test #24 4.13 Flashcards Preview

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Flashcards in test #24 4.13 Deck (136):
1

slow acetylators metabolize which 4 drugs slowly?

P450 acetylation of dapsone, hydralazine, procainamide, and isoniazid

2

methylation is an important drug biotransformation for..

azathioprine and 6-mercaptopurine

3

gilbert syndrome can affect drug metabolism..

bc some drugs require gluronidation for biotransformation.

(dysfunctional glucoronyl transferase)

4

drug hydrolysis occurs with..

esterases and amidases

5

normal amount of amniotic fluid

1000ml.

6

fetal anomalies associated w/ impaired swallowing (2)? increase urination? (polyhydramnios)

impaired swallowing: duodenal, esophageal, or intestinal atresia (GI obstruction) & anencephaly

increased fetal urination: high cardiac output due to (1) anemia or (2) twin-to-twin transfer

7

posterior urethral valve

congenital obstruction to urine flow

8

rachischisis

neural tube defect where vertebral column does not close over spinal cord. (posterior neuropore fails to close).

9

MI w/ normal coronary artery? think (3)

(1) coronary arteritis, (2) hypercoagulability w/ acute thrombosis, (3) coronary vasopasm

10

describe libman-sacks endocarditis

verrucous (wart-like) endocarditis, 25% of patients on EITHER side of valve. sterile, finely granular, fibrinous, eosinophilic. may result from immune complex deposition. can progress to valve fibrosis & regurg or stenosis.

11

Churgg-Strauss

polyarteritis nodosa-associated condition w/ lung vasculitis, severe asthma, and eosinophilia (in atopic patients). have necrotizing granulomas

12

flexor retinaculum aka

transverse carpal ligament.

13

carpa tunnel is associated with what scenarios?

(1) chronic repetitive stress (typing, knitting)
(2) fluid retention (renal failure, hypothyroidism, pregnancy
(3) diabetes mellitus, acromegaly, rheumatoid arthritis

14

dialysis associated amyloidosis

B2-microglobulin. can lead to median nerve compression (often bilateral)

15

endoneural inflammation infiltration with segmental demyelination seen in..

guillain-barre syndrome

16

endoneural arteriole hyalinization occurs in..

diabetic microangiopathy

17

insulin secretion is stimulation by which 3 systems

(1) blood glucose
(2) parasympathetic: secrete

insulin at smell/sight of food
sympathetic can inhibit or stimulate depending on receptor
(1) alpha- INHIBIT insulin release
(2) beta- STIMULATE insulin release

18

diphenhydramine, dimenhydrinate, chorpheniramine

commonly used antihistaminic agent (blocks H1). commonly have (1) anti-muscarinic (2) anti-alpha-adrenergic effects

19

ephedrine

indirect general sympathetic agonist, releases stored catecholamines.

used for nasal decongestion, urinary incontinence, hypotension

20

alpha receptor agonist on insulin?

inhibit insulin release

21

beta receptor agonist on insulin

promote insulin release

22

loratadine, fexofenadine, cetirizine

second generation H1 blockers. less sedating bc less CNS penetration.

still anti-Muscarinic

23

alpha-2 agonists (2)

clonidine & methyl-dopa

24

clonidine use

alpha-2 agonist, does not decrease renal blood flow. hypertensive urgency, ADHD

25

alpha-methyldopa

alpha-2 agonist. hypertension in pregnancy

26

classic anti-inflammatory effects

TGF-beta, IL-10

generally TGF-beta shuts it all down. and IL-10 shuts down cell-mediated and enhances humoral.

TGF-beta: (1) inhibit Th2 lymphocyte differentiation, (2) cytotoxic T cell activities, and (3) B-cell immunoglobulin secretion.

also suppress NK, LAK, and cytotoxicity of mononuclear phagocytes

IL10 (1) inhibits IL-2 and IFN-gamma production by Th1 cells, (2) enhances IL-4 and IL-5 production by Th2 lymphocytes. (3) inhibits TNF-alpha and IL-12 by monocytes and (4) decreases NK cell IFN-gamma production. (5) inhibit monocyte MHC class II and B7 expression (impairing antigen presentation)

27

TNF-alpha

proinflammatory cytokine. made by T cells and monocytes. induces NFKb (important factor in production of inflammatory mediators. IL-1, IL-4, IL-5, IL-12.

