renally excreted)*Geriatric patients lose phase 1 first

7

antineutrophil cytoplasmic antibodies (ANCAs)

vasculitis
1) c-ANCA: Wegener's granulomatosis (a rapidly progressive (crescentic) glomerulonephritis (RPGN))
2) p-ANCA: microscopic polyangiitis (pauci-immune glomerulonerphritis, RPGN), and Churg-Strauss syndrome (pauci-immune, asthma, sinusitis, palpable purpura, peripheral neuropathy))
* "pauci-immune" = form of vasculitis associated with minimal evidence of hypersensitivity upon immunofluorescence.

7

Efficacy vs Potency

Efficacy: -proportional to Vmax (increase Vmax, increase efficacy)-maximal effect a drug can produce-high efficacy drugs: analgesics, antibiotics, antihistamines, decongestantsPotency:-inversely proportional to Km (increase Km, decrease potency)-amount of drug needed for a given effect-increased potency, increased affinity for receptor-highly potent drugs: chemo drugs, anti-hypertensive drugs, antilipid drugs

7

Efficacy vs Potency

Efficacy: -proportional to Vmax (increase Vmax, increase efficacy)-maximal effect a drug can produce-high efficacy drugs: analgesics, antibiotics, antihistamines, decongestantsPotency:-inversely proportional to Km (increase Km, decrease potency)-amount of drug needed for a given effect-increased potency, increased affinity for receptor-highly potent drugs: chemo drugs, anti-hypertensive drugs, antilipid drugs

8

antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA)

SLE (type III hypersensitivity)

8

Pharmacodynamics: Effects of adding competitive antagonists, noncompetitive antagonists, and partial agonists to an agonist on pharmacodynamic curves:

1) Competitive antagonist + agonist --> shift curve to the right = decreased potency (increased Km); no change on efficacy2) Noncompetitive antagonist plus agonist: shift curve down = decreased efficacy (decreased Vmax); no effect on potency3) Partial agonist: acts at the same site as a full agonist, but with reduced maximal effect. Get decreased efficacy (decreased Vmax); potency is variable, can be either increased or decreased.

8

Pharmacodynamics: Effects of adding competitive antagonists, noncompetitive antagonists, and partial agonists to an agonist on pharmacodynamic curves:

1) Competitive antagonist + agonist --> shift curve to the right = decreased potency (increased Km); no change on efficacy2) Noncompetitive antagonist plus agonist: shift curve down = decreased efficacy (decreased Vmax); no effect on potency3) Partial agonist: acts at the same site as a full agonist, but with reduced maximal effect. Get decreased efficacy (decreased Vmax); potency is variable, can be either increased or decreased.

9

antiplatelet antibodies

ITP (idiopathic thrombocytopenic purpura)

9

Therapeutic Index: What is it? What's the equation? Is it safer to have a higher or lower TI?*Examples of drugs with low TI?

TI = measurement of drug safetyTI = LD50/ED50 = median lethal dose/median effective dose("TILE")Safer drugs have higher TI valuesExamples of drugs with low TI (must monitor these patients!):-Phenobarbital-Lithium-Digoxin-Coumadin/Warfarin

9

Therapeutic Index: What is it? What's the equation? Is it safer to have a higher or lower TI?*Examples of drugs with low TI?

TI = measurement of drug safetyTI = LD50/ED50 = median lethal dose/median effective dose("TILE")Safer drugs have higher TI valuesExamples of drugs with low TI (must monitor these patients!):-Phenobarbital-Lithium-Digoxin-Coumadin/Warfarin

10

anti-topoisomerase antibodies

diffuse systemic scleroderma

10

Nicotinic vs Muscarinic ACh receptors

Nicotininc ACh receptors = Na+/K+ channelsMuscarinic ACh receptors = G-protein-coupled receptors, act through 2nd messengers; 5 subtypes = M1, M2, M3, M4, M5

10

Nicotinic vs Muscarinic ACh receptors

Nicotininc ACh receptors = Na+/K+ channelsMuscarinic ACh receptors = G-protein-coupled receptors, act through 2nd messengers; 5 subtypes = M1, M2, M3, M4, M5

11

anti-transglutamase/anti-gliadin/anti-endomysial antibodies

Celiac disease (diarrhea, distention, weight loss)

11

Gq:-what receptors stimulate it?-what are its effects?

-Stimulated by alpha 1, M1, M3, H1, V1-stimulates phospholipase C, which stimulates lipid conversion to PIP2, which stimulates increased diacylglycerol and increased inositol triphosphate. --> increased DAG leads to increased protein kinase C--> increased

11

Gq:-what receptors stimulate it?-what are its effects?

-Stimulated by alpha 1, M1, M3, H1, V1-stimulates phospholipase C, which stimulates lipid conversion to PIP2, which stimulates increased diacylglycerol and increased inositol triphosphate. --> increased DAG leads to increased protein kinase C--> increased

12

"Apple core" lesion on abdominal x-ray

colorectal cancer (usually left-sided)

12

Gs:-what receptors stimulate it?-what are its effects?

-stimulated by: B1, B2, D1, H2, V2-stimulates adenylyl cyclases --> increases cAMP --> increases protein kinase A --> increased intracellular Calcium *lots of bacterial toxins use this mechanism!

12

Gs:-what receptors stimulate it?-what are its effects?

-stimulated by: B1, B2, D1, H2, V2-stimulates adenylyl cyclases --> increases cAMP --> increases protein kinase A --> increased intracellular Calcium *lots of bacterial toxins use this mechanism!

13

Azurophilic granular needles in leukemic blasts

Auer rods (acute myelogenous leukemia, especially the promyelocytic (M3) type)

13

Gi:-what receptors stimulate it?-what are its effects?

-stimulated by: alpha 2, M2, D2-inhibits adenylyl cyclase (so decreased cAMP and decreased protein kinase A)...

13

Gi:-what receptors stimulate it?-what are its effects?

-stimulated by: alpha 2, M2, D2-inhibits adenylyl cyclase (so decreased cAMP and decreased protein kinase A)...

14

Bacitracin response (what organis are sensitive? resistant?)

Sensitive: Streptococcus pyogenes (group A)
Resistant: Streptococcus agalactiae (group B)

14

alpha 1 receptor:-which G-protein class?-Major functions?

*Gq*Functions:-increase vascular smooth muscle contraction (increase BP)-mydriasis-increase intestinal and bladder sphincter muscle contraction

14

alpha 1 receptor:-which G-protein class?-Major functions?

*Gq*Functions:-increase vascular smooth muscle contraction (increase BP)-mydriasis-increase intestinal and bladder sphincter muscle contraction

15

"bamboo spine" on X-ray

Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)

15

alpha 2 receptor:-G-protein class?-major functions?

*Gi*Major functions:-decrease sympathetic outflow (decrease NE secretion)-decrease insulin release-decrease BP (vasodilation)-increase glucagon secretion from alpha cells in pancreas

15

alpha 2 receptor:-G-protein class?-major functions?

*Gi*Major functions:-decrease sympathetic outflow (decrease NE secretion)-decrease insulin release-decrease BP (vasodilation)-increase glucagon secretion from alpha cells in pancreas

16

Basophilic nuclear remnanats in RBCs

Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)

16

Beta 1 receptor:-G-protein class?-Major functions?

*Gs*Functions:-increase HR-increase contractility-increase renin release-increase lipolysis

16

Beta 1 receptor:-G-protein class?-Major functions?

*Gs*Functions:-increase HR-increase contractility-increase renin release-increase lipolysis

17

basophilic stippling of RBCs

lead poisoning or sideroblastic anemia

17

Beta 2 receptor:-G-protein class?-Major functions?

*Gs*Functions:-vasodilation-bronchodilation-increase HR (compensatory to increase BP)-increase contractility-increase lipolysis-increase insulin release-decrease uterine tone

17

Beta 2 receptor:-G-protein class?-Major functions?

*Gs*Functions:-vasodilation-bronchodilation-increase HR (compensatory to increase BP)-increase contractility-increase lipolysis-increase insulin release-decrease uterine tone

18

bloody tap on LP

subarachnoid hemorrhage

18

M1 receptor:-G protein?-Functions?

*Gq*Functions:-CNS, enteric nervous system

18

M1 receptor:-G protein?-Functions?

*Gq*Functions:-CNS, enteric nervous system

19

"boot-shaped" heart on x-ray

tetralogy of fallot, RVH

19

M2 receptor:-G-protein?-Functions?

*Gi*Functions:-decreased HR and contractility of atria

19

M2 receptor:-G-protein?-Functions?

*Gi*Functions:-decreased HR and contractility of atria

20

branching gram + rods with sulfar granules

actinomyces israelii

20

M3 receptor: -G-protein?-Functions?

*Gq*Functions:-increase exocrine gland secretions (ie sweat, gastric acid)-increase gut peristalsis-increase bladder contraction-bronchoconstriction-increase miosis-accommodation (ciliary muscle contraction)

20

M3 receptor: -G-protein?-Functions?

*Gq*Functions:-increase exocrine gland secretions (ie sweat, gastric acid)-increase gut peristalsis-increase bladder contraction-bronchoconstriction-increase miosis-accommodation (ciliary muscle contraction)

21

bronchogenic apical lung tumor

pancoast tumor (carcinoma that occurs in apex of lung and may affect cervical sympathetic plexus / compress sympathetic ganglion and cause Horner's syndrome- ptosis + miosis + anhidrosis)

21

D1 receptor:-G-protein?-Functions?

*Gs*Functions:-relaxes renal vascular smooth muscle

21

D1 receptor:-G-protein?-Functions?

*Gs*Functions:-relaxes renal vascular smooth muscle

22

"brown" tumor of bone

Hemorrhage (hemosiderin) causes brown color of osteolytic cysts. Due to:
1) hyperparathyroidism
2) osteitis fibrosa cystica

22

D2 receptor:-G protein?-Functions?

*Gi*Functions:-modulates transmitter release, especially in brain

22

D2 receptor:-G protein?-Functions?

