Flashcards in test #33 4.22 Deck (114)
antiarrhythmic prolonging QT & bradycardia (prolonged PR)
beta-blocker w/ class III antiarrhythmic properties
how do beta blockers work?
(1) slow AV nodal conduction
(2) prolonging phase 4 depolarization
triglyceride breakdown. fate of fatty acid & glycerol?
triglyceride --> fatty acid & glycerol (via lipases)
FATTY ACID --> fatty acyl-coA
via fatty acid CoA synthetase
carnitine carries fatty acyl-CoA into mitochondria
fatty acyl-CoA --> beta oxidation
GLYCEROL (IN LIVER)
glycerol --> glycerol 3-phosphate
(via glycerol kinase)
glycerol 3-phosphate -> DHAP
DHAP can go into (1) energy via glycolysis or (2) glucose via gluconeogenesis
glycerol also can be used for triglyceride synthesis in any tissue
liver-specific enzyme for energy generation & glucose synthesis
(converts glycerol into glycerol 3 phoshpate)
glycerol 3-phosphate -> DHAP -> either glycolysis or gluconeogenesis
ONLY in liver.
first committed step in fatty acid SYNTHESIS!
acetyl-CoA --> malonyl-CoA
eventually make palmitate
occurs in cytoplasm
where does fatty acid oxidation occur? synthesis?
oxidation in mitochondria
synthesis in cytoplasm
fatty acid synthesis movement from mitochondria to cytosol?
oxaloacetate + acetylCoA --> citrate
citrate shuttled out
converted into oxaloacetate + acetylCoA again (via ATP citrate lyase)
acetyl-CoA --> malonyl CoA--> fatty acid
oxaloacetate --> malate --> pyruvate, back into mito
which is the only organ that can use glycerol as energy source?
how do adipocytes make glycerol for triglyceride synthesis?
synthesizes glycerol phosphate from DHAP
nail clubbing suggests? nail spooning [koilonychia] suggests
clubbing: PROLONGED hypoxia
associated w/ large-cell lung cancer, TB, CF, suppurative lung disease: empyema, bronchiectasis, chronic lung abscesses
(not asthma, bc brief, episodic?)
spooning: Fe2+ deficiency anemia
drumstick appearance, flattening of nail folds, shininess of nail and distal portion of finger.
pressing of nail: spongy, fluctuant (unstable) sensation --> softening of nail beds
potential pathophysiology of digital clubbing
failure of platelet precursors to fragment completely within pulmonary circulation
increased peripheral megakaryocytes & platelet clumps --> impact finger & toe --> release PDGF and VEGF --> increased fibrovascular proliferation --> clubbing!
also, elevated levels of prostaglandin E2 implicated.
wegners: granulomatosis w/ polyangiitis
wegner's (granulomatosis w/ polyangiitis)
what's involved (3)
necrotizing granulomatous vasculitis
1. upper respiratory: ear, nose, sinus, throat: chronic sinusitis, mucosal ulceration (due to mucosal granulomas that later ulcerate)
2. pulmonary symptoms: cough/hemoptysis, focal necrotizing granuloma in lung, can coalesce and undergo cavitation
3. renal disease: RPGN: crescentic
RPGN due to wegner's differs bc
RPGN 1: immunoglobulin against basement membrane
RPGN 2: immune complex mediated
nephritic 2-3 days after upper respiratory infection? nephritic 2-3 wks after URI?
2-3 days: IgA nephropathy
2-3 wks: PSGN: postinfectious strep glomerulonephritis
A is earlier
indirect jaundice post-stress (i.e. hiking, fasting)
gilbert syndrome! weak UDP-glucoronyl-transferase. usu not a big deal, unless stressed.
normal serum total bilirubin
< 0.2mg direct bilirubin
which TB virulence factor allows for intracellular bacterial proliferation
langhan's giant cells
classic locations for disseminated TB
-basal meninges (tuberculous meningitis
-lumbar spine (Pott disease)
-psoas muscle (psoas abscess)
-serous membranes like pericardium and pleura
disseminate TB vs milary
milliary -> extreme form; small scattered seed-like foci of infection throughout body.
preventative measure for all kidney stones?
(most stones result from supersaturation)
low calcium diet on Ca2+ kidney stone formation?
serum Ca2+ is low, compensatory increase in intestinal Ca2+ absorption and Ca2+ release from bone --> increase risk of stone formation
high protein diet on kidney stone formation?
increases body's acid load, stimulate calcium release from bones & Ca2+ excretion into urine.
recommend low protein diet for individuals w/ calcium and uric acid stones
high dietary Na+ on kidney stone formation?
increased Ca2+ release from bone.
recommend low Na+ diet
recommendation for patients w/ calcium stones and hyperoxaluria?
pyridoxine. B6 decreases endogenous oxaloacetate formation --> less stone
difficulty abducting right arm past horizontal position & prominence of scapular angle
long thoracic n.
likely injured during masectomy
past horizontal abduction --> need seratus anterior to rotate glenoid cavity superiorly.
which structures can be damaged in thyroidectomy (2)
1. recurrent laryngeal, when ligate inferior thyroid
2. superior laryngeal, when ligate superior thyroid artery.