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Flashcards in Stuff You Missed II Deck (608):
1

Three important metabolic pathways for glucose

1. Glycolysis and TCA cycle - used to generate ATP. Glucose is first metabolized to pyruvate during glycolysis and then pyruvate is converted to acetyl-COA, which enters TCA cycle
2. Glycogenesis stores glucose for later use avia formation of glyogen from GLUCOSE-1 PHOSPHATE
3. HMP shunt (pentose pathway) generate pentose sugars and NADPH

2

Oxidative portion of HMP shunt

- Is irreversible
- Rate limiting enzyme: Glucose 6 phosphate dehydrogenase (G6PD)

GLUCOSE-6-PHOSPHATE is converted to RIBULOSE-5-PHOSPHATE which results in NAPDH formation.

-

3

Non-oxidative portion of HMP shunt

- Is reversible
- key enzyme is TRANSKETOLASE (B1 dependent)
-Used to convert sugars to ribose-5-phosphate (for nucleotide synthesis) and intermediates (fructose 6 phosphate and glyceraldehyde-3-phosphate) for glycolysis and gluconeogeneis

-

4

Discuss NADPH and Glutathione

NADPH (made in oxidative part of HMP shunt) reduces glutathione, a co-enzyme for gluthathione peroxidase which prevents oxidative damage by converting H2O2 into H2O

5

Where is the oxidative phase of HMP shunt most active?

In tissues that use NADPH in reductive pathways
- Adipose tissue for fatty acid sythesis
- Adrenals for steroid synthesis
- Glutathione reduction in RBC
- Liver for fatty acid and steroid synthesis

6

Glucose 6 Phosphate Dehydrogenase Deficiency

- X-linked recessive disease with predominance in Asia, Mediterranean, Africa (malaria resistance countries)
Hemolytic anemia when RBCs are exposed to oxidative stress because they lack sufficient NADPH production thus less glutathione activity

7

Causes of oxidative stress

Can be dangerous in case of glucose 6 phosphate dehydrogenase
- Infections
- Fava beans ("broad beans")
- Drugs (e.g. sulfonamides, dapsone, primaquine)

8

Describe peripheral smear of patient with Glucose 6 Phosphate Dehydrogenase

RBCs have Heinz bodies (intracellular inclusions composed of denatured hemoglobin)

- Also contain degmacytes (bite cells) - result of splenic macrophages removing Heinz Bodies

9

Hepatocellular Carcinoma - Presentation

Liver mass with increased alpha fetoprotein
- associated with HBV
- integration of viral DNA into host cellular genome is trigger for neoplastic changes
- HBx activates IGF-2 and IGF-1 to stimulate cell proliferatin
- HBV also suppresses p53 tumr suppressor, leading to accumulations of mutations in hepatocytes leading to carcinogenesis

10

Risk factors for Hepatocellular Carcinoma

- HBV and HCV
- Alcoholic Cirrhosis
-Alfatoxins
- Hemochromatosis

11

Anal fissure

tear in lining of canal DISTAL to dentate line that occurs most often on posterior midline.
- Patients complain of severe tearing pain associated with passage of bowel movements
- Associated with low-fiber diets and constipation

12

Parietal cells

release H+ ions into gastric lumen via H/K ATPase , which requires ATP hydrolysis thus active transport mechanism

13

Omeprazole

suppress activity of gastric parietal cell H/K/ATPase leading to an increase in pH of gastric lumen

14

Lidocain

Local anesthetic
- Class IB antiarrhythmic agen that blocks voltage gated Na channels in sensory neurons, Purkinje fibers, and ventricular cells

15

Dofetilide

Class III (K+ blocker) that blocks passive transport of potassium, in cardiomycocytes leading to prolongation of refractory period and QT interval

16

Pancreatic divism

incomplete fusion of ventral and dorsal pancreatic buds. Usually asymptomatic, but may predispose to acute or recurrent pancreatitis.

- No duodenal obstruction

17

Annular pancreas

Due to abnormal migration of ventral pancreatic bud which encircule the duodenum and may lead to sx of duodenal obstruction in neonates

18

Zenker's diverticulum

- due to cricopharyngeal muscle dysfunction caused by diminished relaxation of pharyngeal muscles during swallowing
- Found in upper esophagus
- classically older patients presenting with oropharyngeal dysplasia, coughing, choking, and recurrent aspiration

19

True diverticula (of esophagus)

Due to scarring and traction of esophagus.
- Seen in midportion of esophagus and result from mediastinal lymphadenitis (TB, fungal infections)

20

Intussusception

occurs in children younger than 2 and in region of ileocecal valve
- presents with intermitten, severe, colicky abdominal pain, "currant jelly" still and possible palpable mass in RUQ

21

Fever, jaundice, anorexia in IV drug user

Suggests viral hepatitis (likely caused by Hep C)
- acute viral hepatitis causes hepatocyte apoptosis and necrosis

22

Effects of viral hepatitis on hepatocytes

- Apoptotic hepatocytes shrink, undergo nuclear fragmentation and become intensely eosinophilic
- Eosinophilic bodies called Acidophillic bodies, Councilman bodies, and apoptotic bodies

23

Hep A presentation in children

Commonly silent or subclinical ("anicteric") in children but can present as an acute ilnness characterized by jaundice, malaise, nausea, vomiting, and RUQ pain

24

Thiamine (B1) is a co-factor for which 3 important enzymes?

1.Transketolase (in nonoxidative HMP shunt)
2. Alpha ketoglutarate Dehydrogenase (Alpha ketoglutarae to Succinyl-CoA) in TCA cycle
3. Pyruvate Dehydrogenase (Pyruvate --> Acetyl-CoA)

25

Co-factors needed for Alpha Ketoglutarate Dehydrogenase

1. Thiamine
2. Lipoic Acid
3. CoA
4. FAD
5. NAD

26

Areas most susceptible to ischemia with ischemic colitis

1. SPLENIC FLEXURE (lies between SMA and IMA)
2. DISTAL SIGMOID COLON (lies between IMA and hypogastric arteries)

27

Salmonella Typhi

- causes typhoid or enteric fever
- faculative intracellular parasite orally, penetrates intestinal mucosa and travels to mesenteric lymph nodes where it is phagocytosed by macrophages for survival
- characterized by fever, abdominal pain, diarrhe, and "rose spots"

28

Pseudomonas Aeruginosa

- produces enterotoxin A, similar to diptheria toxin that halts human cellular protein synthesis by inhibiting EF-2
- Arrest in translation as protein chain is unable to change positions in ribosome

29

Vibrio cholerae

- causative agent of cholera and produces exterotoxin, CHOLERAGEN
- Choleragen acts like heat-labile toxin of ETEC in that increases cAMP in intestinal mucosal cells leading to decreased absorption and increased secretion of Na, Cl, and water

30

C. difficile

- produces toxin A (enterotoxin) and toxin B(cytotoxin) and causes pseudomembranous colitis
- mostly seen in patients recently treated with antibiotics

31

Toxin B of C. difficile

Depolymerizes actin filaments causing GI mucosal cells death

32

Enterohemorrhagic E. coli (EHEC) toxin

-produces Shiga-like toxins (aka Vero cytotoxins)
- identical to Shiga toxin produced by Shigella dysenteriae
- toxins inhibit 60S ribosomal subunits thus blocking protein synthesis by preventing binding of tRNA

33

Right sided colon cancer vs. Left sided colon cancer

Left sided colon cancers manifest as partial intestinal obstruction (because right sided colon has larger lumen)
Right sided colon cancers present with symptoms of iron deficiency and systemic symptoms

34

Gastroduodenal artery

Lies along posterior of duodenal bulb (1st part of duodenum). It is more likely to be eroded by posterior duodenal ulcers.
- Ulceration into the gastroduodenal artery is source of life-threatening hemorrhage

35

Brown pigment gallstones

- Arise secondary to infection of billiary tract which in turn releases B-glucuronidase by injured hepatocytes and bacteria
-B-glucoronidase hydrolyzes bilirubin glucuronides and increases amt of uncojugated bilirubin in bile

36

Infections associated with brown pigment gallstones

E. coli
Ascaris lumbricoides
Liver Fluke (Opisthorichis sinesis)

37

Populations associated with brown pigment stones

- Rural Asian populations
- Women
- Elderly

38

7-alpha hydroxylase

Converts cholesterol to bile acids. Deficiency leads to cholesterol gallstone

39

First order kinetics (of Pharmocology)

Same PROPORTION of drug is metabolized per unit of time - thus linked to drug concentration

(e.g. For 20 mg dose of Drug X, 10mg will be metabolized in hour. For 40 mg of Drug X, 20 mg will be metabolized in 1 hr)

40

Zero order kinetics (of Pharmacology)

Same AMOUNT of drug is metabolized independent of drug dose

- If 30 mg of drug Y was administered, 10 mg will be metabolized in one hour.
- If 60 mg of drug Y was administered, 10mg will be metabolized

41

What slows progression of hemochromatosis in women?

Physiological iron loss through menstruation and pregnancy

42

Sx of hemachromatosis

- Micronodular cirrhosis
- Diabetes mellitus
- Skin pigmenation
- Cardiac dysfunction due to accumulation of Fe in myocardium
- Hepatomegaly
- Cardiomegaly

43

CREST

C-alcinosis
R-aynaud Syndrome
E-sophageal dysmotility
S-clerodactly
T-elegienctasia

44

Early sign of systemic sclerosis

Esophageal dysmotility and incompetence of lower esophageal sphincter
- Result of atrophy and fibrous replacement of esophageal muscles
- Esophageal dilation causes reflux, increases risk of Barrett's esophageus and esophageal adenocarcinoma

45

C. difficile toxins

Toxin A - attracts neutrophils to cause mucosal inflammation, loss of water in the gut, and diarrhea
Toxin B - causes actin depolymerization, loss of cytoskeleton integrity, cell death, and mucosal necrosis

46

Colon adenocarcinoma

- Rectosigmoid colon - most common location
- Often present with obstructing glands

47

Colon adenocarcinoma: Pathology

Consist of pleomorphic cells with large dark nuclei forming irregular crowded glands, some of which contain mucus

48

Gallstone ileus

results from passage of large gallstone (>2.5 cm) throug cholecystenteric fistula into small bowel causing obstructing to ileocecal valve.

49

Gas within gallbladder and biliary tree on abdominal X-ray suggests what?

Presence of cholecystenteric fistula to small bowel as intestinal gas can now enter gallbladder.
-Predisposes gallstone ileus

50

TPN-induced gallstone

1. Biliary stasis from absent enteral stimulation due to decreased CCK release
2. In those with ileal resection, disturbance of bile acid circulation results in supersaturation of hepatic bile with cholesterol

51

Antibodies directed against HCV envelope proteins don't confer immunity because?

HCV envelope proteins vary their antigenic structure, thus production of host antibodies always lag behind the mutant strains and thus immunity is not given

52

Sx of adult lead poisoning

1. Colicky abdominal pain, constipation, impaired concentration
2. Bluish pigmentation at gum-line
3. Wrist drop due to peipheral neuropathy
4. MICROCYTIC Anemia and Basophilic stippling

53

Stages of Lead Poisoning (Hint: 4)

1. Nausea, diarrhea, and abdominal pain. Hemorrhage, Hypovolemia, and Shock.
2. GI symptoms resolve and patient appears better
3. Metabolic acidosis, Hepatitic dysfunction, and Hypoglycemia
4. Scarring of recovering GI tract

54

Cholestasis can cause malabsorption of which vitamins?

Fat soluble vitamins (e.g. A,D,E, K)

- Osteomalacia may result of poor Vitamin D absorption

55

Cholestasis

- can arise secondary to hepatocellular dysfuncton and intrahepatic or extrahepatic biliary obstruction

56

Esophagus (on CT)

Found between vertebral bodies in upper thorax and the trachea (remains open). It is typically collapsed and invisible on CT.

57

Are gastric ulcers from peptic ulcer disease seen on distal duodenum?

No. They are typically found on antrum, pyloric area of stomach or in first part of duodenum

58

Zollinger- Eilison Syndrome

Occurs to hypersecretion of gastrin by cardiac tumor.
- Gastrin increases gastric acid production whcih causes peptic ulcers.
- Diarrhea is common symptom in Z-E as excess gastric acid inactivates pancreatic enzymes

59

Pantothenic Acid (Vitamin B5)

- Needed form coenzyme A, essential for aceylation reactions
- Binds with oxaloacetate in first step of TCA to form citate and then succinyl-CoA

60

Sx of Carcinoid syndrome

- Flushing
- Asthma-like symptoms (wheezing, dyspnea)
- Diarrhea
- Syncope (low blood pressure)

61

Carcinoid syndrome

- Sign of GI metastesis
- Associated with appendiceal tumors which secrete active substances like serotonin
- If tumor is localized to GI tract, liver clears serotonin before any systemic symptoms can appear

62

Ondansetron

potent anti-emetic mainly used in patients undergoing chemotherapy. Selectively blocks 5-HT3 receptors.

63

Treatment of Carcinoid Syndrome

Octeotride - somatostatin analog that can inhibit secretion of many hormones and horomone-like substances

64

Secretin

- produced S cells in the DUODENUM
- stimulates Bicarb production in pancreas

65

Secretin release stimulated by what?

