Test 29 Flashcards
(141 cards)
1
Q
How does Nitroprusside work? how does it impact preload and afterload and stroke volume
A
short-acting balanced venous and arterial vasodilator
- decreases both preload and afterload
- same stroke volume
2
Q
Specific MOA of Nitroprusside
A
increase cGMP via direct release of NO
3
Q
Side effect of Nitroprusside
A
cyanide toxicity (releases cyanide)
4
Q
what is the role of carbonic anhydrase activity in erythrocytes
A
forms bicarbonate from carbon dioxide and water
5
Q
Explain chloride shift? what does this cause
A
- bicarb diffuse out of RBC into plasma
- maintain neutrality, Cl- diffuse into RBC
- high RBC chloride content in venous blood
6
Q
What is spectrin
A
structural component of membrane of RBC
-gives cell flexibility
7
Q
Role of 2,3-DPG
A
combines with hemoglobin
- decreases affinity for oxygen, facilitates oxygen delivery to tissue
8
Q
Where is glucose-6-phosphate dehydrogenase enzyme found in the pathway
A
first enzyme in pentose phosphate pathway
9
Q
how do glucose-6- phosphate deficiency pts present
A
episodic hemolysis induced by oxidant stressors
10
Q
Abusive head trauma can be caused by vigorous shaking of an infant and results in what
A
subdural hemorrhage and retinal hemorrhages
- injuries inconsistent with history or developmental age
- posterior rib fractures
11
Q
What gets torn in subdural hemorrhages
A
tearing of bridging veins
12
Q
When does a child start rolling
A
by 6 months rolls and sits
13
Q
what causes idiopathic thrombocytopenia purpura
A
platelet autoantibody formation
14
Q
All newborns are deficient in what vitamin
A
K
15
Q
What is the difference between shaken baby syndrome and vitamin K deficiency in child
A
no retinal hemorrhages seen in vitamin K deficiency
16
Q
What is ocular exam for retinoblastoma
A
absence of “red reflex”
17
Q
what is the most common ocular tumor of infancy
A
retinoblastoma
18
Q
compare perfusion in the lung
A
increases from the apex of lung to the base
- base gets most perfusion
19
Q
compare ventilation of the lung
A
increases slightly from apex to the base
- apex gets most ventilation
20
Q
what is the V/Q in the lung
A
ratio decreases in the lung from apex to base
- highest at apex
21
Q
What are the zones of perfusion
A
Zone 1, 2, 3
22
Q
Zone 1 of lung
A
- apex of lung
- alveolar pressure, arterial pressure, venous pressure
- pulmonary capillaries collapsed
- alveolar dead space
23
Q
Zone 2
A
- middle of lung
- arterial pressure, alveolar pressure, venous pressure
- pulsatile fashion
24
Q
Zone 3
A
- lower lung
- arterial pressure, venous pressure, alveolar pressure
25
in pregnancy who secretes progesterone
- corpus luteum
| - then later by placenta
26
What is the [prolactin] during pregnancy? what inhibits prolactin from doing it's job
increases as pregnancy progresses
| - progesterone works at anterior pituitary
27
role of prolactin
peptide hormone promotes milk production
28
where is prolactin released from
anterior pituitary gland
29
what stimulates prolactin production
thyrotropin-releasing hormone
30
Who secretes Beta-hCG during first trimester
embryonic syncytiotrophoblast
31
role of Beta-hCG
- maintains corpus luteum until placenta assumes responsibility for estrogen and progesterone synthesis
- hormones level drop as pregnancy continues
32
Fibrinolytic system causes what
reperfusion arrhythmia on arterial re-opening
| - arrhythmias usually benign
33
Strepktokinase
non-specific fibrinolytic durg
34
Tisuse plasminogen activitor (tPA), reteplase, and tenecteplase are what
fibrin specific drugs
| - act only on fibrin attached to recently formed clot without systemic activation
35
Deficiency of vitamin B12 is associated with
- megaloblastic anemia
| - neurologic dysfunction
36
Folate deficiency is associated with
- megaloblastic anemia
37
treatment of deficiency in vitamin B12 with folate and vice versa can improve what? treatment of B12 deficiency with folate alone can do what
1. improve hemoglobin levels
| 2. worsen neurologic dysfunction
38
patient being treated with folic acid for anemia. Then experiences bilateral foot numbness. What vitamin is she deficient in
Vitamin B12 (Cobalamin)
39
What is the relationship between folate and phenytoin? impact
high doses of folate may antagonize phenytoin