*Gi*Functions:-modulates transmitter release, especially in brain

23

cardiomegaly with apical atrophy

Chaga's disease (trypanosoma cruzi)

23

H1 receptor:-G protein?-Functions?

*Gq*Functions:-increase nasal and bronchial mucus production-bronchiole contraction-pruritus-pain

23

H1 receptor:-G protein?-Functions?

*Gq*Functions:-increase nasal and bronchial mucus production-bronchiole contraction-pruritus-pain

24

cellular crescents in Bowman's capsule

rapidly progressive crescentic glomerulonephritis

24

H2 receptor:-G protein?-Functions?

*Gs*Functions:-increase gastric acid secretion

24

H2 receptor:-G protein?-Functions?

*Gs*Functions:-increase gastric acid secretion

25

"chocolate cyst" of ovary

Endometriosis (frequently involves both ovaries)

25

V1 receptor:-G protein?-Functions?

*Gq*Functions:-increase vascular SM contraction

25

V1 receptor:-G protein?-Functions?

*Gq*Functions:-increase vascular SM contraction

26

circular grouping of dark tumor cells surrounding pale neurofibrils

Homer Wright rosettes (neuroblastoma, medulloblastoma, retinoblastoma)

26

V2 receptor:-G protein?-Functions?

*Gs*Functions:-increase H20 permeability and reabsorption in the collecting tubules of the kidney("V2 is found in the 2 kidneys")

26

V2 receptor:-G protein?-Functions?

*Gs*Functions:-increase H20 permeability and reabsorption in the collecting tubules of the kidney("V2 is found in the 2 kidneys")

27

collonies of mucoid Pseudomonas in lungs

cystic fibrosis (AR mutation to CFTR resulting in fat-soluble vitamin deficiency and mucous plugs)

27

What class of drugs are these:Bethanochol, Carbachol, Pilocarpine, Methacholine?

Cholinomimetic agents: Direct agonists

27

What class of drugs are these:Bethanochol, Carbachol, Pilocarpine, Methacholine?

Cholinomimetic agents: Direct agonists

28

decreased alpha-fetoprotein in amniotic fluid/maternal serum

down syndrome or other chromosomal abnormality

28

What class of drugs are these:Neostigmine, Pyridostigmine, Edrophonium, Physostigmine, Echothiophate, Donepezil

Cholinomimetic agents: Indirect agonists = anti-cholinesterases

28

What class of drugs are these:Neostigmine, Pyridostigmine, Edrophonium, Physostigmine, Echothiophate, Donepezil

Cholinomimetic agents: Indirect agonists = anti-cholinesterases

29

degeneration of dorsal column nerves

tabes dorsalis (tertiary syphilis)

29

What class of drugs are these:Atropine, homatropine, tropicamide, benztropine, scopolamine, ipratropium, oxybutynin, glycopyrrolate, methscopolamine, pirenzepine, propantheline

muscarinic antagonists = cholinergic antagonists

29

What class of drugs are these:Atropine, homatropine, tropicamide, benztropine, scopolamine, ipratropium, oxybutynin, glycopyrrolate, methscopolamine, pirenzepine, propantheline

muscarinic antagonists = cholinergic antagonists

30

depigmentation of neurons in substantia nigra

parkinson's disease (basal ganglia disorder: rigid, resting tremor, bradykinesia)

30

List the direct agonists/cholinomimetic agents (X4):

#NAME?

30

List the direct agonists/cholinomimetic agents (X4):

#NAME?

31

desquamated epithelium casts in sputum

Curschmann's spirals (bronchial asthma; can result in whorled mucous plugs)

31

List the indirect agonists/cholinomimetic agents = anticholinesterases (X6)

#NAME?

31

List the indirect agonists/cholinomimetic agents = anticholinesterases (X6)

#NAME?

32

dissarayed granulosa cells in eosinophilic fluid

call-exner bodies (granulosa-theca cell tumor of ovary)

32

List the muscarinic antagonists;

#NAME?

32

List the muscarinic antagonists;

#NAME?

33

dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia

koilocytes (HPV: predisposes to cervical cancer)

33

Cholinesterase inhibitor poisoning symptoms (ie excess parasympathetic activity): Antidote to anti-AchE poisoning?

#NAME?

33

Cholinesterase inhibitor poisoning symptoms (ie excess parasympathetic activity): Antidote to anti-AchE poisoning?

#NAME?

34

enlarged cells with intranuclear inclusion bodies

"owl's eye" appearance of CMV

34

What's parathion?

Parathion = insecticide = organophosphate; causes cholinesterase-inhibitor poisoning (DUMBBELSS)

34

What's parathion?

Parathion = insecticide = organophosphate; causes cholinesterase-inhibitor poisoning (DUMBBELSS)

35

enlarged thyroid cells with ground glass nuclei

"orphan annie" eye nuclei (papillary carcinoma of the thyroid)

35

When do you give atropine + pralidoxime?

Give as an antidote to organophosphate poisoning/ Cholinesterase-inhibitor poisoning

35

When do you give atropine + pralidoxime?

Give as an antidote to organophosphate poisoning/ Cholinesterase-inhibitor poisoning

36

eosinophilic cytoplasmic inclusion in liver cell

Mallory bodies (alcoholic liver disease)

36

Atropine:-class of drug?-clinical uses?-effects on eyes, airway, stomach, gi, bladder?-toxicity?

atropine = muscarinic antagonist*used to treat bradycardia and for ophthalmic applications*effects: blocks DUMBBELSS!-Eye--> increases mydriasis, cycloplegia-Airway-->decreases secretions-stomach --> decreases acid secretions-GI --> decreases motility-bladder --> decreases urgency in cystitis*Toxicity: Hot as a hare, Dry as a bone, Red as a beet, Blind as a bat, Mad as a hatter, Bloated as a toad:-increased body temp, decreased sweating-rapid pulse-dry mouth; dry/flushed skin-cycloplegia (blurry, near vision)-constipation (and urinary retention in men with prostatic hyperplasia)-disorientation-acute angle-closure glaucoma in elderly-hyperthermia in infants

36

Atropine:-class of drug?-clinical uses?-effects on eyes, airway, stomach, gi, bladder?-toxicity?

atropine = muscarinic antagonist*used to treat bradycardia and for ophthalmic applications*effects: blocks DUMBBELSS!-Eye--> increases mydriasis, cycloplegia-Airway-->decreases secretions-stomach --> decreases acid secretions-GI --> decreases motility-bladder --> decreases urgency in cystitis*Toxicity: Hot as a hare, Dry as a bone, Red as a beet, Blind as a bat, Mad as a hatter, Bloated as a toad:-increased body temp, decreased sweating-rapid pulse-dry mouth; dry/flushed skin-cycloplegia (blurry, near vision)-constipation (and urinary retention in men with prostatic hyperplasia)-disorientation-acute angle-closure glaucoma in elderly-hyperthermia in infants

37

eosinophilic cytoplasmic inclusion in nerve cell

Lewy body (parkinson's disease)

37

What sympathomimetic should be used to treat:-anaphylactic shock?-cardiogenic shock?-septic shock?

#NAME?

37

What sympathomimetic should be used to treat:-anaphylactic shock?-cardiogenic shock?-septic shock?

#NAME?

38

eosinophilic globule in liver

Councilman body (toxic or viral hepatitis, often yellow fever)

38

Epinephrine:-type of drug-what receptors does it act on?-clinical applications

-direct sympathomimetic-acts on alpha 1, alpha 2, beta 1, beta 2-use for anaphylaxis, open angle glaucoma, asthma, hypotension (anaphylactic shock)

38

Epinephrine:-type of drug-what receptors does it act on?-clinical applications

-direct sympathomimetic-acts on alpha 1, alpha 2, beta 1, beta 2-use for anaphylaxis, open angle glaucoma, asthma, hypotension (anaphylactic shock)

39

eosinophilic inclusion bodies in cytoplasm of hippocampal nerve cells

Rabies virus (Lyssavirus)

39

norepinephrine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on alpha 1, alpha 2, beta 1-use for hypotension (septic shock)

39

norepinephrine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on alpha 1, alpha 2, beta 1-use for hypotension (septic shock)

40

extracellular amyloid deposition in gray matter of brain

senile plaques (Alzheimer's disease)

40

isoproterenol:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts equally on beta 1 and beta 2 receptors-used for AV block

40

isoproterenol:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts equally on beta 1 and beta 2 receptors-used for AV block

41

Giant B cells with bilobed nuclei with prominent inclusions ("owl's eye")

Reed-Sternberg cells (Hodgkin's lymphoma)

41

dopamine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on all receptors, but its effects vary by dose:*low dose --> acts on D1*medium dose --> acts on B1 > B2*high dose --> acts on alpha 1 and alpha 2-used for shock (increases renal perfusion), heart failure

41

dopamine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on all receptors, but its effects vary by dose:*low dose --> acts on D1*medium dose --> acts on B1 > B2*high dose --> acts on alpha 1 and alpha 2-used for shock (increases renal perfusion), heart failure

42

Glomerulus-like structure surrounding vessel in germ cells

Schiller-Duval bodies (yolk sac tumor)

42

dobutamine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on Beta 1 mostly (also, slightly on alpha 1, alpha 2, beta 2)-used for heart failure, cardiac stress testing, cardiogenic shock

42

dobutamine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on Beta 1 mostly (also, slightly on alpha 1, alpha 2, beta 2)-used for heart failure, cardiac stress testing, cardiogenic shock

43

"hair-on-end" (crew-cut) appearance on x-ray

Beta-thalassemia, sickle cell anemia (marrow expansion)

43

phenylephrine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on alpha 1 mostly (and a little on alpha 2)-used for pupillary dilation, vasoconstriction, nasal decongestion; good for stopping epistaxis

43

phenylephrine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on alpha 1 mostly (and a little on alpha 2)-used for pupillary dilation, vasoconstriction, nasal decongestion; good for stopping epistaxis

44

hCG elevated

choriocarcinoma, hydatidiform mole (occurs with and without embryo)

44

Metaproterenol, Albuterol, Salmeterol, Terbutaline:-types of drugs?-what receptors do they act on?-Applications

-direct sympathomimetics-B2-agonists (also act very slightly on B1)-Metaproterenol and Albuterol --> used for acute asthma-Salmeterol --> for long-term treatment of asthma-Terbutaline --> to reduce premature uterine contractions

44

Metaproterenol, Albuterol, Salmeterol, Terbutaline:-types of drugs?-what receptors do they act on?-Applications

-direct sympathomimetics-B2-agonists (also act very slightly on B1)-Metaproterenol and Albuterol --> used for acute asthma-Salmeterol --> for long-term treatment of asthma-Terbutaline --> to reduce premature uterine contractions

45

Heart nodules (granulomatous)

Aschoff bodies (rheumatic fever)

45

Ritodrine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on B2 receptors ONLY!-used to reduce premature uterine contractions

45

Ritodrine:-type of drug-what receptors does it act on?-applications

-direct sympathomimetic-acts on B2 receptors ONLY!-used to reduce premature uterine contractions

46

Heterophile antibodies

Infectious mononucleosis (EBV)

46

List 3 indirect sympathomimetics:-What are their actions?-What are their clinical applications?

