Term4 wk1 lecture 6 on inflammation Flashcards by Aisha Ghias

Boils, furuncles, and abscess are example of the following inflammation:

a. fibrinous inflammation
b. inflammatory inflammation
c. suppurative inflammation
d. serous inflammation

c. Suppurative inflammation.

An exudate consisting of large numbers of neutrophils, liquefied debris of necrotic cells, and edema fluid.

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Of the following cell derived mediators, which of the following are secreted by platelets.

Leukotrienes
serotonin
Histamine
Prostaglandins

Answer:

2. and 3.

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Which of the following inhibits platelet aggregation and causes vasodilation

Cox1
PGl2
TXA2
PGE2

Prostacyclin PGL2 inhibits platelet aggregation and causes vasodilation and has opposite effect of TXA2. Both TXA2 and PGL2 are derivative of Cyclooxygenases.

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How can we stop Arachidonic acid its derivatives.

Steroid administration can stop Phospholipases, which in turn, will stop Arachidonic acid and its derivatives.

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Why drugs with short half lives can be given once a day?

This is because of the high initial concentration in relation to the EC50.

initial dose has a higher effect that last longer, regardless of the short half life.
E = Emax xC/C+Ec50

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What happens to the effect, if you double the dose ?

a. Double the plasma concentration
b. triple the effect.
c. Prolong the effect by one half.
d. A + C
e. B+C

D
Doubling the dose will double the drug plasma concentration.
• Therefore, doubling the dose will prolong the drug effect by one half-life.

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A patient c/o lethargy, wt gain, and generalized swelling. She is found to have TSH of 164 (NL: 0.03-5). Pt is given 75 mg IV levothyroxine with half life of 9 days. which of the following represents, doubling the IV dose to 150 microgram affecting plasma dose and half life
a. double the increase in drug plasma conc with double the half life duration.

b. Double the increase in plasma concentration with no change in half life.
c. Double in plasma concentration with prolonging the drug effect by one half life.
d. since it is IV drug, no change in half life or drug conc.

C. Doubling the dose will double the drug plasma concentration.
• Therefore, doubling the dose will prolong the drug effect by one half-life.

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What cells can cause freckles
a. dermal macrophages
b. basal keratinocytes
c. Melanocytes only. 
d. A+B
E. C +B

D:
Although melanocytes are the only source of melanin, adjacent basal keratinocytes in the skin can accumulate the pigment (e.g., in freckles), as can dermal macrophages.

Melanin can be stored by other cells (freckles), nevus cells, melanophages

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A 79 y/o male with PMH of dementia, died after falling from 3 feet stair case. Heart biopsy showed brown pigmentation, most likely represents:

Hemochromatosis
lipofuscin
saponification
hemosiderosis

Answer: Lipofsucin granules: old age related.

Old age people!

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58 y/o retired nurse with no PMH presented to the office c/o right toe pain x 1 day. She reports that she woke up with a swollen toe with redness x 1 day. She denies fever, chills, n/v, any fall, or trauma. She admits applying topical OTC antibiotics without any relief. She admits to high protein diet and heavy ethoH intake, since she has recently retire and has been celebrating her retirement. PE: right toes: swollen and red. Tender to touch. vitals: T = 37 degrees, HR: 67, BP: 131/67, R 18. Labs: creatine 1.2, WB 11. serum Uric acid level: 800 mg. Upon needle aspiration of the right toe, negative bifirenges noted:

Which of the following is not clinical presentation.

a. Gout
b. Pseudogout only
c. septic arthritis.
d. b+C

The patient has gout.

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why do most drugs follow first order kinetics?

a. Enzymes and sites are saturated.
b. plasma concentration is well below Km ( conc. of drug to saturate half of the receptors).
c. Because the initial concentration are high

B.
CL = Vmax x C/Km, since Km is always very high, c can be ignored.
Clearance: Vmax/Km; concentration is less than Km and can be ignored.
Rate of elimination = clearance x conc.

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Does increasing the infusion rate, double the steady state when compared to doubling the infusion rate.

a. yes
b. no

Doubling the infusion rate doubles the Css. • But increasing the infusion rate does not influence the time required to reach Css.

