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Flashcards in test #45 5.4 Deck (197):
1

when to involve ethics committee or risk management?

basically never on USMLE. handle it on your own.

2

sudden onset headache and nuchal rigidity

subarachnoid hemorrhage

meningeal irritation from blood

can also see papilledema and pupillary dilation, but no other focal neurological signs

3

xanthochromia

blood in CSF

4

diff between intracerebral hemorrhage & subarachnoid hemorrhage

intracerebral: focal neurological impairment

subarachnoid: no focal issues

5

carrier frequency for mom 1/30
carrier frequency for dad: 1/100

chance child will have disease?

(1/30 x 1/2) x (1/100 x 1/2)

6

what % of observations fall in 1 standard deviation of mean

68%

7

what % of observations fall in 2 standard deviations of mean

95%

8

what % of observations fall in 3% of standard deviation of mean

99.7%

9

normal pulmonary arterial pressure

< 20mmHg

10

definition of pulmonary artery hypertension

> 25mmHg

11

major causes of pulmonary artery HTN

-hereditary (AD: BMPR2 mutation)
-left heart failure
-chronic hypoxia: obstructive sleep apnea, COPD
-chronic thromboembolism
-HIV infxn

12

idiopathic pulmonary artery HTN inheritence

autosomal dominant w/ variable penetrance

2 hit:
1. mutation in BMPR2. normally suppresses smooth muscle proliferation
2. activates disease process (i.e. infxn, drug)

13

cardiac sounds that can arise w/ pulmonary HTN (2)

1. accentuated S2
2. holosystoic tricuspid regurg (diastolic) due to increased 'afterload'

14

etiology of pulmonary HTN in COPD, obstructive sleep apnea, interstitial lung disease

hypoxic vasoconstriction

15

compensation for chronic respiratory acidosis

3-5 days
(at least 24hr)

kidney excrete acid & retain HCO3-

> 30

16

Kussmal breathing

shallow breathing seen in diabetic ketoacidosis, attempt to blow off CO2 to compensate for metabolic acidosis (low bicarb, low CO2, low pH)

17

adverse effects of succinylcholine (3)

1. malignant hyperthermia in genetically susceptible people

2. hyperkalemia in pts w/ burns, myopathy, crush injury, denervation -> quadriplegia, guillan-barre

(due to upregulation of muscle nAChR & rhabdomyolysis --> increase K+ efflux)

3. bradycardia, from parasympathetic stimulation or tachycardia, from sympathetic ganglion effects

18

side effects of atracurium

1. release histamine ->
bp drop, flushing, bronchoconstriction

2. spontaneous degradation to laudanosine --> seziure

but, good for renal/hepatic insufficiency

19

baclofen mechanism

GABAb at level of spinal cord
CNS

20

phase I of succinylcholine

strong agonist of nAChR
binds & depolarizies
insensitive to AChE, so prolonged depolarization --> twitching

potentiate: AchE inhibitors, bc Ach will help further depolarize & inactivate muscle.

eventually degraded by plasma cholinesterases

21

phase II of succinylcholine

w/ continuous infusion or SLOW metabolizers

eventually nAChR insensitive to succinylcholine, which can bind & block site, but can no longer depolarize

--> becomes nondepolarizing blocker

antidote: AChE inhibitors (increase Ach concentration)

22

infective dose of shigella, salmonella, and vibrio cholera, ETEC

least --> most
shigella -- 10 - 10^2
salmonella -- 10^ 7
vibrio cholera: 10^5- 10^7
ETEC: 10^ 8-10^ 10

23

why is shigella so infective? when does infxn start

- survive stomach acid & bile
- uniquely bind to mucosal M cells in peyer's patches

24-72 hrs incubation

24

tenesmus

painful spasm of rectum associated w/ urge to defecate, yet little passage of stool occurs

25

infective dose of c. perfinges

500 organisms

26

organisms that can cause diarrhea w/ small innoculum

- camplyobacter jejuni - 500
- entamoeba histolytica - as few as 1
- giardia lamblia - as few as 1

27

TB virulence factor: cord factor

- inhibit macrophage & neutrophil maturation
- induce release of TNF-alpha
- damages mitochondria

mycoside (2 mycolic acid molecules bound to disaccharide trehalose)

correlates w/ virulence.

no cord factor -> no disease.