Excess HCl

66

Hepatocyte injury in viral hepatitis

- Diffuse swelling termed "balloow dengerating"
Hepatocyte death characterized by lobular architecture disruption and hepatocyte necrosis called "bridging fibrosis
-Presence of mononuclear inflammation

67

Common side effects for nitrates

Headaches and cutaneous flushing due to vasodilation caused by nitrates (including nitroglycerin and isosorbide)

68

Common cause of mitral regurgitation in undeveloped countries

Rheumatic fever

69

Strep viridans and adherence during subacute endocarditis

S. viridans - normal oral cavity inhabitans
- Dextrans produced by S. viridans with sucrose as substrate facilitate bacterial adherence and colonization to fibrin
- MUST HAVE PRE-EXISTING DAMAGE

70

S. aureus vs. Strep viridans in endocarditis

S. aureus can adhere to INTACT/ NON-DAMAGED endothelium to cause endocarditis

S. viridans can only attach to ALREADY DAMAGED valvular leaflet to cause endocarditis

71

Genetic mutation in Hypertrophic cardiomyopathy

Due to defect in cardiac sarcomere proteins. Most common defect is is Beta-myosin heavy chain

72

Dilated cardiomyopathy

Majority cases are due to autosomal dominant mutaitons of cardiac myocyte cytoskeletal proteisns (dystrophin) or mitochrondrial enzymes

73

Sx: of coarctation of aorta

Diminished femoral pulses compared to brachial pulses, symptoms of inadequate perfusion of lower extremities

74

Genetic syndrome associated with Coarctation of Aorta

Turner's Syndrome

75

Cardiac defect in Down Syndrome

Endocardial Cushion Defects (Ostium primum ASD, regurgitant atrioventricular valves)

76

Cardiac defect in DiGeorge Syndrome

Tetralogy of Fallot and interrupted aortic arch (truncus arteriosus)

77

Cardiac defect in Friedrich's ataxia

Hypetrophic cardiomyopathy

78

Cardiac defect in Marfan's Syndrome

Cystic medial necrosis of the aorta

79

Cardiac defect in Tuberous Scleross

Valvular obstruction due to cardiac rhabdomyoma

80

Most likely cause of fatigue and new-onset murmur in young adult

Bacterial endocarditis. Acute, diffuse, proliferative glomerulonephritis secondary to circulating immune complexes may complicate BE and result in renal insufficiency

81

Long term hemodynamic compensatory response to volume overload of Aortic Regurgitation

Increase in left ventricular preload (LV end-diastolic volume) in associated with ECCENTRIC left venticular hypertrophy

82

Concentric hypertrophy of the LV

Response to pressure overload, involves in PARALLEL deposition of sarcomeres which results in wall thickening and decreased EDV

83

Cyanotic neonate with severe tachypnea and continuous machine like murmur
ECG shows aorta that lies anterior to and to the right of pulmonary artery

Transposition of Great Arteries

84

Transposition of Great Arteries

Failure of aorticopulmonary septum to spiral normally during fetal development.
- Result is aorta is connected to right ventricle and pulmonary artery is connected to left ventricle
- Only VSD, PDA, or ASD allows this to be compatible with lidfe

85

Number Needed To Treat

1/ Absolute Risk Reduction

86

Absolute Risk Reduction

(No disease/ Total receiving placebo) - (No disease/ Total receiving treatment)

87

Sx: Atrial Myxoma

- Constitutional symptoms
- Mid-diastolic rumbling murmur heard at apex (mitral stenosis)
- Large penduculated mass in LA

88

Atrial Myxoma

Tumor compoed of scattered cells with mucopolysaccharide stroma, abnormal blood vessels, and hemorrhaging

89

Patient presents with hx of malabsorption complains of pruritic skin rash over extensor surfaces of arms.

Dermatitis herpetiformis
- associated with celiac disease
- erythematous, puritic papules, vesicles, bullae that appear over extensor surfaces

90

Treatment for acute gouty arthritis

NSAIDs, Colchicine

91

Colchicine

- affects tubulin polymerization into microtubules which disrupts chemotaxis and phagocytosis
- associated side effects: nausea, abdominal pain, and diarrhea

92

Caudal regression syndrome

characterized by sacral agenesis causing lower extremity paralysis and urinary incontinence
- associated with poorly controlled maternal diabetes

93

Cocaine abuse on fetus

- Due to vasocontrictive effect, can cause insufficient blood flow to fetus, results in spontaneous abortion, intrauterine growth retardation, placental abruption, and/or prematurity

94

Congenital effect of rubella

- Can cause mental retardation and congenital heart defects

95

Congenital effects of Vitamin A overdose

Craniofacial abnormalities
Posterior fossa CNS defects (Arnold-Chiari syndrome??)
- Auditory defects
- Abnormalities of great vessels (similar to DiGeorge)

96

Iron deficiency during pregnancy

Can restrict fetal growth
- important in 2nd half of pregnancy when maternal blood volume expands a lot

97

PTH effects on calcium and phosphate

- increases serum calcium level
- mediates bone resorption by causing osteoBLasts to inc. production of RANK-ligant and M-CSF to stimulate osteoCLasts
- decreases serum phosphate (loss in urine)

98

Manifestations of sickle cell disease

1. HEMOLYSIS - repeated sickling of RBCs to leads to permanent sickling and premature erythrocyte destruction
2. VASOOCCLUSIVE symptoms: pain from small bone or bone marrow infarctions in hand, feet, wrist, and ankles (dactylitis)
3. INFECTIONS - predisposed to encapsulated organisms due to repeated splenic infarcts

99

Dactylitis

- Painful swelling of hands and feet
- common vasooclusive presentation of sickle cell anemia in young children

100

Hemolysis and haptoglobin levels

In hemolysis, haptoglobin levels decrease by binding to free hemoglobin and the complex is hepatically cleared

101

Raloxifene

Selective Estrogen Receptor Modulator (SERM)
- binds to estrogen receptors and exhibits tissue-specific behavior that antagonize natural estrogen effects
- IN BONE, acts like estrogen AGONIST and inhibits osteopeross

102

Effects of raloxifene in breast vs. bone

In breast, raloxifene is an estrogen ANTAGONIST thus useful treatment for estrogen-positive breast cancer

In bone, raloxifene is an estrogen AGONIST and inhibits osteoporosis

103

Markers for osteoblast activity

Bone-specific osteoblastic activity

104

Markers for osteoclast activity

- Tartrate-resistant acid phosphatase
- Urinary hydroxyproline
- Urinary deoxypyridinoline (most reliable)

105

Vitamin D analogs and Psoriasis

Vitamin D analogs (calcipotriene, calcitrol, and tacalcitol) are used to treat psoriasis

106

Calcipotriene, Calcitriol, Tacalcitol

- Vitamin D analogs, can be used to treat psoriasis
- bind to Vitamin D receptor (bind and inhibit KERATINOCYTE PROLIFERATION and stimulate KERATINOCYTE differentiation

107

Ustekinumab (Stelara)

human monoclonal antibody used to treat psoriasis by targeting IL-12 ad IL-23
- Inhibits differentiation of CD4+ Th1 and Th17 cells

108

Cyclosporine

- inhibits NFAT (nuclear factor of activated T cells) from entering nucleus and modulating transcription activity by impairing production and relaese of IL-2 thus inhibiting T-cell proliferation

109

Keloid formation

- result from excessive collagen formation
- present as soft/firm nodules BEYOND borders of wound with "claw-like" extensions into normal tissue
- composed of large disorganized collagen bundles and excess cellular connective tissue

110

Most likely diagnosis
- young athlete in 20s with nodular and comedonal acne

- Likely from anabolic steroid (e.g. methyltestosterone) use. Androgens stimulate epidermal follcular epidermal hyperproliferation and excessive sebum leading to acne

111

Elements of pathophysiology of acne (hint: 4)

1. Follicular epidermal hyperproliferation
2. Excessive sebum production
3. Inflammation
4. Propionibacterium

112

Reiter's syndrome (reactive arthritis) triad

1. Urethritis
2. Conjunctivitis
3. Arthritis
- associated with HLA-B27
- seen weeks after a GU or GI infection
- may be seen with sacroillitis

113

Lentigos

-small brown/tan macules seen in sun exposed skin of elderly person

114

RBC cell extravasations

Petechiae (< 5mm)
Purpurae (5mm to 1cm)
Echymoses (> 1 cm)

115

Telangiectasias

- small permanent dilations of superficial capillaries and venules
- usually found on skin or mucous membranes
- blanch under pressure

116

Achondroplasia

- autosomal dominant disease due to mutation of FGFR-3
- patients present with normal spine length but short arms and legs with normal sized head
- issue with endochrondrall ossification (long bones) not membranous ossification (flat bones)

117

Supraspinatous muscle

- assists in abduction of arm and stablization of glenohumeral joint
- tendon is commonly injured of rotator cuff muscles
- commonly injured due to impingement of acromion and head of humerus`

118

Infections associated with reactive arthritis

Chlamydia
Campylobacter
Salmonella
Shigella
Yersinia

119

Skeletal muscle contraction

- Ca from SR binds to TROPONIN C to uncover binding sites on actin
- Myosin (energized by ATP+Pi) binds to actin
- Once myosin is bound, Pi is released which changes myosin head conformation and causes power stroke
- After power stroke, ATP binds myosin head causing myosin detachment from actin
- ATP hydrolysis (ATP --> ADP+Pi) energizes myosin for next contraction

120

Smooth muscle contraction

- Ca (Sarcoplasmic Reticulum OR ECF) binds to calmodulin to activate myosin-light chain kinase
- Phosphorylated MLCK more likely to bind with actin
**Unphosphorylated MLCK has low affinity for actin. Actin is NOT covered up)
- As long as Ca is present, MLCK will stay bound to actin
- Ca-ATPase will remove Ca once stimulus is over

121

Treatment for male pattern baldness

Finasteride (5-alpha-reductase) inhibitor because male pattern baldness involves 5-alpha reductase and androgenic effects of dihydrotestosterone

122

Mitochondrial myopathy

Patients present with Neuromuscular lesions
Ragged red skeletal muscle fibers, and
Lactic acidosis
- Mitochondrial disorder thus follows maternal inheritence

123

Why do mitochondrial defects cause lactic acidosis?

Mitochondria responsible for OXPHOS.
No mitochondria = No OXPHOS thus presence of lactic acidosis

124

Heteroplasmy

Variable clinical expression of mitochondrial DNA defects in different family members due to co-existence of mutated and wild type mitochondrial genomes in each cell

125

Possible structures damaged during injury to mid-shaft of humerus

Radial nerve
Deep brachial artery

** Supracondylar fractures associated with injury to brachial artery

126

Physical findings of rickt

- Unmineralized osteoid matrix
- Widened osteoid seams
- Bowed legs
- Rachitic rosary (prominence at costevertebral junction)
- Harrison's sulci (indentations in lower ribs)
- Craniotabes
- Growth retardation

127

Paget's disease of bone findings

- mosaic of lamellar bone, irregular sections of lamellar linked by "cement lines"
- local osteoclastic activity followed by increased osteoblastic activity
- formation of abnormal bone
- new collagen is laid haphazardly


128

Common fracture sites in osteoporosis

- Primarily involves trabecular bone
- patients might present with fractures in lumbar vertebrae (mostly trabecular) or in neck of femur (50% trabecular/50% cortical)

129

Osteoporosis

represents loss of "total bone mass" that results in trabecular thinning.
-common fracture sites are: lumbar vertebrae and neck of femur

130

Leprosy

- caused by Mycobacterium lepare
- deforming infection of skin and nerves
- associated with armadillo contact in SW U.S.
- severity depends on strength of cell-mediated immune response, with tuberculoid leprosy and lepromatous leprosy (more severe form)

131

African patient presents with patchy areas of skin anesthesia and hypopigmentation in upper extremities. Microscopy shows bacteria invading Schwann cells. Likely diagnosis?

Leprosy (Hansen's disease)
- caused by Mycobacterium leprae

132

Measles virus

enveloped, non-segmented, negative sense RNA virus
causes Rubeola

133

Measles (Rubeola)

- caused by measles virus (paramyxovirus)
- Kolik spots (white/blue-gray lesions on buccal mucosa that precede maculopapular rash
- Cough
- Coryza
- Conjunctivitis

- vaccine given at 12-15 months

134

Mneumonic for Measles Diagnosis

"CCCK"
C-oryza
C-ough
C-onjunctivitis
K-olik spots (white/blue-gray spots on buccal mucosa)

135

Rotavirus symptoms

Upper respiratory infection followed by diarrhea

136

Xanthelesma

- eyelid papule or plaque containing lipid-laden macrophages
- occur in primary or secondary hyperlipidemia
- Biliary cirrhosis is potential cause of hyperlipidemia

137

Cutaneous manifestations of HYPERthyroidism

-Thinning hair
- Pretibial myxedema
- Alopecia areata
-Hyperhidrosis

138

Side effects of hydrochlorothiazide

HyperGLUC

HyperGlycemia
HyperLipidemia
HyperUricemia
HyperCalcemia

** can be used for women who have osteoporosis and hypertension

139

Wound contractures

- Due to excessive metalloproteinase activity and myofibroblat accumulation in wound margins
-Contracture produce wound deformities and surrounding tissues esp in palms, soles, anterior thorax, or serious burn sites

140

Erythema infectiosum (fifth disease)

- caused by parvovirus B19 and is transmitted commonly via respiratory route
- Sx include bright-red rash on cheeks ("slapped cheeks") and lace-like rash on trunk and extremities

141

Hand and foot mouth disease

- caused by Coxsackie virus type A
- presents with dever and ulcers on tongue and oral mucosa
- maculopapular and/or vesicular rash on palms and soles

142

Scarlet fever

- caused by Group A Strep (Strep pyogenes)
- present with fever, sore throat, diffuse erythematous rash with small papules ("sandpaper-like")

143

Ecthyma gangrenosum

- cutaneous necrotic injury associated with Pseudomoans aeroginosa bacteremia and septicemia
- P. aeruginosa invades perivascularly and releases exotoxins causing vascular destruction and resultant insufficiency of bloof to patches of skin which become edematous and necrose

144

Populations susceptible to P. aeruginosa

- Neutropenic patients
- Hospitalized patients
- Patients with burns and chronic indwelling catheters