1) Amphetamines:-indirect general sympathetic agonist; release stored catecholamines-used for narcolepsy, obesity, ADD2) Ephedrine:-indirect general sympathetic agonist-release stored catecholamines-used for nasal decongestion, urinary incontinence, hypotension3) cocaine:-indirect general sympathetic agonist; uptake inhibitor-causes vasoconstriction and local anesthesia

46

List 3 indirect sympathomimetics:-What are their actions?-What are their clinical applications?

1) Amphetamines:-indirect general sympathetic agonist; release stored catecholamines-used for narcolepsy, obesity, ADD2) Ephedrine:-indirect general sympathetic agonist-release stored catecholamines-used for nasal decongestion, urinary incontinence, hypotension3) cocaine:-indirect general sympathetic agonist; uptake inhibitor-causes vasoconstriction and local anesthesia

47

Hexagonal, double-pointed, needle-like crystals in bronchial secretions

Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)

47

clonidine and alpha-meythldopa:-type of drugs?-act on what type of receptor?-applications?

#NAME?

47

clonidine and alpha-meythldopa:-type of drugs?-act on what type of receptor?-applications?

#NAME?

48

High level of D-dimers

DVT, pulmonary embolism, DIC

48

-azole =

anti-fungal (ie ketoconazole)

48

-azole =

anti-fungal (ie ketoconazole)

49

Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)

Ghon complex (Primary TB: Mycobacterium bacilli)

49

-cillin =

penicillin (ie methicillin)

49

-cillin =

penicillin (ie methicillin)

50

"Honeycomb lung" on x-ray

Interstitial fibrosis

50

-cycline =

antibiotic, protein synthesis inhibitor (ie tetracycline)

50

-cycline =

antibiotic, protein synthesis inhibitor (ie tetracycline)

51

Hypersegmented neutrophils

Megaloblastic anemia (B12-deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms)

51

-navir =

protease inhibitor (HIV trtmt) (ie saquinavir)

51

-navir =

protease inhibitor (HIV trtmt) (ie saquinavir)

52

hypochromic, microcytic anemia

iron-deficiency anemia, lead poisoning, thalassemia (HbF sometimes present)

52

-triptan =

5-HT1B/1D-agonists (for migraines) (ie sumatriptan)

52

-triptan =

5-HT1B/1D-agonists (for migraines) (ie sumatriptan)

53

increased alpha-fetoprotein in amniotic fluid/maternal serum

dating error, anencephaly, spina bifida (neural tube defects)

53

-ane=

inhalational general anesthetic (ie halothane)

53

-ane=

inhalational general anesthetic (ie halothane)

54

increased uric acid levels

Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics

54

-caine=

#NAME?

54

-caine=

#NAME?

55

intranuclear eosinophilic droplet-like bodies

cowdry type A bodies (HSV or CMV)

55

-operidol=

butyrophenone (neuroleptic) (ie haloperidol)

55

-operidol=

butyrophenone (neuroleptic) (ie haloperidol)

56

iron-containing nodules in alveolar septum

ferruginous bodies (asbestos: increases chance of mesothelioma)

56

-azine =

phenothiazine (neuroleptic, antiemetic) (ie chlorpromazine)

56

-azine =

phenothiazine (neuroleptic, antiemetic) (ie chlorpromazine)

57

large lysosomal vesicles in phagocyte, immunodeficiency

Chediak-Higashi disease (congenital failure of phagolysosome formation)

57

-barbital =

barbiturate (ie phenobarbital)

57

-barbital =

barbiturate (ie phenobarbital)

58

"lead pipe" appearance of colon on x-ray

ulcerative colitis (loss of haustra)

58

-zolam =

benzodiazepine (ie alprazolam)

58

-zolam =

benzodiazepine (ie alprazolam)

59

linear appearance of glomeruli on immunofluorescence

Goodpasture's syndrome

59

-azepam =

benzodiazepine (ie diazepam)

59

-azepam =

benzodiazepine (ie diazepam)

60

Low serum ceruloplasmin

Wilson's disease (hepatolenticular degeneration)

60

-etine =

SSRI (ie fluoxetine)

60

-etine =

SSRI (ie fluoxetine)

61

"lumpy-bumpy" appearance of glomeruli on immunofluorescence

post-streptococcal glomerulonephritis (immune complex deposition of IgG and C3b)

61

-ipramine =

TCA (ie imipramine)

61

-ipramine =

TCA (ie imipramine)

62

lytic ("hole-punched") bone lesions on x-ray

multiple myeloma

62

-triptyline =

TCA (ie amitriptyline)

62

-triptyline =

TCA (ie amitriptyline)

63

mammary gland ("blue-domed") cyst

fibrocystic change of the breast

63

-olol =

beta-antagonist (ie propranolol)

63

-olol =

beta-antagonist (ie propranolol)

64

monoclomal antibody spike

1) Multiple myeloma (called the M protein; usually IgG or IgA)
2) Monoclonal gammopathy of undetermined significance (MGUS; normal consequence of aging)
3) Waldenstrom's (M protein=IgM) macroglobulinemia
4) Primary amyloidosis

64

-terol =

beta2-agonist (ie albuterol)

64

-terol =

beta2-agonist (ie albuterol)

65

monoclonal globulin protein in blood/urine

Bence Jones proteins (multiple myeloma [kappa of lambda Ig light chains in urine]), Waldenstrom's macroglobulinemia (IgM)

65

-zosin =

alpha 1-antagonist (ie prazosin)

65

-zosin =

alpha 1-antagonist (ie prazosin)

66

mucin-filled cell with peripheral nucleus

Signet ring (gastric carcinoma)

66

-oxin =

cardiac glycoside (inotropic agent) (ie digoxin)

66

-oxin =

cardiac glycoside (inotropic agent) (ie digoxin)

67

narrowing of bowel lumen on barium radiograph

"string sign" (Crohn's disease)

67

-pril =

ACE-inhibitor (ie captopril)

67

-pril =

ACE-inhibitor (ie captopril)

68

needle-shaped, negatively birefringent crystals

Gout (monosodium urate crystals)

68

-afil =

erectile dysfunction (ie sildenafil)

68

-afil =

erectile dysfunction (ie sildenafil)

69

Nodular hyaline deposits in glomeruli

Kimmelstiel-Wilson nodules (diabetic nephropathy)

69

-tropin =

pituitary hormone (ie somatotropin)

69

-tropin =

pituitary hormone (ie somatotropin)

70

Novobiocin response

on the office's staph retreat, there was NO StRES:
Sensitive: Staphylococcus epidermidis
Resistant: Staphylococcus saprophyticus

70

-tidine =

H2-antagonist (ie cimetidine)

70

-tidine =

H2-antagonist (ie cimetidine)

71

"nutmeg" appearance of liver

chronic passive congestion of liver due to right heart failure

71

-dronate =

bisphosphonate (for osteoporosis) (ie alendronate)

71

-dronate =

bisphosphonate (for osteoporosis) (ie alendronate)

72

"onion-skin" periosteal reaction

"going out for EWINGS and ONION RINGS!"
Ewing's sarcoma (malignant round-cell tumor)

72

-sartan =

Ang II-receptor-antagonist (ie losartan, valsartan)

72

-sartan =

Ang II-receptor-antagonist (ie losartan, valsartan)

73

Optochin response

OVRPS (overpass):
Sensitive: Strep pneumoniae
Resistant: Viridans streptococcus

73

-chol =

cholinergic/muscarinic agonist (ie bethanechol, carbachol)

73

-chol =

cholinergic/muscarinic agonist (ie bethanechol, carbachol)

74

Periosteum raised from bone, creating triangular area

Codman's triangel on x-ray (osteosarcoma, Ewing's sarcoma, pyogenic osteomyelitis)

74

-curium or -curonium =

paralytic drugs (non-depolarizing NM-blocking drugs; reversed with neostigmine) (ie atracurium, vecuronium)

74

-curium or -curonium =

paralytic drugs (non-depolarizing NM-blocking drugs; reversed with neostigmine) (ie atracurium, vecuronium)

75

Podocyte fusion on EM

minimal change disease (child with nephrotic syndrome)

75

-stigmine =

anti-cholinesterase (ie neostigmine, physostigmine, pyridostigmine)

75

-stigmine =

anti-cholinesterase (ie neostigmine, physostigmine, pyridostigmine)

76

polished, "ivory-like" appearance of bone at cartilage erosion

eburnation (osteoarthritis resulting in bony sclerosis)

76

-mustine =

nitrosureas (cross BBB, used to treat brain cancers)

76

-mustine =

nitrosureas (cross BBB, used to treat brain cancers)

77

Protein aggregates in neurons from hyperphosphoylation of protein tau

neurofibillary tangles (Alzheimer's disease and CJD)

77

-statins =

HMG-coA reductase inhibitors (ie atorvastatin)