28

TB virulence factor: sulfatides (surface glycolipids)

- inhibit phagolysosomal fusion

29

thick, ropelike cords of mycobacterial organisms in twisted "serpentine" pattern

TB, consistent w/ presence of cord factor

30

eyes, lies, and capsize

wernicke encephalopathy

-opthalmoplegia / nystagmus:

anterograde amnesia: mamillary body
ataxia : cerebellum

31

what nutrient is often deficient in alcoholics

thiamine!
wernicke korsakoff

give IV dextrose & thiamine

32

wernicke encephalopathy is exacerbated when..

IV dextrose WITHOUT THIAMINE

thiamine needed for pyruvate dehydrogenase (pyruvate --> acetyl CoA for glycolysis -> TCA)

33

Wernicke encephalopathy?
Korsakoff psychosis?

acute thiamine def:
Wernicke encephalopathy
ataxia, nystagmus, opthalmoplegia, anterograde amnesia

chronic thiamine def:
Korsakoff
- anterograde & retrograde amnesia, apathy, lack of insight, confabulation

34

what brain structure is most affected by thiamine deficiency

mammillary body, undergoes necrosis.

papez circuit, neural pathway of limbic system involved in cortical control of emotion & memory.

35

fornix

originate from hippocampal subiculum, projects to mamillary body

36

alexia w/o agraphia

suggests corpus callosum lesion

37

before giving dextrose to alcoholic / malnourished, must give..

THIAMINE! to avoid ppt of wernicke encephalopathy.

38

virus w/ nuclear membrane envelope

herpesfamily!

herpes, CMV, EBV, etc

39

how do antithyroid drugs work (3)


1. oxidation of iodine
2. iodination of tyrosine residues
3. coupling of iodotyosine molecules

40

different between PTU and methimazole (3)

1. propylthiouracil also blocks peripheral conversion of T4 -> T3
2. PTU shorter half life
3. PTU for pregnancy!

methimazole = teratogen

41

both PTU and methimazole as associated with..

agranulocytosis.
both: thioamides

42

preferred rx for hyperthyroidism in US

radioactive iodine

43

definition of agranulocytosis

absolute neutrophil count of less than 500/mL

44

presentation of agranulocytosis

fever & sore-throat
often induced by medication

45

drugs that cause agranulocytosis

drugs cccrush myeloblasts & promyeloblasts

dapsone
clozapine
carbamazepine
colchicine
methimazole
propylthiouracil

46

how to check for agranulocytosis?

WBC & differential

47

patient w/ hyperthyroidism w/ fever & throat pain?

worry about methimazole / PTU induced agranulocytosis

48

PO2 in venous blood
PCO2 in venous blood

PO2: 40mmHg
PCO2: 47 mmHg

49

PO2 in arterial blood
PCO2 in arterial blood

PaO2: 104
PaCO2: 40

50

describe bronchial arterial supply

left & right arise from descending thoracic aorta

oxygenated to bronchi & bronchioles

w/ pulmonary artery, form dual blood supply to lungs

51

describe bronchial drainage

drainage:
-part to right heart via azygous, accessory hemiazygous, intercostal veins
- MOST drain to left heart via pulmonary veins