145

Dystonia

- prolonged, repetitive muscle contractions
- may be result of impaired function of ganglia
- most common types of focal dystonia are cervical dystonia (spasmodic torticolis), blepharosparm, and writer's crap

146

Myoclonus

sudden, brief sometimes serve (shock-like) muscle contraction
- associated with hiccups or hypnic jerks (when falling asleep)

Pathological myoclonus is seen in epilepsy and Creutfeldt-Jakob disease

147

Lepromin skin test

Tuberculoid patients will have positive test because they exhibit strong CD4+ Th1 cell-mediated immune response to M.leprae

- Leprematous leprosy (more severe form) will have negative test because they exhibit weak immune response

148

Dantrolene

- relax skeletal muscle by reducing release of Ca from SR
- used to treat malignant hyperthermia

149

Succinylcholine

- depolarizing NMJ blocker administered during intubation and induction

- can be augmented by neostigmine (anti-cholinesterase) during phase I block

- can be reversed by neostigmine during phase II block

- paralysis caused by succinylcholine depends on catabolism by plasma cholinesterase

150

Digital clubbing

- "drumstick" sign at end of fingers
- sign of prolonged hypoxia
- often accompanies large lung-cell cancer, tuberculosis, cystic fibrosis, bronchiectasis and suppurative lung diseases (e.g empyema and chronic lung abcesses)

151

Androgenetic alopecia

- most common cause of hair loss in both males and female
- demonstrates polygenic inheritance with variable penetrance`

152

Common condition affected by multiple genes

- Androgenetic alopecia
- Epilepsy
- Ischemic heart disease
- Schizophrenia
- Glaucoma
- Hypertension

153

Myasthenia gravis

- autoimmune disease that results in decrease in acetylcholine receptors on post-synaptic terminal of muscle end plate
- results in decreased ability of ACh to bind and open post-synaptic cation channels, thus decreasing end-plate potential

154

Treatment of myasthenia gravis

- involves cholinesterase inhibitors, immunosuppresants, and somtimes thymectomy

- cholinesterase inhibitors can be improved by antimuscarinics (e.g. scopolamine) to counter muscarinic overstimulation in sites like gut without affecting skeletal muscle function

155

Apocrine glands

- found in breast areolae, axillae, genital regions of humans
- secrete sweat into hair follicle instead of directly to skin surface
- innervated by sympathetic fibers and not functional until puberty
- secretions odorless until bacterial decomposition

156

Eccrine glands

- also called merocrine glands
- present in skin throughout most of body except areas like skin and glans pens
- secrete water fluid rich in Na and Cl (think CF!!) directly to skin surface

157

Isoretinoin

- treats severe acne refractory to topical therapies via interaction with RAR
- main adverse effects: hypertriglyceridemia and teratogenicity

158

What test must be administered before giving isoretinoin to a young female?

Must give pregnancy test (test for B-hCG) because isoretinoin can cause birth defects?

159

Sx of Dermatomyositis

- Gottron papules - flat topped plaques over bony prominences
- Heliotrope rash - "racoon eyes"
- Proximal muscle weakness, difficulty standing or rising up from chair
- Anti-Jo 1 positive
- elevated CK levels

160

Telomerase

-enzyme that posesses reverse transcriptase (RNA-dependent DNA polymerase) activity and is normally expressed in stem cells as well as cancer cells
- adds TTAGGG to 3' end of DNA
- Cancer cells continue to divide without aging and shortening telomeres

161

Gout

results from deposition of monosodium rate in joints and soft tissues
- underpolarized light, appear needle shaped and negatively birefringent

162

Psoriasis

- salmon colored plaque covered with silvery scale
- common areas include elbows, knees, gluteal cleft, lumbosacral area
- may have yellow-brown discoloration on nails with associated pitting, thickening, or crumbling

163

Long thoracic nerve injury

- commonly caused by mastectomy but any trauma or surgery in axillary area can damage this nerve
- damage to this nerve causes "winged scapula" and inability to abduct shoulder past 90 degrees

164

Rheumatoid arthritis

- swelling in pain, swelling, and morning stiffness for > 6 months
- tends to get better as day progresses

165

Tx for rheumatoid arthritis

Short term therapy: glucocorticoids (quick and effective)

Long term therapy: Methotrexate (used for moderate to severe rheumatoid arthritis)

166

Hematogenous osteomyelitis

- predominantly seen in children and affects long bones
- caused by Staph. aureus
- sx: include malaise, fevers, and pain over long bones
- Bone pain caused by abscess within bone leading to periosteal disruption and bone necrosis

167

Moraxella cararrhalis

- normal flora of upper respiratory tract of healthy adults and children
- causes otitis media and sinusitis in healthy ppl
- responsible for bronchitis and pneumonia in elderly patient with COPD

168

Sciatic nerve

L4 - S3
- splits into tibial nerve and common peroneal nerve

169

Tibial nerve

- inverts and plantarflexes foot
- when not working, the foot is everted and dorsiflexed (opposite of common peroneal nerve)

provides sensation to plantar aspect of foot

170

Most abundant amino acid in collagen

Glycine
- appears ever third amino acid position
as collagen formula is (-Gly-X-Y)333

171

Essential amino acid for formation of collagen alpha helix

Proli

172

Septic arthritis

- usually due to gonococcus infection, common cause of infection in your adults
- suspect if affected joint has high WBC count but absent crystals
- requires immediate treatment (e.g. ceftriazone) to prevent joint destriction, osteomyelitis, and sepsis
-

173

Bacteroid species

Gram - anaerobic rods
- areas of necrosis and diminished blood supply (e.g. chronic non-healing ulcers) facilitate growth of anaeroes
- produce B-lactamase, which breaks down peniccilin

174

B-lactamase inhibitors

Tazobactam
Clavulanic acid
Sulbactasm

* most effectie against most gram - enteric rods, including Pseudomonas aeruginoise and Bacteroides fragilis

175

Trauma or sustained pressure to neck of fibula causes injury to what nerve

- Common peroneal nerve ( as it runs around neck of fibula)
- susceptible to traima from lateral blows of knee to tightly applied plaster casts

176

Migratory thrombophlebitis

- should always think cancer
- hypercoagulability is very common paraneoplastic syndrome seen in adenocarcinomas of pancrease, colon or lug
- adenocarcinomas produce thromboplastin-like substance capable causing chronic intravascular coagulations

177

Cachexia

syndrome that encompasses anorexia, malaise, anemia, weight loss and generalized wasting due to underlying systemic disease.

TNF-alpha is a cytokine that causes necrosis of some tumors in utero
- Inhibitig

177

IVC

formed by union of right and left common illiac veins at level of L4-L5

* Renal arteries lie at L1

177

Apoptosis

can occur either the intrinsic (mitochondria-mediated) pathway or extrinsic (receptor-initiated) pathway.
- Both pathways require activation of caspases that cleave cellular proteins

177

Foamy urine

- caused by proteinuria/
Heavy proteinuria (e.g. nephrotic syndrome) can caused interstitial edema because of decrease in serum albumn

178

Migratory thrombophlebitis

- should always think cancer
- hypercoagulability is very common paraneoplastic syndrome seen in adenocarcinomas of pancrease, colon or lug
- adenocarcinomas produce thromboplastin-like substance capable causing chronic intravascular coagulations

180

Auer rods

deformed azurophilic granules found in cytoplasm of myeloblasts that stain positively for MYELOPEROXIDASE

- found in abundance in AML M3

181

Paroxysmal Nocturnal Hemoglobinuria

Triad: hemolytic anemia, hypercoaguable state, pancytopenia

- causes thrombosis
- deficiecy of CD55 and 59 which disallows complement activation

181

Migratory thrombophlebitis

- should always think cancer
- hypercoagulability is very common paraneoplastic syndrome seen in adenocarcinomas of pancrease, colon or lug
- adenocarcinomas produce thromboplastin-like substance capable causing chronic intravascular coagulations

182

Migratory thrombophlebitis

- should always think cancer
- hypercoagulability is very common paraneoplastic syndrome seen in adenocarcinomas of pancrease, colon or lug
- adenocarcinomas produce thromboplastin-like substance capable causing chronic intravascular coagulations

184

Hereditary spherocytosis

autosomal dominant condition that results form red blood cell cytoskeletaon abnormalities
- most commonly spectrin and ankrin defects
- definitive test: positive osmotic fragility test

185

Tx for hyperlipidemia

Niacin (Vitamin B3) - decreases synthesis of hepatic triglyceride and VLDL by suppressing release of FA from peripheral tissues

- also decreases VLDL conversion to LDL, thus decreasing LDL
- also increases HDL

187

Bile-acid binding resins

can cause constipation and abdominal bloating (potentiall worsening diverticulosis), hypertriglyceridemia, cholesteral gall stone and vitamin K malabsorption

187

Factor V Leiden mutation

causes factor Va resistance to inactivation by activated protein C, may account for approximately 20% of cases in atypcial venous thrombosis

188

Sx of hereditary spherocytosis

anemia, reticulocytosis and increased indirect bilirubin, indicating hemolytic anemia

- MCHC (increased because of mild dehydration of red blood cell)

- blood smear dysmorphic red cells with no central pallor

189

Henoch-Schonlein purpura

- seen in young boys (3 - 10 years old)
-palpable skin lesions associated with abdominal pain, arthralgias, and renal involvement

- occurs due to deposition of Ig-A containing immune complexes and shows up in purpura on buttocks, legs

190

Glioblastoma multiforme

- pallisading tumor cells around areas of necrosis
- commonly crosses midline ("butterfly distribution")
- most common primary brain tumor in adults

191

AML (M3 variant)

- associated with Auer rods
- t(15;17) which codes for chimeric PML/RAR (retinoic acid receptor)
- this inhibits differentiation of myeloblasts and triggers development of APML

193

Selective COX-2 inhibitors

e.g. celecoxib
- have no effect on platelet aggregation and cause little GI irritation
- the reduced risks of GI bleeding are only advantages over traditional NSAIDS

194

Microangiopathic hemolytic anemia

- associaed with RBC fragments, Burr cells, and helmet cells
- in patients with prosthetic valves, RCs are exposed to excessive shear and turbulence in circulation causing damage

194

Glomangioma

- very tender small red-blue lesion under nail bed
- originates from modified smooth muscle cells that control thermoregulatory functions of dermal glomus bodies

195

Sx: "Mismatched V/Q with perfusion defect, sudden onset chest pain

Signs of pulmonary embolism
- often caused by deep vein thrombosis and continuum of pulmonary thromboembolism

197

Bile acid-binding resins (cholestyramine, colestpiol, colesevelam)

- bind to bile acid in GI tract, interfereing with its enterohepatic circulation
- LDL is decreased b/c hepatic cholesterol is consumed in re-sythesis of bile acids
- since bile is being re-synthesized, cholesterol content of bile increases thus increased risk of gallstone

198

Bcl-abl

- associated with CML
- result of t(9;22) - Philadelphia chromosome

199

C-myc overexpression

- associated with Burkitt's lymphoma
- associated with t(8;14)
- myc oncogene on chr 8
- Ig heavy chain on chr 14

200

Bcl-2 overexpression

- associated with Follicular lymphoma
- associated with t(14;18)
- Bcl-2 has anti-apoptotic effects

202

Greater activity against Factor Xa and Thrombrin.
Unfractionated heparin or LMWH

Unfractionated heparin - contains pentasaccharide that binds to antithrombin causing confirmational change that increases ability to inactivate Factor Xa
- is able to bind to both antithrombrin and thrombrin to allow antithrombrin to inactivate thrombrin

202

Effect modification (of study)

- is present when effect of main exposure on outcome is modified by presence of another variable. Effect modificatiion is not a bias.

203

Atherosclerosis

initiated by repetitive ENDOTHELIAL cell injury, which leads to chronic inflammatory state in underlying intima of large elastic arteries as well as large and medium-size elastic arteries

204

CML vs. leukemoid reaction

- both have increased WBC count
- differentiated based on neutrophil alkaline phosphatase level
- in leukemoid reaction (decreased alkaline phosphotase)
- in CML: decreased alkaline phosphatase

205

Causes of isolated systolic hypertension

- caused by age-related decrease in compliance (increased stiffness) of the aorta and its proximal major branches

207

Discuss protein C deficiency and Warfarin therapy

Transient pro-coagulant/anti-coagulant imbalance is present at start of warfarin therapy , leading to relative hypercoaguable state with thrombotic occlusion of microvasculature and skin necrosis

207

Sx: urinary urgency, nocturia, and hesistancy associated with constant back pain in elderly main

- Suggestive of metastatic prostate cancer

- Prostate cancer likes to metastasize to bone

209

Prostate cancer

- adenocarcinomas in PERIPHERAL zone of gland (vs. periurethral zone of gland in BPH)
- increased levels of PSA
- in advanced disease, may see elevated prostatic acid phosphatase (tumor penetrates capsule) and increase alkaline phosphatase

210

Discuss obstructive sleep apnea and EPO secretion

Obstructive sleep apnea - recurrent episodes of aphyxia during sleep
- peritubular cells in renal cortex sense hypoxia and release EPO which increases hematocrit

211

Ovarian cancer

- presents as ovarian mass
- possible amenorrhea
- associated with CA-125
- risks of cancer decreased by OCP, multiparity, and breast feedings

212

Factors which decrease ovarian and/or endometrial cancers

** Things that decrease the number of ovulatory cycles
Multiparity
OCP use
Breastfeeding

213

Sx of hemorrhagic cystitis

- can be result of nitrogen mustard based chemotherapeutic agent (e.g. cyclophosophamide or ifosfamide)
- metabolized by kidneys into ACROLEIN, which toxic to uroepithelial cells and cause renal cell death and necrosis

214

Tx for hemorrhagic cystitis due to nitrogen mustard based chemotherapeutic agents

Mesna, a sulfhydryl compound that binds acrolein in urine

215

Osler-Weber-Rendu syndrome

autosomal dominant condition marked by telangiectasias in skin as well as in mucous membranes of lips, oranonasopharynx, respiratory tract, GI, and urintary tract
- may cause epitaxis, GI bleeding or hematuria

216

Tx of DVT in pregnant women

Heparin
- increases antithrombrin III activity

** Cant use Warfarin because it's teratogenic

217

Clopidogrel

inhibits ADP mediated platelet aggeregation
used in treatment of coronary artery disease, peripheral vascular disease and cerebrovascular disease NOT DVT

218

Tx for diabetic ketoacidosis

Intravenous hydration with normal saline and insulin
- This will result in serum glucose, osmolality, and potassium as increases in serum HCO3 and sodium

219

Phentolamine

non-specific alpha 1 and alpha 2 blocker with no beta blocking effects that cause profound fall in diastolic blood pressure and reflex tachycardia
-

220

Phenylephrine

- selective alpha adrenerigc agonist. Administation may be associated with reflect bradycardia

221

Isoproterenol

non-selective Beta adrenergic agonist that stimulates both B2 receptors vascular smooth muscle (vasodilation) and cardiac B1 (increases in cardiac rate and contractility)

222

Epinepherine (effect on systolic blood pressure, HR, and diastolic blood pressure)

Systolic BP: increases (alpha 1 and B 1)
HR: increases (B1)
Diastolic BP: (dose-dependent)
Low dose - B2 > a1 (decrease)
High dose - a1 > B2 (increase)

223

Cachexia

syndrome that encompasses anorexia, malaise, anemia, weight loss and generalized wasting due to underlying systemic disease.