| - precipitating seizures
40
What is the most important environmental risk factor for pancreatic cancer? other
- smoking
| - greater than 50, chronic pancreatitis, DM, MEN
41
Courvoisier sign
palpable but nontender gallbladder
42
1. Courvoisier sign
2. weight loss
3. obstructive jaundice ( associated with pruritus, dark urine, and pale stools)
these indicate what
adenocarcinoma at head of pancreas
43
what patient would be put on a low-fiber diet
risk for colon adenocarcinoma
44
H. pylori increases the risk for what
gastric adenocarcinoma
| gastric lymphoma
45
What is sertoli-leydig cell tumors of the ovary
arise from sex cord stroma and secrete testosterone
46
clinical features of sertoli-leydig tumors of ovary
- large ovarian mass
| - virilization
47
histo for sertoli-leydig tumor of ovary
- tubular structures lined by Sertoli cells
| - surrounded by fibrous stroma
48
What is granulosa cell tumor
sex cord-stromal tumor
| - produces excessive estrogen
49
hist for granulosa cell tumor
Call-exner bodies - small follicle-like structures filled with eosinophilic secretion that lined by granulosa cells containing coffee bean nuclei
50
how does endodermal sinus (yolk sac) tumor present
abdominal pain due to ovarian torsion without virilization
51
histo for endodermal sinus (yolk sac)
Schiller-Duval bodies: glomerulus-like papillary structures with a central vessel
52
What is the most common benign germ cell tumor
mature cystic teratoma
53
what is mature cystic teratoma on histo
keratinized epithelial tissue with sebaceous glands
54
What is the most common epithelial ovarian cancer
serous cystadenocarcinoma
55
how does serous cystadenocarcinoma present
- post-menopausal
- adnexal mass
- ascites without excess hormonal activity
56
autopsy for serous cystadenocarcinoma
Psoamma bodes: concentrically laminated, calcified spheric deposits
57
A side effect of using inhaled glucocorticoids
- oropharyngeal candidiasis
| - dysphonia - myopathy of laryngeal muscles and mucosal irritation
58
young Female patient with virilization, amenorrhea for 5 months, adnexal mass, large ovarian cyst
Sertoli-Leydig tumor
59
increased alpha-fetoprotein is a serum tumor marker for what liver stuff
chronic viral hepatitis
| hepatocellular carcinoma
60
Serum tumor marker CA19-9
pancreatic
61
serum tumor marker CA125
ovarian
62
When is alpha-fetoprotein produced
fetal liver and yolk sac during gestation
63
what should be suspected in young otherwise healthy patients with fatigue, progressive dyspnea, atypical chest pain or unexplained syncope
pulmonary hypertension
64
pulmonary hypertension impact on heart
hypertrophy and/or dilation of the right ventricle (cor pulmonale)
65
severe right ventricular hypertrophy in young women with progressive dyspnea suggests
pulmonary arterial hypertension
66
what is the physical finding of PAH pulmonary arterial hypertension
intimal hyperplasia
fibrosis
medial hypertrophy
capillary tufts
67
Wolff-Parkinson-White syndrome
electrophysiological abnormality of AV node conduction
| histo: small accessory AV impulse conduction pathway anatomically separate from AV node
68
when should a doctor suspect Wolff-Parkinson-White syndrome
sudden cardiac death in otherwise healthy young individual
69
clinical presentation of tertiary syphilis
- cardiovascular involvement
| - gummas
70
what is a guma
necrotizing granulomas occurring on skin, mucosa, subcutaneous tissue, and bones within other organs
71
when does neurosyphilis occur
any stage of infection
72
what is physical presentation of primary syphilis
chancre at the treponema pallidum inoculation site
- 1-3 weeks after contact
- resolves 3-6 weeks
73
Secondary syphilis PE
- macular rash on palms and soles
| - Condylomata lata: large gray wart like growths
74
Latent syphilis PE
asymptomatic
75
Tertiary Late syphilis
- Gummas
- ascending aortic aneurysms ( calcifications seen on X-ray)
- aortic valve insufficiency
76
patients with granuloma inguinale, a sexually transmitted disease caused by what
Klebsiella granulomatis
77
define cachexia
```
anorexia
malaise
anemia
weight loss
generalized wasting
```
78
role of tumor necrosis factor - alpha (TNF-alpha)
- causes necrosis of some tumors in vitro
79
who releases TNF-alpha
macrophages
80
Where does TNF-alpha do?