DEOXYGENATED blood into LEFT ventricle

52

explain why pO2 (100) in left ventricle is lower than pO2 (104) in pulmonary capillaries

bc admixture w/ venous blood from bronchial VEINS

most drain into right heart via pulmonary vein

53

what normally limits blood gas exchange in alveoli

CO2 & O2: usu perfusion limited

CO2 equilibrates really fast
O2 also does

54

perfusion limited

CO2, N2O

also O2

55

diffusion limited

CO

56

what shifts hemoglobin curve to the right

unload O2

high temp, pCO2, 2,3DPG

57

degenerate code

more codons (61) than there are amino acids (20)

each tRNA molecule = specific for an AA

multiple tRNA can code for same aa

wobble

58

explain basis of wobble in tRNA

5' tRNA has different spatial orientation than other 2 bases

may be inosine, which can hydrogen bond w/ uracil, adenine, and cytosine

allows for different codons to = same amino acid

59

3 categories of vitamin A toxicity

think: intracranial HTN, skin changes, hepatosplenomegaly

1. acute
-n/v, vertigo, blurred vision

2. chronic
-alopecia, dry skin, hyperlipidemia, hepatoxicity, hepatosplenomegaly, visual difficulty, papilledema (pseudotumor cerebri)

3. teratogenic
1st trimester: microcephally, cardiac anomalies, fetal death

60

thiamine deficiency associated w/

beri beri wet & dry
wernicke korsakoff

61

large doses of vitamin C associated w/

diarrhea, abdominal bloating
false negative stool guaiac results

62

large doses of vitamin E

-hemorrhagic stroke in adult
-necrotizing enterocolitis in infants

63

major use of ELISA

quantiative

to measure AMOUNT of protein in body fluid

64

indirect vs. direct ELISA

indirect: test antigen to see if patient has antibody

indirectly assume if you Ab, you must have antigen

direct: test antibody to see if patient has antigen

[directly see if you have antigen]

65

HIV ELISA

look for patient antibody
(indirect)

66

name loop diuretics (4) & major use

furosemide, toresemide, bumetanide, ethacrynic acid

use for volume overloaded state: CHF

67

name thiazide diuretic (4) & major use (2)

hydrochlorothiazide, chlorthalidone, indapamide, metolazone

use: HTN, calcium nephrolithiasis prophylaxis

68

ENaC blockers (2)

amiloride, triamterene

69

mineralcorticoid receptor antagonist (2)

spironolactone, eplerenone

70

which diuretic is most likely to produce hyponatremia

thiazides

have normal corticomedullary concentration, better able to retain free water in response to ADH

(loop diuretics loose some corticomedullar gradient in TAL, less able to absorb free water in loop of henle & CD)

71

diuretic causing hypocalcemia?

loop (furosemide etc)

BAD for renal nephrolithiasis

72

hepatitis w/ isoniazid presentation

fever, anorexia, nausea

73

how can isoniazid peripheral neuropathy be averted?

administer vitamin B6

74

fever, urticaria, arthalgia, proteinuria, lymphadenopathy 5-10 days after drug exposure

serum sickness
type III HSR

75

fatigue & new onset cardiac murmur in young adult

bacterial endocarditis

76

nephritic issues with bacterial endocarditis?

can have circulating immune complexes --> diffuse proliferative glomerulonephritis

77

inheritance of hemophilia A? hemophilia B?

A: factor 8; X-linked recessive

B: factor 9; X-linked recessve -> christmas disease

78

difference between hemophilia A & B

clinically indistinguishable

79

common cause of PT prolongation

warfarin therapy

80

common causes of increased bleeding time

von willebrand disease

NSAID use

81

general side effect of sulfonylurea?
1st generation risk?
2nd generation risk?

general: hypoglycemia w/ renal failure
1st gen: disulfram-like rxn
2nd gen: hypoglycemia

82

risk of rapid acting insulin

hypoglycemia, rare HSR

83

side effect of metformin

lactic acidosis
CONTRAINDICATED in renal failure

84

diabetes drug contraindicated w/ renal failure

metformin!

can cause lactic acidosis

85

side effect of thiazolidinediones (4)

1. weight gain (fluid)
2. edema
3. hepatotoxicity
4. heart failure (bc of fluid retention)

86

which diabetes drug can cause weight gain, edema, hepatoxicity, and heart failure

thiazolidinediones

87

which diabetes drugs can cause hypoglyemia

insulin & sulfonylureas

not TZD or metformin

88

drugs associated w/ pulmonary fibrosis

amiodarone, bleomycin, mitomycin C, busulfan, methysergide

89

how to identify lunate on X-ray

most medial articulation w/ radius!

be careful when counting!