28

persistent lymphedema (chronic dilatation of lymphatic channels) predisposes to..

lymphangiosarcoma.

rare malignant neoplasm of endothelial lining of lymphatic channels.

29

pyogenic granuloma

polypoid form of capillary hemangioma. often grow rapidly, as exophytic red nodules attached by a stalk on gingival or oral mucosa or skin. bleed easily, may be ulcerated. resemble hypertrophic granulation tissue.

30

port-wine stain

birthmark of malformed, dilated blood vessels in superficial dermis. permanent.

31

kaposi sarcoma (histology)

HHV-8. hyperplasia or neoplasm of spindle-like cells w/ markers for (1) smooth muscle (2) vascular endothelium lining

32

liver hemangiosarcoma. caused by... (3)?

MALIGNANT tumor of endothelial origin. associated w/ exposure to..
(1) arsenic - pesticide
(2) vinyl chloride (plastics in industry)
(3) thorotrast - former radioactive contrast

33

PDA murmur

continuous, but will still hear distinct S1 / S2. can hear inspiratory splitting. best heart left infraclavicular. maximal intensity at S2.

34

Lutembacher syndrome

ASD presenting as continuous murmur when there is mitral valve obstruction due an elevated pressure gradient across atria. very uncommon

35

what travels through the optic canal (3)

CNII (optic n), opthalmic artery, central retinal vein.

36

what travels through superior orbital fissure (6)

CN III, IV, V1, VI, opthalmic vein, sympathetic fibers

37

what travels through foramen rotundum

CN V2 (travels in pterygopalatine fossa and then through inferior orbital fissure [[not in orbit]]

38

what travels through foramen ovale

CN V3

39

what travels through foramen spinosum

middle meningeal artery

40

what travels through internal auditory meatus? (2)

CN VII, and VIII

41

what travels through jugular foramen? (4)

CN IX, X, XI, jugular vein

42

what travels through hypoglossal canal?

CN XII

43

what travels through foramen magnum (3)

spinal roots of CN XI, brain stem, vertebral arteries

44

where do the branches of the trigeminal n leave the skull (3)

standing room only.

V1: superior orbital fissure
V2: foramen rotundum
V3: foramen ovale

45

foramen lacerum

occluded by cartilage. internal carotid artery courses just superior to the foramen lacerum in the carotid canal

46

ways to damage radial n

proximal: uses crutches improperly, passing out on chair. midshaft fracture of humerus (travels w/ deep brachial artery)

distal: medial epicondyle fracture.

path: medial to surgical neck of humerous, inferior to teres major within axilla. enters posterior arm between long head of triceps brachii and posterior humerus.

47

roots and cord of radian n.

C5-T1. posterior cord.

48

suprascapular n.

supraspinatus and infraspinatus. abduct and laterally rotate arm

49

damage to long thoracic nerve. how is it often damaged?

damage serratus anterior. winging of scapula (medial border).

damage long thoracic w/ lymph node dissection, radial masectomy

50

fracture of surgical neck of humerus / anterior dislocation of glenohumeral joint

axillary nerve injury. paralysis of deltoid and teres minor.

problems w/ abduction, extension, flexion, lateral rotation of arm at sohulder

51

spinal accessory innervates

trapezius and sternocleidomastoid

52

what % of small cell carcinoma occur in nonsmokers

1%

53

what extrapulmonary feature is large cell carcinoma of lung associated w.

gynecomastia and galactorrhea

54

what extrapulmonary feature is adenocarcinoma associated with (2)

hypertrophic osteoarthropathy and clubbing

55

most common lung cancer in population (female and nonsmokers)?

adenocarcinoma

56

endometrium days 1-14 (proliferative/follicular phase)

estrogen stimulates proliferation of stratum functionale. nonbranching, nonbudding, UNIFORM glands evenly distributed throughout uniform stroma. glands are TUBULAR, NARROW, STRAIGHT, lined w/ pseudostratified elongated mitotically active epithelial cells. spiral artery in deep layers.

gland:stroma ratio < 1:1

begins w/ menses and ends w/ ovulation

57

endometrium days 15-28 (secretory phase)

progesterone promotes development of secretory endothelium. glands larger, more COILED, cells lining glands have cytoplasmic vacuoles. glycogen-rich MUCUS released. stroma = EDEMATOUS. prominent spiral arteries extend to endometrial surface.

gland:stroma ratio ~1:1

begins w/ ovulation and ends w/ onset of menses.