TNF-alpha is a cytokine that causes necrosis of some tumors in utero
- Inhibitig

224

IVC

formed by union of right and left common illiac veins at level of L4-L5

* Renal arteries lie at L1

225

Tx for hyperlipidemia

Niacin (Vitamin B3) - decreases synthesis of hepatic triglyceride and VLDL by suppressing release of FA from peripheral tissues

- also decreases VLDL conversion to LDL, thus decreasing LDL
- also increases HDL

226

Discuss protein C deficiency and Warfarin therapy

Transient pro-coagulant/anti-coagulant imbalance is present at start of warfarin therapy , leading to relative hypercoaguable state with thrombotic occlusion of microvasculature and skin necrosis

227

Factors which decrease ovarian and/or endometrial cancers

** Things that decrease the number of ovulatory cycles
Multiparity
OCP use
Breastfeeding

228

Propranolol

non-selective beta adrenergic antagonist
effect on B2: vasoconstriction
effect on B1: slows heart contractility

229

Cachexia

syndrome that encompasses anorexia, malaise, anemia, weight loss and generalized wasting due to underlying systemic disease.

TNF-alpha is a cytokine that causes necrosis of some tumors in utero
- Inhibitig

230

IVC

formed by union of right and left common illiac veins at level of L4-L5

* Renal arteries lie at L1

231

Explain relationship between blood flow and resistance

Blood flow is directly proportional to vessel radius raised to fourth power.

Resistance to blood flow is inversely proportional to vessel radius raised to fourth power.

232

Cystic medial degeneration

- myxomatous changes in media of large arteries which development of aortic dissections and aortic aneurysms

233

Cachexia

syndrome that encompasses anorexia, malaise, anemia, weight loss and generalized wasting due to underlying systemic disease.

TNF-alpha is a cytokine that causes necrosis of some tumors in utero
- Inhibitig

234

IVC

formed by union of right and left common illiac veins at level of L4-L5

* Renal arteries lie at L1

235

Li-Fraumeni syndromee

- autosomal dominant disorder caused by inherited mutation of p53

236

Cyclin D1 overexpression

- associated with Mantle lymphoma
- associated with t(11;14)

237

Migratory thrombophlebitis

- should always think cancer
- hypercoagulability is very common paraneoplastic syndrome seen in adenocarcinomas of pancrease, colon or lug
- adenocarcinomas produce thromboplastin-like substance capable causing chronic intravascular coagulations

238

Fatty streaks

- multiple yellow spots approx 1mm in diam
- earliest lesion of atherosclerosis and present in all people > 10 y.o
- composed of lipid filled foamy cells and smooth muscle cells that have engulfed lipoproteins
- occurrence and location in child don't predict locations of plaques later on in lide

239

Factor Xa inhibitors

- new class of anticoagulants with activity against factor Xa
- increase prothrombrin and aPTT times but don't affect thrombrin time

240

Schilling test

- helps differentiate between dietary defiency of vitamin B12, pernicious anemia, and malabsorption syndromes

** Low absorpton of cobalamin not correctable by IF means malabsorptive syndrome such as ileal disease, pancreatic insufficiency, or bacterial overgrowth

241

Sx of steroid abuse

erythrocytosis
abnormal testicle size and function
hepatic abnormalities
acne

242

Strong evidence of lymph node malignancy

Monoclonal lymphocytic proliferation, esp. monoclonal T-cell receptor gene arrangements

243

Polyclonal proliferation of lymphocytes

associated with benign lymph node enlargement in response to antigenic stimulation

244

Sx of lead poisoning

- erythrocyte basophillic stippling
- microcytic anemia

245

Net filtration pressure

(Gh - Bh) - (Go - Bo)

246

von Willebrand disease

- causes impairments in platelet function and coagulation pathway abnormalities.
- associated with prolonged bleeding time
- prolonged PTT
- decreased platelet aggregation in response to ristocetin

247

Polycythemia vera

clonal myeloproliferative disease in pluripotent stem cells
- increased RBC mass, inc. plasma volume and low EPO
- majority have JAK2 V617F mutation, rendering RBCs more sensitive to growth factors

248

Strawberry hemangioma

benign vascular tumors of childhood
- appear during first few weeks of life, initially grow rapidly, then regress by 5-8 years old
- composed of capillaries separated by connective tissue

249

Alpha adrenergic agonists

- increase both systolic and diastolic blood pressure via stimulation of a-1 adrenoreceptors
- elevated systemic blood pressure is associated with reflex increase in vagal influence on heart, results in decreased heart rate

250

Vascular reaction to endothelial and intimal injury (e.g. atherosclerosis)

Intimal hyperplasia and fibrosis, predominantly mediated by reactive smooth muscle cells that migrate from media to the intima

251

Nitroprusside

- agent of choice in treating hypertensive emergency
- quick onset of action and short duration of action
- initially metabolized to cyanide , with conversion to thocyonate by liver rhodanase

252

Treatment for nitroprusside toxicity

Na thiosulfate used to treat cyanide toxicity and works by donating sulfur to liver rhodamase to enhance conversion of cyanide to thiosulfate

253

Likely diagnosis:
necrotizing vasculitis of upper and lower respiratory tract (nasal ulcerations, sinusitis, hemoptysis) and rapidly progressive Wegners

- Wegner's granulomatosis (granulomatous with polyangitis)

- cANCA

254

Tx for familial hyoalphalipoproteinemia

- low HDL thus increased risk of CAD
- Niacin (B3) is best treatment

255

Tx for hypercholesteremia

Statins and ezetimbe
- High LDL is a risk factor for atherogenesis

256

Ezetimbe

- tx of hypercholestermia
- decreases LDL by inhibiting cholesterol absorption from GI tract
- does not increase HDL concentrations
- used in combo with statins to achieve greater LDL reduction

257

Statins

- treatment of hypercholesteremias by inhibiting HMG CoA reductase, rate limiting enzyme of cholesterol syntehsis
- in response hepatocytes, INCREASE expression of LDL receptors

258

ApoB

apoprotein present in VLDL and LDL
- decreases in VLDL and LDL will cause apolipoprotein to decrease

259

Discuss energy expenditure in fatty acid oxidation vs. glycolysis in cardiac function

- More energy needed for fatty acid oxidation than glycolysis
- inhibition of fatty acid inhibitors promote oxygen effiency and decreases oxygen needed for cardiac support

260

Energy for sources of cardiac function

- Glycolysis
- Glucose oxidation
- Fatty acid synthesis

261

Main source of energy production in cardiac function

Fatty acid oxidation > Glucose oxidation > Glycolysis

262

Varicose veins

- caused by incompetent calves in lower extremities allow retrograde blood flow from deep to superficial veins
- increases pressure in superficial veins --> dilated veins

263

Orthostatic hypotension

- defined as fall > 20 mmHg in systolic pressure or >10 mm Hg in diastolic pressure

264

Describe events to correct normal physiological "orthostatic hypotension"

1. Decreased venous return to heart
2. Decreased ventricular filling and drop in CO and BP
3. Drop in BP evokes compensatory baroreceptor reflect (increased sympathetic activity and decreased PS activity)
4. Increased sympathetic tone raises peripheral vascular resistance via ALPHA-1 of peripheral vasculature. Leads to venous return and CO

265

Understimulaion of alpha adrenoreceptorss

- leads to cerebral hypoperfusion (light headedness and syncope

266

Sinus venosus

forms smooth portion of right atrium

267

Bulbus cordis

forms smooth portions of right and left ventricles

268

Primitive atrium

forms rough portions of left and right atrium

269

ductus arterious

derived from 6th embryonic aortic arch

270

Tertiary syphillis

- can result in thoracic aortic aneurysm
- compresses adjacent structures and dilates aortic valve ring, a murmur and mediastinal widening is heard
- aneurysm begins with vaso vasorum endarteritis and obliteration resulting in inflamation

271

FTA-ABS

specific test for syphillis

272

Gemfibrozil and fenofibrate (Fibric acid derivatives)

- first line treatments for hyperTRIglyceridemia
- decrease serum triglycerides by reducing hepatic triglyceride production

273

Bile acid resins (e.g. cholestyramine, colestpiol, colesevelam) and effect on triglycerides

- increase triglycerides

274

Niacin (Vitamin B3) used to treat...

hyperlipidemia
Side effects: cutaneous (flushing, warmth, itching) - better tolerated in slow release preparations

275

Capsaicin

- reduces pain by decreasing substance P in the peripeheral nervous system

276

Buerger's disease

- seen in heavy cigarrete smokers < 35 years old
- associated with intradermal injection of tobacco extracts
- thrombosing vascultis extends into contiguous veins and nerves, encasing them in fibrous tissue

277

Polyarteritis Nodosa

- segmental, transmural, necrotizing inflammation of medium to small sized arteries in any organ
- typically affects kidney, liver, heart, and GI tract but NOT LUNGS!!
- sx: livedo reticularis, palpable purpura, hemorhage, ischemia

278

Henoch-Schonlein purpura

- seen in young boys (3 - 10 years old)
-palpable skin lesions associated with abdominal pain, arthralgias, and renal involvement

- occurs due to deposition of Ig-A containing immune complexes and shows up in purpura on buttocks, legs

279

Glioblastoma multiforme

- pallisading tumor cells around areas of necrosis
- commonly crosses midline ("butterfly distribution")
- most common primary brain tumor in adults

280

AML (M3 variant)

- associated with Auer rods
- t(15;17) which codes for chimeric PML/RAR (retinoic acid receptor)
- this inhibits differentiation of myeloblasts and triggers development of APML

281

Selective COX-2 inhibitors

e.g. celecoxib
- have no effect on platelet aggregation and cause little GI irritation
- the reduced risks of GI bleeding are only advantages over traditional NSAIDS

282

Sx: "Mismatched V/Q with perfusion defect, sudden onset chest pain

Signs of pulmonary embolism
- often caused by deep vein thrombosis and continuum of pulmonary thromboembolism

283

C-myc overexpression

- associated with Burkitt's lymphoma
- associated with t(8;14)
- myc oncogene on chr 8
- Ig heavy chain on chr 14

284

Greater activity against Factor Xa and Thrombrin.
Unfractionated heparin or LMWH

Unfractionated heparin - contains pentasaccharide that binds to antithrombin causing confirmational change that increases ability to inactivate Factor Xa
- is able to bind to both antithrombrin and thrombrin to allow antithrombrin to inactivate thrombrin

285

Cystic medial degeneration

- myxomatous changes in media of large arteries which development of aortic dissections and aortic aneurysms

286

Ovarian cancer

- presents as ovarian mass
- possible amenorrhea
- associated with CA-125
- risks of cancer decreased by OCP, multiparity, and breast feedings

287

Factors which decrease ovarian and/or endometrial cancers

** Things that decrease the number of ovulatory cycles
Multiparity
OCP use
Breastfeeding

288

Sx of hemorrhagic cystitis

- can be result of nitrogen mustard based chemotherapeutic agent (e.g. cyclophosophamide or ifosfamide)
- metabolized by kidneys into ACROLEIN, which toxic to uroepithelial cells and cause renal cell death and necrosis

289

Osler-Weber-Rendu syndrome

autosomal dominant condition marked by telangiectasias in skin as well as in mucous membranes of lips, oranonasopharynx, respiratory tract, GI, and urintary tract
- may cause epitaxis, GI bleeding or hematuria

290

Tx for diabetic ketoacidosis

Intravenous hydration with normal saline and insulin
- This will result in serum glucose, osmolality, and potassium as increases in serum HCO3 and sodium

291

Phentolamine

non-specific alpha 1 and alpha 2 blocker with no beta blocking effects that cause profound fall in diastolic blood pressure and reflex tachycardia
-

292

Phenylephrine

- selective alpha adrenerigc agonist. Administation may be associated with reflect bradycardia

293

Isoproterenol

non-selective Beta adrenergic agonist that stimulates both B2 receptors vascular smooth muscle (vasodilation) and cardiac B1 (increases in cardiac rate and contractility)

294

Epinepherine (effect on systolic blood pressure, HR, and diastolic blood pressure)

Systolic BP: increases (alpha 1 and B 1)
HR: increases (B1)
Diastolic BP: (dose-dependent)
Low dose - B2 > a1 (decrease)
High dose - a1 > B2 (increase)