90

how to identify scaphoid on X-ray

lateral articulation w/ radius

be careful when counting

91

what carpal bone articulates w/ thumb?

trapezium

thumb swings on trapezium

92

linitis plastica

stomach wall grossly thickened & leathy, diffuse stomach adenocarcinoma

93

progression of gastric adenocarcinoma

early aggrssive local spread & node/liver mets

recall
1. virchow node
2. krukenberg tumor
3. sister mary joseph node

94

signet cells in stomach

diffuse adenocarcinoma, associated w/ linitis plastica

95

nodular, polypoid-well demarcated masses in stomach.

microscopy: well-formed glands w/ columnar/cuboidal cells

intestinal-type adenocarcinoma

resembles colon cancer

96

prognostic factors of gastric adenocarcinoma

depth of invasion through gastric wall & regional lymph involvement

97

what type of gastric carcinoma can ulcerate

intestinal type, can present as upper GI bleed

98

rugal thickening w/ acid hypersecretion in stomach

think zollinger-ellison; bc gastrin increases acid secretion & parietal cell growth factor

99

hypertrophy of brunner's gland

suggests peptic ulcer disease

brunner gland in duodenum --> secrete mucous via crypts of lieberkuhn

100

bicarbonate in small intestine comes from.. (2)

1. pancreatic duct secretions
2. brunner's gland (only in duodenum)

101

brunner gland. where am i?

duodenum

102

crypt of lieberkuhn. where am i?

anywhere from small intestine to colon.

stomach: has gastric glands

103

CCK and secretin on pancreatic secretions

CCK stimulates mostly acinar cells (enzymes)

secretin stimulates mostly ductal cells (bicarb)

104

CCK and secretin on gallbladder

CCK stimulates gallbladder contraction & sphincter of Odi opening

secretin stimulates bile secretion

105

chronic gastritis w/ h. pylori leads to..

diffuse gland atrophy & intestinal emtaplasia

increase risk of gastric carcinoma

106

resistance to rifampin

mutation in DNA-dep RNA pol

107

best indicator of MR severity?

presence of S3 gallop

reflects increase rate of left ventricular filling due to large volume of regurgitant flow re-entering ventricle during mid diastole

108

functional diastolic rumbling?

suggests mitral regurg leading to high rate of regurgitant flow across MV in diastole

109

is intensity of murmur a good indicator of mital regurg?

no, bc low intensity means larger regurg orifice --> worse!

110

what causes mid systolic click in MVP?

tensing of chordae tendineae as they are being pulled taut by valve leaflets into atrium.

111

chordae tendinae

connect papillary muscles to AV valves leaflets (mitral & tricuspid)

collagen & elastin

112

most common cause of aortic stenosis?

degenerative senile calcification of valves

result of prolonged hemodynamic stress on valves

common >65 y/o

113

physical exam of aortic stenosis (3)

1. pulsus parvus et tardus:
-small & slow rise in carotid pulse

2. diminished aortic component to S2

3. harsh systolic crescendo-decrescendo murmur right upper border

114

valve issues w/ rheumatic fever (3)

1. mitral stenosis (late)
2. mitral & aortic regurg

115

what type of valvular issue is caused by infectious endocarditis

insufficiency of any valve
(regurg)

NOT stenosis

116

cystic medial necrosis can lead to what valve issue

aortic regurg
(dilation of ascending aorta)

117

non-musculoskeletal issues associated w/ ankylosing spondylitis

peripheral enthesopathies
uveitis
apical pulmonary fibrosis
aortic insufficiency

118

medical to prevent calcium stone formation

DON'T GET CONFUSED

thiazides!!

reduce calcium in tubules

119

diuretic that worsens calcium stones

furosemide!

looses Ca2+ means more in the tubules

120

how to thiazides reduce hypercalciuria (2)

1. block Na/Cl -->
-less Na+ in tubular cell, activates basolateral Na/Ca2+ antiporter, which pumps Na into cell in exchange for Ca2+

