Step 2 Flashcards
(196 cards)
1
Q
What’s the difference between reticulate and elementary bodies in chlamydia?
A
Elementary bodies are extracellular infxs form
Reticulate bodies are intracellular, active metabolic form
2
Q
Ketoacidosis: Which PFK will be down, What happens to HSL, and what happens to GLUT expression in skeletal muscle?
A
PFK-1 activity will be down ( less glycolysis)
HSL will be up to use FA for energy
GLUT-4 expression will decrease in skeletal muscle
3
Q
Difference btwn GLUT-2 and GLUT-4
A
GLUT-2 is bidirectional, insulin independent. In liver, kidney and small intestine
GLUT-4 is insulin dependent in the skeletal muscle and adipose tissue
4
Q
What happens w/ recurrent branch of the median n. injury?
A
Weakness of thenar muscles
Opponens policis (most likely)
Abductor pollicis brevis (APL unaffected - deep radial n.) and
Flexor pollicis brevis (FPL-anterior interosseous n.)
5
Q
Fractional excretion of water equation
A
FEwater= urine flow rate / GFR GFR= Inulin estimates GFR
6
Q
What do PAH and inulin estimate?
A
PAH-estimates RPF
Inulin -estimates GFR
7
Q
HFR to F- cell, What is oriT and how can you tell which genes will be transferred and their frequency
A
oriT is the origin and tra is the end both will not be present after crossing conjugal bridge. The genes closest to the origin will be transferred most frequently
8
Q
Sulfasalazine SE
A
Anorexia, reversible oligospermia, erythema multiformes, SJS, exfoliative dermatitis, Toxic epidermal necrolysis
9
Q
G6PD aggravators
A
-quine, nitrofurantoin, sulfonamides, fava beans, and naphthalene
10
Q
Drug induced bronchoconstriction can be caused by what commonly used class of drugs?
A
NSAIDS
COX block can shift pathway to more production of leukotrienes precipitating (aspirin sensitive asthma)
11
Q
Buccal smear of newborn has 3 barr bodies, What is karyotype
A
All except one X become barr body so she must have 4 Xs
48 XXXX
12
Q
Which NT is outside of NL range in schizophrenia?
A
Excess DA, block w/ antipsychotics that block D2-R
13
Q
Decreased NE and 5HT, are characteristic of what condition?
A
Depression
14
Q
Elevated NE is associated w/ what neuro condition?
A
Anxiety
15
Q
Baclofen MOA
A
GABA B agonist- tx spasticity common in ALS
16
Q
What is the most important tx for anaphylaxis?
A
IM Epi to reverse bronchial and upper airway constriction
17
Q
Mixed respiratory alkalosis w/ metabolic acidosis after increased med use. What med?
A
Aspirin (salicylate)
18
Q
What can cause delayed emergence phenomenon from general anesthesia?
A
Increased Vd due to ascites or CHF
19
Q
Kid eats aunt’s pills (just had a baby) gets brown/black emesis, n, abd pn, then metabolic acidosis. Tx
A
Kid took Fe pills, tx w/ deferoxime
20
Q
Mouse has exaggerated response to B agonists, what is deficient?
A
B-arrestin
bind to GPCR after activation and endocytose GPCR to modulate response
21
Q
Where is a drug that has Vd of 15,000
A
Bound to fat depots and intracellular constituents
22
Q
Best cholinergic agent for xerostomia
A
Pilocarpine -salivation, sweating, lacrimation, and contract pupil sphincter to open trabecular meshwork in Schlemm’s canal
23
Q
What are the pharmacokinetics of aspirin?
A
Zero order - constant amount eliminated
24
Q
RLS of catecholamine synthesis
A
Tyrosine hydroxylase - tyrosin to DOPA
25
Child ingest med and has bradycardia, hypotension, lethargy, and weak pulses. What did she ingest and how to tx?
B-blocker
| Tx w/ glucagon, saline, or atropine
26
What pathway does insulin activate intracellularly?