295

Propranolol

non-selective beta adrenergic antagonist
effect on B2: vasoconstriction
effect on B1: slows heart contractility

296

Treatment for nitroprusside toxicity

Na thiosulfate used to treat cyanide toxicity and works by donating sulfur to liver rhodamase to enhance conversion of cyanide to thiosulfate

297

Likely diagnosis:
necrotizing vasculitis of upper and lower respiratory tract (nasal ulcerations, sinusitis, hemoptysis) and rapidly progressive Wegners

- Wegner's granulomatosis (granulomatous with polyangitis)

- cANCA

298

Tx for familial hyoalphalipoproteinemia

- low HDL thus increased risk of CAD
- Niacin (B3) is best treatment

299

Tx for hypercholesteremia

Statins and ezetimbe
- High LDL is a risk factor for atherogenesis

300

Ezetimbe

- tx of hypercholestermia
- decreases LDL by inhibiting cholesterol absorption from GI tract
- does not increase HDL concentrations
- used in combo with statins to achieve greater LDL reduction

301

Statins

- treatment of hypercholesteremias by inhibiting HMG CoA reductase, rate limiting enzyme of cholesterol syntehsis
- in response hepatocytes, INCREASE expression of LDL receptors

302

ApoB

apoprotein present in VLDL and LDL
- decreases in VLDL and LDL will cause apolipoprotein to decrease

303

Discuss energy expenditure in fatty acid oxidation vs. glycolysis in cardiac function

- More energy needed for fatty acid oxidation than glycolysis
- inhibition of fatty acid inhibitors promote oxygen effiency and decreases oxygen needed for cardiac support

304

Energy for sources of cardiac function

- Glycolysis
- Glucose oxidation
- Fatty acid synthesis

305

Main source of energy production in cardiac function

Fatty acid oxidation > Glucose oxidation > Glycolysis

306

Varicose veins

- caused by incompetent calves in lower extremities allow retrograde blood flow from deep to superficial veins
- increases pressure in superficial veins --> dilated veins

307

Orthostatic hypotension

- defined as fall > 20 mmHg in systolic pressure or >10 mm Hg in diastolic pressure

308

Describe events to correct normal physiological "orthostatic hypotension"

1. Decreased venous return to heart
2. Decreased ventricular filling and drop in CO and BP
3. Drop in BP evokes compensatory baroreceptor reflect (increased sympathetic activity and decreased PS activity)
4. Increased sympathetic tone raises peripheral vascular resistance via ALPHA-1 of peripheral vasculature. Leads to venous return and CO

309

Understimulaion of alpha adrenoreceptorss

- leads to cerebral hypoperfusion (light headedness and syncope

310

Sinus venosus

forms smooth portion of right atrium

311

Bulbus cordis

forms smooth portions of right and left ventricles

312

Primitive atrium

forms rough portions of left and right atrium

313

ductus arterious

derived from 6th embryonic aortic arch

314

Tertiary syphillis

- can result in thoracic aortic aneurysm
- compresses adjacent structures and dilates aortic valve ring, a murmur and mediastinal widening is heard
- aneurysm begins with vaso vasorum endarteritis and obliteration resulting in inflamation

315

FTA-ABS

specific test for syphillis

316

Gemfibrozil and fenofibrate (Fibric acid derivatives)

- first line treatments for hyperTRIglyceridemia
- decrease serum triglycerides by reducing hepatic triglyceride production

317

Bile acid resins (e.g. cholestyramine, colestpiol, colesevelam) and effect on triglycerides

- increase triglycerides

318

Niacin (Vitamin B3) used to treat...

hyperlipidemia
Side effects: cutaneous (flushing, warmth, itching) - better tolerated in slow release preparations

319

Capsaicin

- reduces pain by decreasing substance P in the peripeheral nervous system

320

Buerger's disease

- seen in heavy cigarrete smokers < 35 years old
- associated with intradermal injection of tobacco extracts
- thrombosing vascultis extends into contiguous veins and nerves, encasing them in fibrous tissue

321

Polyarteritis Nodosa

- segmental, transmural, necrotizing inflammation of medium to small sized arteries in any organ
- typically affects kidney, liver, heart, and GI tract but NOT LUNGS!!
- sx: livedo reticularis, palpable purpura, hemorhage, ischemia

322

Cachexia

syndrome that encompasses anorexia, malaise, anemia, weight loss and generalized wasting due to underlying systemic disease.

TNF-alpha is a cytokine that causes necrosis of some tumors in utero
- Inhibitig

323

IVC

formed by union of right and left common illiac veins at level of L4-L5

* Renal arteries lie at L1

324

Apoptosis

can occur either the intrinsic (mitochondria-mediated) pathway or extrinsic (receptor-initiated) pathway.
- Both pathways require activation of caspases that cleave cellular proteins

325

Explain relationship between blood flow and resistance

Blood flow is directly proportional to vessel radius raised to fourth power.

Resistance to blood flow is inversely proportional to vessel radius raised to fourth power.

326

Foamy urine

- caused by proteinuria/
Heavy proteinuria (e.g. nephrotic syndrome) can caused interstitial edema because of decrease in serum albumn

327

Auer rods

deformed azurophilic granules found in cytoplasm of myeloblasts that stain positively for MYELOPEROXIDASE

- found in abundance in AML M3

328

Paroxysmal Nocturnal Hemoglobinuria

Triad: hemolytic anemia, hypercoaguable state, pancytopenia

- causes thrombosis
- deficiecy of CD55 and 59 which disallows complement activation

329

Hereditary spherocytosis

autosomal dominant condition that results form red blood cell cytoskeletaon abnormalities
- most commonly spectrin and ankrin defects
- definitive test: positive osmotic fragility test

330

Tx for hyperlipidemia

Niacin (Vitamin B3) - decreases synthesis of hepatic triglyceride and VLDL by suppressing release of FA from peripheral tissues

- also decreases VLDL conversion to LDL, thus decreasing LDL
- also increases HDL

331

Bile-acid binding resins

can cause constipation and abdominal bloating (potentiall worsening diverticulosis), hypertriglyceridemia, cholesteral gall stone and vitamin K malabsorption

332

Factor V Leiden mutation

causes factor Va resistance to inactivation by activated protein C, may account for approximately 20% of cases in atypcial venous thrombosis

333

Sx of hereditary spherocytosis

anemia, reticulocytosis and increased indirect bilirubin, indicating hemolytic anemia

- MCHC (increased because of mild dehydration of red blood cell)

- blood smear dysmorphic red cells with no central pallor

334

Microangiopathic hemolytic anemia

- associaed with RBC fragments, Burr cells, and helmet cells
- in patients with prosthetic valves, RCs are exposed to excessive shear and turbulence in circulation causing damage

335

Glomangioma

- very tender small red-blue lesion under nail bed
- originates from modified smooth muscle cells that control thermoregulatory functions of dermal glomus bodies

336

Bile acid-binding resins (cholestyramine, colestpiol, colesevelam)

- bind to bile acid in GI tract, interfereing with its enterohepatic circulation
- LDL is decreased b/c hepatic cholesterol is consumed in re-sythesis of bile acids
- since bile is being re-synthesized, cholesterol content of bile increases thus increased risk of gallstone

337

Bcl-abl

- associated with CML
- result of t(9;22) - Philadelphia chromosome

338

Li-Fraumeni syndromee

- autosomal dominant disorder caused by inherited mutation of p53

339

Bcl-2 overexpression

- associated with Follicular lymphoma
- associated with t(14;18)
- Bcl-2 has anti-apoptotic effects

340

Cyclin D1 overexpression

- associated with Mantle lymphoma
- associated with t(11;14)

341

Effect modification (of study)

- is present when effect of main exposure on outcome is modified by presence of another variable. Effect modificatiion is not a bias.

342

Atherosclerosis

initiated by repetitive ENDOTHELIAL cell injury, which leads to chronic inflammatory state in underlying intima of large elastic arteries as well as large and medium-size elastic arteries

343

CML vs. leukemoid reaction

- both have increased WBC count
- differentiated based on neutrophil alkaline phosphatase level
- in leukemoid reaction (decreased alkaline phosphotase)
- in CML: decreased alkaline phosphatase

344

Causes of isolated systolic hypertension

- caused by age-related decrease in compliance (increased stiffness) of the aorta and its proximal major branches

345

Discuss protein C deficiency and Warfarin therapy

Transient pro-coagulant/anti-coagulant imbalance is present at start of warfarin therapy , leading to relative hypercoaguable state with thrombotic occlusion of microvasculature and skin necrosis

346

Sx: urinary urgency, nocturia, and hesistancy associated with constant back pain in elderly main

- Suggestive of metastatic prostate cancer

- Prostate cancer likes to metastasize to bone

347

Prostate cancer

- adenocarcinomas in PERIPHERAL zone of gland (vs. periurethral zone of gland in BPH)
- increased levels of PSA
- in advanced disease, may see elevated prostatic acid phosphatase (tumor penetrates capsule) and increase alkaline phosphatase

348

Discuss obstructive sleep apnea and EPO secretion

Obstructive sleep apnea - recurrent episodes of aphyxia during sleep
- peritubular cells in renal cortex sense hypoxia and release EPO which increases hematocrit

349

Cystic medial degeneration

- myxomatous changes in media of large arteries which development of aortic dissections and aortic aneurysms

350

Ovarian cancer

- presents as ovarian mass
- possible amenorrhea
- associated with CA-125
- risks of cancer decreased by OCP, multiparity, and breast feedings

351

Factors which decrease ovarian and/or endometrial cancers

** Things that decrease the number of ovulatory cycles
Multiparity
OCP use
Breastfeeding

352

Tx for hemorrhagic cystitis due to nitrogen mustard based chemotherapeutic agents

Mesna, a sulfhydryl compound that binds acrolein in urine

353

Tx of DVT in pregnant women

Heparin
- increases antithrombrin III activity

** Cant use Warfarin because it's teratogenic

354

Clopidogrel

inhibits ADP mediated platelet aggeregation
used in treatment of coronary artery disease, peripheral vascular disease and cerebrovascular disease NOT DVT

355

Migratory thrombophlebitis

- should always think cancer
- hypercoagulability is very common paraneoplastic syndrome seen in adenocarcinomas of pancrease, colon or lug
- adenocarcinomas produce thromboplastin-like substance capable causing chronic intravascular coagulations

356

Nitroprusside

- agent of choice in treating hypertensive emergency
- quick onset of action and short duration of action
- initially metabolized to cyanide , with conversion to thocyonate by liver rhodanase

357

Treatment for nitroprusside toxicity

Na thiosulfate used to treat cyanide toxicity and works by donating sulfur to liver rhodamase to enhance conversion of cyanide to thiosulfate

358

Likely diagnosis:
necrotizing vasculitis of upper and lower respiratory tract (nasal ulcerations, sinusitis, hemoptysis) and rapidly progressive Wegners

- Wegner's granulomatosis (granulomatous with polyangitis)

- cANCA

359

Tx for familial hyoalphalipoproteinemia

- low HDL thus increased risk of CAD
- Niacin (B3) is best treatment

360

Tx for hypercholesteremia

Statins and ezetimbe
- High LDL is a risk factor for atherogenesis

361

Ezetimbe

- tx of hypercholestermia
- decreases LDL by inhibiting cholesterol absorption from GI tract
- does not increase HDL concentrations
- used in combo with statins to achieve greater LDL reduction

362

Statins

- treatment of hypercholesteremias by inhibiting HMG CoA reductase, rate limiting enzyme of cholesterol syntehsis
- in response hepatocytes, INCREASE expression of LDL receptors

363

ApoB

apoprotein present in VLDL and LDL
- decreases in VLDL and LDL will cause apolipoprotein to decrease

364

Discuss energy expenditure in fatty acid oxidation vs. glycolysis in cardiac function

- More energy needed for fatty acid oxidation than glycolysis
- inhibition of fatty acid inhibitors promote oxygen effiency and decreases oxygen needed for cardiac support

365

Energy for sources of cardiac function

- Glycolysis
- Glucose oxidation
- Fatty acid synthesis

366

Main source of energy production in cardiac function

Fatty acid oxidation > Glucose oxidation > Glycolysis

367

Varicose veins

- caused by incompetent calves in lower extremities allow retrograde blood flow from deep to superficial veins
- increases pressure in superficial veins --> dilated veins

368

Orthostatic hypotension

- defined as fall > 20 mmHg in systolic pressure or >10 mm Hg in diastolic pressure

369

Describe events to correct normal physiological "orthostatic hypotension"

1. Decreased venous return to heart
2. Decreased ventricular filling and drop in CO and BP
3. Drop in BP evokes compensatory baroreceptor reflect (increased sympathetic activity and decreased PS activity)
4. Increased sympathetic tone raises peripheral vascular resistance via ALPHA-1 of peripheral vasculature. Leads to venous return and CO

370

Understimulaion of alpha adrenoreceptorss

- leads to cerebral hypoperfusion (light headedness and syncope

371

Sinus venosus

forms smooth portion of right atrium

372

Bulbus cordis

forms smooth portions of right and left ventricles

373

Primitive atrium

forms rough portions of left and right atrium

374

ductus arterious

derived from 6th embryonic aortic arch

375

Tertiary syphillis

- can result in thoracic aortic aneurysm
- compresses adjacent structures and dilates aortic valve ring, a murmur and mediastinal widening is heard
- aneurysm begins with vaso vasorum endarteritis and obliteration resulting in inflamation

376

FTA-ABS

specific test for syphillis

377

Gemfibrozil and fenofibrate (Fibric acid derivatives)

- first line treatments for hyperTRIglyceridemia
- decrease serum triglycerides by reducing hepatic triglyceride production

378

Bile acid resins (e.g. cholestyramine, colestpiol, colesevelam) and effect on triglycerides

- increase triglycerides

379

Niacin (Vitamin B3) used to treat...

hyperlipidemia
Side effects: cutaneous (flushing, warmth, itching) - better tolerated in slow release preparations

380

Capsaicin

- reduces pain by decreasing substance P in the peripeheral nervous system

381

Buerger's disease

- seen in heavy cigarrete smokers < 35 years old
- associated with intradermal injection of tobacco extracts
- thrombosing vascultis extends into contiguous veins and nerves, encasing them in fibrous tissue

382

Polyarteritis Nodosa

- segmental, transmural, necrotizing inflammation of medium to small sized arteries in any organ
- typically affects kidney, liver, heart, and GI tract but NOT LUNGS!!
- sx: livedo reticularis, palpable purpura, hemorhage, ischemia

383

Cachexia

syndrome that encompasses anorexia, malaise, anemia, weight loss and generalized wasting due to underlying systemic disease.

