Sat Aug 1 Flashcards
(112 cards)
1
Q
what phase is the oocyte arrest in until ovulation?
A
prophase I
2
Q
At ovulation, an oocyte continues dividing and is arrested in what phase, until fertilization by sperm
A
metaphase II
3
Q
how does low Cl effect HCO?
A
low Cl- impairs renal excretion of HCO- –> can lead to metabolic alkalosis
4
Q
Total body chloride depletion may lead to…
A
metabolic alkalosis (impaired ability to excrete HCO)
5
Q
What can cause chloride depletion?
A
Severe vomiting - loss of H and Cl
Loop or thiazide overuse – Cl excreted in urine
6
Q
If someone has metabolic alkalosis due to Cl depletion, how do you treat them?
A
Normal saline with Cl repletion
7
Q
if someone has metabolic alkalosis, measurement of what substance can help determine the etiology?
A
urine Cl-
8
Q
what type of genetic material does adenovirus have?
A
DS DNA
9
Q
a patient with diverticulosis presents with painless hematochezia, what is the pathophys of the bleed?
A
- diverticula tend to form in weak points of the colon, usualyl where the vasa recta penetrate through smooth muscle
- enlargement of the diverticula can lead to painless hematochezia, as a result of ulceration/rupture of the vasa recta
10
Q
is P aeruginosa and B cepacia lactose fermenting?
A
NOOOO
11
Q
what is dialtezam?
A
NON dihydropyridine Ca channel blocker
12
Q
risk factors for calcium oxalate stones?
A
- hypercalciuria
- hyperoxaluria
- hypocitraturia
- low Ca diet
13
Q
how can you prevent calcium oxalate stones?
A
- reduce sodium, protein and oxalate intake
- increase potassium intake, moderate calcium intake (low Ca diet is actually a risk factor)
- thiazides
14
Q
risk factors for uric acid kidney stones?
A
- gout
- myeloproliferative disorders
15
Q
why does hypocitruria increase the risk of calcium oxalate stones?
A
-the normal function of citrate in the urine is to bind to Calcium, making it soluble and preventing the formation of calcium oxalate complexes
16
Q
what type of drug is abacavir?
A
NRTI
17
Q
Abacavir A/E?
A
delayed hypersensitivty reaction (type IV)
18
Q
whcih patients are at increased risk for a hypersensitivity reaction when taking abacavir?
A
Those with HLA-B*57-01 allele
19
Q
what should be done before starting a patient on abacavir?
A
genetic testing for HLA-B*57-01 allele
20
Q
what is emtricitabine?
A
NRTI
21
Q
emtricitabine A/E?
A
hyperpigmented macular rash on palms and soles
22
Q
which bacteria has Protein A?
A
S aureus
23
Q
MOA of protein A?
A
binds Fc region of IgG - prevents complement - impaired opsonization and phagocytosis
24
Q
which bacteria secrete igA protease?
A
S pneumonia and N gonorrhea
25
what are the major risk factors for AAA?
Male
>65
SMOKING
26
what is kussmauls sign?
increased JVP on inspiratio
27
POST MI TIMEFRAME: right ventricular failure?
acute
28
POST MI TIMEFRAME: papillary muscle rupture?
3-5 days OR acute
29
POST MI TIMEFRAME: interventricular septal rupture?
3-5 days OR acute
30
POST MI TIMEFRAME: left ventricular aneurysm?
within several months
31
what will be seen on ECG of someone with carotid sinus hypersensitivity during a symptomatic episode?
A prolonged sinus pause
32
When does the early, and late, phase of a type I hyersensitivity occur?
Early - immediate
| Late- hours later
33
Findings of early type I hypersensitivty?
Wheal and flare
34
Pathophys of early type I hypersensitivity?
Preformed IgE from previous exposure crosslinks on mast cells and causes release of histmaine and leukotrienes ->vasodilation and increased permeability
35
findings of late type I hypersensitivity?
palpable, indurated lesion
36
pathophys of late type I hypersensitivity?
IgE also stimulates the late phase -- stimulates Th2 helper T cells to release cytokines that activate eosinophils, which release major basic protein and peroxidase --> tissue damage
37
what is metolazone?
thiazide
38
histologic findings of HNSCC?
- sheets of polygonal cells with abundant eosinophilic cytoplasm
- intercellular bridges and keratin pearls (irregular foci of keratinization)
39
location of Kiesselbachs plexus?
nasal septum
40
frontal bossing is a finding in...
rickets
41
which organelle is required for heme synthesis?
mitochondria
42
pathophys of hemoglobin C
Mutation on beta chain results in glutamate being replaced by lysine.
-hemoglobin C then forms crystals and promotes red cell dehydration ->mild chronic hemolytic anemia
43
why are hemoglobin H and hemoglobin barts innefective at oxygen delivery?
they have extreme oxygen affinity
44
beta globin tetramers =
hemoglobin H
45
gamma globin tetramers =
hemoglobin barts
46
what type of bone metastasis does melanoma cause?
osteoLYTIC
47
which types of cancers result in mixed (osteoblastic AND osteolytic) bone lesions?
breast and GI
48
does total lung capacity change with aging?
No - the decreased chest wall compliance and increase lung compliance cancer eachother out
49
attributable risk formula?
ARPe = 100 x ((risk of exposued-risk of unexposed)/risk of exposed)
50
if you are given the relative risk, what is the attributable risk formula?
ARP = 100 x ((RR - 1)/(RR))
-used the relative risk of the exposed group obviously
51
what is the function of ApoE3 and ApoE4?