RAS, Raf MAPK via intrinsic tyrosine kinase
27
Neurogenic bladder tx w/?
Bethanechol or carbachol
28
What enzyme performs final metabolism of opioids before elimination in the kidney?
UDP glucuronosyltransferase
| Polar molecules are eliminated by the kidney (Phase II)
29
Phase II metabolism does what transformations
Glucuronidation, acetylation, and sulfation
| Make the drug inactive and more polar
30
Therapeutic index equation
TI= Toxic dose/ efficacious dose
31
Eccentric contraction
Muscle lengthens while contracting
32
Concentric contraction
Muscle shortens while contracting
33
Isometric contraction
Muscle length is constant while contracting
34
What muscle can cause sciatica and is sometimes pierced by the sciatic n?
Piriformis syndrome - external rotator of the hip. Commonly running and cycling
35
Painful popliteal cyst (Baker cyst) txmnt
Glucocorticoid injection to decrease inflammation and pressure
36
Sjogren's syndrome has increased risk of what?
Marginal zone lymphoma
37
Vitamin D deficiency(osteomalacia) findings on spinal x-ray
Blurry vertebral bodies
38
Sprained ankle tx
NSAIDS and compression wrap
| X-ray if malleolar tenderness
39
How does exercise improve insulin sensitivity?
Increase GLUT4 expression on skeletal muscle
40
Bevacizumab MOA
VEGF mab
Renal cell carcinoma
Colorectal CA
41
Eculizimab
Complement C5 mab
PNH tx
Prevents C5 from cleaving to C5a (chemotaxis) and C5b (MAC)
42
Natalizumab
Alpha-4-integrin mab
| blocks Alpha-4-integrin, which is required for WBC to cross blood into organs
43
Tx of GCA and mechanism
Corticosteroids block PLA2, which normally releases arachidonic acid from the cell membrane
44
Causes of myopathy w/ elevated CK
Hypothyroidism
Muscular dystrophy
Inflammatory (dermato or polymyositis)
Statin inhibitors
45
Proximal muscle weakness w/ myoedema (mound of muscle after percussion)
Hypothyroidism
| Slow reabsorption of Ca by the SR
46
4 yo boy w/ increased growth, pubes, and increased testosterone and 17-hydroxyprogesterone.
21-hydroxylase deficiency
Non-salt wasting
excess 17-hydroxyprogesteron is specific to 21 hydroxylase deficiency
47
Txmnt of CAH
Low dose corticosteroids to suppress excess ACTH secretion
48
Thiazolidinedione MOA
Binds PPAR-gamma and RX to bind DNA
Increased GLUT-4 (skeletal and fat)
Increased adiponectin (increase insulin responsive fat cells and FA oxidation)
Decrease TNF alpha and leptin
49
Increased urinary orotic acid causes
Ornithine transcarbamylase deficiency
| Heriditary orotic aciduria
50
Failure to thrive, hyperammonemic encephalopathy
Decreased BUN
Increased urinary orotic acid
Ornithine transcarbamylase deficiency
| Excess carbamoyl phosphate goes down pyrimidine pathway and makes excess orotic acid
51
Failure to thrive, developmental delay, megaloblastic anemia, mental retardation, and excess orotic acid
Hereditary orotic aciduria
Defect in UMP synthass
orotic acid can't be converted to UMP
supplement w/ uridine (converted to UMP via nucleoside kinases)
52
Fat loss from the face and trunk fat increased, what med
NRTI like zidovudine and stavudine
53
What is the most common cause of primary hyperaldosteronism?
b/l adrenal hyperplasia
| u/l adrenal adenoma
54
Initial presentation of pt w/ adrenocortical tumor secreting excess aldosterone
Paresthesias and muscle weakness due to hypokalemic alkalosis
No significant extracellular volume expansion due to aldosterone escape
55
How do catecholamines, TNF-alpha, glucocorticoids and glucagon cause insulin resistance?
