Test 11 Flashcards by Sarah Carlson

What is the main toxin produced by C. perfringens? What is it’s function?

Alpha toxin (lecithinase= phospholipase C)

Lecithinase degrades lecithin (component of cell phospholipid membranes) that leads to cell destruction NECROSIS (gas gangrene) and hemolysis.

PERFringens PERForates a gangenous leg with alpha toxin.

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Why does c. perfringens produce gas?

It uses carbs for energy–the rapid metabolism of muscle tissue produces gas that can be seen on xray or CT.

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What are the three plasminogen activators?

streptokinase (Exotoxin released by S. Pygoenes)
urokinase
TPA

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What is one of the most common reasons for elevated AFP levels?

underestimation of gestational age, confirmed by fetal US

*fetal liver, GI tract and yolk sac= source

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What are other reasons for elevated AFP?

Neural tube defects
Anterior abdominal wall defects (omphalocele, gastroschisis)
Multiple gestation
Down Syndrome

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What are decreased estriol levels indicative of?

Placental insufficiency

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What are INCREASED levels of hCG (synth from trophoblastic tissue) associated with?

multiple gestation
hydatiform mole
choriocarcinoma

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What is a mitochondrial enzyme that activates caspases and indirectly brings about cell death through intrinsic pathway apoptosis?

Cyt C

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What is Edwards Syndrome?

47 xx +18 (nondisjunction)

Small jaws
small eyes
low formed ears
rocker bottom feet  (also in Patau)
CLENCHED HANDS W/ OVERLAPPING FINGERS**

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Flat face, abnormal ears, slanted palpebral fissures, redundant neck skin, single transverse palmar crease are associated with what genetic disorder?

Down syndrome

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Cleft lip and palate, polydactyly and omphalocele are associated with what genetic disorder?

Patau syndrome

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Tall male w/ gynecomastia and infertility is indicative of…

Klinefelter syndrome (47XXY)

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An inability to normally metabolize fat is indicative of…

exocrine pancreatic insufficiency

Often from alcholism

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What cytokines down regulate local inflammation?

TGF-B

IL-10

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Do advance directives take precedence over wishes of family members?

Yes

Physicians should adhere to patient’s wishes outlined in advance directives

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What is the most prevalent collagen in the human body?

Type I

Bone
Skin
Tendon

LATE wound repair

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What type of collagen is associated w/ osteogenesis imperfecta?

type I

easily fracturable bones

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What is made of type II collagen?

carTWOLage (hyaline)
vitreous body (jelly in eye)
nuclous pulposus (jelly in spine)

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What is made of type III collagen?

Reticulin
skin
blood vessels
uterus
fetal tissue
granulation tissue

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What is deficient in ED syndrome?

type III collagen

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What is made of type IV collagen?

Basement membranes
basal lamina
lens

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What is defective in alport syndrome?

type IV collagen

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What is targeted by autoantibodies in Good pasture syndrome?

type IV collagen

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Pain sensation from the mediastinal/diaphragmatic parietal pleura is carried by what nerve?

phrenic

C3, 4, 5

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Damage to what nerve causes a winged scapula?

long thoracic | serratus anterior

What is the CFTR protein?

Transmembrane ATP gated Cl channel

What causes CF?

Mutation in the CFTR gene on chromosome 7 AR disease

What is the agent of choice for prevention and tx of post-MI arrythmias?

Lidocaine Binds depolarizing and depolarized cells--> ISCHEMIC myocardium is depolarized tissue

What are class IB antiarrythmics?

Little Mexican w/ an M Lidocaine MEXiletine Decreases AP

What antiarrythmic is used to treat re-entrant or ectopic SVT/VT?

Class IA QDP: Quinidine Procainamide Disopyramide Increases AP/ERP/QT

What antiarrythmic causes cinchonism?

1A: QDP

What antiarrythmics are often used to treat SVTs like a. fib?

1C: FP Flecainide Propafenone Increase ERP in AV node and accessory bypass tracts doesn't affect AP duration

What drugs are CONtraindicated in isCHEMIC heart disease?

1C: Flecainide, Propafenone

What drugs help control ventricular rate and are used for a. fib and a flutter?

Class I (Beta blockers) Decrease SA/AV nod by decreasing cAMP /Ca currents *decrease the slope of phase 4

What drug is especially good for v. TAch?

Class II (AIDS) Amiodarone (specifically) Ibutilide Dofetilide Sotalol Increased AP, ERP, QT--> prolonged repolarization

What beta blockers are good for TDPs?