77

-statins =

HMG-coA reductase inhibitors (ie atorvastatin)

78

Pseudopalisading tumor cells on brain biopsy

Glioblastoma multiforme

78

-glitazones =

increase target cell response to insulin (ie rosiglitazone, pioglitazone)

78

-glitazones =

increase target cell response to insulin (ie rosiglitazone, pioglitazone)

79

RBC casts in urine

Acute glomerulonephritis

79

-bendazoles=

anti-parasitic (esp anti-helminthic)

79

-bendazoles=

anti-parasitic (esp anti-helminthic)

80

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

Reinke crystals (Leydig cell tumor)

80

-dipine =

Ca-channel blockers (specifically dihyropyridine CCB's) (ie nifedipine, amlodipine)

80

-dipine =

Ca-channel blockers (specifically dihyropyridine CCB's) (ie nifedipine, amlodipine)

81

Renal epithelial casts in urine

Acute toxic/viral nephrosis

81

-prost =

prostaglandin analogues (treat glaucoma) (ie unoprostone)

81

-prost =

prostaglandin analogues (treat glaucoma) (ie unoprostone)

82

Rhomboid crystals, positively birefringent

pseudogout (calcium pyrophosphate dihydrate)

82

-mab =

monoclonal antibody (ie infliximab, daclizumab)

82

-mab =

monoclonal antibody (ie infliximab, daclizumab)

83

Rib notching

Coarctation of the aorta

83

alpha 1 blockage leads to?alpha 2 blockage leads to?

alpha1-blockage --> vasodilationalpha2-blockage --> vasoconstriction

83

alpha 1 blockage leads to?alpha 2 blockage leads to?

alpha1-blockage --> vasodilationalpha2-blockage --> vasoconstriction

84

Ring-enhancing brain lesions in AIDS

toxoplasma gondii

84

phenoxybenzamine:-type of drug?-application?-toxicity?

-nonselective alpha-blocker (irreversible/non-competitive)-used for pheochromocytoma (use phenoxybenzamine before removing tumor)-toxicity: orthostatic hypotension, reflex tachycardia

84

phenoxybenzamine:-type of drug?-application?-toxicity?

-nonselective alpha-blocker (irreversible/non-competitive)-used for pheochromocytoma (use phenoxybenzamine before removing tumor)-toxicity: orthostatic hypotension, reflex tachycardia

85

Sheets of medium-sized lymphoid cells ("starry sky" appearance on histology)

Burkitt's lymphoma (t[8:14] c-myc activation, associated with EBV; "black sky" made up of malignant cells)

85

Phentolamine:-type of drug-application?

-nonselective alpha-blocker (reversible/competitive)-give to patients on MAO-inhibitors who eat tyramine-containing foods

85

Phentolamine:-type of drug-application?

-nonselective alpha-blocker (reversible/competitive)-give to patients on MAO-inhibitors who eat tyramine-containing foods

86

silver-staining spherical aggregation of tau proteins in neurons

Pick bodies (Pick's disease: progressive dementia, changes in personality)

86

prazosin, terazosin, doxazosin:-types of drugs?-applications?-toxicity?

-alpha-1-selective-blockers-used for hypertension, urinary retention in BPH-toxicities: orthostatic hypotension with first dose; dizziness, headache (should give pts first dose before bed, while lying down)

86

prazosin, terazosin, doxazosin:-types of drugs?-applications?-toxicity?

-alpha-1-selective-blockers-used for hypertension, urinary retention in BPH-toxicities: orthostatic hypotension with first dose; dizziness, headache (should give pts first dose before bed, while lying down)

87

"Soap bubble" in femur or tibia on x-ray

Giant cell tumor of bone (generally benign)

87

mirtazapine:-type of drug-application-toxicity

#NAME?

87

mirtazapine:-type of drug-application-toxicity

#NAME?

88

"Soap bubble" in femur or tibia on x-ray

Giant cell tumor of bone (generally benign)

88

List the B1-selective antagonists (A BEAM):

Acebutolol (partial agonist)BetaxololEsmolol (short-acting)AtenololMetoprolol

88

List the B1-selective antagonists (A BEAM):

Acebutolol (partial agonist)BetaxololEsmolol (short-acting)AtenololMetoprolol

89

"spikes" on basement membrane, "dome-like" subepithelial deposits

Membranous glomerulonephritis (may progress to nephrotic syndrome)

89

List the nonselective Beta-antagonists (Please Try Not being Picky)

PropranololTimololNadololPindolol

89

List the nonselective Beta-antagonists (Please Try Not being Picky)

PropranololTimololNadololPindolol

90

"spikes" on basement membrane, "dome-like" subepithelial deposits

Membranous glomerulonephritis (may progress to nephrotic syndrome)

90

List the partial beta-agonists (PAPA):

PindololAcebutolol

90

List the partial beta-agonists (PAPA):

PindololAcebutolol

91

Stacks of red blood cells

Rouleaux formation (high ESR, multiple myeloma)

91

Nonselective alpha and beta -antagonists:

CarvelidolLabetalol

91

Nonselective alpha and beta -antagonists:

CarvelidolLabetalol

92

Stacks of red blood cells

Rouleaux formation (high ESR, multiple myeloma)

92

Clinical applications of beta-blockers:

-hypertension (decrease CO, decrease renin secrtion - by beta-receptor blockade on JGA cells)-angina pectoris (decrease HR and contractility, so have decreased O2 consumption of myocardium)-MI (metoprolol and carvedilol --> decrease mortality from MIs)-SV

92

Clinical applications of beta-blockers:

-hypertension (decrease CO, decrease renin secrtion - by beta-receptor blockade on JGA cells)-angina pectoris (decrease HR and contractility, so have decreased O2 consumption of myocardium)-MI (metoprolol and carvedilol --> decrease mortality from MIs)-SV

93

stippled vaginal epithelial cells

"clue cells" (Gardnerella vaginalis)

93

Toxicity of Beta-blockers

-impotence!-exacerbates asthma-CV adverse effects (bradycardia, AV block, CHF)-CNS adverse effects (sedation, sleep alterations)-use caustiously with diabetics! (b/c B-blockers block sympathetically-mediated symptoms of hypoglycemia; so, patient won't be

93

Toxicity of Beta-blockers

-impotence!-exacerbates asthma-CV adverse effects (bradycardia, AV block, CHF)-CNS adverse effects (sedation, sleep alterations)-use caustiously with diabetics! (b/c B-blockers block sympathetically-mediated symptoms of hypoglycemia; so, patient won't be

94

stippled vaginal epithelial cells

"clue cells" (Gardnerella vaginalis)

94

Bethanechol applications

Bethanecol = direct cholinomimetic-used for postoperative and neurogenic ileus and urinary retention (activates Bowel and Bladder)

94

Bethanechol applications

Bethanecol = direct cholinomimetic-used for postoperative and neurogenic ileus and urinary retention (activates Bowel and Bladder)

95

"tennis-racket"-shaped cytoplasmic organelles (EM) in Langerhans cells

Birbeck granules (histiocytosis X: eosinophilic granuloma)

95

Carbachol applications

carbachol = direct cholinomimetic-used for glaucoma, pupillary contraction, relief of intraocular pressure

95

Carbachol applications

carbachol = direct cholinomimetic-used for glaucoma, pupillary contraction, relief of intraocular pressure

96

"tennis-racket"-shaped cytoplasmic organelles (EM) in Langerhans cells

Birbeck granules (histiocytosis X: eosinophilic granuloma)

96

Pilocarpine applications

-pilocarpine = direct cholinomimetic-used to stimulate sweat, tears, saliva ("cry, spit, sweat on your pillow")

96

Pilocarpine applications

-pilocarpine = direct cholinomimetic-used to stimulate sweat, tears, saliva ("cry, spit, sweat on your pillow")

97

thrombi made of white/red layers

Lines of Zahn (arterial thrombus, layers of platelets/RBCs)

97

Which cholinomimetics are resistant to AChE?

Bethanechol, Pilocarpine

97

Which cholinomimetics are resistant to AChE?

Bethanechol, Pilocarpine

98

thrombi made of white/red layers

Lines of Zahn (arterial thrombus, layers of platelets/RBCs)

98

Methacholine applications?

methacholine = direct cholinomimetic-used as a challenge test to diagnose asthma

98

Methacholine applications?

methacholine = direct cholinomimetic-used as a challenge test to diagnose asthma

99

"thumb sign" on lateral x-ray

epiglottitis (Haemophilus influenzae)

99

Neostigmine applications?

neostigmine - anticholinesterase (indirect cholinomimetic)-used for postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of NM jxn blockade-increases endogenous ACh; does not penetrate the CNS

99

Neostigmine applications?

neostigmine - anticholinesterase (indirect cholinomimetic)-used for postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of NM jxn blockade-increases endogenous ACh; does not penetrate the CNS

100

"thumb sign" on lateral x-ray

epiglottitis (Haemophilus influenzae)

100

Pyridostigmine applications?

pyridostigmine = anticholinesterase (indirect cholinomimetic)-used for myasthenia gravis (gets RID of MG)-does not penterate CNS-increases endogenous ACh

100

Pyridostigmine applications?

pyridostigmine = anticholinesterase (indirect cholinomimetic)-used for myasthenia gravis (gets RID of MG)-does not penterate CNS-increases endogenous ACh

101

Thyroid-like appearance of kidney

chronic bacterial pyelonephritis

101

Edrophonium applications

endrophonium = anticholinesterase (indirect cholinomimetic)-used to diagnose myasthenia gravis-increases endogenous Ach

101

Edrophonium applications

endrophonium = anticholinesterase (indirect cholinomimetic)-used to diagnose myasthenia gravis-increases endogenous Ach

102

Thyroid-like appearance of kidney

chronic bacterial pyelonephritis

102

Physostigmine applications

physostigmine = anticholinesterase (indirect cholinomimetic)-used to treat glaucoma and atropine overdose ("phyxes" atropine OD)-crosses the BBB!-increases endogenous Ach

102

Physostigmine applications

physostigmine = anticholinesterase (indirect cholinomimetic)-used to treat glaucoma and atropine overdose ("phyxes" atropine OD)-crosses the BBB!-increases endogenous Ach

103

"tram-track" appearance on LM

membranoproliferative glomerulonephritis

103

Echothiophate applications

echothiphate = anticholinesterase (indirect cholinomimetic)-used to treat glaucoma-increases endogenous Ach

103

Echothiophate applications

echothiphate = anticholinesterase (indirect cholinomimetic)-used to treat glaucoma-increases endogenous Ach

104

"tram-track" appearance on LM

membranoproliferative glomerulonephritis

104

Donepezil applications

donepezil = anticholinesterase (indirect cholinomimetic)-used to treat Alzheimer's disease-increases endogenous Ach!