Activate serine kinases that phosphorylate B-subunit of IRS. This inhibits the tyrosine phosphorylase of IRS done by the intrinsic tyrosin kinase and shuts down RAS/MAPK pathway
56
ApoE, purpose and dz when defective
```
Mediates remnant uptake
Familial dysbetalipoproteinemia (palmar xanthomas, premature atherosclerosis)
```
57
ApoB-100 and apoB-48, purpose and dz when defective
B-100 binds the LDL-R, Familial hypercholesterolemia -tendon xanthomas, premature atherosclerosis
B-48 mediates chylomicron secretion
58
ApoC2, Purpose and dz when defective
LPL cofactor, Familial chylomicronemia-pancreatitis, lipemia retinalis
59
ApoA1 purpose
Activate LCAT-helps esterify cholesterol
60
What is the major regulator of the zona glomerulosa?
Angiotensin II, not ACTH
61
What is the major regulator of the zona fasciculata and reticularis?
ACTH
62
Prolonged excess ACTH stimulation causes what change in the adrenal gland?
Hyperplasia of the zona fasciculata and reticularis
| Zona glomerulosa is primarily regulated by angiotensin II
63
What is a ketogenic AA? Name two
Lysine and leucine
| Generate ketone body precursor acetyl CoA
64
```
What is a glucogenic AA?
Name 3 (MVH)
```
Produce pyruvate or TCA intermediates that can be used for gluconeogenesis
Methionine, valine, histidine
65
Where is GTP synthesized in the TCA cycle?
```
Succinate thiokinase (succinyl CoA synthase)
Succinyl CoA to succinate
```
66
Where is FADH2 synthesized in the TCA cycle?
Succinate dehydrogenase
| Succinate to fumarate
67
Where is NADH synthesized in the TCA cycle?
Isocitrate dehydrogenase (isocitrate to alpha-ketoglutarate)
Alpha ketoglutarate dehydrogenase (alpha to succinyl CoA)
Malate dehydrogenase
Malate to oxaloacetate
68
Prolonged glucocorticoid use w/ Cushing syndrome, What will the adrenals look like?
b/l adrenal atrophy
| The adrenals have quit since exogenous steroids were doing the work
69
Statin SE
Myopathy
| Hepatotoxicity
70
Cholestyramine and bile acid sequestrant SE
Increase TG, GI upset, decrease other drug absorption, and decrease Vit A,D,E,K absorption
71
Ezetimibe MOA and SE, what lipid lab is affected
Prevent cholesterol absorption, Only LDL down
| Diarrhea, rare increase LFTs
72
Fibrate SE
Myopathy, increase risk of gallstones
73
Niacin SE
Red flushing, Hyperglycemia, hyperuricemia (gout)
74
Pt taking lipid lowering drug gets muscle pain and elevated LFTs. What drug?
Statin
75
Pt taking lipid lowering drug develops gout, hyperglycemia, and flushed face
Niacin, Pretx w/ NSAID to reduce flushing
76
Pt taking lipid lowering med develops gallstone and muscle pain
Fibrates
77
Pt taking lipid lowering med has increased TG, decreased absorption of Vit A,D,E,K
Cholestyramine
78
What effect does DM2 have on adipocytes and how does that contribute to insulin resistance?
Blocks antilipolytic effects of insulin, Increased lipolysis and FA ->impair insulin dependent glucose uptake and increase hepatic gluconeogenesis
79
Where does HMG-CoA exist in the cell?
Mitochondrial enzyme
80
Where in the cell does the pentose phosphate pathway take place?
Cytosol
81
Primary hyperaldosteronism w/ HTN, what would the values of Na, K, and HCO3 be?
Na would be NL, as more Na gets reabsorbed via aldosterone the increased volume causes pressure natriuresis limiting Na retention
K would be decreased due to high aldosterone
HCO3 is increased by alpha intercalated cells due to increased loss of H+ (metabolic alkalosis)
82
What does aldose reductase do?
