test #40 4.29 Flashcards
membranous nephropathy is associated w. underlying..
- systemic disease: DM, solid tumor, immunologic disorders (i.e. SLE)
- drugs: gold, penicllamine, NSAID
- infection: hep B, hep C, malaria, syphillis
focal sclerosing glomerular sclerosis
HIV
obesity
sickle cell
heroin abuse
spike & dome in membranous glomerulonephropathy
immune complex deposition
subepithelial
IgG & C3
no increase in cellularity
intoxication, slurred speech, impaired decision making at what alcohol level?
marked motor impairment, loss of consciousness, memory blackouts at what level?
- 0.10% (100mg/dl)
2. 0.2% (200mg/dl)
alveolar-arterial oxygen gradient helps determine
CAUSE of hypoxemia
normal alveolar PaO2
assumed to be partial pressure of oxygen in alveolar air.
healthy person at sea level, usu around 100mmHg
alveolar gas equation
to determine A-a gradient
PAO2 = 150 - PaCO2/0.8
ratio of carbon dioxide production to oxygen consumption
0.8 (important in calculating alveolar gas)
normal A-a gradient?
no more than 10-15mmHg
hypoxemia w/ normal A-a gradient? (2)
- high altitude (FiO2 down)
2. hypoventilation
hypoxemia w/ increased A-a gradient? (3)
- V/Q mismatch
- diffusion limitation (pulmonary edema, intersitital fibrosis
- right-to-left shunt
what values are needed to calculate A-a gradient
PaCO2! will assume normal FiO2, etc
PAO2 = 150 - PaCO2 / 0.8
when is diffusion capacity of lungs decreased (2)
alveolar walls thickened
- pulmonary fibrosis / hyaline membrane / edema
alveolar walls destroyed
- emphysema
when is mixed venous blood oxygen increased (2)
(1) abnormal hemoglobin binds w/ greater affinity to oxygen, preventing unloading
(2) oxidative metabolism inhibited (i.e. cyanide or CO toxicity)
thiazolidinediones (-glitazones) bind..
intracellular nuclear receptor
PPAR-gamma
pioglitazone, rosiglitazone increase expression of..
most importantly, ADIPONECTIN
(a cytokine released by fat cells, what is decreased in type 2 DM
exenatide, liraglutide are..
GLP-1 analogs, related to incretin effect
increase insulin, decrease glucagon release
linagliptin, saxagliptin, sitagliptin are..
DPP-4 inhibitors, related to incretin effect
normally cleave GLP-1
also increase insulin, decrease glucagon
repaglinide is..
meglitinide
like sulfonylurea but does not release insulin when blood glucose is low
weaker binding affinity & faster depolarization
GLP-1 is secreted by..
intestinal L cells in response to food
‘incretin effect’
GLP-1 works on what receptor
Gprotein - adenyl cyclase
which diabetes drugs work via enzyme inhibition (2)
metformin (block enzymes related to liver gluconeogenesis, etc)
alpha-glucosidase inhibitors (acarbose, miglitol)
miglitol
like acarbose, alpha-glucosidase-inhibitor,
diabetes med.
hyperestrinism state of cirrhosis due to (2)
- decrease metabolism of androstenidione, results in excess estrogen.
- increase in sex-hormone binding globulin (SHB) -> binds testosterone, decreases free testosterone
results in: gynecomastia, testicular atrophy, spider angiomata, less hair