TNF-alpha is a cytokine that causes necrosis of some tumors in utero
- Inhibitig

384

IVC

formed by union of right and left common illiac veins at level of L4-L5

* Renal arteries lie at L1

385

Apoptosis

can occur either the intrinsic (mitochondria-mediated) pathway or extrinsic (receptor-initiated) pathway.
- Both pathways require activation of caspases that cleave cellular proteins

386

Explain relationship between blood flow and resistance

Blood flow is directly proportional to vessel radius raised to fourth power.

Resistance to blood flow is inversely proportional to vessel radius raised to fourth power.

387

Foamy urine

- caused by proteinuria/
Heavy proteinuria (e.g. nephrotic syndrome) can caused interstitial edema because of decrease in serum albumn

388

Auer rods

deformed azurophilic granules found in cytoplasm of myeloblasts that stain positively for MYELOPEROXIDASE

- found in abundance in AML M3

389

Paroxysmal Nocturnal Hemoglobinuria

Triad: hemolytic anemia, hypercoaguable state, pancytopenia

- causes thrombosis
- deficiecy of CD55 and 59 which disallows complement activation

390

Hereditary spherocytosis

autosomal dominant condition that results form red blood cell cytoskeletaon abnormalities
- most commonly spectrin and ankrin defects
- definitive test: positive osmotic fragility test

391

Tx for hyperlipidemia

Niacin (Vitamin B3) - decreases synthesis of hepatic triglyceride and VLDL by suppressing release of FA from peripheral tissues

- also decreases VLDL conversion to LDL, thus decreasing LDL
- also increases HDL

392

Bile-acid binding resins

can cause constipation and abdominal bloating (potentiall worsening diverticulosis), hypertriglyceridemia, cholesteral gall stone and vitamin K malabsorption

393

Factor V Leiden mutation

causes factor Va resistance to inactivation by activated protein C, may account for approximately 20% of cases in atypcial venous thrombosis

394

Sx of hereditary spherocytosis

anemia, reticulocytosis and increased indirect bilirubin, indicating hemolytic anemia

- MCHC (increased because of mild dehydration of red blood cell)

- blood smear dysmorphic red cells with no central pallor

395

Henoch-Schonlein purpura

- seen in young boys (3 - 10 years old)
-palpable skin lesions associated with abdominal pain, arthralgias, and renal involvement

- occurs due to deposition of Ig-A containing immune complexes and shows up in purpura on buttocks, legs

396

Glioblastoma multiforme

- pallisading tumor cells around areas of necrosis
- commonly crosses midline ("butterfly distribution")
- most common primary brain tumor in adults

397

AML (M3 variant)

- associated with Auer rods
- t(15;17) which codes for chimeric PML/RAR (retinoic acid receptor)
- this inhibits differentiation of myeloblasts and triggers development of APML

398

Selective COX-2 inhibitors

e.g. celecoxib
- have no effect on platelet aggregation and cause little GI irritation
- the reduced risks of GI bleeding are only advantages over traditional NSAIDS

399

Microangiopathic hemolytic anemia

- associaed with RBC fragments, Burr cells, and helmet cells
- in patients with prosthetic valves, RCs are exposed to excessive shear and turbulence in circulation causing damage

400

Glomangioma

- very tender small red-blue lesion under nail bed
- originates from modified smooth muscle cells that control thermoregulatory functions of dermal glomus bodies

401

Sx: "Mismatched V/Q with perfusion defect, sudden onset chest pain

Signs of pulmonary embolism
- often caused by deep vein thrombosis and continuum of pulmonary thromboembolism

402

Bile acid-binding resins (cholestyramine, colestpiol, colesevelam)

- bind to bile acid in GI tract, interfereing with its enterohepatic circulation
- LDL is decreased b/c hepatic cholesterol is consumed in re-sythesis of bile acids
- since bile is being re-synthesized, cholesterol content of bile increases thus increased risk of gallstone

403

Bcl-abl

- associated with CML
- result of t(9;22) - Philadelphia chromosome

404

C-myc overexpression

- associated with Burkitt's lymphoma
- associated with t(8;14)
- myc oncogene on chr 8
- Ig heavy chain on chr 14

405

Li-Fraumeni syndromee

- autosomal dominant disorder caused by inherited mutation of p53

406

Bcl-2 overexpression

- associated with Follicular lymphoma
- associated with t(14;18)
- Bcl-2 has anti-apoptotic effects

407

Cyclin D1 overexpression

- associated with Mantle lymphoma
- associated with t(11;14)

408

Greater activity against Factor Xa and Thrombrin.
Unfractionated heparin or LMWH

Unfractionated heparin - contains pentasaccharide that binds to antithrombin causing confirmational change that increases ability to inactivate Factor Xa
- is able to bind to both antithrombrin and thrombrin to allow antithrombrin to inactivate thrombrin

409

Effect modification (of study)

- is present when effect of main exposure on outcome is modified by presence of another variable. Effect modificatiion is not a bias.

410

Atherosclerosis

initiated by repetitive ENDOTHELIAL cell injury, which leads to chronic inflammatory state in underlying intima of large elastic arteries as well as large and medium-size elastic arteries

411

CML vs. leukemoid reaction

- both have increased WBC count
- differentiated based on neutrophil alkaline phosphatase level
- in leukemoid reaction (decreased alkaline phosphotase)
- in CML: decreased alkaline phosphatase

412

Causes of isolated systolic hypertension

- caused by age-related decrease in compliance (increased stiffness) of the aorta and its proximal major branches

413

Discuss protein C deficiency and Warfarin therapy

Transient pro-coagulant/anti-coagulant imbalance is present at start of warfarin therapy , leading to relative hypercoaguable state with thrombotic occlusion of microvasculature and skin necrosis

414

Sx: urinary urgency, nocturia, and hesistancy associated with constant back pain in elderly main

- Suggestive of metastatic prostate cancer

- Prostate cancer likes to metastasize to bone

415

Prostate cancer

- adenocarcinomas in PERIPHERAL zone of gland (vs. periurethral zone of gland in BPH)
- increased levels of PSA
- in advanced disease, may see elevated prostatic acid phosphatase (tumor penetrates capsule) and increase alkaline phosphatase

416

Discuss obstructive sleep apnea and EPO secretion

Obstructive sleep apnea - recurrent episodes of aphyxia during sleep
- peritubular cells in renal cortex sense hypoxia and release EPO which increases hematocrit

417

Cystic medial degeneration

- myxomatous changes in media of large arteries which development of aortic dissections and aortic aneurysms

418

Ovarian cancer

- presents as ovarian mass
- possible amenorrhea
- associated with CA-125
- risks of cancer decreased by OCP, multiparity, and breast feedings

419

Factors which decrease ovarian and/or endometrial cancers

** Things that decrease the number of ovulatory cycles
Multiparity
OCP use
Breastfeeding

420

Sx of hemorrhagic cystitis

- can be result of nitrogen mustard based chemotherapeutic agent (e.g. cyclophosophamide or ifosfamide)
- metabolized by kidneys into ACROLEIN, which toxic to uroepithelial cells and cause renal cell death and necrosis

421

Tx for hemorrhagic cystitis due to nitrogen mustard based chemotherapeutic agents

Mesna, a sulfhydryl compound that binds acrolein in urine

422

Osler-Weber-Rendu syndrome

autosomal dominant condition marked by telangiectasias in skin as well as in mucous membranes of lips, oranonasopharynx, respiratory tract, GI, and urintary tract
- may cause epitaxis, GI bleeding or hematuria

423

Tx of DVT in pregnant women

Heparin
- increases antithrombrin III activity

** Cant use Warfarin because it's teratogenic

424

Clopidogrel

inhibits ADP mediated platelet aggeregation
used in treatment of coronary artery disease, peripheral vascular disease and cerebrovascular disease NOT DVT

425

Tx for diabetic ketoacidosis

Intravenous hydration with normal saline and insulin
- This will result in serum glucose, osmolality, and potassium as increases in serum HCO3 and sodium

426

Phentolamine

non-specific alpha 1 and alpha 2 blocker with no beta blocking effects that cause profound fall in diastolic blood pressure and reflex tachycardia
-

427

Phenylephrine

- selective alpha adrenerigc agonist. Administation may be associated with reflect bradycardia

428

Isoproterenol

non-selective Beta adrenergic agonist that stimulates both B2 receptors vascular smooth muscle (vasodilation) and cardiac B1 (increases in cardiac rate and contractility)

429

Epinepherine (effect on systolic blood pressure, HR, and diastolic blood pressure)

Systolic BP: increases (alpha 1 and B 1)
HR: increases (B1)
Diastolic BP: (dose-dependent)
Low dose - B2 > a1 (decrease)
High dose - a1 > B2 (increase)

430

Propranolol

non-selective beta adrenergic antagonist
effect on B2: vasoconstriction
effect on B1: slows heart contractility

431

Fatty streaks

- multiple yellow spots approx 1mm in diam
- earliest lesion of atherosclerosis and present in all people > 10 y.o
- composed of lipid filled foamy cells and smooth muscle cells that have engulfed lipoproteins
- occurrence and location in child don't predict locations of plaques later on in lide

432

Factor Xa inhibitors

- new class of anticoagulants with activity against factor Xa
- increase prothrombrin and aPTT times but don't affect thrombrin time

433

Schilling test

- helps differentiate between dietary defiency of vitamin B12, pernicious anemia, and malabsorption syndromes

** Low absorpton of cobalamin not correctable by IF means malabsorptive syndrome such as ileal disease, pancreatic insufficiency, or bacterial overgrowth

434

Sx of steroid abuse

erythrocytosis
abnormal testicle size and function
hepatic abnormalities
acne

435

Strong evidence of lymph node malignancy

Monoclonal lymphocytic proliferation, esp. monoclonal T-cell receptor gene arrangements

436

Polyclonal proliferation of lymphocytes

associated with benign lymph node enlargement in response to antigenic stimulation

437

Sx of lead poisoning

- erythrocyte basophillic stippling
- microcytic anemia

438

Net filtration pressure

(Gh - Bh) - (Go - Bo)

439

von Willebrand disease

- causes impairments in platelet function and coagulation pathway abnormalities.
- associated with prolonged bleeding time
- prolonged PTT
- decreased platelet aggregation in response to ristocetin

440

Polycythemia vera

clonal myeloproliferative disease in pluripotent stem cells
- increased RBC mass, inc. plasma volume and low EPO
- majority have JAK2 V617F mutation, rendering RBCs more sensitive to growth factors

441

Strawberry hemangioma

benign vascular tumors of childhood
- appear during first few weeks of life, initially grow rapidly, then regress by 5-8 years old
- composed of capillaries separated by connective tissue

442

Alpha adrenergic agonists

- increase both systolic and diastolic blood pressure via stimulation of a-1 adrenoreceptors
- elevated systemic blood pressure is associated with reflex increase in vagal influence on heart, results in decreased heart rate

443

Vascular reaction to endothelial and intimal injury (e.g. atherosclerosis)

Intimal hyperplasia and fibrosis, predominantly mediated by reactive smooth muscle cells that migrate from media to the intima

444

Nitroprusside

- agent of choice in treating hypertensive emergency
- quick onset of action and short duration of action
- initially metabolized to cyanide , with conversion to thocyonate by liver rhodanase

445

Treatment for nitroprusside toxicity

Na thiosulfate used to treat cyanide toxicity and works by donating sulfur to liver rhodamase to enhance conversion of cyanide to thiosulfate

446

Likely diagnosis:
necrotizing vasculitis of upper and lower respiratory tract (nasal ulcerations, sinusitis, hemoptysis) and rapidly progressive Wegners

- Wegner's granulomatosis (granulomatous with polyangitis)

- cANCA

447

Tx for familial hyoalphalipoproteinemia

- low HDL thus increased risk of CAD
- Niacin (B3) is best treatment

448

Tx for hypercholesteremia

Statins and ezetimbe
- High LDL is a risk factor for atherogenesis

449

Ezetimbe

- tx of hypercholestermia
- decreases LDL by inhibiting cholesterol absorption from GI tract
- does not increase HDL concentrations
- used in combo with statins to achieve greater LDL reduction

450

Statins

- treatment of hypercholesteremias by inhibiting HMG CoA reductase, rate limiting enzyme of cholesterol syntehsis
- in response hepatocytes, INCREASE expression of LDL receptors

451

ApoB

apoprotein present in VLDL and LDL
- decreases in VLDL and LDL will cause apolipoprotein to decrease

452

Discuss energy expenditure in fatty acid oxidation vs. glycolysis in cardiac function

- More energy needed for fatty acid oxidation than glycolysis
- inhibition of fatty acid inhibitors promote oxygen effiency and decreases oxygen needed for cardiac support

453

Energy for sources of cardiac function

- Glycolysis
- Glucose oxidation
- Fatty acid synthesis

454

Main source of energy production in cardiac function

Fatty acid oxidation > Glucose oxidation > Glycolysis

455

Varicose veins

- caused by incompetent calves in lower extremities allow retrograde blood flow from deep to superficial veins
- increases pressure in superficial veins --> dilated veins