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Which of the following would decrease half life

a. heart failure
b. obesity
c. cyp induction
d. Cyp inhibition.

Cyp induction will increase metabolism, thus decreasing half life of the medication.

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what is saturation kinetics?

a. when Km is less than conc.
b. When Km exceeds Con.
c. When km equals Conc.
d. when Km is linear.

a.
When km is less than the concentration. When drug concentration exceeds Km, nonlinear kinetics is observed.
Zero order elimination.

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Which of the following is zero order Elimination?

a. constant amount of drug elimination regardless of the dosage concentration.
b. constant fraction of the drug eliminated regard to the drug dosage.
c. Constant drug amount regard to the dosage concentration.

a.
The rate of elimination is maximal and independent of drug concentration.
• Elimination is zero-order.
• A constant amount of drug is eliminated per unit time.
• Recall that in first-order kinetics a constant fraction of drug is eliminated per unit time.

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54 y/o comes in c/o generalized edema, with SOB and chest pain x1 wk. Diagnostics: CXR showed left sided pleural effusion. Echo showed pericardial effusion. A repeat fat pad bx showed amyloidosis with the evidence of having apple green biferingence on polarized light, after congo staining with red. Which type of amyloidosis possibly the pt have.

a. AL amyloidosis
b. AA
c. B2 Amyloid and B2 macroglobulin amyloidosis

d. all of the above.

e not enough information.

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46 y/o female with PMH of DM, HTN, and obesity presented with hypocalcemia; a thyroid nodule bx confirmed medullary ca of the thyroid, in addition tumor cells noted to be in amyloid background.

a. AL amyloidosis
b. AA
c. B2 Amyloid and B2 macroglobulin amyloidosis

d. all of the above.

e not enough information.
f. A calcitonin precursor protein

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Which of the following types of Amyloidosis are not inherited and are due to abnormal accumulation of the normal protein aggregates.
A. Systemic senile amyloidosis
b. Lambda amyloidosis (AL)
c. Familial Mediterranean fever.

Multiple myeloma is an example.

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Does GI tract contributes towards first pass ?

a. yes
b. yes

a. Yes. Liver is the site of metabolism, but GI track can contribute towards first pass.

Other organs that contribute toward drug metabolism, include skin, liver-of course, GI track, lungs, and kidneys.

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Where do first pass reactions occur?

a. Golgi bodies,
b. nucleus,
c. Lysozymes.
d. ER
e. mitochondria.

D. ER

First pass reactions occur in smooth ER and Second phase reactions occur cytoplasm.

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Which of the following correct sets of medications that are inducers of P450

a. phenobarbital, rifampin, ampicillin, carbamazepine.
b. Phenobarbital, metronidazole, ampicillin.
c. Phenobarbital, rifampin, carbamazepine, St. Johns Wort
d. Tylenol, phenobarbital, rifampin.

Inducers increase metabolism and as a result lower the plasma concentration.

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Foreign substances that can enter the cell, similar to steroid action, can activate the transcription machinery and make a desired toxic or non toxic cellular product.

a. peroxisomes,
b catalysts
c. xenobiotics
d. probiotics

C. Xenobiotics.

They come in to the cell and take dictate the transcription.

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Go to ACE and GET a Key Chain: Pneumonic made by Aisha for P450 Inhibitors or Inducers?

Amiodarone
C: Cimetidine
E: Erythromycin
G: grape fruit
K: Ketoconazole
C: chloramphenicol

P450 Inhibitors!

Will metabolize drug slowly, can have toxic levels of the drug in the blood.

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Would rifampin induce or inhibit P glycoprotein

Yes you are correct!

It will induce P 450 as a result, more drug in the plasma and less in the intestinal cells for absorption.

REMEMBER:
All P450 inducers ALSO INDUCE P GLYCOPROTEINS.

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Which of the following sets of medications are not inducers of P glycoproteins. a. Macrolides, ketoconazole b. Macrolides mostly c. grapefruit d. B+C e. None of the above

D MACROLIDES ARE INHIBITORS OF P Glycoprotein. when given with digoxin, digoxin is not kicked out into the lumen and is absorbed with high levels in the blood. Grapefruit juice inhibits both CYP3A4 and P-glycoprotein in the small intestine.