hypothalamus, leading to appetite suppression
- increases basal metabolic rate
- fever
81
Eaton-Lambert Syndrome
autoantibodies to voltage-gated calcium channels
82
PE for eaton-Lambert syndrome
- progressive, symmetric proximal muscle weakness ( rather than wasting)
- Ocular and autonomic symptomts
83
who synthesizes interferon-alpha
leukocytes
| - anti viral and anti tumor
84
who produces IL-3
activated CD4+ Th cells
| - stimulates growth and differentiation of myeloid cells
85
Transforming growth factor-beta function
inhibition of inflammatory response
| - decreases T cell proliferation and cytokine production
86
What does Thiazolidinediones bind to
peroxisome proliferator-activated receptor gamma (PPAR-gamma)
87
what is peroxisome proliferator-activated receptor-gamma (PPAR- gama)
intracellular nuclear receptor
| - transcriptional regulator of many genes involved in glucose and lipid metabolism
88
one of the most important genes regulated by PPAR-gamma is one that codes for
adiponectin: cytokine secreted by fat tissue that enhances insulin sensitivity and fatty acid oxidation
- low in diabetics
89
Diabetic drug target: intracellular mitochondrial enzyme
Metformin, reduces hepatic gluconeogenesis
90
Diabetic drug target: membrane-bound enzymes
alpha-glucosidase inhibitors
91
Diabetic drugs target: membrane ion channel
Sulfonylureas
92
Diabetic drug target: surface adenylate cyclase-coupled receptor
Glucagon-like polypeptide-1 (GLP1-)
93
Diabetic drug target: surface tyrosine kinase receptor
insulin
94
what kind of drug is prioglitazone
thiazolidinediones
95
MOA of fibrinolytic agents like alteplase
- bind to fibrin in thrombus
- activate plasmin
- leads to thrombolysis
96
most common adverse effect of thrombolysis
hemorrhage
97
When is it advisable to give fibrinolysis
acute MI patients within 12 hours of symptoms
98
which is preferred and why PCI vs. fibrinolysis
PCI: lower rates of intracerebral hemorrhage
99
MOA of alteplase
binds fibrin in thrombus
- converts entrapped plasminogen to plasma
- plasmin hydrolyzes bonds in fibrin matrix
- causing clot lysis
100
signs of increased intercranial hemorrhage
- decreased level of consciousness
- asymmetric pupil
- irregular breathing
101
man comes in with MI, given Alteplase, then gets irregular breathing patterns and asymmetric pupils? what caused this condition
intracerebral hemorrhage
102
what is the preferred disease-modifying treatment for patients with moderate to severe rheumatoid arthritis
Methotrexate
103
adverse effects of Methotraxate
stomatitis
bone marrow suppression
liver function abnormalities
104
middled- aged women with polyarthritis, morning stiffness , and systemic symptoms has what
Rheumatoid arthritis
105
MOA for Methotrexate
folate antimetabolite
| - halting purine and pyrimidine synthesis through irreversible binding of dihydrofolate reductase
106
When is hydroxychloroquine used? toxicity
mild RA and systemic lupus erythematous
| - irreversible retinopathy
107
Minocycline MOA? toxicity
tetracycline antibiotic with weak antirheumatic activity
| - photosensitivity dermatitis
108
A women with RA, painful mouth ulcers and nausea. AST and ASP elevated. what drug is she taking
Methotrexate
109