-this increases uptake of Ca2+ across apical membrane

2. hypovolemia --?
increases Na and H20 absorption in PCT, leading to passive Ca2+ too

121

acetazolamide on calcium levels

induces metabolic acidosis -> increase bone release of Ca2+ PO4-

hypercalciuria, worsens calcium stones

122

comedocarcinoma

DCIS w. solid sheets of pleomorphic, high grade cells w/ central necrosis

chroni inflammation & periductal concentrib fibrosis

calcify necrosis --> mammographic detection

123

paget's disease of nipple

malignant cells spread from DCIS into nipple w/o having crossed basement membrane

erythema and scale crust

124

medullary breast carcinoma

good prognosis

invasive, lymphocytic infiltrate

solid sheets of vesicular, pleomorphic, mitotically active cells w/ lymphoplasmacytic infiltrate around & within tumor & pushing noninfiltrating border

125

sclerosing adenosis

central acinar compression & distortion by surrounding fibrotic tissue w/ peripheral ductal dilation

fibrocystic change

slight association w/ carcinoma risk

126

breast ductal dilation, inspissated breast secretion, chronic granulomatous inflammation in periductal & interstitial area

mammary duct ectasia

127

phyllodes tumor

like fibroadenoma but increased cytological atypia & stromal cellularity & overgrowth

biphasic

leaflike

128

how long will myocardium look normal on histology post MI

up until 4 hours post MI.

then waviness in myofibrils (due to relaxation) will start, w/ edema, hemorrhage, early coagulative necrosis

129

earliest sign of coagulative necrosos of cardiac myocytes

cytoplasmic hypereosinophilia

also: punctate hemorrhage & edema

130

when do neutrophils come into myocardium post MI

days 1-3

131

when do macrophages come into myocardium post MI

days 5-10

132

when does granulation tissue form post MI

10-14 days post MI

133

when does collagen start to lay down post MI

2 weeks post MI -> 2 months

134

causes of acute pancreatitis (common & uncommon)

usu gallstones & alcoholism

also

1. drugs: azathioprine, sulfasalazine, furosemide, valproic acid
2. infxn: mumps, coxsackie virus, mycoplasma pneumoniae
3. hypertriglyceridemia
4. structure abnormalities of pancreatic duct (stricture, cancer, divisum) or ampulla (choledochal / bile duct cyst, stenosis of sphincter of odi)
5. hypercalcemia

6. surgery of stomach / bilary tree
7. recent endoscopic retrograde cholangiopancreatography

135

repeated acute pancreatitis that resolves on fasting w/ no risk factors in young patient?

consider hypertriglyceridemia

136

how does hypertriglyceridemia lead to acute pancreatitis

DIRECT TISSUE TOXICITY

high TG -> increased production of free fatty acids within pancreatic capillaries via pancreatic lipase

normally is bound to albumin

when TG >1000mg/dl -> will exceed albumin's binding capacity & directly injure pancreatic acinar cells

137

increased cholesterol predisposes to.. (3)

1. coronary artery disease
2. peripheral vascular disease
3. stroke

138

hemachromatosis on pancreas

pancreatic fibrosis --> secondary diabetes

does NOT cause pancreatitis

139

things that can cause pancreatitis mnemonic

GET SMASHED

1. gallstones
2. ethanol
3. trauma (seat belt)
4. steroids
5. mumps
6. autoimmune
7. scorpion sting
8. hypercalcemia / hypertriglyceridemia
9. ERCP
10. drugs (esp sulfa)

140

wilson disease signs

Copper is Hella BAD

unable to loose Cu2+ in bile

1. low ceruloplasmin, cirrhosis, corneal deposit (kaiser-fleisher ring), hepatocellular carcinoma
2. hemolytic anemia
3. basal ganglia degeneration (parkinsonian)
4. asterixis
5. dementia, dyskinesia, dysarthria

141

turbid plasma

suggests lots of chylomicrons in blood stream

(think: turbid blood 30min post hamburger!)