Converts glucose to sorbitol
83
What enzyme works to metabolize fructose in fructokinase deficiency?
Hexokinase converts fructose to fructose-6-P
84
Lysosome storage dz w/ increased cerebroside sulfate? Peripheral neuropathy and ataxia
Metachromatic leukodystrophy
Arylsulfatase A deficiency
Central and peripheral demyelination
85
How does niacin precipitate gout?
Niacin decreases renal excretion of uric acid
86
What is the most important cofactor in branched chain alpha ketoacid dehydrogenase?
Thiamine
87
What cofactor is needed to go from propionyl CoA to methylmalonyl CoA?
B6
88
What cofactor is needed to go from methylmalonyl CoA to succinyl CoA?
B12
89
What 5 factors are needed for the enzyme complexes: Pyruvate, alpha-ketogluturate and branched chain alpha-ketoacid dehydrogenase? (Tender Loving Care For Nancy)
```
Thiamine
Lipoate
CoA
FAD
NAD
```
90
Newborn w/ restricted joint movement, sever mental retardation, skeletal abnormalities, abnl vacuolization and inclusions in the cytoplasm of mesenchyme cells
I cell dz
Defect in golgi phosphotransferase
Phosphate is not added to mannose so the enzymes are sent out of the cell rather than remaining in the cell
91
What happens to specificity, sensitivity, PPV, and NPV if you raise the cutoff?
Fewer false positives
Increase specificity
Increase PPV
More false negatives
Decrease sensitivity
Decrease NPV
92
Sensitivity relationship to PPV and NPV
Sens up NPV up (proportional)
| Sens up PPV down (inverse)
93
Borderline personality
Borderline -Unstable realtionships, splitting, suicidal gestures, fear abandonment
94
Histrionic personality
Attention seeking, stuck on appearance, dramatic presentation, unstable relationships, rash decisions
95
Cushing syndrome w/ mass in adrenal gland: Levels of urine 17-hydroxycorticosteroid, Urine cortisol, and serum ACTH
Urine 17-hydroxycorticosteroid and cortisol will be high due to overproduction of cortisol
ACTH will be low due to negative feedback
96
Which diuretic acts synergistically w/ furosemide?
Hydrochlorothiazide
97
Demeclocycline MOA and use
ADH
| Tx DI
98
Neonatal septicemi and menigitis. What bug?
Listeria
| Granulomatosis infantisepticum
99
Thenar vs hypothenar, innervation
Thenar - Opponens pollicis, abductor pollicis brevis and flexor pollicis brevis - Recurrent branch of radial n
Hypothenar - opponens digiti minimi, abductor digiti minimi, and flexor digiti minimi brevis-ulnar n.
100
Vascular malformations of the skin (port-wine stain), leptomeninges, and cerebral cortex (seizures)
Sturge-Weber Syndrome
101
MRI color of blood in the brain
White
102
Blood across most of right hemisphere, sparing brainstem and cerebellum, What vessel is damaged?
Internal carotid artery supplying ACA, MCA, PCA
103
Nonresponder to HBV vaccine gets HBV, what serum marker would you see 2 weeks later?
HbsAg -first serum marker
| Doesn't have HbsAb (nonresponder)
104
Cholelithiasis: levels of direct and indirect bili
Regardless of cause, usually
Direct bili is high ( blockage)
Indirect bili is normal
105
Ovoid peach colored smooth area of skin w/ few hairs tapered near proximal end
Alopecia areata (exclamation point hairs)- Antithyroglobulin and anti-microsomal Ab
106
In specialized transduction which genes are most likely to be transferred?
The genes closest to the insertion site
107
What are the transferrin levels in hemochromatosis?
Trasnferrin, serum Fe, and ferritin are all elevated
108
Metronidazole SE
```
Gi distress
convulsions
insomnia
peripheral neuropathy
thrombophlebitis
```
109
Red man Syndrome
Vancomycin
110
Alpha cells of pancreas secrete what?
Glucagon
111
Beta cells of pancreas secrete what?