In Tylenol poisoning, sulfation and gluconation: a. Phase I b. Phase II reaction c. or both.

Phase II. | Using CyP2E1 reaction. Same enzyme used for alcohol.

Which of the following are toxic metabolites in Tylenol Over dose (OD). a. glucornate b. N-acetyl benoquinoneapine (NAPQ) c. Marceptopuric acid.

b. Hurry.....Need glutathione to convert NAPQ to Marceptopuric acid; Drug of choice is NAC. if severe, call transplant center!

A pesticide handler, who is obese with a 40 PPY smoking history wants to lose weight. He admits to you that he eats a lot barbecue meat with cauliflower rice. and likes to barbecue his meat like dark. You recommend, since he is 450 pounds, a weight loss medication that gets metabolized via P450 pathway. Would you consider higher dose of this medication, with the above risk factors or a lower dose. . (don't laugh-answer correctly). Higher/ lower dose?

Higher dose, since he has all the risk factors that lead to induction of P450, quickly metabolizing the drug. Good luck with the weight loss; may be better than fasting. Aromatic hydrocarbons in cigarette smoke cause AhR-mediated P450 enzyme induction. • Charcoal-broiled foods and cruciferous vegetables induce CYP1A enzymes. • Industrial workers exposed to some pesticides metabolize certain drugs more rapidly than non-exposed individuals

Glomerular filtration is affected by which of the following? a. Pressure, PH, Lipophilicity b. Pressure, small molecules (<20,000 D), Hydrophilicity c. PH, Lipophilicity

b PH and Lipophilicity do not affect glomerular filteration but they do affect reabsorption.

function of Laminin and fibronectin are following: a. connect the cells and the ECM together. b. connect the ECM component together c. give signals for differentiate and proliferation. e. all of the above f. none of the above. e. a and b only

e. all of the above.

GAG and Protoeoglycan: a. have negative charge, store steroids type growth factors b. store growth factors. c. make up ECM and have negative charges, store growth factors.

Which cells have tendency to proliferate and differentiate. a. skin (labile), liver (stable) b. skin only c. neuron ( permanent d. Gi track (labile)

a. stable cell do not have stem cells but can come out of the G0, if need be, like liver cells. the Liver, kidney, pancreas, endothelial cells, fibroblasts and smooth muscle cells • Have a limited capacity to regenerate after injury except for the liver

which of the following is strongest stimulus for growth factors a. Hypoglycemia b. Hyperglycemia, c. ischemia, d. hypoxia

c. Ischemia. Ischemia is a strong stimulus for vascular endothelial Growth Factor (FEGF)

which of the following are involved in closing of a wound. 1. GAGS 2. Laminins 3. Moncytes. 4. myofibroblast

4. Myofibroblasts.

What are the key players in granulation tissue formation; a. TGF beta b. PDGF c. FGF-2 d. all of the above

d: fibroplasia: granulation tissue formation is controlled by cytokines and growth factors: 1. Transforming growth factor-β (TGF-β): – Most important cytokine for the synthesis and deposition of connective tissue proteins – Produced by the cells involved in granulation tissue and by M2 2. PDGF 3. FGF-2

A 26 y/o female presents to the ED with an open wound. She reports that she hit a glass at the corner of her bed this morning. Since she had an exam, she did not report to the ED for at least 7 hrs. You examine the her open wound in her right dorsum of the hand. 4 cm x 2 cm. What is your management at this point. a. closure by primary intention b. closure by secondary intention c. closure by tertiary intention.

b. You clean wound with Normal saline and let it heal by secondary intention, since wound is open for more than 6 hrs and has a chance of being infected. Scar formation ( Healing by 2nd intention) and this follows the same four processes: • Hemostasis • Inflammatory phase • Proliferative phase • Remodeling phase

Bone Healing requires; Haematoma formation • Immobilization by callus formation • Repair of the fracture gap • Remodeling, which of the do not occur in bone tissue healing? a. proliferation b. scar formation c. keloid formation d. a+b+c e. b+c -

e. scar formation does not occur in bone.