142

lipoprotein lipase deficiency

1 form of hyperchylomirconemia:

autosomal recessive

childhood: hyperlipidemia, abdominal pain (pancreatitis), lipema retinalis, xanthomas, hepatosplenomegaly

reduced LPL response to heparin

143

what converts nascent HDL to mature HDL

LCAT: which esterifies cholesterol

144

role of CETP

cholesterol ester transfer protein: transfers cholesterol liporotein particles from mature HDL to VLDL, IDL, LDL

145

hyperchylomicronemia can develop with what 2 deficiencies

autosomal recessive.

1. deficiency of lipoprotein lipase
2. mutation in apo C-II

recall, apo C-II activates LPL

146

hypertriglyceridemia results from..

autosomal dominant.
hepatic overproduction of VLDL

CAUSES PANCREATITIS

increased blood levels of VLDL and TG

147

presentation of hyperchylomicronemia

increased chylomicrons & TG

PANCREATITIS, hepatosplenomegaly, eruptive/pruritic xanthoma

no increase risk of atherosclerosis

148

heparin on lipase activity

heparin releases endothlium-bound lipases, encourage triglyceride clearance from circulation.

149

pain w/ hyperchylomicronemia / hypertriglyceridemia?

pain w/ hypercholesterolemia?

high chylomicron & TG --> abdominal pain --> PANCREATITIS

high LDL cholesterol --> chest pain --> MI

150

hallmark of familial hypercholesterolemia

tubular xanthomas (tendon)

also have: xathelasma & acrus cornea

151

what increases risk of pancreatic cancer?

-tobacco smoke
-obesity

152

what increases risk of gastric cancer?

-dietary nitrates (smoked food)
-alcohol & tobacco
-h. pylori

153

what increases risk of liver cancer?

- hep B & C
- liver cirrhosis
- hemochromatosis
- wilson's
- aflatoxin
- carbon tetrachloride

154

what increases risk of colorectal cancer?

-hereditary colorectal cancer
-inflammatory bowel disease
-obesity
-charred / fried food

155

what increases risk of renal cancer?

-tobacco smoke
-obesity
-hypertension

156

what increases risk of bladder cancer

-tobacco smoke
-occupational exposure to..
-rubber
-aromatic amine-containing dyes (benzidine, 2-napthylamine,
-textiles
-leather
-aniline dye
-phenacetin

157

what increases risk of breast cancer

-early menarche
-late menopause
-nulliparity
-BRCA mutation

158

what increases risk of prostate cancer

age
african american race

159

what increases risk of leukemia / lymphoma

alkylating agents

160

what increases risk of angiosarcoma in liver

arsenic
vinyl chloride

161

what increases risk of papillary thyroid cancer?

ionizing radiation

162

2nd leading cause of lung cancer?

radon exposure

163

angiosarcoma prognosis

aggressive & difficult to treat

164

gross appearance of transitional cell carcinoma of bladder?

histology

gross cystoscopy: multifocal sessile or papillary tumors

histology: pleomorphic, hyperchromatic nuclei, increased NC ratio, disrupted oritentation & polarity

165

how does cyclophosphamide & ifosfamide cause hemorrhagic cystitis

acrolein -- irritates bladder mucosa

166

carcinoma, mesothelioma, thymoma, sarcoma, trophoblastic tumor, desmoplastic small round cell tumor all..

stain positive for ketatin!

167

desmin, caldesmon, actin +

muscle tissue stain

168

stain for endothlium

CD34+, von willebrand factor

169

presentation of dermatomyositis (3)

grotton papule
- red violaceous fat-topped papules w/ light scale. over bony prominences.

heloptrope rash: erythematous or violaceous edematous eruption on upper eye-lid & periorbital skin

proximal muscle weakness!

170

serum findings in dermatomyositis

ANA +
anti-Jo1 +
anti-SRP
anti-Mi2
elevated creatinine kinase

171

prognosis of dermatomyositis

if present after age 50 --> increased risk of underlying occult malignancy

172

dermatomyositis is associated w/ underlying

lung cancer!