Insulin
112
Delta cells of pancreas secrete what?
Somatostatins
113
Acinar cells of pancreas secrete what?
Lipases and proteinases
114
What technique to identify translocations, inversions, aneuploidy, and interstitial deletions?
FISH
115
What technique for trinucleotide repeats?
Southwestern blot to detect methylation and number of repeats
116
Cholangitis and cholangiocarcinoma in eosinophilic pt from SE Asia
clonorchis sinesis-undercooked fish
117
Villous structures containing nucleated erythrocytes in a vaginal clot specimen
Aborted fetus
Chorionic villi -loosely fibrous core covered w/ trophoblastic cells. More mature villi may have nucleated erythrocytes from the fetus
118
What ACheI do you give in myasthenia gravis?
Pyridostigmine and neostigmine-carbamoylation of AChE
119
When is physostigmine used?
Glaucoma, AcheI
120
Where does cyanide bind?
Complex IV Cytochome C oxidase
121
Burn victim w/ edema and NL pulmonary artery and pulmonary wedge pressure: Lymph flow, microvascular permeability, interstitial oncotic pressure, and microvascular hydrostatic pressure
Increased microvascular permeability is main cause of edema
Lymph flow increases
Proteins flow out into interstitium increasing interstitial oncotic pressure (edema)
Microvascular hydrostatic pressure is NL ( pulmonary pressure are NL)
122
Prego w/ cushings during pregnancy, ectopic receptors on adrenal glands, improves w/ OC use. What hormone receptor is ectopic on adrenal glands?
LH
The Hcg is high during pregnancy, which would bind LH and cause her sx.
It can not be estrogen or progesterone b/c OC would cause those hormones to bind their receptors (she would get increased sx w/ OC use)
123
Gastrointestinal stromal tumors, what kind of cells and what markers?
GI pacemaker cells, Interstitial cells of Cajal
Express CD-34 and c-kit
actin, desmin, and s-100 are less common
124
What does c-kit do and what medication inhibits it?
Tyrosine kinase that acts as stem cell factor. Imatinib inhibits
125
What condition can Imatinib be used for and what are the markers?
CML- Bcr-Abl tyrosine kinase
| GIST - C-kit tyrosine kinase
126
What enzyme will be increased and what will be decreased in Lesch Nyhan?
HGPRT is deficient so purines (AG) can't be recycled
| Must increase purine production - PRPP amidotransferase is 1st commited step of de novo purine synthesis
127
Eccentric eater: papilledema, dry skin, and hepatomegaly. What vitamin abnormality?
Vit A overuse
128
Which E. coli virulence factor is responsible for bacteremia and sepsis?
LPS- Macrophage activation -IL-1, IL-6, TNF alpha
129
What e. coli virulence factor is responsible for neonatal meningitis?
K1 capsular polysaccharide-prevent phagocytosis and complement mediated lysis
130
What E. coli virulence factor is responsible for bloody gastroenteritis?
Shiga toxin
| Inactivate 60S ribosome-> cell death
131
What E. coli virulence factor causes watery diarrhea?
```
Heat labile (cAMP)
Heat stable (cGMP)
```
132
What E. coli virulence factor causes urinary tract infections?
P fimbriae
133
How do you dx Cryptococcus Neoformans?
Mucicarmine stain
India ink of CSF
Agglutination of CSF
Methanamine (GMS)
134
Narrow Budding yeast in the CSF
Cryptococcus neoformans
135
Facultative, intracellular gram + rod, narrow zone of beta hemolysis, tumbling motility at 22 degrees
Listeria Monocytogenes
136
What is the most important immune defense against listeria?
Cell-mediated since they are obligate intracellular
137
Dizziness, dysarthria, b/l limb ataxia. lung mass and cerebellar Purkinje cell degeneration
Subacute cerebellar degeneration
Paraneoplastic
Immune response to tumor cells that cross react with Purkinje neuron antigens
138
Anti-Yo, Anti-P/Q, Anti-Hu
Subacute cerebellar degeneration
139
Where are very long chain fatty acids and phytanic acid oxidized?
