Common drug/chemotherapy for testicular cancer (+ MOA + toxicities)
- Bleomycin = active @ G2 phase of cell cycle; inhibits DNA synthesis via generation of free radicals that bind DNA and cause strand breaks
- Toxicities
- pulmonary fibrosis
- myelosuppression
- skin pigment changes
- pulmonary fibrosis
- myelosuppression
- skin pigment changes
Bleomycin: use, MOA, toxicities
- Bleomycin = used to tx testicular cancer and lymphoma
- Bleomycin = active @ G2 phase of cell cycle; inhibits DNA synthesis via generation of free radicals that bind DNA and cause strand breaks
- Toxicities
- pulmonary fibrosis
- myelosuppression
- skin pigment changes
- pulmonary fibrosis
- myelosuppression
- skin pigment changes
Clomiphen citrate: MOA, use
- clomiphene citrate = selective estrogen receptor modulator (SERM) = antiestrogen @ hypothalamus ==> reduced feeback inhibition effect of estrogen
- ==> increased GnRH ==> increased FSH/LH ==> ovulation or increased testosterone
- Use:
- females: commonly used for female infertility in polycystic ovarian syndrome
- males: off-label use to improve fertility
- ==> increased GnRH ==> increased FSH/LH ==> ovulation or increased testosterone
- females: commonly used for female infertility in polycystic ovarian syndrome
- males: off-label use to improve fertility
Characteristics of Kawasaki's disease
- acute necrotizing vasculitis of medium to small muscular arteries
- suspected immune mechanism
- generally effects children < 5yo
- higher prevalence in Japanes population
- sx:
- fever
- red eyes
- erythematous rash on palms and soles
- tachycardia
- mucosal inflammation
- labs:
- normocytic anemia
- neutrophillic leukocytosis
- elevated ESR
- suspected immune mechanism
- fever
- red eyes
- erythematous rash on palms and soles
- tachycardia
- mucosal inflammation
- normocytic anemia
- neutrophillic leukocytosis
- elevated ESR
Tx of Kawasaki's disease
- aspirin (only condition in which to give aspirin to child)
- AND intravenous immunoglobulin
Possible complications of Kawasaki's disease
- coronary artery aneurysms
Fracture ==> lost contour and flattening of shoulder
- proximal humerus fracture ==>
- axillary nerve damage ==>
- atrophy of deltoid muscle ==> lost contour/flattening
- axillary nerve damage ==>
- atrophy of deltoid muscle ==> lost contour/flattening
Lithium toxicity presentation
- physical presentation
- N/V
- dysarthria (= speech difficulties)
- lethargy
- coarse hand tremors
- ataxia, incoordination
- hyperreflexia
- vision changes
- labs/physio presentation
- nephrogenic DI ==>
- high serum sodium
- high serum osmolality
- low urine osmolality
- N/V
- dysarthria (= speech difficulties)
- lethargy
- coarse hand tremors
- ataxia, incoordination
- hyperreflexia
- vision changes
- nephrogenic DI ==>
- high serum sodium
- high serum osmolality
- low urine osmolality
Lithium tetragoenic effects
- Lithium during pregnancy ==> Ebstein's anomaly
- apically displaced tricuspid valve
- atrialization of proximal right ventrical
- enlarged right atrium
- hypoplastic functional right ventricle
- associated with atrial-septal defects
- apically displaced tricuspid valve
- atrialization of proximal right ventrical
- enlarged right atrium
- hypoplastic functional right ventricle
- associated with atrial-septal defects
Cyanide effects
- binds to iron @ final cytochrome complex in ETC
- prevents oxygen from serving as the final electron acceptor in the ETC
Cyclophosphamide MOA + (toxicities + prevention)
- Cyclophosphamide = chemotherapeutic DNA alkylating agent
- tx of non-Hodgkin's lymphoma
- myelosuppression
- hemorrhagic cystitis
- prevented w/mesna = binds cyclophosphamide metabolites in urine and neutralizes them
- tx of non-Hodgkin's lymphoma
- prevented w/mesna = binds cyclophosphamide metabolites in urine and neutralizes them
Myelosuppression characteristics
- global depression of bone marrow activity ==>
- overall lower cell count
- anemia
- decreased WBCs
- thrombocytopenia
- side effect of some cancer treatments
- overall lower cell count
- anemia