A patient who has vitamin C deficiency, might have which of the following a. increase in wound healing b. keloid formation c. scar formation d. bone healing.

Beside having many uses of vitamin C, bone healing, fx healing is affected by Vitamin deficiency.

In eye surgery, how do prevent formation of scar tissue

yes correct! inject with steroid to avoid scar tissue formation.

which of the following is proliferation phase in wound healing . a. increase in fiber size in ECM b. cross linking for collagen fibers. c. differentiation of keratinocytes into stratified squamous cells. d. callus formation.

Regarding drug absorption, is lipid diffusion via: a. transcellular b. paracellular c. active transport d. secondary transport e. transcytosis.

Correct answer is: A

If a drug makes it way from oral ingestion to the blood, what kind of parameter this phenomenon suggests? a pharmacokinetics b. pharmacodynamics c psychological d. philosophical (ok I am getting sick of making these cards)

A. Absorption = transfer of a drug from its site of administration to the bloodstream.

which of the following routs bypass the Phase I modification completely. a. Rectal suppository b. Sublingual nitroglycerin c. PO (oral) Metronidazole

You are an ED physician and you have an arrival of a patient, while he is coding. EMS team notified you that they have on 21 Guage one IV. You have been trained in Intraosseous injection. What routes medication takes; a. bypasses the hepatic modification; phase I and Phase II b. 100 % bioavailability via blood c. medications made by osteoclasts d. Phase oxidation only.

Synthroid (brand name) and Levothyroxine (generic) are interchangeable; FDA approved their use for hypothyroid b/c they have which of the following. a. similar active ingredient, same color, and same dose. b. similar conc. vs time plots: superimposable only c. similar active ingredient only d. similar active ingredient, same dose, route of administration, and have superimposable bioequivalent conc. vs. time plots.

d. Drug products are considered to be pharmaceutically equivalent if they contain the same active ingredients and are identical in concentration, dosage form, and route of administration.

``` Which of the following do not contribute towards distribution of a drug: a. Blood flow b. Drug binding to plasma proteins c.Tissue binding d. Drug liposolubility e. Drug dosage ```

``` e The amount of drug distributed into tissues is mainly determined by: • Blood flow • Drug binding to plasma proteins • Tissue binding • Drug liposolubility ```

Which of the following modes brain needs for a drug absorption. a. Active transport, paracellular route, and lipophilicity b. secondary transport, paracellular route, and lipophilicity. c. Active transport only d. Active transport, or transcellular route, lipophilicity

if a snake bites you, which granulocytes will be activated. a. eosinophils b. mast cells c. neutrophils d. Langerhan cells.

b. Mast cells: They Play a role in allergic reactions to food, insect venom or drugs

Macrophages involved in granulomas as M2 are in which of the following forms: a. langerhan giant cell only. b. epitheloid macrophages: activated, including Langerhan giant cells, and foreign body giant cells c. activated neutrophil form.

Upon vasodilation in acute inflammatory reaction, vasodilation and blood stasis decrease shearing forces in the blood vessels, as a result, which of the following is favored. a. vessel turbulence b. leukocyte activation c. leukocyte margination d. diapedesis.

A ten year boy is noted to have HGPRT deficiency and his behavior (self mutilation) is consistent with his diagnosis. He is also diagnosed with Lung cancer. He is started on chemotherapy, which of the following will not be effective in treating his disease. a. Mycophenolate b. bleomycin c. 6 mercaptopurine d. Allopurinol

C. Mercaptopurinol is a prodrug and needs HGPRT to be converted into thioIMP to be effective as a chemotherapy.

39 y/o female with PMH of gout is being treated for ALL with 6 Mercaptopurine. She is place on Allopurinol to avoid excessive uric acid accumulation, resulting in worsening or flaring of her gout. How should the dose of Mercaptopurine be titrated, while being treated with this regimen. a. Higher dose of Mercaptopurine be used. b. Lower Mercaptopurine be used. c. No need to adjust the dose.

b. Lower dose should be administered. Allopurinol is changed to oxypurinol by Xanthine oxidase, which in return, inhibits Mercaptopurine conversion to thiouric acid for excretion. Mercaptopurine will accumulate and will cause harm such as n/v, bone suppression and hepatotoxicity

49 y/o carpenter with PMH of DM, gout, alcoholism, and obesity, is diagnosed with AML. You chose chemotherapy regimen 6 Mercaptopurinol (MP) He does not tolerate the medication due to persistent n/v. You, as physician, consider changing MP to 6 Thioguanine. Would you require a lower dose adjustment for 6 thioguanine, to avoid toxicity. a. yes b. No

b. No, | since vey little 6 thio guanine is converted into thio uric acid, it does not require a lower dose to prevent gout.