Peroxisomes
140
Disorders of Very long chain fatty acid oxidation commonly create neuro issues do to what?
Unable to form myelin in the CNS
141
Primary cause of morbidity in acute rheumatic fever
Heart failure from severe pancarditis
142
What CN exits at the lateral aspect of the mid pons ath the level of the middle cerebellar peduncle
CN V
| Trigeminal
143
Phenytoin pt has diffuse confluent erythema, palpable generalized LAD, symmetrical face swelling
Drug rxn w/ eosinophilia and systemic sx (DRESS)
144
3 yo w/ high fevers and malaise won't walk on his leg, where will scintigraphy have increased focal radiotracer uptake?
Metaphysis-slow flowing sinusoidal vasculature
| Hematogenous Osteomyelitis
145
Most common site of hematogenous osteomyelitis in adults
Vertebral body
146
2 causes of MG exacerbation when being txd w/ pyridostigmine
1) myasthenic crisis -undertxd, Edrophonium (tensilon test) improves sx
2) Cholinergic crisis- dose of ACheI too high. Excess ACh desensitizes NMJ. Tensilon test shows no improvement
147
Pramipexole MOA
DA agonist
148
DA agonist used in PD, Ergot and non ergot
Ergot: bromcriptine
| Non-ergot: pramipexole and ropinirole
149
Selegiline MOA
MAOI B
150
Amantadine MOA in PD
Enhances effects of endogenous DA, anticholinergic stops tremors
151
Entcapone and tolcapone MOA
Block COMT from breaking down DA
152
Anticholinergics used to tx PD
Benztropine and trihexyphenidyl
153
Txmnt of Psoriasis that inhibits keratinocyte proliferation and keratinocyte differentiation
Topical Vit D analogs
| Calcipotriene, calcitriol, tacalcitol
154
Ustekinumab (stelara) MOA
Targets Il-12 and IL-23
| Inhibits differentiation and activation of Th1 and Th17
155
Regulation of ALA synthase
Upregulated by CYP450 inducers (smoking and alcohol)
| Downregulated by heme and glucose
156
Acute intermittent porphyria defect
PBG deaminase deficiency
| Red pee
157
PD-1 and PDL-1 due what to the immune system
When PD-1 on T cell and PDL-1 on tumor cell bind they inhibit CTL allowing the tumor cell to live
158
What receptors are targeted to prevent chemotherapy induced emesis?
DA-metoclopramide, prochlorperazine
NK - Aprepitant, fosaprepitant
5HT - Odansetron, granisetron
159
What receptors are targeted in motion sickness and hyperemesis gravidarum?
Antimuscarinic -Scopolamine
| Histamine - diphenhydramine, meclizine, promethazine
160
What takes place in the germinal centers in a LN?
Isotype switching
B-cell CD40
T cell CD40L
161
Why do sickle cells sickle?
HbS allows hydrophobic interaction btwn Hgb molecules allowing it to clump
162
Which part of the spleen is involved in removal of defective RBCs?
Red pulp reticuloendothelial cells
163
What converts pro-carcinogens to active metabolites?
CYP450 microsomal monoxygenase
164
What enzyme converts heme to biliveridin (green color in old bruise?
Heme oxygenase in macrophages
165
Cytokines, EPO, and GH have what in common?
Same kind of JAK-STAT cytoplasmic kinase
166
Cervical CA risk factors
```
HPV 16 and 18
STI
Early sexual activity
Immunosuppression
OC use
Tobacco use
```
167
Felbamate, memantine, and ketamine MOA
NMDA blockers
Ketamine - anesthetic
Memantine-Alzheimer dz
Felbamate-anticonvulsant
168
Donepezil MOA
ACheI used in Alzheimer's
169
Main SE of carbamazepine
Bone marrow suppression
| SIADH
170
Anesthetic had very high Arteriovenous gradient. What properties does it have?
