weak spots

Question 1

what is winter’ formula?

Answer 1

PaCO2 = (1.5 *HCO3-) +8 +/-2

used to evaluate reps compensation when there is metabolic acidosi

PaCO2 > than predicted: concurrent resp acidosis

PaCO2 less than predicted: concurrent resp alkalosis.

Question 2

name the retroperitoneal organs

SAD PUCKER

Answer 2

Suprarenal glands

Aorta and IVC

Duodenum (2nd and 3rd parts)

P-pancreas (except tail)

U- Ureters, bladder

C-ascending and descending colon

K- kidneys

E-esophagus lower 2/3

R-rectum lower 2/3

imaging in retroperitneum - use CT

Question 3

what is moa of varenicline

Answer 3

partial agonist at AcH receptors (alpha 4, beta 2 receptor) and leads to partial stimulation of receptor —> reduced nicotine withdrawal + prevents nicotine from binding and inducing reward response (reduces withdrawal cravings and rewarding effects of nicotine)

Question 4

what is the kozak sequence?

Answer 4

kozak sequence = gccRccAUGG where R = adenine or guanine

kozak sequences plays role in initation of translation.

mutation of 3 bases uspream(guannine replaced for cytosine) from start codon (AUG) assocaited with thalassemia intermedia

Question 5

contets of Thayer martin media

what is it used to grow?

recall :VPN

Answer 5

chocolate agar with:

Vancomyocin - inhibit gram +

Polymyxin - inhibits gram - except Neisseria

Nyastatin to inhibit fungi

used to culture N. gonorrhea or N. meningitidis

Question 6

fabry’s

defective enzyme:

accumulated substance

findings

Answer 6

enzyme: alpha galactosidase A
substance: ceramide trihexoside
finding: peripheral neuropathy, angiokeratomas, cardiovascular/renal disease

Question 7

gaucher’s diseae

which enzyme

what accumulates

findings

Answer 7

MOST common

def of beta-glucocerebrosidease

accum: glucocerebroside

hepatosplenomegaly, aseptic necrosis of feymer, bone crises,

**macros that look like crumpled up tissue paper **

Question 8

niemann pick picks the liver

which enzyme?

what accumulates

presentation

Answer 8

enzyme: spingomyelinase
accum: sphingomyelin
presentation: neurodegenration, **hepatosplenomegaly, cherry-red-spot on macula **

**foam cells **

Question 9

tay sach’s

which enzyme

what accumlulates

Answer 9

enzyme: hexosaminidase A
accum: GM2 ganglioside
presen: cherry red spot on macula NO hepatosplenomegaly, progressive neuro degeneration, **lysosomes w/onion skin, developmental delay **

Question 10

krabbe’s disease

which enzyme

what accum

presentation

Answer 10

enzyme: galactocerebrosidase
accum: galactocerebroside
present: peripheral neuropathy, developmetha delay, optic atrophy, globoid cells

Question 11

metachromatic leukodystrophy

which enzyme

what accumulates?

Answer 11

eznyme: aryl sulfasase A
accum: cerebroside sulfate
presentation: **central and peripheral demyelination + ataxia+ dementia **

Question 12

what are the two mucopolysacchridoses

Answer 12

hunter’s -XR w/no corneal clouding

hurler’s - AR

Question 13

Hunter vs. HUrler

which enzymes def?

presentation?

what accumulates?

Answer 13

Hunter: def of alpha-L-iduronidase and presents with developmental delay, gargoylism, airway obstrution, corneal clouding, hepatosplenomegaly

Hurler: def of iduronate sulfatase + mild Hurler’s + aggressive behavior + no corneal clouding

accum for both: heparan and dermatan sulfate

Question 14

what are 3 high potentcy typical antipsychotics

Try to Fly High

Answer 14

T-trifluoperazine

F - fluphenazine

H - haloperidol

Question 15

what are 2 low potency antipsychotics?

Cheating Theives are Low

Answer 15

C-chlorpromazine

T-thioridazine

Question 16

haloperizol + azines

Answer 16

typical antipsychotics

Question 17

4 clinical uses of typical anti psychotics

Answer 17

schizophrenia (positive symptoms)

psycosis

acute mania

tourette

Question 18

ADE of typical antipsychotics

1. what are the extrapyramidal symptoms
2. what are the endocrine ADEs
3. what are the three receptors blocked here?