104

Donepezil applications

donepezil = anticholinesterase (indirect cholinomimetic)-used to treat Alzheimer's disease-increases endogenous Ach!

105

triglyceride accumulation in liver cell vacuoles

fatty liver disease (alcoholic or metabolic syndrome)

105

pKa = acid dissociation constant = ?

pKa = pH at which amount of the non-protonated form = the amount of the protonated form

105

pKa = acid dissociation constant = ?

pKa = pH at which amount of the non-protonated form = the amount of the protonated form

106

triglyceride accumulation in liver cell vacuoles

fatty liver disease (alcoholic or metabolic syndrome)

106

if pH < pKa...

acidic environment; have more of the protonated form (so, basic drugs get trapped)

106

if pH < pKa...

acidic environment; have more of the protonated form (so, basic drugs get trapped)

107

WBCs that look "smudged"

CLL (almost always B cell; affects elderly)

107

if pH > pKa...

basic environment; have more of the nonprotonated form (acidic drugs get trapped)

107

if pH > pKa...

basic environment; have more of the nonprotonated form (acidic drugs get trapped)

108

WBCs that look "smudged"

CLL (almost always B cell; affects elderly)

108

Treat acidic drug OD (ie slicylates) with?

NaHCO3 (traps the acidic drug in the basic urine)

108

Treat acidic drug OD (ie slicylates) with?

NaHCO3 (traps the acidic drug in the basic urine)

109

"wire loop" glomerular appearnce on LM

Lupus nerphropathy

109

Treat basic drug OD (ie amphetamines) with?

NH4Cl (ammonium chloride; traps basic drug in the acidic urine)

109

Treat basic drug OD (ie amphetamines) with?

NH4Cl (ammonium chloride; traps basic drug in the acidic urine)

110

"wire loop" glomerular appearnce on LM

Lupus nerphropathy

110

What class of drugs can cause excess parasympathetic activity (ie DUMBBELSS symptoms)?

Cholinomimetic agents

110

What class of drugs can cause excess parasympathetic activity (ie DUMBBELSS symptoms)?

Cholinomimetic agents

111

Yellow CSF

Xanthochromia (previous subarachnoid hemorrhage)

111

What drug regenerates AchE after organophosphate poisoning?

Pralidoxime (regenerates active AchE) (also, give atropine to treat symptoms!)

111

What drug regenerates AchE after organophosphate poisoning?

Pralidoxime (regenerates active AchE) (also, give atropine to treat symptoms!)

112

Yellow CSF

Xanthochromia (previous subarachnoid hemorrhage)

112

What are the symptoms of inhibiting parasympathetic activity?

(ie atropine side effects)Hot as a hareDry as a boneRed as a beetBlind as a batMad as a hatterBloated as a toad

112

What are the symptoms of inhibiting parasympathetic activity?

(ie atropine side effects)Hot as a hareDry as a boneRed as a beetBlind as a batMad as a hatterBloated as a toad

113

Erlenmeyer flask bones on X-ray (bones flare out)

Osteopetrosis (abnormal osteoclasts)

113

In what populations is atropine contraindicated?

-Glaucoma (because don't want to dilate eyes)-BPH or any urinary retention-GI obstruction (ie ileus)-Dementia or Elderly (because can cause delirium)-Infant with fever (because can cause hyperthermia)-

113

In what populations is atropine contraindicated?

-Glaucoma (because don't want to dilate eyes)-BPH or any urinary retention-GI obstruction (ie ileus)-Dementia or Elderly (because can cause delirium)-Infant with fever (because can cause hyperthermia)-

114

"double bubble" or "soap bubble" appearance on x-ray

Giant cell tumor (osteoclastoma)

114

List 4 classes of drugs with anti-cholinergic side effects:

1) First generation H1-Blockers (diphenhydramine, doxylamine, chlorpheniramine)2) Traditional neuroleptics3) TCAs4) Amantadine

114

List 4 classes of drugs with anti-cholinergic side effects:

1) First generation H1-Blockers (diphenhydramine, doxylamine, chlorpheniramine)2) Traditional neuroleptics3) TCAs4) Amantadine

115

codman's triangle or sunburst pattern on x-ray

osteosarcoma (osteogenic sarcoma); pattern is from elevation of periosteum

115

List 4 treatment options for Myasthenia Gravis:

1) Anti-cholinesterases (indirect cholinergic agonists)2) Corticosteroids (because MG = autoimmune disease)3) Thymectomy (often curative)4) Plasmapheresis

115

List 4 treatment options for Myasthenia Gravis:

1) Anti-cholinesterases (indirect cholinergic agonists)2) Corticosteroids (because MG = autoimmune disease)3) Thymectomy (often curative)4) Plasmapheresis

116

Disease associated with HLA-A3

Hemochromatosis

116

What are the 5 classes of drugs used to treat glaucoma?

1) alpha-agonists2) beta-blockers3) Diuretics (Carbanic anhydrase inhibtors and mannitol)4) cholinomimetics5) prostaglandins

116

What are the 5 classes of drugs used to treat glaucoma?

1) alpha-agonists2) beta-blockers3) Diuretics (Carbanic anhydrase inhibtors and mannitol)4) cholinomimetics5) prostaglandins

117

Disease associated with HLA-B27

PAIR: Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, Reither's syndrome (Reactive arthritis)

117

P-450 Inducers

Barb Steals Phen-phen and Refuses Greasy Carbs Chronically:BarbituratesSt. John's wortPhenytoinRifampinGriseofulvinCarbamazepineChronic alcohol use

117

P-450 Inducers

Barb Steals Phen-phen and Refuses Greasy Carbs Chronically:BarbituratesSt. John's wortPhenytoinRifampinGriseofulvinCarbamazepineChronic alcohol use

118

Disease associated with HLA-B8

Graves' disease

118

P-450 inhibitors

Q-MAGIC RACKS:QuinidineMacrolidesAmiodaroneGrapefruit juiceIsoniazidCimetidineRitonavirAcute alcohol abuseCiprofloxacinKetoconazoleSulfonamides

118

P-450 inhibitors

Q-MAGIC RACKS:QuinidineMacrolidesAmiodaroneGrapefruit juiceIsoniazidCimetidineRitonavirAcute alcohol abuseCiprofloxacinKetoconazoleSulfonamides

119

Diseases associated with HLA-DR2

Multiple sclerosis, hay fever, SLE, Goodpasture's

119

acetaminophen antidote? (toxic dose = 4 g/day = 8 extra-strength tablets)

N-acetylcysteine (replenishes glutathione)

119

acetaminophen antidote? (toxic dose = 4 g/day = 8 extra-strength tablets)

N-acetylcysteine (replenishes glutathione)

120

Disease associated with HLA-DR3

Diabetes mellitus type I

120

salicylates (ie aspirin) antidote?

NaHCO3 (alkalinizes urine)Dialysis

120

salicylates (ie aspirin) antidote?

NaHCO3 (alkalinizes urine)Dialysis

121

Diseases associated with HLA-DR4

Rheumatoid arthritis, Diabetes mellitus type I

121

amphetamines antidote

NH4Cl (acidifies urine)

121

amphetamines antidote

NH4Cl (acidifies urine)

122

Disease associated with HLA-DR5

Pernicious anemia --> B12 deficiency,
Hashimoto's thyroiditis

122

anti-acetylcholinesterase and organophosphates antidote?

Atropine + Pralidoxime

122

anti-acetylcholinesterase and organophosphates antidote?

Atropine + Pralidoxime

123

Disease associated with HLA-DR7

Steroid-responsive nephrotic syndrome

123

antimuscarinic, anticholinergic agents (ie atropine) antidote?

physostigmine salicylate

123

antimuscarinic, anticholinergic agents (ie atropine) antidote?

physostigmine salicylate

124

Abdominal pain, ascites, hepatomegaly

Budd-Chiari syndrome (posthepatic venous thrombosis)

124

beta-blockers antidote?

(same as verapamil antidote!) = glucagon, calcium, atropine (all increase HR)

124

beta-blockers antidote?

(same as verapamil antidote!) = glucagon, calcium, atropine (all increase HR)

125

Achilles tendon xanthoma

familial hypercholesterolemia (decreased LDL receptor signaling)

125

Iron antidote

deferoxamine

125

Iron antidote

deferoxamine

126

Adrenal hemorrhage, hypotension, DIC

Waterhouse-Friderichsen syndrome (meningococcemia)

126

lead antidote

CaEDTA (in adults)Dimercaprolsuccimer (in kids)penicillamine

126

lead antidote

CaEDTA (in adults)Dimercaprolsuccimer (in kids)penicillamine

127

Arachnodactyly (spider-like fingers), lens dislocation, aortic dissection, hyperflexible joints

Marfan's syndrome (fibrillin defect)

127

mercury, arsenic, gold antidote

-dimercaprol (BAL) (dimes = money = gold; merc = mercury!)-succimer

127

mercury, arsenic, gold antidote

-dimercaprol (BAL) (dimes = money = gold; merc = mercury!)-succimer

128

Athlete with polycythemia

erythropoietin injection

128

copper, arsenic, gold antidote

penicillamine (copper pennies!)

128

copper, arsenic, gold antidote

penicillamine (copper pennies!)