6 Mercaptopurine and 6 thioguanine, Inosine analog are m etabolized by which of the following enzymes: a. CYP A1, b. CYP 2A1 c. Thiopurine methyltransferase (TPMT) d. Butylcholinesterase e. NAT2

c. Pts. who are slow metabolizers of TPMT, are at higher risk of 6 Mercaptopurine and 6 thioguanine toxicities.

A 41 y/o female G0P0 is diagnosed with breast cancer but wants to have a baby within a year of her diagnosis after her chemotherapy tx. She is treated with 5FU for her breast cancer. Which of following are pathology could occur in her future child, if she does not continue good diet and vitamin supplementation. a. Hiatal hernia. b. duodenal atresia c. neural tube defect d. blindness

c. Folic acid pathway: DHF is converted to THF by thymidylate Synthase. chemotherapy with 5 FU would affect her folic acid level and metabolism; hence, her child is at high risk of developing neural crest defect if supplementation of folic acid is not continued. Of course, chemotherapy has to stop first...

Why 5FU works better with Leucovorine. a. Leucovorine binds to methyl THF. b. 5FU makes a quarternary structure, MTHF, 5FU, FdUMP, and Leucovorine, makes 5FU more stable. c. Question b is not possible. d. 5FU combined with Leucovorine inhibit DPD

Anthracylcins, such as "Rubicins" like Doxirubicin can cause cardiac toxicity, through which of the mechanisms; a. radical formation b. DNA telomerase inhibition c. Ribosomal destruction. d. Calcium deposits in the heart.

Anthracyclines related cardiotoxicity can be alleviated by giving which of the following a. steroids b. IV calcium c. dexrazoxane d. doxirubicin

c dexrazoxane is Iron chelating Other effects of Anthracyclines is myelosupression

G1-S phase of cell cycle is controlled by tumor suppressor gene P53. Which of the following chemotherapeutic agents work on G2 phase of the cell cycle instead of G1. a. Doxirubicin b. Dexrazoxane c. Bleomycin d. Folic acid.

c Bleomycin is cell specific and arrest the cells in G2 phase.

which of following anticancer agents cause pulmonary fibrosis a. Amiodarone and bleomycin b. bleomycin alone c. bleomycin and -busulfan d. 5FU and Dexrazoxane

pulmonary fibrosis is caused by busulfan and bleomycin. these drugs correspond to which of the following combination of chemotherapy agents a. alkylating agents ang anthracyclines b. antimetabolites, and antibacterial c antibacterial and anthracyclines d. alkylating and antibiotics

34 y/o male is being treated with chemotherapy agents known to be alkylating agent. Pt is presented with acute mental status change, peripheral neuropathy, and hematuria. Which of the following agents, the pt is being treated with: 1. Mesna 2. Isophophsamide. 3 Cyclophosphamide. 4. Bleomycin

Which of the following chemotherapeutic drugs are lipophilic and can be used to treat brain tumor via transcellular transport. a. Lomusitne b. Doxirubicin c. bleomycin d. Cyclophosphamide

Which of the following inhibit Topoisomerase a. Vinblastine b. Torpotecan c. Etoposide d. doxirubicin

b. Topotecan and Irinotecan inhibit topoisomerase I

What is the difference that Taxanes do to stop cell division, when compared to Vinca alkaloids a. Vinca alkaloikds stabilize the microtubles and Taxanes don't. b. Taxanes promote microtuble polymerization, and Vinca alkaloids don't.

b. | Taxanes polymerize microtuble, but make them a stable structure so further Dna synthesis is halted.