Answer 18

1. extrapyramidal: 4hrs - acute dystonia (muscle spasm, stiffness, oculogyric crisis) , 4 day akathisia (restlessness), 4 wk bradykinesia(parkinsonianism), 4 mo tardive dyskinesia (stereotypical oral facial movememnts often irreversible)
2. endocrine –>D2 receptor antagonism —>hyperprolactnemia—>galactorrhea

3 recepors: muscarinic - dry mouth, constipation. alpha 1- hypotension, histamine - sedation

Question 19

what is neuroleptic malingant syndrome and how do you tx?

Answer 19

NMS = rigidity, myoglobinuria, autonomic instabilty, hyperpyrexia

tx: dantroline, D2 agonist (ie bromocriptine)

NMS - think FEVER

Fever

Encephalopathy

V-vitals unstable

E-elevated enzymes

R-rigidity of muscles

Question 20

what are the 6 atypical antipsychotics

mnemonic: its atypical for old closets to **quietly **risper from **A to Z **

Answer 20

its atypical for old closets to quietly risper from A - Z. olazapine, clozapine, quietapine, risperidone, arirprirazole, ziprasidone

Question 21

moa of all typical anti-psychotics

Answer 21

block dopamine D2 receptors –> increaed cAMP

Question 22

ADE of olanzapine/clozapine

Answer 22

weight gain

Question 23

ADE of clozapine

Answer 23

agranulocytosis + seizure(needs weekly WBC monitoring)

Question 24

ade of ziprasidone

Answer 24

prolong QT syndrome

Question 25

what blocks effects of adenosine

Answer 25

theophylline and caffeine

Question 26

use of Mg2+ in arrhythmias

Answer 26

used in torsades de pointes and digoxin toxicity

Question 27

how does adenosine work

Answer 27

incraseK+ out of cells ---\> cell hyperpolarization --\> decrease Ica coming into cells. makes your heart stop!

Question 28

photosensitivity drugs

Answer 28

SAT for phoot Sulfonamides amiodarone tetracycle

Question 29

which two class of anti-arrhymics predispose to torsades via incrased QT interval (ecompasses ventricular repolarization)?

Answer 29

class III (AIDS = amiodarone, ibutilide, dofelitide, sotalol (note amiodarone not assocaited w/torsades), class IA(b/c have K+ blocking activity) = dqp = disopyramide, quinindine, procainamide (lupus like syndrome)

Question 30

what causes increased tox for all class I drugs?

Answer 30

hyperkalemia

Question 31

what is the equation for collapsing pressure?

Answer 31

P = 2T(surface tension)/r principle - the smaller the radius, the larger the suface tension

Question 32

what has a bright red central papule surrrounded by outwardly radiating vessels that blanch w/pressure and refill centrifugally on release due to dilataion of a central arteriole and its superfifical capillary network. it is estrogen dependent

Answer 32

spider angiomas

Question 33

cavernous hemangiomas(dilated vascular spaces with thin walled endothelial cells that presetn as soft, blue compressible masses up to a few cm in size) of the brain and viscera are associated with wihch condition?

Answer 33

von Hippel-Lindau disease

Question 34

what are benign tumors made up of lympahtic cysts and lined by a thin endothelium that present at birth and are most commonly located on the neck and the lateral chest wall? which 2 conditions are associated with tumors above?

Answer 34

cystic hygromas turner syndrome down syndrome

Question 35

what are small, red cutaneous papules in aging adults that do not regress spontaneously and increased with age and light microscopy would show: **proliferation of capillaries and post-cap venules in papillary dermis**

Answer 35

cherry hemangiomas

Question 36

polyuria polydipsia polyphagia accompanied by fatigue and weight loss in caucasian young man who is sexually active

Answer 36

type I diabetes

Question 37

what mediates niacin cutaneous flusing and how can it be prevented? how does capsaicin reduce pain

Answer 37

niacin flusing mediated by prostaglandings and reduce by giving aspirin capsaicin reduces pain by decreasing levels of substance P in PNS