129

back pain, fever, night sweats, weight loss

Pott's disease (vertebral TB)

129

cyanide antidote

(may get cyanide poisoning from nitroprusside, used for malignant HTN; also, from house fires -- see CN toxicity along with CO poisoning)-nitrite-hydroxocobalamin-thiosulfate

129

cyanide antidote

(may get cyanide poisoning from nitroprusside, used for malignant HTN; also, from house fires -- see CN toxicity along with CO poisoning)-nitrite-hydroxocobalamin-thiosulfate

130

Bilateral hilar adenopathy, uveitis

Sarcoidosis (non-caseating granulomas)

130

Carbon monoxide antidote

100% O2Hyperbaric O2

130

Carbon monoxide antidote

100% O2Hyperbaric O2

131

blue sclera

osteogenesis imperfecta (collagen defect)

131

opioids antidote

naloxone/naltrexone

131

opioids antidote

naloxone/naltrexone

132

bluish line on gingiva

Burton's line (lead poisoning)

132

benzodiazepines antidote

flumazenil

132

benzodiazepines antidote

flumazenil

133

Bone pain, bone enlargement, arthritis, increased hat size, fractures

Paget's disease of bone (increased osteoblastic AND osteoclastic activity)

133

TCAs antidote

NaHCO3 (plasma alkalinization)

133

TCAs antidote

NaHCO3 (plasma alkalinization)

134

bounding pulses, diastolic heart murmur, head bobbing

aortic regurgitation

134

Heparin antidote

protamine (H+ = Proton-amine!)

134

Heparin antidote

protamine (H+ = Proton-amine!)

135

"butterfly" facial rash and Raynaud's phenomenon in a young female

SLE

135

Warfarin antidote

vitamin Kfresh frozen plasma

135

Warfarin antidote

vitamin Kfresh frozen plasma

136

cafe-au-lait spots, polyostotic fibrous displasia, precocious puberty

McCune-Albright syndrome (mosaic G-protein signaling mutation)

136

tPA, streptokinase, urokinase antidote?

Aminocaproic acid

136

tPA, streptokinase, urokinase antidote?

Aminocaproic acid

137

cafe-au-lait spots, Lisch nodules (iris hamartoma =excess of normal iris tissue)

Neurofibromatosis type I (and pheochromocytoma, optic gliomas) and Neurofibromatosis type II (and bilateral acoustic neuromas)

137

theophylline antidote

Beta-blocker(theophylline is an option for COPD pts; it has a low TI with cardio-toxicity; so, give beta-blockers for the cardio-toxic effects)

137

theophylline antidote

Beta-blocker(theophylline is an option for COPD pts; it has a low TI with cardio-toxicity; so, give beta-blockers for the cardio-toxic effects)

138

calf pseudohypertrophy

muscular dystrophy (most commonly Duchenne's): X-linked recessive deletion of dystrophin gene

138

Verapamil antidote

same as beta-blocker antidote! = glucagon, calcium, atropine (all increase HR)

138

Verapamil antidote

same as beta-blocker antidote! = glucagon, calcium, atropine (all increase HR)

139

"cherry red spot" on macula

1) Tay-Sachs (ganglioside accumulation)
2) Niemann-Pick (sphingomyelin accumulation)
3) Central retinal artery occlusion

139

Digitalis antidote

-Normalize K+ and Mg2+-lidocaine (if there's tachyarrhythmia) -anti-dig fab fragments (if there's arrhythmia)-atropine (if there's bradycardia)

139

Digitalis antidote

-Normalize K+ and Mg2+-lidocaine (if there's tachyarrhythmia) -anti-dig fab fragments (if there's arrhythmia)-atropine (if there's bradycardia)

140

chest pain on exertion

angina (stable: moderate exertion; unstable: minimal exertion)

140

methemoglobin antidote

-methylene blue-vitamin C

140

methemoglobin antidote

-methylene blue-vitamin C

141

chest pain, pericardial effusion, friction rub, persistent fever following MI

Dressler's syndrome (autoimmune-mediated post-MI fibrinous pericarditis; 1-12 weeks after acute episode)

141

methanol, ethylene glycol (anti-freeze) antidote

-Fomepizole = 1st choice! (inhibits alcohol dehydrogenase)-2nd choices = ethanol, dialysis

141

methanol, ethylene glycol (anti-freeze) antidote

-Fomepizole = 1st choice! (inhibits alcohol dehydrogenase)-2nd choices = ethanol, dialysis

142

child uses arms to stand up from squat

Gower's sign (Duchenne muscular dystrophy)

143

child with fever develops rash on face that spreads to body

"slapped cheeks" (erythema infectiosum/fifth disease: parvo B19)

144

chorea, dementia, caudate degeneration

Huntington's disease (autosomal-dominant CAG repeat expansion)

145

5 C's of Huntington's disease?

Chorea
Crazy
Caudate degeneration
CAG repeats
Choline (decrease Ach)

146

chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria

McArdle's disease (muscle glycogen phosphorylase deficiency)

147

Cold intolerance

Hypothyroidism

148

conjugate lateral gaze palsy, horizontal diplopia

internuclear ophthalmoplegia (damage to MLF; bilateral [multiple sclerosis], unilateral [stroke])

149

continuous "machinery" heart murmur

PDA (close with indomethacin; open with misoprostol (a PG))

150

decreased Ach in? increased Ach in?

decreased Ach: Alzheimer's and Huntington's
increased Ach: Parkinson's

151

cutaneous/dermal edema d/t connective tissue deposition

myxedema (caused by hypthyroidism, Grave's disease (periorbital) = not a typo! :))

152

dark purple skin/mouth nodules

Kaposi's sarcoma (usually AIDS pts; assoc with HHV-8)

153

Deep, labored breathing/hyperventilation

Kussmaul breathing (diabetic ketoacidosis)

154

Dermatitis, dementia, diarrhea

Pellagra (niacin [vitamin B3] deficiency)

155

Dilated cardiomyopathy, edema, polyneuropathy

wet beriberi(thiamine [vitamin B1] deficiency)

156

dog or cat bite resulting in infection

Pasteurella multocida (cellulitis at inoculation site)

157

dry eyes, dry mouth, arthritis

Sjogren's (autoimmune destruction of exocrine glands)

158

dysphagia (esophageal webs), glossitis, iron deficiency anemia

Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)

159

elastic skin, hypermobility of joints

Ehler's-Danlos syndrome (type III collagen defect)

160

enlarged, hard left supraclavicular node

Virchow's triad (commonly abdominal metastasis)

161

Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T-cells

1) Sezary syndrome (cutaneous T-cell lymphoma)
2) Mycosis fungoides

162

facial muscle spasm upon tapping

Chvostek's sign (hypocalcemia)

163

fat, female, forty, and fertile

acute cholelithiasis (bile duct blockage)

164

fever, chills, headache, myalgia, following antibiotic treatment for sphyilis

Jarisch-Herxheimer reaction (rapid lysis of spirochetes results in toxin release)

165

fever, cough, conjunctivitis, coryza (allergy symptoms), diffuse rash

Measles (Morbillivirus)

166

fever, night sweats, weight loss

1) B symptoms (Lymphoma)
2) TB

167

fibrous plaques in soft tissue of penis

Peyronie's disease (connective tissue disorder)

168

gout, mental retardation, self-mutilation behavior in a boy

Lesch-Nyhan syndrome (HGPRT-deficiency; X-linked recessive)

169

Green-yellow rings around peripheral cornea

Kayser-Fleischer rings (copper accumulation from Wilson's disease)

170

Hamartomatous GI polyps, hyperpigmentaion of mouth/feet/hands

Peutz-Jeghers syndrome (genetic benign polyposis can cause bowel obstruction; increased cancer risk)

171

hepatosplenomegaly, osteoporosis, neurologic symptoms

Gaucher's disease (glucocerebrosidase deficiency; "crinkle-tissue paper cytoplasm")

172

Hereditary nephritis, sensourineural hearing loss, cataracts

Alport syndrome (mutation in alpha chain of collagen IV; "can't see, can't pee, can't hear)

173

hypercoagulability (leading to migrating DVTs and vasculitis)

Trousseau's sign (adenocarcinoma of pancreas of lung)

174

hyperphagia, hypersexuality, hyperorality, hyperdocility

Kluver-Bucy syndrome (bilateral amygdala lesion)

175

hyperreflexia, hypertonia, positive Babinski

UMN damage

176

hypertension, hypokalemia, metabolic alkalosis

Conn's syndrome (primary hyperaldosteronism)

177

hyporeflexia, hypotonia, atrophy

LMN damage

178

hypoxemia, polycythemia, hypercapnia

"blue boater" (chronic bronchitis: hyperplasia of mucous cells)

179

non-painful, indurated, ulcerated genital lesion

chancre (primary syphilis = treponema pallidum)

180

painful, indurated, ulcerated genital lesion, with exudate

chancroid (hamophilus ducreyi)

181

infant with ftt, hepatosplenomegaly, neurodegeneration, cherry red spots on macular disc

Niemann-Pick disease (genetic sphingomyelinase deficiency)

182

infant with ftt, hypoglycemia, hepatomegaly

Cori's disease (debranching enzyme deficiency)

183

infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect

Edward's syndrome (trisomy 18)

184

Keratin pearls on a skin biopsy

squamous cell carcinoma

185

large rash with bull's-eye appearance

erythema chronicum migrans from Ixodes tick bite (Lyme disease: Borrelia)

186

lucid interval after traumatic brain injury

epidural hematoma (middle meningeal artery rupture)

187

male child, recurrent infections, no mature B cells

Bruton's disease (X-linked agammaglobulinemia)

188

mucosal bleeding and prolonged bleeding time

Glanzmann's thrombasthenia (defect in platelet aggregation due to lack of GpIIb/IIIa)

189

multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth

Gardner's syndrome (subtype of FAP)

190

myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance

Pompe's disease (lysosomal alpha-1,4-glucosidase deficiency)

191

necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

1) Wegener's (c-ANCA)
2) Goodpasture's syndrome (anti-BM antibodies)