58

how does c. tetani cause disease

tetanospasmin toxin binds to presynaptic membrane of motor neurons, migrates retrograde axonal transport to cell bodies, into spinal cord & brain stem. block glycine and gaba release from central system.

59

cardiac output with ficks principle

co = o2 consumption / arteriovenous O2 difference

how much blood must flow through pulmonary / systemic circulation to account for the difference in oxygen content between arterial and venous circulations

60

respiratory quotient

ratio of CO2 to O2 across alveolar membrane. estimates metabolic rate. usu 0.8.

61

ovary findings in turner's

various degrees of ovarian dysgenesis (complete absence to streaked [connective tissue w/ no or minimal follciles]

62

hirsuitism and primary amenorrhea

polycystic ovarian syndrome

63

disseminated candida infxn? test?

rarely, in very immunosuppressed, any organ. pneumonia, esophagitis, right sided endocarditis, abscesses, candidemia (sepsis)

cold - yeast. heat - mold.

on light microscope: budding yeasts w/ pseudohyphae.

innoculation into serum 37 C (98.6) for 3 hours: form true hyphae (see yeast transforming to mold) on scope

64

adult lead poisioning

less common, miners or industrial workers, especially battery manufacturing

65

presentation of lead poisioning

weakness, abdominal pain, constipation. severe: neuro. blue "lead lines" at junction of teeth and gingivae. peripheral blood smear: coarse basophillic stippling on background of hypochromic microcytic anemia.

inhibition of ALAD and ferrochelatase

accumulate protoporphyrin and d-ALA

66

mees lines -- white lines on finger nails

arsenic poisioning

67

purple / blue ilnes on gingiva

lead poisioning

68

basophillic stippling in lead poisioning

ribosomal aggregates

69

enzyme deficiency in acute intermittent porphyria. symptoms.

porphobillinogen deaminase.

build up porphobillinogen, d ALA, and (coporphobillinogen in urine)

symptoms = 5 P's
painful abdomen, port-wine coloured urine, polyneuropathy, psychological disturbances, ppt by drugs, alcohol, and starvation.

rx: glucose + heme, to stop ALAS (rate-limiting step) reduces production of d-ALA & porphobillinogen

70

porphyria cutanea tarda

deficient in uroporphyrinogen decarboxylase

71

first step in heme synthesis requires. blocked in?

glycine, succinyl-CoA ----> d-ALA
enzyme: d-ALA synthase
cofactor: B6

defective in x-linked sideroblastic anemia

72

steps in heme synthesis blocked by lead poisioning (2)

1. d-ALA ---> porphobillinogen
via d-ALAD (d-ALA dehydratase)

build up d-ALA

2. protoporphrin + Fe2+ ---> heme
via ferrochelatase

both steps in mitochondria!

73

defective step in acute intermittent porphyria

conversion of porphobillinogen ---> hydroxymethylbilane.

via porphobilinogen deaminase

(will have corporbillinogen in urine)

74

defective step in porphyria cutanea tarda

uroporphyrinogen III ----> coproporphyrinogen III


via uroporphryrinogen decarboxylase

build up uropohryin (tea coloured urine

75

tea-coloured urine + blistering photosensitivity

porphyria cutanea tarda. defective uroporphyrinogen decarboxylase.

76

abdominal pain w/o abdominal tenderness

acute intermittent porphyria

77

leukoerythroblastosis

immature granulocytes w/ nucleated tear drop-shaped RBCs. results from myelopthisic processes

78

Pica

abnormal compulsive consumption of nonfood and/or non-staple food. can occur in any stage of pregnancy. associated w/ iron-deficiency anemia.

can LEAD to anemia bc of decreased nutritional intake.

vs. normal pregnancy craving: overeat normal foods

79

anorexia nervosa

excessive DIETING. weight loss of 25% of body weight. or 15% below normal weight for age / height. distorted body image.

