test #33 4.22 Flashcards Preview

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Flashcards in test #33 4.22 Deck (114)
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1

antiarrhythmic prolonging QT & bradycardia (prolonged PR)

sotalol

beta-blocker w/ class III antiarrhythmic properties

2

how do beta blockers work?

(1) slow AV nodal conduction
(2) prolonging phase 4 depolarization

3

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

4

liver-specific enzyme for energy generation & glucose synthesis

glycerol kinase
(converts glycerol into glycerol 3 phoshpate)

glycerol 3-phosphate -> DHAP -> either glycolysis or gluconeogenesis

ONLY in liver.

5

acetyl-CoA carboxylase

first committed step in fatty acid SYNTHESIS!

acetyl-CoA --> malonyl-CoA
(acetyl-CoA carboxylase)

eventually make palmitate

occurs in cytoplasm

6

where does fatty acid oxidation occur? synthesis?

oxidation in mitochondria
synthesis in cytoplasm

7

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

8

which is the only organ that can use glycerol as energy source?

LIVER

9

how do adipocytes make glycerol for triglyceride synthesis?

synthesizes glycerol phosphate from DHAP

10

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

11

nail clubbing:

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

12

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.

13

c-ANCA targets

lysosomal enzymes

wegners: granulomatosis w/ polyangiitis

14

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

15

RPGN due to wegner's differs bc

pauci-immune.

RPGN 1: immunoglobulin against basement membrane
RPGN 2: immune complex mediated

16

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

17

indirect jaundice post-stress (i.e. hiking, fasting)

gilbert syndrome! weak UDP-glucoronyl-transferase. usu not a big deal, unless stressed.

18

normal serum total bilirubin

.2-1 mg/ml
< 0.2mg direct bilirubin

19

which TB virulence factor allows for intracellular bacterial proliferation

sulfatide

20

horseshoe nuclei

langhan's giant cells

21

classic locations for disseminated TB

-basal meninges (tuberculous meningitis
-lumbar spine (Pott disease)
-psoas muscle (psoas abscess)
-serous membranes like pericardium and pleura

22

disseminate TB vs milary

milliary -> extreme form; small scattered seed-like foci of infection throughout body.

23

preventative measure for all kidney stones?

drink fluids
(most stones result from supersaturation)

24

low calcium diet on Ca2+ kidney stone formation?

INCREASES risk.

serum Ca2+ is low, compensatory increase in intestinal Ca2+ absorption and Ca2+ release from bone --> increase risk of stone formation

25

high protein diet on kidney stone formation?

increases risk.

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

26

high dietary Na+ on kidney stone formation?

increased Ca2+ release from bone.

recommend low Na+ diet

27

recommendation for patients w/ calcium stones and hyperoxaluria?

pyridoxine. B6 decreases endogenous oxaloacetate formation --> less stone

28

difficulty abducting right arm past horizontal position & prominence of scapular angle

serratus anterior
long thoracic n.

likely injured during masectomy

past horizontal abduction --> need seratus anterior to rotate glenoid cavity superiorly.

29

which structures can be damaged in thyroidectomy (2)

1. recurrent laryngeal, when ligate inferior thyroid
2. superior laryngeal, when ligate superior thyroid artery.

30

anterior dislocation of shoulder OR fracture of neck of humerus can injure..

axillary n. delt & teres minor & sensation to upper lateral arm