192

neonate with arm paralysis following difficult birth

Erb-Duchenne's palsy (superior trunk [C5-C6] brachial plexus injury: "waiter's tip")

193

no lactation postpartum, absent menstruation, cold intolerance

Sheehan's syndrome (pituitary infarction)

194

nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia

multiple sclerosis

195

oscillating slow/fast breathing

Cheyne-Stokes respirations (central apnea in CHF or increased intracranial pressure)

196

painful blue fingers/toes, hemolytic anemia

cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious mononucleosis)

197

painful, pale, cold fingers/toes

Raynaud's syndrome (vasospasm in extremities)

198

painful, raised red lesions on palms and soles

Osler's node (infective endocarditis)

199

painless erythematous lesions on palms and soles

Janeway lesions (infective endocarditis)

200

painless jaundice

cancer of the pancreatic head obstructing bile duct

201

palpable purpur on buttocks/legs, joint pain, abdominal pain (child)

Henoch-Schonlein purpura (IgA vasculitis affecting skin and kidneys)

202

pancreatic (Zollinger-Ellsion syndrome, insulinomas, VIPomas, glucagonomas), pituitary (prolactin or GH), parathyroid tumors

MEN 1 = "Wermer's syndrome" (autosomal dominant)

203

pink complexion, dyspnea, hyperventilation

"pink puffer" (emphysema: centroacinar [smoking], panacinar [alpha-1-antitrypsin deficiency])

204

polyuria, acidosis, growth failure, electroylte imbalances

Fanconi's syndrome (proximal tubular reabsorption defect)

205

positive anterior "drawer sign"

ACL (anterior cruciate ligament) injury

206

ptosis (droopy eyelid), miosis, anhidrosis

Horner's syndrome (sympathetic chain lesion)

207

pupil accommodates but doesn't react

Argyll Robertson pupil (neurosyphilis)

208

rapidly progressive leg weakness that ascends (following GI/upper respiratory infection)

Guillan-Barre syndrome (autoimmune acute inflammatory demyelinating polyneuropathy)

209

rash on palms and soles

CARS:
-Coxsackie A
-Rocky mountain spotted fever
-Syphilis (secondary)

210

Recurrent colds, unusual eczema, high serum IgE

hyper-IgE syndrome = Job's syndrome (neutrophil chemotaxis abnormality)

211

red "currant jelly" sputum in alcoholic or diabetic patients

Klebsiella pneumoniae

212

red, itchy, swollen rash of nipple/areola

Paget's disease of breast (represents underlying neoplasm)

213

red urine in the morning, fragile RBCs

paroxysmal nocturnal hemoglobinuria

214

renal cell carcinoma (bilateral), hemangioblastoma, angiomatosis, pheochromocytoma

von-Hippel-Lindau disease (dominant tumor suppressor gene mutation)

215

resting tremor, rigidity, akinesia, postural instability

Parkinson's disease (nigrostriatal dopamine depletion)

216

retinal hemorrhages with pale centers

Roth's spots (bacterial endocarditis)

217

severe jaundice in neonate

Crigler-Najjar syndrome (congenital unconjugated hyperbiliribunemia)

218

severe RLQ pain with rebound tenderness

McBurney's sign (appendicitis)

219

short stature, increased incidence of tumors/leukemia, aplastic anemia

Fanconi's anemia (genetic loss of DNA crosslink repair; often progresses to AML)

220

single palm crease

Simian crease (Down's syndrome)

221

situs inversus, chronic sinusitis, bronchiectasis, infertility

Kartagener's syndrome (dynein arm defect affecting cilia)

222

skin hyperpigmentation

Addison's disease (primary adrenocortical insufficiency causes increased ACTH and alpha-MSH production)

223

slow, progressive muscle weakness in boys

Becker's muscular dystrophy (X-linked missense mutation in dystrophin; less severe than Duchenne's

224

small, irregular red spots on buccal/lingual mucosa with blue-white centers

Koplik spots (measles; rubeola virus)

225

smooth, flat, moist white lesions on genitals

condylomata lata (secondary syphilis)

226

splinter hemorrhages in fingernails

bacterial endocarditis

227

"strawberry tongue"

1) Scarlet fever
2) Kawasaki disease
3) Toxic Shock Syndrome

228

streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth

Turner syndrome (45XO, short stature, webbed neck, lymphedema)

229

sudden swollen/painful big toe joint, tophi

gout/podagra (hyperuricemia)

230

swollen gums, mucous bleeding, poor wound healing, spots on skin

scurvy (vitamin C deficiency: can't hydroxylate proline/lysine for collagen synthesis)

231

swollen, hard, painful finger joints

osteoarthritis (osteophytes on PIP [Bouchard's nodes], DIP [Heberden's nodes])

232

systolic ejection murmur (crescendo-decrescendo)

aortic valve stenosis

233

thyroid and parathyroid tumors (medullary thryoid carcinoma - secretes calcitonin), pheochromocytoma

MEN 2A = Sipple's syndrome (autosomal dominant "ret" mutation)

234

Thyroid tumor (medullary thyroid carcinoma - secretes calcitonin), Pheochromocytoma, Ganglioneuromatosis (oral/intestinal - associated with marfanoid habitus)

MEN 2B (autosomal dominant "ret" mutation)

235

toe extension/fanning upon plantar scrape

Babinski sign (UMN lesion)

236

unilateral facial drooping involving forehead

Bell's palsy (LMN CN VII palsy)

237

urethritis, conjunctivitis, arthritis in a male

reactive arthritis associated with HLA-B27

238

vascular birthmark (port-wine stain)

hemangioma (benign, but associated with Sturge-Weber syndrome)

239

vomiting blood following esophagogastric lacerations

Mallory-Weiss syndrome (alcoholic and bulimic patients)

240

"waxy" casts with very low urine flow

chronic end-stage renal disease

241

WBC casts in urine

acute pyelonephritis

242

weight loss, diarrhea, arthritis, fever, adenopathy

Whipple's disease (Tropheryma whippeli)

243

"worst headache of my life"

subarachnoid hemorrhage

244

Ptosis or Diplopia that worsens throughout the day?

Myasthenia gravis

245

Signs of lead toxicity:

ABCDEFG!
Anemia
Basophilic stippling
Colicky pain
Diarrhea
Encephalopathy
Foot drop
Gums ("lead line")

246

Which coronary artery is most often occluded and what kind of MI does it cause?

coronary artery occlusion most commonly occurs in the LAD (left anterior descending). this causes an anterior wall MI

247

Cardiac output = ?

CO = SV X HR

248

Fick Principle:

CO = (rate of O2 consumption)/(arterial O2 content - venous O2 content)

249

Mean Arterial Pressure = ?

MAP = 2/3(DP) + 1/3(SP)
MAP = CO X TPR
P = Q X R

*TPR = total peripheral resistance
*P = MAP
*Q=CO
*R = TPR

250

Pulse pressure = ?

Systolic pressure - Diastolic pressure

pulse pressure is proportional to SV

251

Stroke Volume = ?

SV = CO/HR = EDV - ESV

252

What factors affect stroke volume?
List 3 conditions which lead to increased SV:

SV CAP:
-Contractility
-Afterload
-Preload
(increased SV when increased contractility, increased preload, or decreased afterload)
-get increased SV in:
1) anxiety (b/c increased catecholamines)
2) pregnancy (b/c increased blood volume and preload)
3) exercise (b/c increased preload and catecholamines)

253

List 4 factors that increase contractility (and thus SV too):

1) Catecholamines (via B1 receptors)
2) increased intracellular Calcium
3) decreased extracellular Sodium (and therefore decreased Na+/Ca2+-exchanger --> so increased intracellular calcium)
4) Digitalis (blocks Na+/K+-ATPase leading to decreased Na+/Ca2+-exchanger and increased intracellular calcium)

254

List five factors that decrease contractility (and thus SV too):

1) Beta-1 Blockade
2) Heart failure
3) Acidosis
4) Hypoxia/Hypercapnea
5) non-dihydropyridine Calcium channel blockers (ie Verapamil and Diltiazem)

255

List 3 ways to decrease the Oxygen demand in a heart attack (mechanism + types of drugs used to achieve mechanism)?

1) decrease afterload --> give Ace-inhibs or ARBs
2) decrease contractility --> Beta-blockers
3) decrease HR --> Beta-blockers

256

Ejection Fraction = ?

EF = SV/EDV = (EDV - ESV)/EDV

basically, EF = what heart can pump out/what heart can hold

*normal EF > 55%

257

Resistance: relationship to length viscosity? radius?

Equation: Resistance = (8nviscosity X length)/(piXr^4)
So:
*Resistance is proportional to length
*Resistance is proportional to viscosity
*Resistance is inversely proportional to radius (specifically, 1 R is inversely proportional to r^4)

258

3 states in which see increased viscosity:

*Viscosity depends mostly on hematocrit; see increased viscosity in:
1) Polycythemia
2) Hyperproteinemic states (ie multiple myeloma)
3) Hereditary spherocytosis

259

List the classes of antiarrhythmic drugs

"No Bad Boy Keeps Clean"
Class I - Na+ channel blockers; 3 subclasses
Class 2 - Beta-Blockers
Class 3 - K+ channel blockers
Class 4 - Ca2+ channel blockers

260

List the class I antiarrhythmic drugs:

What is their mechanism?

Na+ channel blockers
3 subclasses: "Double Quarter Pounder - Lettuce, Tomato, Mayo, (Pickles) - Fries, Please"

Class Ia: "Double Quarter Pounder"
Disopyramide
Quinidine
Procainamide

Class Ib: "Lettuce, Tomato, Mayo"
Lidocaine
Mexiletine
Tocainide
(Phenytoin)

Class Ic: "Fries, Please"
Flecainide
Propafenone

*Class I anti-arrhythmics decrease the slope of phase 0 depolarization

261

List the class II antiarrhythmic drugs:

What is their mechanism?

Beta-Blockers

Propranolol
Esmolol
Metoprolol
Atenolol
Timolol

*Class II drugs decrease the slope of phase 4; increase the PR interval

262

List the class III antiarrhythmic drugs:

Mechanism?