456

Orthostatic hypotension

- defined as fall > 20 mmHg in systolic pressure or >10 mm Hg in diastolic pressure

457

Describe events to correct normal physiological "orthostatic hypotension"

1. Decreased venous return to heart
2. Decreased ventricular filling and drop in CO and BP
3. Drop in BP evokes compensatory baroreceptor reflect (increased sympathetic activity and decreased PS activity)
4. Increased sympathetic tone raises peripheral vascular resistance via ALPHA-1 of peripheral vasculature. Leads to venous return and CO

458

Understimulaion of alpha adrenoreceptorss

- leads to cerebral hypoperfusion (light headedness and syncope

459

Sinus venosus

forms smooth portion of right atrium

460

Bulbus cordis

forms smooth portions of right and left ventricles

461

Primitive atrium

forms rough portions of left and right atrium

462

ductus arterious

derived from 6th embryonic aortic arch

463

Tertiary syphillis

- can result in thoracic aortic aneurysm
- compresses adjacent structures and dilates aortic valve ring, a murmur and mediastinal widening is heard
- aneurysm begins with vaso vasorum endarteritis and obliteration resulting in inflamation

464

FTA-ABS

specific test for syphillis

465

Gemfibrozil and fenofibrate (Fibric acid derivatives)

- first line treatments for hyperTRIglyceridemia
- decrease serum triglycerides by reducing hepatic triglyceride production

466

Bile acid resins (e.g. cholestyramine, colestpiol, colesevelam) and effect on triglycerides

- increase triglycerides

467

Niacin (Vitamin B3) used to treat...

hyperlipidemia
Side effects: cutaneous (flushing, warmth, itching) - better tolerated in slow release preparations

468

Capsaicin

- reduces pain by decreasing substance P in the peripeheral nervous system

469

Buerger's disease

- seen in heavy cigarrete smokers < 35 years old
- associated with intradermal injection of tobacco extracts
- thrombosing vascultis extends into contiguous veins and nerves, encasing them in fibrous tissue

470

Polyarteritis Nodosa

- segmental, transmural, necrotizing inflammation of medium to small sized arteries in any organ
- typically affects kidney, liver, heart, and GI tract but NOT LUNGS!!
- sx: livedo reticularis, palpable purpura, hemorhage, ischemia

471

6-mercaptopurine

- cytotoxic purine analog (along with 6-thioguanine) that inhibits de novo purine synthesis after being converted to active metabolites by hypoxanthine-gunine phosphoribosyl transferase (HGPRT)

- inactivated by XANTHINE OXIDASE in liver

472

Allopurinol

- inhibits xanthine oxidase and thus can increase 6-mercaptopurine significantly

473

Adenosine deaminase

- converts adenosine to iosine as part of purine metabolims
- enzyme is deficient in SCID
- inhibited by Pentostatin

474

Glioblastoma

-tumor from astrocytes and is common adult tumor
- typically found in hemispheres (frontal or temporal lobes) or near basal ganglia
- may become large enough to cross midline
- on gross exam: soft and poorly defined with areas of necrosis and hemorrhage
- poor prognosis

475

Meningiomas

- derived from arachnoid cells and 2nd most common tumor
- located on brain surface and attached to dura
- found on lateral and parasagittal brain convexities, falx cerebri, sphenoidal ridge and olfactory groove

476

Acoustic schwannomas

- special type that are arise from Schwann cells of CN VIII
- found at cerebellopontine angle

477

Precursor B-ALL immunophenotyping

can be distinguished from Precursor T-ALL by immunophenotyping
- TdT+
- CD10 +
- CD19+

478

Precursor T-ALL immunophenotyping

- express T-cell markers and are TdT+
CD2
CD3
CD4
CD7
CD8

479

Epstein-Barr Virus

- responsible for acute mononucleosis, nasopharyngeal carcinoma, lymphomas, and Burkitt's lymphoma
- via contact through oropharyngeal secretions
- binds to CD21 on surface of B-cells and epithelial cells

480

Parvovirus

- attaches to human epithelioid cells via blood group P antigen (globoside)
- immature cells of erythroud family are most vulnerable and why fetal liver and adult bone marrow are most vulnerable

481

Essential to viral invasion of cells

the initial attachment of virion envelope or capsid surface to complementary cell surface receptorss
(e.g CD4 and HIV gp120) OR CD21 and EBVgp350

482

ERB-B2

- overexpressed in 25 - 30% of breast cancers
- member of epidermal growth factors
- transmembraine protein with tyrosine kinase activity and is present in breast/ovarian cells
- associated with aggressive cancers

483

Stop codons

UAG - "U Are Gone
UGA - "U Go Away"
UAA - "U Are Away

484

Treatment for cyanide poisoning

Amyl nitrates
- cause methoglobinemia which contains Fe (2+)
- Cyanide binds to Fe(2+)/ ferric iron more avidly than cytochrone enzymes which mitochrondrial enzymes

485

Anaphylatic shock

- characterized by vasodilation, increased vascular permeability, bronchoconstriction, hypotension, tachycardia
- epinephrine is treatment for anaphylatic shock

486

Aplastic anemia

- causes pancytopenia as bone marrow is replaced with fat cells and fibrous stroma
- absence of splenomegaly
- need bone marrow biopsy to distinguish from myeloproliferative disease

487

Polyarteritis Nodosa (PAN)

- TRANSMURAL inflammation with arterial wall fibrinoid necrosis
- sx;: fever, malaise, weight loss, abdominal pain and melensa
- associated with Hep B infection

488

Sx of norepinephrine extravasation

- blanching of a vein into which norepinepherine is being infused together with induration and pallor of tissues surrounding IV site
- due to leak of alpha-1 causing vasoconstriction
- prevented by administering phentolamine mesylate

489

Tx of norepinephrine extravasation

- alpha 1 blocker (phentolamine)
- counteracts the alpha-1 receptor mediated vasocontriction

490

Sx of aortic dissection

- severe retrosternal pain that radiates to pack
- intimal tear is thought to the initiating process
- intramural hematoma dissects through media and can compress major arterial branches

491

Vitamin K dependent coagulation factors

- II, VII, IX, X - (which are initially produced in liver until activation by Vitamin K
- failure of prolonged PT to correct with Vit K indicates liver disease

492

DIC (Disseminate Intravascular Coagulation

- associated with sepsis, particularly Gram - rods
- occurs to exposure of blood to procoagulants that initiate intravascular thrombosis, which is followed by thrombolysis
- result is consumption of coagulation factors, coagulopatjy, and bleeding

493

TTP-HUS

** TTP - associated with adults with neurological disorders
** HUS - associated with children with predominant renal involvement
- patients usually don't bleed
- ONLY platelets are activated
- normal PT and PTT
- normal fibrinogen

494

DIC

- patients bleed
- coagulation cascade is activated
- PT and PTT are prolonged
- Low fibrinogen and increased FDP (fibrin degredation products)

495

Sx: Hemophilia

- history of hemarthrosis and bleeding after tooth extractions
- due to decreased levels of factors VIII (Hemophilia A) or levels of factors IX (Hemophilia B) which lead to failure to convert prothrombrin to thrombrin and deficient thrombrin formation
- Addition of thrombrin to hemophiliac patients' serum causes clotting

496

Cliostazol

phosphodiesterase inhibitor used in patients with intermittent claudication
- inhibits platelet aggregation AND direct vasodilator
- shown to be superior to asprin in treatment of peripheral arterial disease

497

Ticlopidine / Clopidogrel

- similar drugs that block ADP receptor thus preventing GPIIb/IIIa receptors from functioning (platelet aggregation)

498

Argatroban

- anti-thrombic drug largely used in treatment of heparin induced thrombocytopenia

499

Concern when initiating ACE inhibitor therapy

- first dose HYPOtension
- risk factors: hyponatremia, hypovolemia secondary to diuretics, low baseline BP, high renin or aldosterone levels, renal impariemtn and heart failure
- minimize risk with low doses

500

Etoposide

chemotherapeutic agen that inhibits sealing activity of toperisomerase II.

- treatment causes chromosomal break to accumulate in dividing cells, causing cell death

501

Topoisomerases

- enzymes that relieve supercoiling that occurs during DNA replicating by creating nicks
Topoisomerase I -- makes SINGLE stranded nicks
Topoisomerase II - makes DOUBLE stranded nicks

502

Most common VIRAL cause of aplastic crisis in patients with sickle cell anemia or chronic hemolytic anemia

Parvovirus B19 (non-enveloped, single stranded DNA virus) - infects erythroid progenitor cells

503

Hepatic C

- enveloped single stranded + RNA virus

504

Hepatitis E

NON-ENVELOPED single stranded + RNA virus

505

Paracortex of lymph node

populated by T lymphocytes and dendritic cells
- internal to cortex between follicles and medulla)
- can become enlarged during proliferation of T-lymphocytes
- poorly developed in DiGeorge Syndrome

506

Follicles of lymph node

sites of B cell lymphocyte localization and proliferation
- dense and dormant
- secondary follicles have pale germinal center containing proliferating B cells and follicular dendritic cells
-

507

Discuss agammaglobulinemia and follicles of lymph nodes

In agammaglobulinemia, germinal centers and primary lymph node follicle don't form due to absence of B cells

508

Medulla of lymph node

- consists of medullary cords and sinuses
- medullary cords contain B cells, plasma cells, and macrophages
- medullary sinuses contain reticular cells and macrophages

509

Median

value that is located at the precise center of an ordered dataset. Divides the right half data from left side

510

BRCA-1 and BRCA-2

inherited as an autosomal dominant trait
BRCA-1 on chromosome 17 and is a tumor suppressor gene
- should be suspected if two or more relatives have premenopausal breast cancer

511

Hemolytic Uremic Syndrome

- affects young children and manifests with acute renal failure microangiopathic hemolytic anemia and thrombocytopenia
- decreased RBC count, hematocrine, platelet count
- Increased bleedigng time, LDH, BUN, and creatiine

512

Organisms associated with HUS

- E.coli O157:H7
- Shigella

513

Presence of erythroid precursors in liver and spleen..

- Extramedullary hematopoiesis, condition characterized by erythropoietin-stimulated hyperplastic marrow cell invasion of extramedullar organs
- caused by severed chronic hemolytic anemia, such as B-thalassemia

514

APC gene mutation

- found in patients with familial polyposis syndromes, sporadic colon cancer, and melenoma
- responsible for maintaining low levels of B-catenin (oncogenic) ad for intercellular adhesion

515

Non-nucleoside reverse transcriptase inhibitors

Nevirapine, Efavirenz, Delaviradine

516

Non-nucleoside reverse transcriptase inhibitors (Nevirapine, Efavirenz, Delaviradine)

- anti-retroviral drugs that do not require activation via intracellular phosphorylation
- best used with other anti-retroviral agents in treatment of HIV

517

Adverse effects of NNRTs (Nevirapine, Efiravenz, Delaviradine)

- abrupt onset of flu-like symptoms, jaudine, or fever - may indicate hepatic failure with encephalopathy
- most likely to occur during first 6 weeks of therapy
- Stevens - Johnsons syndrome

518

Pure red cell aplasia

Rare form of marrow failure characterized by severe hypoplasia of marrow erythroid elements in setting of normal granulopoiesis and thromboeisis

- involves inhibition of erythropoietic precursors and progenitors by IgG auto-antibodies or T lymphocytes

519

Pure red cell aplasia is associated with which conditions?

- Thymoma
- Lymphocytic leukemias
- Parovirus B19 infection

520

Volume of distribution

- hypothetical volume of fluid into which administered amt of drug would be need to uniformly distributed to produced observed plasma concentration

521

Volume of distribution formula

- amount of drug (mg)/ plasma concentration of drug (mg/L)

522

Low Vd (3-5L)

- high molecular weight
- high plasma protein binding
- high charge
- hydrophilicity tend to trap the drug

523

High Vd

- Lipophilic drugs tend to readily cross cell membranes and distribute widely outside the plasma and interstitial compartments
- tendency to collect with cells gives these drugs a high volume of distrubution

524

ARBs

- by blocking AT-1 receptors and inhibiting effects of angiotensin II
- results in arterial vasodilation and decreased aldosterone secretion

525

Discuss AT-1 receptors and RAAS

- Stimulation of AT-1 receptors on juxtaglomerular cells will decrease renin release from kidneys, consequently decreasing angiotensin I and II levels

526

Attributable risk percent

- measures of impact of a risk factor being studies
= (risk in exposed - risk in unexposed)/ risk in exposed


ARP = (RR - 1)/RR

527

Sickle cell patients are at increased risk for infection by which organisms

- Encaspsulated organisms (Strep pneumoniae and H. influenzae)

- Salmonells is most common cause of osteomyelitis, followed by E. coil and S. aureus

528

Reed Sternberg cells

bi-nucleated cells with "owl's eyes" appearance that appear on background of lymphocytic infiltrate
- seen in non-Hodgkin lymphoma

529

Most common cancers in women

Incidence : Breast > Lung > Colon

Mortality: Lung > Breast > Colon

530

Rituximab

- monoclonal antibody directed against CD20 (B-cell marker) antigen.
- introduction of prognosis of some lymphomas

531

P450 microsomal oxidase system

- plays an important role in detoxification
- CCl(4) - produces free radicals that start vicious cycle of hepatic injury

532

Henoch Schonlein Purpura

- small vessel leukocytoclastic angiitis associated with IgA and C3 deposition
- most common in children in 3 - 11 years old
- most children with palpable skin lesions with or without abdominal pain and athralgias

533

Anti-retroviral agents

- selectively bind to HIV envelope transmembrane glycoprotein gp41 prevent the conformational changes necessary for viral membrane to fuse with target cellular membrane
- "fusion inhibitor"