80

bulimia

episodic & secretive BINGE eating followed by self-induced vomiting / fasting / laxatives.

81

olfactory craving

common appetite disturbance of pregnancy. craving certain smells. often, dangerous items like gasoline, automobile exhaust, liquid

82

what kind of polymerase is telomerase

reverse transcriptase (RNA-dependent DNA pol) TTAGGG to 3' end.

consists of TERT reverse transcriptase and built in TERC RNA template (read repeatedly)

83

bloom syndrome

premature aging. associated w/ shortened telomeres

84

what cofactor is needed for oxaloacetate ---> PEP (via PEP carboxykinase

GTP (made from succinyl-CoA to succinate in TCA)

85

metabolites made in TCA! 5

1. isocitrate --> a-KG makes NADH
2. a-KG --> succinyl-CoA makes NADH
3. succinyl-CoA --> succinate makes GTP
4. succinate --> fumarate makes FADH2
(fumarate --> malate makes nothing)
5. malate --> oxaloacetate makes NADH

(malate can leave mitochondria to become oxaloacetate --> PEP consuming GTP

86

how can oxaloacetate get from mitochondria to cytoplasm for gluconeogenesis?

(1) PEP carboxykinase in mitochondria can convert oxaloacetate ---> PEP
(2) oxaloacetate transamination to aspartate
(3) oxaloacetate reduction to malate

PEP, aspartate, and malate can all leave mitochondria. oxaloacetate cannot.

87

medications that can cause seizures

bupropion, clozapine, isoniazid, ciprofloxacin, imipenem

88

rare but important side effect of ticlopidine

neutropenia, presents w/ fever and mouth ulcers!

must monitor CBC biweekly for first 3 months!

89

fever and mouth ulcers in patient treated w/ meds post-stroke

ticlopidine

90

nipple inversion in breast cancer suggests

tumor invades central region of breast

91

skin retraction "focal dimpling"

cancer infiltrates suspensor Cooper ligaments

92

peu de orange -- lympedema and putting and thickening of skin

dermal lymphatic invasion/obstruction, seen w/ invasive breast carcinoma. often inflammatory type. 50% survival in 5 years.

93

diphenoxylate & meperidine

mu-optiate agonist. anti-diarrheal. SLOWS gastric motility.

since high doses --> euphoria. add atropine in med to discourage abuse

94

sulfasalazine

combination of (1) sulfapyridine (antibacterial) and (2) 5-aminosalicylic acid (anti-inflammatory.

activated by colonic bacteria.

used for crohn's and ulcerative colitis.

95

kaolin-pectin & attapulgite

make stool less watery, symptomatic relief

96

rx for secretory diarrhea

can be due to many things. rx: octreotide, bismuth salicylate, probiotics help

97

psychogenic polydipsia

(1) serum Na+ low
(2) urine concentrates w/ water deprivation (after dehydration)
(3) <10% increase in urine concentration after ADH

98

DHT binds to..

testosterone receptor; has higher affinity than testosterone

99

which drug decreases leydig cell synthesis of testosterone

ketoconazole (block 17,20 desmolase) & spironolactone (17-alpha-hydroxlase)

100

ketoconazole's endocrine effects

weak anti-adrenergic. blocks leydig production of testosterone and adrenal production of steroid hormones.

blocks 17,20 desmolase

101

anastrozole

aromatase inhibitor

102

flutamide & cyproterone acetate, and spironolactone

block testosterone intxn w/ receptor

103

treat metastatic prostate cancer

flutamide

104

spironolactone's endocrine effects

(1) blocks testosterone receptor (2) blocks 17,20 desmolase (steroid synthesis)
(3) blocks 17-alpha-hydroxylase

105

adenoma to carcinoma sequence

AK-53 & DCC
normal mucosa --> cancer
APC --> K-ras --> p53

APC --> makes adenomatous polyp.
K-Ras --> increase polyp size
p53 + DCC --> malignant transformation

106

mutation in WT-1

Wilms tumor

107

normal fxn of BRCA

suppresses cell cycle

108

role of APC

implicated in sporadic colon cancer (normal mucosa --> polyp --> cancer) & FAP (autosomal dominant inheritance of mutated APC gene.