K+ channel blockers
"K IS BAD"

Ibutilide
Sotalol
Bretylium
Amiodarone
Dofetilide

*act on phase 3; increase AP duration by slowing the efflux of K from the cell; increase QT interval

263

List the class IV antiarrhythmic drugs:

Mechanism?

Ca2+ channel blockers

Verapamil
Diltiazem

*decrease phase 0, so slow depolarization; increase the effective refractory period; increase the PR interval

264

Which anti-arrhythmic drugs increase the QT interval?

Class IA (qunidine, procainamide, disopyramide)
Class III

Both cause a prolonged AP duration and increase the ERP (effective refractory period)

*Note: a side effect of increased QT interval = torsades de pointes

265

Which anti-arrhythmic drug causes an increased QT interval but has a low risk of causing torsades de pointes?

Amiodarone

266

Which anti-arrhythmic drugs decrease the AP duration?

Class IB: Lidocaine, Mexiletine, Tocainide (and Phenytoin)

267

Which class of anti-arrhythmic drugs are contra-indicated post-MI?

Class IC is CI post-MI (Flecainide, Propafenone)

268

Which 2 drugs can be used to treat WPW (Wolf-Parkinson-White)?

Procainamide (only indication for this drug; side effect = drug-induced lupus)
Amiodarone

269

What should be checked before initiating Amiodarone therapy?

Amiodarone = a class III antiarrhythmic

Toxicities include: Pulmonary fibrosis, Hepatotoxicity, Hypothyroidism/Hyperthyroidism (because it is 40% iodine by weight); also: corneal deposits, skin deposits, photosensitivity, neurologic effects, constipation, CV effects....

So, before starting treatment: check PFTs, LFTs, TFTs (pulmonary, liver, and thyroid function tests)

270

Which anti-arrhythmic drug is 40% iodine by weight?

Amiodarone (a class III antiarrhythmic)

271

Drug of choice in diagnosing/abolishing SVT (supraventricular tachycardia)?

Adenosine (increases K+ out of cells --> hyperpolarizes the cell and decreases intracellular calcium)

Can block effects of adenosine with THEOPHYLLINE.

272

Indications for Mg2+ as an anti-arrhythmic?

Torsades de pointes and Digoxin toxicity

273

Drug class of choice to decrease LDL?

Statins = HMG-CoA reductase inhibitors (lovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin)

274

Side effects of Statins?

Hepatotoxicity (increased LFTs)
Myopathy/Rhabdomyolysis

275

Drug of choice to increase HDL?

Niacin = Vitamin B3

276

Which lipid-lowering agent has side effects that include:
-red, flushed face
-hyperglycemia,
-hyperuricemia
?

Niacin (Vitamin B3; lipid lowering agent of choice to increase HDL)

277

Drug class of choice to decrease triglycerides?

#1 = Fibrates (gemfibrozil, clofibrate, bezafibrate, fenofibrate)
#2 = Omega 3 FAs

278

Which lipid-lowering agents may lead to myositis and hepatotoxicity?

Statins and Fibrates (so don't use these 2 classes together!)

279

Digoxin mechanism and clinical use?

*inhibits Na+/K+-ATPase thereby inhibiting Na+/Ca2+-exchanger. This leads to increased intracellular Calcium and increased contractility. So can be used in CHF to increase contractility

*Also stimulates vagus nerve, so stimulates the parasympathetic NS! So, it can be used in atrial fibrillation (because slows the rate of AV node conduction and depresses the SA node)

280

Digoxin toxicities (KNOW this :))

*cholinergic: nausea, vomiting, diarrhea, blurry yellow vision
*ECG: increased PR, decreased QT, T-wave inversion, arrhythmia, hyperkalemia, bradycardia
*worsened by renal failure (because decreased excretion), hypokalemia, quinidine (decreased digoxin clearance)

281

Digoxin antidotes:

-normalize K+ and Mg2+
-Lidocaine (if there's a tachyarrhythmia)
-cardiac pacer
-anti-Dig-Fab fragments (if there's an arrhythmia)

282

List 4 drugs that decrease BP (anti-hypertensives...) that are SAFE to use in PREGNANCY:

Hydralazine
Nifedipine
Labetalol
Methyldopa

283

Anti-hypertensive treatment choice for Essential HTN?

-Diuretics (spec thiazides, ie hydrochlorothiazide)
-ACE-inhibs, ARBs
-CCBs

*Note: only use thiazides in essential HTN pts without CHF or diabetes; if a pt has CHF or diabetes, then ACE-inhibs = #1 choice!

Can also use Beta-Blockers

284

Anti-hypertensive treatment choice in CHF?

-Loop Diuretics (ie furosemide; because increase Calcium excretion in urine!)
-ACE-inhibs/ARBs
-Beta-blockers in compensated CHF (use cautiously!)
-K-sparing diuretics (ie spironolactone)

285

anti-hypertensive treatment choices in diabetes pts?

-ACE-inhibs/ARBs
-CCBs
-Diuretics
-Beta-blockers (use cautiously, because may mask symptoms of hypoglycemia!)
-alpha-blockers

286

Why must one be careful when using Beta-Blockers in a diabetic pt?

beta-blockers may mask the symptoms of hypoglycemia; so, pt may be hypoglycemia, but won't show normal symptoms... DANGER!

287

Which CV drug vasodilates arterioles more than veins and reduces afterload?

Hydralazine (used for severe HTN, HTN in pregnancy, CHF)

288

Calcium Channel Blockers:
-2 types?
-actions

Dihyropyridines
Non-dihydropiridines

Reduce muscle contractility

*need to add more info here...

289

CV drug that can cause cyanide toxicity?

Nitroprusside (used to treat malignant hypertension)

290

CV drug that decrease preload AND afterload?

Nitroprusside (malignant HTN trtmnt)

291

Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate:

*Vasodilators (relase NO in smooth muscle cause increased cGMP and smooth muscle relaxation)
*dilate veins way more than arteries, so get decreased preload
*Uses: angina, pulmonary edema; aphrodisiac and erection enhancer!
*Isosorbide Mononitrate - active metabolite of isosorbide dinitrate; has almost 100% bioavailability

292

CV drug class that may enhance erections?

Nitrates

293

Nitrates toxicities

-Reflex tachycardia (side effect of all vasodilators)
-Hypotension
-Cutaneous flushing and throbbing headaches
-"Monday disease" = tolerance development during week, then on weekend lose tolerance, get tachycardia, dizziness, headache on re-exposure.

294

Drugs with side of effect of coronary vasospasm:

cocaine
sumatriptan
amphetamines

295

drugs with cutaneous flushing side effect

"VANC"
-vancomycin
-adenosine
-niacin (also nitrates!) (can give aspirin to prevent niacin-induced flushing)
-Ca-channel blockers

296

drugs with dilated cardiomyopathy side effect

doxorubicin
daunorubicin
(these are both anti-cancer drugs that act by forming free radicals)

297

drugs with torsades de pointes side effects

-anti-arrhythmics: class IA (ie quinidine) and class III (ie sotalol)
-macrolides
-haloperidol
-risperidone
-chloroquine
-methodone
-HIV-protease inhibitors

*cause torsades by prolonging the QT interval
**treat torsades with an Mg2+ push

298

drugs with side effect of agranulocytosis

"Agranulocytosis Could Certainly Cause Pretty Major Damage"
-Clozapine
-Carbamezapine
-Colchicine
-Propylthiouracil (hyperthyroidism trtmt)
-Methimazole (hyperthyroidism trtmt)
-Dapsone

299

drugs with side effect of aplastic anemia

chloramphenicol
benzene
NSAIDs
propylthiouracil
methimazole

300

drug with reaction of: direct coombs-positive hemolytic anemia

methyldopa (anti-HTN, used to treat HTN in pregnant women)

301

drug that may cause gray baby syndrome

chloramphenicol

302

drugs that may cause hemolysis in G6PD-deficient pts

"hemolysis IS PAIN and fava beans...."
-Isoniazid
-Sulfonamides
-Primaquine (malaria)
-Aspirin (only at high doses)
-Ibuprofen
-Nitrofurantoin (antibiotic)
-fava beans!

303

drugs that may cause megaloblastic anemia

"having a blast with PMS"
-Phenytoin
-Methotrexate
-Sulfa drugs

304

drugs that may have thrombotic complications

oral contraceptives (estrogens and progesterones)

305

drugs that may lead to thrombocytopenia:

-heparin
-H2-blockers (ie antacids: cimetidine, ranitidine, famotidine, nizatidine

306

drugs with side effect of cough

ACE-inhibitors (ARBs do NOT cause cough..)

307

drugs that may cause pulmonary fibrosis

"BAB"
-bleomycin (anti-cancer drug)
-amiodarone (class III antiarrhythmic)
-busulfan (anti-cancer drug)

308

drugs with side effect of acute cholestatic hepatitis

erythromycin (a macrolide; not all macrolides cause acute cholestatic hepatitis though)

309

drugs with side effect of focal to massive hepatic necrosis

HAVA
-Halothane (inhaled anesthetic)
-Acetaminophen
-Valproic acid (anti-epileptic)
-Amanita phalloides (poisonous mushroom)

310

drug that may cause hepatitis

INH (Isoniazid)

311

drugs that may cause pseudomembranous colitis (c. diff)

-clindamycin
-ampicillin

312

drugs that may cause adrenocortical insufficiency (ie tertiary adrenal insufficiency)

rapid glucocorticoid withdrawal (suppresses the HPA)

313

drugs that may cause gynecomastia

"Some Drugs Create Awesome Knockers"
-Spironolactone
-Digitalis
-Cimetidine
-Alcohol (chronic use)
-Ketoconazole
-also estrogens

314

drugs that may cause hot flashes

SERM: tamoxifen, clomiphene

315

drugs that may cause hypothyroidism

-lithium
-amiodarone
-sulfanamides

316

drugs that may cause hyperglycemia

-niacin
-tacrolimus (immunosuppressive used in transplant pts)
-protease inhibitors