High tissue binding, so little makes it to the veins. This will give it a slow onset of action. Negatively affects brain saturation. The potency will not be affected
171
Qualities of anesthetic w/ low solubility in the blood
Rapid induction and rapid recovery times, as it quickly leaves the blood and goes to the brain
172
Qualities of anesthetic w/ increased solubility in lipids
Slow induction but high potency (1/MAC)
173
What is MAC in anesthetics?
Minimum alveolar concentration to prevent 50% from moving
174
What can you say about the potency of a anesthetic w/ slow onset due to increased lipid solubility?
High potency (1/MAC)
175
Toxic effects of neisseria menigitis are mediated by? Correlates w/ morbidity and mortality
Lipooligosaccharide (LOS)
Outermembrane lipooligosaccharide
The inner and outer membran proteins are involved in homeostasis
176
How do type I interferons act in viral illness?
IFN-A and B bind to infected and neighboring cells and lead to transcription of RNAse L (endonuclease breaks down RNA) and protein kinase R (inactivates eIF2). Protein synthesis gets inhbited but only in the presence of dsRNA
177
Motile gram - rods w/ green metallic sheen on eosin methylene blue agar and hemolysis on blood agar? Facultative anaerobe
E. Coli has green metallic sheen on EMB
178
Most important virulence factor for UTI w/ E. Coli
Fimbriae
179
Earliest manifestation of diabetic nephropathy
Microalbuminemia, Prevent worsening w/ ACEI
180
Kid w/ facial rash and lacy, reticular body rash
Parvovirus B19
| Erythema infectiosum
181
Pt grew up in rural Guatemala, has sz, no immunocompromise and has minimally enhancing cyst
```
Neurocysticercosis
Taenia Solium (pork tapeworm eggs) secreted in feces
```
182
Labs of neurocysticercosis
Taenia solium
Increased ESR
Eosinophilia
183
What does parenteral mean?
Not by mouth, IV or IM
184
Pt returns from Mexico. High grade fever, myalgias, HA, and joint pn. Diffuse maculopapular rash, multiple purpuric lesions, HM, thrombocytopenia, leukopenia, elevated LFTs. Had less severe sx last time he went to Mexico
Dengue fever
1st infxn asx
2nd infxn
Ab dependent enhancement of infxn, increased T cell response
185
Buzz words of dengue virus
Break bone fever
Rash (white island in sea of red)
+ tourniquet test (petechiae after bp cuff)
186
Do fibrates inhibit LDL-R degradation or reduce hepatic VLDL production?
Reduce hepatic VLDL production
187
2 mechanisms of fibrates via PPAR-alpha
1) Increase LPL to breakdown TG (chylomicrons) and VLDL (free FA)
2) Decrease hepatic VLDL production
188
What do PCSK9 Inhibitors do?
Proprotein convertase subtilisin kexin 9 inhbitor
| mab that reduces LDL-R degradation in the liver
189
Niacin MOA in hyperlipidemia
Decrease HSL in adipocytes (decreases lipolysis)
| Reduces hepatic VLDL synthesis
190
Difference btwn aspergillus and pneumocystis on CXR
Aspergillus - dense infiltrate
| Pneumocystis - Diffuse b/l interstitial infiltrates
191
Daptomycin MOA
Create transmembrane channels in gram + bx
192
In what conditions is daptomycin ineffective?
Gram - bx, can't pentrate
| Pneumonia -inactivated by surfactant
193
Daptomycin SE
myopathy, elevated CPK
194
Linezolid MOA and SE
Binds ribosome 50S subunit
Thrombocytopenia
Optic neuritis
High risk for 5HT syndrome
195
Milrinone MOA
PDEI - Increase cAMP
| Vasodilates vasculature and increased inotropy in the heart
196
Where do analgesics harm the kidney compared to b-lactam abx?
Analgesics - Papillary necrosis
| B-lactams - Acute interstitial nephritis