173

lichen sclerosis

elevated white lesion near vagina

174

acute pyelonephritis pathogenesis

must have vesicoureteral reflux in some way

175

fat embolism syndrome triad

1. acute onset neuro issues
2. hypoxemia
3. petechial rash

trauma of long bone/pelvis

176

pathogenesis of fat embolism syndrome

1. trauma dislodge fat in marrow
2. travels in bone marrow sinusoud

- pulmonary vasculature
- CNS (via AV shunt)
- thrombocytopenia & petechial rash due to platelet coating fat microglobules

177

why see petechial rash in fat embolism syndrome?

thrombocytopenia

platelet coats fat globule in vasculature

178

presentation of epidural hematoma

talk and die

may loose consciousness after injury. then lucid interval -> loss of consciousness

179

epicranial aponeurosis & periosteum cover..

outer surface of skull

180

why is there a physiological drop in systolic pressure with inspiration

increased pulmonary vascular capacitance --> reduced left ventricle preload

181

what is there a exacerbated drop in systolic pressure w/ inspiration w/ pulsus paradoxus?

physiologic: increased pulmonary capacitance -> reduced preload

+

increased filling of right heart, normally bulges into pericardium, but when filled will blood -> push against interventricular septum, reducing LV stroke volume

182

low potency antipsychotics associated with

non neurologic:

histamine block: sedation
cholinergic block
alpha-1 block: orthostatic hypotension

183

name 2 low potency 1st generation antipsychotics

chlorpromazine
thioridazine

184

name 2 high potency 1st generation antipsychotics

haloperidol
fluphenazine

185

migratory thrombophlebitis suggests

underlying visceral malignancy

trousseau's sign

186

explain trousseau's sign

migratory thrombophlebitis

bc common paraneoplastic syndrome: hypercoagulability, esp adenocarcinoma (of pancreas, lung, colon)

secrete thromboplastin-like substance -> cause chronic intravascular coagulation --> disseminated & tend to migrate

187

superficial venous thromboses that appear in one site, resolves & appears elsewhere

migratory thrombophlebitis --> underlying visceral malignancy

188

WBC casts ppt by what in renal tubular cells

Tamm-Horsfall protein, secreted by tubular epithelial cells

189

what will have highest rate of metabolism in glycolytic pathway: glucose 6-phosphate, mannose 6-phosphate, galactose 1-phosphate, fructose 1-phosphate, glucose 1-phosphate

fructose 1-phosphate, bypasses rate limiting step of PFK-1

all others enter before PFK-1

190

rate limiting enzyme in glycolysis

phosphofructokinase

F 6-phosphate -> F 1,6 bisphosphate

191

mannose metabolism

formed from metabolism of several polysaccharides & glycoproteins

phosphorylated to mannose 6-P, converted to fructose 6-P (by mannose isomerase) then acted on by PFK-1

192

galactose metabolism

galactoskinase makes galatose 1-P

transfer of UDP to galactose 1-phosphate, then epimerization to UDP-glucose (by galactose 4-epimerase).

resultant glucose 1-P -> glucose 6-P via phosphoglucomutase

then PFK-1

193

fructose metabolism

fructokinase
fructose 1-phosphate

F 1P--> DHAP & glyceradehyde
via aldolase B

glyceraldehyde -> glyceraldehyde 3-P
via tiokinase

becomes pyruvate eventually

bypass PFK-1

194

gaucher disease

defect: glucocerebrocidase
accumulate: glucocerebroside

hepatosplenomegaly, aseptic necrosis, gaucher cells

195

presentation of fabry's

1. peripheral neuropathy of hand and feet
2. angiokeratoma
3. cardiovascular / renal disease (COD)

196

DNR means (3)

1. no intubation or mechanical ventillation
2. no defibrillation or IV drugs to acutely treat terminal rhythm
3. no chest compressions

can otherwise specify additionally:
-no artificial feeding
- etc

197

order of next of kin

spouse
adult children
parents
adult siblings