534

Heparin

drug of choice for acute management of venous thrombosis or thromboembolism
- activates antithrombin III

535

Warfarin

inhibits Vitamin K dependent-carboxylation of glutamic acid residues of clotting factors II, VII, IX, and X (vitamin K dependent clotting factors)

536

Discuss ACE inhibitors and patients with bilateral renal stenosis

- May cause drop in GFR, as ACE inhibition leads to vasodilation of EFFERENT arterioles

537

Hyperplastic arteriosclerosis

- can result from perpetual malignant hypertension
- diastolic blood pressure > 120 - 130 mmHg
- leads to onion-like concentric thickening of walls of arterioles as result of laminated smooth muscle cells and reduplicated BM
- seen in renal vasculature

538

Hereditary spherocytosis

- results from RBC cytoskeleton abnormalities (deficient in ankyrin, spectrin)

Sx: hemolytic anemia, jaundice and splenomegaly

539

Aplastic anemia

- characterized by panocytopenia, low reticulocyte count, and absent splenomegaly
- usually "dry" and histopathology shows marrow replacement with fat cells and fibrous stroma

540

Myelofibrosis

- replacement of bone marrow with FIBROUS tissue (no fat)
- pancytopenia
- evidence of extramedullary hematopoiesis

541

Hairy leukemia

- can bone marrow fibrosis
- often described as "fried egg" appearance
- evidence of splenomegaly

542

Chloramphenicol

- lead to both dose-dependent (reversible) and dose-dependent (irreversible) pancytopenia
- anti-bacterial by binding to ribosomal 50 subunit and inhibiting peptidyl transferase enzyme thus suppresses bacterial synthesis

543

Gentamicin side efects

- Ototoxicity
- Nephrotoxicity
- Neuromusclar paralysis (

544

Metronidazole side effect

- Side effects are GI (nausea, vomiting, crampy abdominal pain)
- neurologica (parasthsias, dizziness)
- induces disulfiram-like reaction

545

Vancomycin-side effect

Can cause histamine release, results in flushing
"red man syndrome" - cause by rapid infusin

- dose-related ototoxicity

546

Common cardinal veins make what post-natal structure?

SVC

547

EBV virus

- causes infectious mononucleosis
- sx: sore throat, cervical lymphadenopathy, splenomegaly
- heterophile antibody tests sensitive
- associated with Burkitt lymphoma (African type) and nasopharyngeal carcinoma (in Cinese)

548

Features of anaplasia

- loss of cell polarity and normal tissue architecture
- variation in shape and size
- hyperchromatism and nuclear pleomorphisn
- High nucleus to cytoplasm ration
- Numerous, often abnormal mitoses
- giant, multi-nucleated tumor cells

549

Southwestern blotting

technique that analyzes DNA- binding proteins using pricincples of Southern and Western bots
- DNA- binding proteins recognized by ability to ind to specific oligonucleitides

550

Western blotting

- used to identify target polypeptide from saple
- target proteins undergo gel electrophoresis
- separated proteins are probed with specific antibody of interest
- then radioactive marker is bound to first antibody

551

Metalloproteinases

Zn-containing enzymes that degrade extracellular matrix.
- participate in tissue remodeling and in tumor invasion

552

Angioedema

- rare but serious effect of ACE inhibitors
- involves swelling of tongue, lips, or eye lipds and pts may experience difficulty breathing
- due to increased bradykinin levels

553

ACE inhibitors are contraindicated in which patients?

- In patients with peripheral vascular disease or atherosclerortic CV disease as they can develop ACUTE RENAL FAILURE
- patients with renal disease dependent on ACE constriction to maintain renal failure and ACE inhibitors would reduce renal perfusion

554

Causes of "LEFT" shift of oxygen - disassociation curve

- indicates increased oxygen- hemoglobin affinity ("L= LUNGS")
- increased pH
- decreased CO2, temperature and 2,3 DPG

555

Causes of "RIGHT" shift of oxygen - disassociation curve

- indicates decreased oxygen-hemoglobin affinity
- decreased pH
- increased CO2, temperature and 2,3 DPG

556

Side effects of topic preparations of alpha-adrenergic agonists

- Alpha adrenergics can cause vasocontriction of nasal mucosa vessels and are used nasal decongestants
- Overuse can cause negative feedback resulting in decreassed NE synthesis

557

Streptokinase

- thrombolytic agents that acts by converting plaminogen to plasmin, which degrades fibrin
- most common side effect is hemorrhage
- foreign protein derived from Streptococci and can induce hypersensitivity reactions

558

Regulation of iron absorption

- regulated through hepcidin's effect on absorption of dietary iron by intestinal epithelial cells and release of iron by macrophages

559

Discuss iron absorption

- After iron is absorbed by DMT-1, iron can take 1 of 2 pathways:
1. may bind to ferritin (intracellular iron-binding protein) and remain stored within enterocyte. can be excreted into stool as enterocytes are sloughed off
2. may enter circulation via ferroprotein, BL iron transporter of enterocyte. Free iron is transported by transferrin which becomes internalized after interacting with transferrin receptors on all cells

560

B-thalassemia

HbA2 is elevated in B-thalassemia minor (trait) and B-thalassemia intermedia because B-globin chain underproduction causes decreased synthesis of HbA

561

Hemoglobin components in adult blood

HbA1 = (a2B2) - 97% of total Hb
HbA2 = (alpha2delta2) - 2.5% of total Hb
HbF = (alpha2gamma2) - < 1% of total Hb

562

Hemophilia A

- defect in coagulation factor VIII
- NORMAL bleeding time (b/c bleeding is indication of platelet function)
- prolonged PTT

563

von Willebrand disease

- vWF is a mediator for coagulation factor VIII and mediator of platelet aggregation
- absence causes functional VIII deficiency and platelet deficiency
- prolonged bleeding time (platelet function)
- bleeding time

564

Warfarin inhibits which

- coagulants II, VII, IX, X
- anti-coagulants Protein C and Protein S

565

K-ras

- associated with cancers of bladder, lung, colon, pancreas and kidney
- proto-oncogene (tumor promotor) resulting stimulation of cellular proliferation, inactivation of anti-oncogenes

566

Proto-oncogenes

- ras: bladder/colon/pancreas/kidney
- ERB-B1: squamous cell of lung
- ERB-B2: breast/ovarian cancer
-TGFa: astrocytoma, hepatocellular carcinoma
-sis: astrocytomas, osteosarcoma
- abl: chronic myeloid leukemias

567

Anti-oncogene

-NFI
-APC/B-catenin
-DCC
-p53
-RB
-WT-1

568

Drugs that decrease progression of diabetic nephropathy

- ACE inhibitors
- ARBs

569

Age-related macular degeneration

- leading cause of blindness in industrialized nations
- involves degeneration of central retina
- "dry AMD" - subretinal deposits leading to gradual loss of vision
- "wet AMD" - more acute presentation - abnormal blood vessels with subretinal hemrrohage, gray subretinal membrane - due to increased VEGF

570

Tx of wet AMD

- due to increased vascular endothelial growth factors (VEGF) causing
- treat with anti-VEGF

571

Anti-inflammatory agents that do not inhibit platelet aggregation

Selective COX-2 inhibitors

**Platelets express mostly COX-1

572

Drugs that inhibit thymidylate formation

Methrotrexate
5-FU

** Note that methotrexate can overcome by N5-formyl tetrahydrofolate (folinic acid, leucovorin)

573

What metabolizes pro-carcinogens?
(Hint: it's in the liver)

Converted by cytochrome p450 monooxygenase which is present in hepatocytes and ER of certain cells
- these enzymes convert the pro-oncogenes into active enzymes

574

Which organ extracts blood more efficiently than any other organ?

Heart - thus venous blood is the most deoxygenated.

575

HER2/neu oncogene

- encodes 185kd transmemembrane protein that has intracellular tyrosine kinase activity
- member of EGFR family
- overexpression can lead to breast and ovarian cancers

576

Statin side effect

Myopathy (leading to muscle pain)
- Statins commonly prescribed after MI as they reduce cholesterol and stabilize atheromatous plaques

577

Sx of T- ALL

- usually young child
- presents with mediastinal mass that can cause respiratory symtoms, dysphagia or superior vena cava syndrome

578

Aldosterone excess

- will canse hypertension, hypokalemia, metabolic alkalosis and depressed renin

579

Aldosterone antagonists (e.g. eplerenone and spironolactone)

- can cause hypoaldosterone (which can cause type IV renal tubular acidosis
- can be used as medical therapy for Conn's syndrome (adrenal mass)

580

Aldosterone

- secreted by adrenal glands

581

Raltegavir

- integrase inhibitor that disrupts ability of HIV to integrate genome into the host's cells chromosome, thus preventing host cellular machinery from being used to synthesize HIV mRNA

582

Patients with Sickle Cell Trait

HbA - 60%
HbS - 40%
** usually assymptomatic and have relative protection from malaria
- usually have normal peripheral smears and indices, reticulate counts and MCHC values
- may have RBCs that will sickle when sodium metabisulfite is added

583

Vinicristine side effect

- neurotoxicity (dose-limited) - results form failure of microtubule polymerization in neuronal axons
- pulmonary fibrosis and flagellate skin discoloration

584

Bleomycin side effect

Pulmonary fibrosis and flagellate skin discoloration

585

Doxorubicin side effect

CHF

586

Cycophosphamide side effect

hemorrhagic cystitis

587

Transketolase

- carry out non-oxidative reactions of HMP shunt
- some cells don't use oxidative phase to produce cytosolic NADPH but ALL cells can syntehsize fructose-6-phosphate using the non-oxidative reactions

588

Giant cell arteritis

- characterized by granulomatous inflammation of media, with fragmentation of internal elastic lamina of medium and small branches of carotid artery
- most common in > 50 y.o paitent
- jaw claudication is most important symptom
- irreversible blindness due to ophthalmic artery occlusion is severe complication of GCA
- Tx: immediate prednisone therapy

589

Cherry hemangioma

- small red cutaneous papules common in aging adults
- don't regress spontaneously and increase in number with age
- micro: proliferation of capillaries and postcapillary venules in the papillary dermis

590

Drug to prevent venous thrombosis in non-ambulatory patient or patients undergoing elective surgery

Heparin - increases the effect of naturally occuring anti-thrombrin III

591

Ancathocytes

"spur ce;;"
- seen in abetalipoproteinemia

592

Teardrop cells

- seen in myelofibrosis.
- when bone marrow is replaced with fibrosis (or metastatic cancer), RBCs must squeeze through spaces

593

Target cells

"bulls eye" cells
- seen in "HALT"
HbC
Asplenia
Liver disease
Thalassemia

594

Schistocytes

- seen in DIC, TTP/HUS
traumatic hemolysis (e.g. metal heart valve prosthesis)

595

DIC

- complication of gram - sepsis, acute pancreatitis, and burn injury
- gram negative spesis - activatio of coagulation cascade by bacterial endotoxins, causing formation of micro-emboli

596

Lab values for DIC

- fragmented RBCs (microangiopathic hemolytic anemia) and thrombocytopenia
- prolongation of PT, PTT, and decreased fibrinogen, factor V, and factor VIII levels

597

Most common cause of hypochromic, microcytic anemia

Iron deficiency

** most common cause of iron deficiency is blood loss

598

Suspected etiology of iron deficiency in woman of childbearing age

- Menstruation

599

Suspected etiology of iron deficiency of blood loss in adult male or postmenopausal woman

- Occult blood loss in GI tract

600

Common cause of thrombocytopenia
(esp. in patients with ecchymoses, petechiae, and mucosal bleeding with signs and symptoms of TTP/HUS, pancytopenia, marrow failure, and splenomegaly

Autoimmune destruction of platelets

601

ACE inhibitors on R-A-A- system

- INCREASED RENIN (due to decreased renal perfusion)
- INCREASED ANGIOTENSIN I, because renin converts angiotensinogen to angiotensin I
- DECREASED ANGIOTENSIN II because ACE inhibitors prevent this conversion
- DECREASED ALDOSTERONE because no angiotensin II to increase aldosterone secretion and induce vasoconstriction
- INCREASED BRADYKININ - because less angiotensin II means less degradation of bradykinin

-

602

Patient experiences parasthesias after receiving several units of blood. Serum calcium level is 7.2 mg/dL (hypocalcemic).
What's the etiology?

- Patients who receive more than one body blood volume (5-6 L) over 24 hrs may have elevated citrate levels (substance added to blood)
- Citrate chelates calcium and magnesium and may reduce their plasma levels thus causing parasthesias

603

Discuss carbon monoxide poisoning and methemoglobinemia

- binds to hemoglobin with much higher affinity than oxygen, thus preventing oxygen from binding to hemoglobin
- DOES NOT AFFECT OXYGEN SATURATION
- DOES NOT CAUSE METHEMOGLOBINEMIA

604

Dysplasia

- REVERSIBLE change in epithelial cells
- progress through low-grade dysplasia --> high-grade dysplasia/carcinoma in site --> invasive carcinoma
- once breached basement membrane, no longer reversible

605

Amlopidine

- calcium channel blocker used to treat hypertension
side effect: flushing and peripheral edema

606

Discuss Hemoglobin S in deoxygenated state

- HbS aggregates in deoxygenated state
- form fibrous strands that reduce RBC membrane flexibility and promote sickling
-

607

Biphospoglycerate mutase

- produced in large quantities in erythrocytes
- creates 2,3 BPG from 1,3 BPG

608

Discuss 2,3 BPG and oxygen delivery to peripheral tissues

- 2,3 BPG is produced in erythrocytes with enzyme biphosphoglycerate mutae
- increased 2,3 BPG DECREASES affinity of Hb for oxygen thus allowing oxygen delivery to peripheral tissues