- decreased WBCs
- thrombocytopenia
Common cause of acute bacterial endocarditis in drug-abusing patient
S. aureus
Most common cause of bacterial endocarditis
- Viridans streptococci
- usually subacute
- colonize heart valves damaged by past rheumatic fever ==> L-side infective endocarditis
- common source: dental procudeures ==> oropharynx flora into bloodstream
- usually subacute
- colonize heart valves damaged by past rheumatic fever ==> L-side infective endocarditis
Common drug used to tx nephrogenic DI + MOA
- Amiloride = potassium-sparing diuretic
Conditions associated with Marfan's syndrome
- lens dislocation
- pneumothorax
- mitral valve prolapse
- aortic root dilation ==> aortic dissection
Presentation of dissecting aortic aneurysm
- dissecting aortic aneurysm ==> cardiac tamponade ==>
- decreased ventricular filling
- decreased CO
- Beck's triad
- hypotension
- increased JVP
- distant heart sounds
- ECG:
- diffuse low-voltage QRS complexes
- electrical alternans = amplitude of QRS complex oscillates w/each beat
- decreased ventricular filling
- decreased CO
- hypotension
- increased JVP
- distant heart sounds
- diffuse low-voltage QRS complexes
- electrical alternans = amplitude of QRS complex oscillates w/each beat
Nerves blocked by transvaginal pudendal nerve bock (+ common use)
- pudendal nerve fibers = S2-S4 nerve roots
- commonly used for anesthesia of perineum and inferior quarter of vagina
T-ALL presentation
- teenage males
- thymic lymphomas (widened mediastinum)
- elevated WBCs
- weakness, fever, anorexia
- petechiae (arms & legs)
- diffuse lymphadenopathy
- biopsy = pre-t cells, Tdt (terminal deoxynucleotidyl transferase) positive
Tx of Pneumocystitis jirovecii pneumonia
- first-line: trimethoprim-sulfamethoxazole (sulfa drug)
- contraindicated in sulfa allergy
- if sulfa-allergy: pentamidine
- contraindicated in sulfa allergy
Mechanism of induction of lac operon in bacterio
- Lactose (+ no glucose) stimulates lac operon
- allolactose acts as inducer via binding and activation of repressor
- No glucose ==> increased cAMP ==> binds cAMP receptor protein ==> binds lac operon promoter ==> transcription initiation
- allolactose acts as inducer via binding and activation of repressor
Parozysmal nocturnal hemoglobinuria: cause, consequences
- cause = PIG-A glycosyl phosphatidulinositol anchor protein
- consequences ==>
- intravascular hemolysis (usually @ night)
- hemosiderin in urine
- anemia
- episodic DVTs
- intravascular hemolysis (usually @ night)
- hemosiderin in urine
- anemia
- episodic DVTs
Lethary, weakenss, bony pain + lytic bone lesions + M spike in gamma-immunoglobulin regions ==> dx?
Multiple myeloma
Multiple myeloma vs. ...other cause of lytic bone lesions?
Common complication in multiple myeloma that leads to systemic/renal problems + pathologic findings
- multiple myeloma ==> primary amyloidosis
- primary amyloidosis ==>
- amyloid deposition @ mesangium and subendothelial space
- glomerular obliteration ==> heavy proteinuria ==> end-stage renal disease
- pathologic findings
- staining w/congo red ==> positive w/apple-green birefringence
- amyloid deposition @ mesangium and subendothelial space
- glomerular obliteration ==> heavy proteinuria ==> end-stage renal disease
- pathologic findings
- staining w/congo red ==> positive w/apple-green birefringence
Location of renin-producing cells
- juxtaglomerular cells = @ afferent arteriole
Presentation/mechanism of Bruton's agammaglobulinemia
- recurrent bacterial infections in boys older than 6 months
- X-linked defect in tyrosine kinase required for production of mature B cells
- low levels of all immunoglobulin classes
- normal T-lymphocyte counts
- X-linked defect in tyrosine kinase required for production of mature B cells
Immune respone: live attenuated vs. inactivated vaccines
- live attenuated ==> cell-mediated AND humoral immunity
- capable of replicating w/in cells of recipient
- inactivated ==> b-lymphocyte (humoral) immunity w/out T-cell cell involvement
- capable of replicating w/in cells of recipient