Sotalol | Ibuitilide

What class III antiarrythmic can affect the lung, liver and thyroid and lead to blue/gray skin deposits?

Amiodarone

What drugs are used to prevent nodal arrhythmias (SVT)?

Class IV: Verapamil, diltiazem Decrease conduction velocity, increase ERP, PR Blocks Ca channels> slows depol in phase 0 and latter part of phase 4> slows rate of SA node firing and AV node conduction

What antiarrythmic causes constipation, flushing , edema, HF?

IV: VP

What is the drug of choice for supraventricular tachycardia?

Adenosine (increases K out of cell> hyperpolarizing cell> decraese Ca)

What is digoxin used for?

A. Fib slows conduction through AV node

What electrolyte abnormalities are seen in a pts with primary adrenal insufficiency (Addisons)?

Decreased aldosterone> decreased reabsorption Na> decreased excretion of K and H 1. Hyponatremia 2. Hyperkalemia 3. Met acidosis> low serum bicarb> compensatory incrase in Cl 4. Hypercholremia

What is the most effective way to provide long term relief to pts with PUD?

Eradicate H. pylori using Antibiotics

Ranitidine

H2 blockers> decreased H secretion by parietal cells

Sucralfate

Binds to base of mucosal ulcers and protectsa gainst gastric acid allwoing ulcers to heal

Metoclopramide

DA antagonist> increases resting tone, LES tone, motility Diabetic and postsurgery gastroparesis Antiemetic

Misoprostol

PGE1 analog | Prevents NSAID induced ulcer disease

How does CO affect O2 binding on heme iron?

CO binds to Hb w/ 220 times the affinity of O2 for Hb leading to Carboxyhemoglobin. This causes a left shift and a decreased in O2 binding capacity as well as deficient unloading of O2. tx: 100 O2 and hyperbaric O2

Night blindness, xeropthalmia, vulnerability to infection (measoles)

vit A

Cheilosis, corneal vascularization

Vit B2

Cheilosis and periopheral neuorpathy

Pellagra

Niacin (dermatitis, dementia, diarrhea)

Scurvy, impaired wound healing

Vit C

Pernicious anemia

B 12

What syndrome is characterized by low plasma Na and osmolality, concentrated urine and increased urine Na volume, but NORMAL extracellular fluid volume?

SIADH

What is an important cause of SIADH?

paraneoplastic effect secondary to small cell lung cancer

What is the power of a study?

The ability of a study to detect a difference between groups when a difference really exists. Related to type II error (not an effect when one exists) P= 1-B (B is type II error rate)

Where are receptors for cortisol located?

In the cytoplasm, then translocate to the nucleus

Receptor for insulin?

cell surface receptor> activation TK> suppression gluconeogenesis

Receptor for GH?

memberane bound Jak/STAT> increased gluconeogenesis

Receptor for NE/EPI/Glucagon?

GPCR membrane receptors> increases cAMP> AC> increase glycogenolysis

What causes meningoencephalitis in HIV + patients?

Cryptococcus neoformas Inhalation> hematogneous dissemination to meninges

What is used for dx of c. neoformas?

latex agglutination detects the polysaccharide capsule Ag of Cryptoccus INDIA INK shows ROUND/OVAL unequal budding yeast

Nonspetate hyphae that branch at wide angles

Mucor and Rhizopus cause infection of paranasal sinuses in immunosuppressed

Germ tubes (sprouts of true hyphae from yeast cells)

Candida

Spherules

Tissue form of Coccidiomycosis

What is the neurotoxin released by C. Tetani?

Tetanospasm> exotoxin> tetanus Block release of inhibitory interneurons in spinal cord that use GABA and glycine as their NT> prevents release of NT> spastic paralysis

What causes flaccid paralysis?

C. Botulinum> releases pre-formed heat labile toxin that inhibits ACh at NM jxn> flaccid paralysis

What is the mechanism of penicillins and cephalosporins?

Irreversibly bind to PBPs (transpeptidases)

Where does Vancomycin bind

Terminal D alanine residues of CELL WALL glycoproteins preventing transpeptidases from forming cross links

What is the mechanism of fluoroquinolones?

bind to proteins like DNA gyrase > interfere w/ DNA replication

What is a mechanism of resistance to ceophalosporins?

Change in PBP structure

How do corticosteroids affect a CBC?

Corticosteroids lead to dermarginalization of neutrophils that were previously attached to a vessel wall> increased neutrophils Decreased: lymphocyte, monocyte, basophil and eosinophil

Test 11 Flashcards

(73 cards)