needed to maintain low levels of beta-catenin (oncogenic) & maintain intercellular adhesion

109

fall from free & catch tree trunk as falling

damage lower trunk C8-T1: klumpke's palsy

110

musculocutaneous n injured when...

w/ upper trunk lesions, like head and shoulder are violently stretched apart

111

long thoracic n injury

axially node dissection w/ radical masectomy

112

common side effect of all nitrates

headaches & cutaneous flushing

113

causes of secondary hyperaldosteronism

high aldosterone due to high renin.
(1) renal artery stenosis, associated w/ fibromuscular dysplasia, or atheroscerlosis.
(2) malignant hypertension (leading to microvascular damage and renal ischemia).
(3) renin-secreting tumors (juxtaglomerular cells)

114

cancers associated with Rb

retinoblastoma and osteosarcoma

115

cancers associated w/ BRCA

breast and ovarian

116

cancer associated w/ APC

colon cancer (FAP and sporadic), and melanoma

keep beta-catenin low & maintain intercellular adhesion

117

most common cancers in li-fraumeni

inherited autosomal dominant. p53 (tumor suppressor). need to have sporadic mutation in second.

breast, brain, adrenal cortex.

118

bile soluble means..

it will die in bile! like s. pneumoniae

119

differentiate s. bovis & enterococci

both survive in bile. s. bovis DIES in NaCl

120

hypertrophic cardiomyopathy (HCM) associated w/ mutations in..

sarcomere proteins

(myosin heavy chain, myosin binding protein, cardiac troponin T, tropomyosin)

121

inherited dilated cardiomyopathy

1/3rd are inherited. majority due to autosomal dominant defect in cytoskeletal protein (like distrophin) or mitochondrial enzymes

122

where is ADH / vassopressin made

supraoptic / paraventricular nuclei of hypothalamus

123

transient central diabetes insipidus

damage to posterior pituitary. magnocellular neurons in hypothalamus hypertrophy and undergo axonal regeneration --> allows for release of fxnal ADH eventually.

124

permanent central diabetes insipidus

damage to hypothalamus or supraoptic-hypophysial tract. not enough magnocellular neurons to make enough ADH

125

main feature of G1, S, and G2 phase

G1: synthesis of RNA, protein, lipid and carbohydrate
S: DNA replication
G2: ATP synthesis

126

active Rb

hypophosphorylated 'unleashed'. prevents G1--->S transition

127

evidence of frontal lobe damage

inappropriate behavior, impaired judgement, poor executive fxn. incontinence and gait disturbances

128

damage to inferior parietal lobe of DOMINANT hemisphere? non-dominant?

dominant (usu left): Gerstmann's syndrome: right/left confusion, dysgraphia, dyslexia, dyscalculia.

nondominant: apraxia, contralateral neglect

129

marantic endocarditis

non-bacterial thrombotic endocarditis associated w/ underlying visceral malignancy. often: mucinous adenocarcinomas of pancreas & adenocarcinoma of lung (relate to procoagulant effects of circulating mucin)

(bc cancer-related wasting of body "marasmus")

tumor-associated release of procoagulants also thought to be responsible for migratory thrombophlebitis (Trousseau syndrome)

130

Trousseau syndrome

migratory thrombophlebitis sometimes seen w/ underlying malignancy (GI).

like marantic endocarditis: mucin-related GI malignancy --> hypercoagulable state --> NBTE

131

achalasia

failure of LES to relax. absence of myenteric (auerbach's plexus) --> high LES opening pressure and uncoordinated peristalisis. progressive dysphagia to solids and liquids. "bird beak" on barium swallow

132

which pharyngeal muscle is important to initiate wave of peristalisis

cricopharnyngeus muscle, push bolus down.

133

cricopharyngeal dysfunction

failure of cricopharyngeal muscle to relax during swallowing. causes choking or food sticking sensation and pain with swallowing

134

brain metastasis

multiple well-circumscribed masses and junction of gray and white matter.

135

gross oligodendrogliomas

well circumscribed gray messes. areas of necrosis and hemorrhage not common

136

gross glioblastoma

frequently cross midline, in white matter. foci of necrosis and hemorrhage common