Ace inhibitors or angiotensin II receptor blockers cause what to arteries and GFR
- efferent arteriolar vasodilation causes GFR to fall, may lead to acute kidney failure
110
Atherosclerosis involving renal arteries can cause
bilateral renal artery stenosis
111
reduced renal blood flow does what to GFR
decreased
112
role of angtiotensin II on kidney
constricts the efferent arteriole
113
difference between urethritis and cystitis
- suprapubic pressure and tenderness more specific for cystitis
114
where are pyuria and bacteriuria found in the urinary tract
both upper and lower urinary tract infections
115
where are white blood cell casts found in urinary tract
form in renal tubules
116
what does white blood cell casts with UTI indicate
acute pyelonephritis
117
Sterile pyuria
WBC with no bacteria
118
MOA of Rifamycin (Rifampin)
block action of bacterial DNA-dependent RNA polymerase
| - inhibit transcription
119
MOA for Isoniazid
inhibit mycolic acid synthesis
120
side effect of rifamycins
harmless red-orange discoloration of body fluids
121
what is the major cause of the morbidity and mortality from theophylline intoxication? other major concern
Seizures
| - tachyarrhythmias
122
how is theophyllin intoxication treated
- activated charcoal: reduce GI absorption
- beta blockers: cardiac tachyarrhythmias
Benzodiazepines and barbiturates
123
what can cause hematemesis and melena
iron poisoning
124
what is used to treat acetaminophen toxicity
acetylcysteine
| - glutathione donor
125
severe sedation
respiratory depression
constricted pupils
what happened
opioid intoxication
126
treatment for opioid intoxication
naloxone
127
Cholesteatomas ? lead to?
collections of squamous cell debris that form a mass behind the tympanic membrane
- may have hearing loss due to erosion into auditory ossicles
- pearly mass
128
A complete mole is composed of what ( reproductive)
multiple cystic edematous hydropic villi
| - result from trophoblast proliferation
129
what should be measured in complete mole?
Beta-hHCG
| as increased levels may signify invasive mole or choriocarcinoma after uterine evacuation
130
macroscopic appearance of complete mole
bunch of grapes
131
What is the immunochemistry staining for complete moles
p57- negative
132
classical clinical findings for complete mole
vaginal bleeding
hyperemesis gravidarum
theca-lutein cysts
133
MOA for Baclofen ? impact?
agonist at GABA-B receptor at spinal cord level
| - inducing skeletal muscle relaxation
134
Duloxetine ? MOA? uses
norepinephrine reuptake inhibitor
| - treat anxiety/depression
135
what type of drug is Levetiracetam
anti-epileptic
136
What type of drug is Nortriptyline? used for
tricyclic antidepressant
| - treat neuropathic pain and migraine headaches
137
MOA of Metformin
- inhibits hepatic gluconeogenesis
| - increases peripheral glucose utilization
138
complication of metformin with a patient with underlying renal insufficiency
lactic acidosis
139
What should be checked before placing someone on Metformin
serum creatinine
140
3-hour glucose tolerance test used for
diagnose diabetes, esp. gestational diabetes
141
Vanillylmandelic acid (VMA)? what is it. what is it used to screen
- metabolite of catecholamines
| - catecholamine-producing tumors ( pheochromocytoma_