Pure antiestrogens are: a. Fulvestrant b. Raloxifene c. Tamoxifen d. Aromatase inhibitor.

if a woman is at high risk of breast cancer, which of the following would you use as therapy a. Aromatase inhibitor b. More estrogen

Why to give androgen receptor blocker at the same time of giving GnRH (continuous), in treating prostate cancer.

b/c regular GnRH works in a pulsatile manner and continuous will increase the LH and FSH, and make more androgen, to avoid, we give androgen blocker (Flutamide)

Is cardiac toxicity by Trantuzumab reversible. a yes b. no

Yes.

Asparagine causes seizure, coma, for what reason. a. makes the ammonia level high b. makes the glutamine level high c. increases calcium d. kills cells in s phase.

a. Makes the ammonia.

What is the difference between these two drugs: Raloxifene and Fulvestrant? a. Fulvestrant is SERM Raloxifene is SERDS b. c. Both are the same. c. Fulvestrant is SERD: it is devoid of estrogen activity. It inhibits dimerization of the estrogen receptor, hence increasing estrogen receptor degradation. d. Raloxifene is SERD. It is a Modulator of the estrogen receptors and binds and inhibit estrogen receptor in the breast and is an agonist to the estrogen receptors elsewhere.

C. The correct choice. For D, Raloxifene is SERM and SERD.

What kind of collagen scar tissue has? a. Collagen II, b. Collagen IV c. Collagen V d. Collagen VI e. Collagen I

e Collagenase removes the collagen III and needs zn, and scar tissue has collagen I.

Which protein reduces the scar tissue; meaning makes it smaller. a. Macrophages b. Fibroblast. c. Myofibroblasts d. Collagenase.

a. | Myofibroblasts

Which vitamins /cofactors are culprit for delayed wound healing. a. Vitamin A, C, and biotin b. Vitamin C, Zn, copper c. Vitamin A, Vitamin K and calcium d. Vitamin K, copper, Zn.

C. Hydroxylation of the proline and lysine and requires Vitamin C. Lysyl oxidse requires copper. Zn is a cofactor for collagenase and replaces collagen III with collagen I in scar formation.

Keloid have what type of collagen. a. collagen I only. b. Collagen III and I c. Collagen III only d. Collagen III and IV.

c. collagen III only.

Which of the following leukotrienes activate neutrophil a. LTE4, b. LTC4, c. LTD4 d. LTB4

D. LTB2 activates and attracts neutrophils.

``` Which of the following mediates fever and pain. a. LTC4, LTE4, LTB4 b. PGE2, c. PGE2, PGD2, PGl2. d PEG2 and IL1 ```

d. Remember Leukotriene is a delayed response.

During acute inflammation, coagulation and fibrinolytic systems, complement, and Kinin systems are activated by which of the following activated protein; a. Factor II b. Factor III c. Factor IV d. Factor X e. Factor XII

E Factor XII is formed in the liver in an inactivated form and gets activated upon exposure to subendothelial and tissue collagen exposure and, in turn, activates coagulation and fibrinolytic systems,complement, and Kinin systems.

``` pain inducers are Name them? a. LTC4, LTE4, LTB4 b. PGE2, PGD2 c. PGE2, PGD2, PGl2. d PEG2 and IL1 e. PGE2 and Bradykinin ```

E. PGE2, Bradykinin

IL10, TGFbeta, IL8 and IL12 are secreted by who? in inflammation? a Neutrophils b. Basophils, c. plasma cells. d. Macrophages d. TH1 cells.

What common processes do keratomalacia and myositis ossificans have in common? a. Hyperplasia b atrophy c dysplasia d. metaplasia

d | metaplasia.

Pao2 tends to be within normal range in anemia, CO poisoning, and Methemoglobinemia. what happens to SaO2 in these conditions. a. Sao2 is normal in all of them. b. Sao2 is decreased in anemia and CO but not in Methemoglobinemia. c. Sao2 is decreased in CO Poisoning and Methemoglobinemia but not in anemia. d. Sao2 increases in all of the m.

we have ascites, what mechanism is at play

Hydrostatic pressure increases.

Term4 wk1 lecture 6 on inflammation Flashcards

(83 cards)