These are found on chylomicrons and VLDL -they bind to hepatic apolipoprotein receptors and are then taken up by the liver
52
what will mutated ApoEs result in?
the liver wont be able to remove chylomicrons and VLDL remnants from the blood, leading to increased circulating triglycerides and cholesterol
53
which familial dyslipedemia has defective ApoE proteins?
type III - familial dysbetalipoproteinemia
54
patient symptoms of cataracts
- excessive glare at night
- halos around bright lights
- difficulty reading
55
clinical findigns of cataracts?
- loss of red reflex
- cloudiness of the lens
- decreased visualization of retinal detail
56
pathogenesis of cataracts?
from oxidative damage -> opacification of the lens
57
which drugs increase the risk for cataracts?
glucocorticoids
58
what is a normal alveolar pO2?
104
59
what is a normal alveolar pCO2?
40
60
is blood gass exchange at the lungs usually diffusion or perfusion limitied?
Perfusion limited- the gases equilibrate after transversing only one third the lenght of the capillary
61
What findings may indicate diffusion limited gas exchange in the lungs?
An increased gradient between alveolar pO2 and pulmonary venous pO2 -enough gas isnt able to diffuse to equillibrate in time
62
Will pCO2 in the venous blood usualyl be affected in diffusion limited gas exchange?
No - it equibilrates much faster than O2 so is usually normal
63
What normal condition can result in diffusion limited gas exchange?
Exercise --- blood very high perfusion rates so that diffusion cant keep up
64
Is a pulmonary vein PO2 of 70 normal?
NO - should be closer to 100 - this indicates diffusion limited gas exchange
65
antigenic shift AKA
genetic reassortment - reassortment of RNA segments between different strains
66
statins MOA
HMG coa reductase inhibitors
67
statins effects
-decreased LDL, decreased triglycerides
68
statins S/E
hepatotoxicity, muscle toxicity
69
ezitimibe MOA
decreased intestinal cholesterol absorbtion
70
ezitimibe effects
decreased LDL
71
ezitimibe A/E
Increased hepatotoxicity when given with statins
72
bile acid sequesterants MOA
prevent reabsorption of bile from intestine
73
bile acid sequesterants effects
decreased LDL
74
bile acid sequesterants A/E
- nausea, bloating, cramping
| - impaired absorption of drug and fat soluble vitamins
75
niacin MOA
- decreases FA release
- decreases VLDL synthesis
- decreases HDL breakdwon
76
niacin effects
decreased LDL
| increased HDL
77
niacin A/E
- flushing and pruritis
- gout/hyperuricemia
- hepatoxicity
78
fibrates MOA
- activate PPAR-alpha
| - decrease VLDL synthesis
79
fibrates effects
- decreased triglycerides
| - increased HDL
80
fibrates A/E
- muscle toxicity
| - gallstones
81
fish oil MOA
- decrease VLDL synthes
| - decrease apolipoprotien B synthesis
82
fish oil effects
- decrease triglycerides
| - increase HDL
83
clinical manifestations of congenital hypothyroidism?
- initially normal at birth
- enlarged fontanelle
- protruding tongue
- umbilical hernia
- poor feeding
- constipation
- dry skin
- jaundice
84
why are babies with congenital hypothyroidism normal at first?
they have maternal T4
85
inheritance of vWF disease?
AD
86
what causes a decreased maternal alpha fetoprotein?
Aneuploides - trisomy 18, 21, etc.
87
What causes an increased maternal alpha fetoprotein?
- open neural tube defects
- abdominal wall defects
- multiple gestations
88
does the maternal quadrupel screening test detect fetal alcohol syndrome?
NOOO
89
what does adalimumab bind?
TNF-alpha
90
chronic lymphadema is a risk factor for which cancer?
cutaneous angiosarcoma
91
what is stewart treves syndrome
the development of angiosarcoma in the presence of lymphadema - often after radical masectomy
92
pharmacological treatment of restless leg syndrome?
Dopamine agonists
| Gabapentin/pregabalin
93
pramipexole moa?
dopamine agonist (DR3)
94
lacy, reticular rash =
parvovirus
95
what is the purpose of carnitine acyltransferase?
shuttles fatty acids into the mitochondria for beta oxidation
96
what substance inhibits carnitine acyltransferase?
malonyl-coa
97
in what state is there increased malonyl-coa?
well-fed state
98
explain trastuzomab cardiotoxicity?
it causes a decrease in cardiac contractility but does not cause any cardiomyocyte destruction or fibrosis. Often results after cessation of treatment
99
antidote to serotonin toxicity?
cyproheptidine
100
which drugs may cause a significant first dose hypotension?
ACE inhibitors -should start with low doses
| in the presence of preexisiting volume depletion
101
what is dystonia?
sustained, involuntary muscle contraction
102
what is myoclonus?
sudden, brief, muscle contraction
103
phenylalanine is converted into waht?
tyrosine
104
what enzyme converts phenylalaline to tyrosine?
phenylalaline hydroxylase
105
what is the cofactor for phenylalaline hydroxylase?
BH4
106
what is the precursor to serotonin?
tryptophan
107
what is the cofactor of tryphtophan hydroxylase?
BH4
108
Neurologic manifestations of PKU?
developmental delay, hypotonia, dystonia and seizures
109
the superior thryoid artery runs along with which nerve?
external branch of the superior laryngeal nerve
110
what muscle is innervated by the external branch of the superior laryngeal nerve?
cricothyroid
111
all laryngeal muscles except for the cricothryoid are innervated by what nerve?
reccurent laryngeal nerves
112
the recurrent laryngeal nerves are at risk during ligation of which artery?
the inferior thyroid artery
