kaplan q bank HY
Anatomy “
ï† Drainage of ovaries/testes : left gonadal ïƒ left renal vein ïƒ IVC ¢ right gonadal vein ïƒ IVC ¢ same situation occurs for left & right adrenal veins
ï† Cervix drainage : cervical vein ïƒ uterine vein ïƒ internal iliac
ï† Uterine tubes drainage : pampiniform plexus ïƒ ovarian vein ïƒ IVC
ï† Radial nerve injury : inability to extend the wrist ¢ digits (= wrist drop) ¢ weakness of grip ¢ anesthesia of dorsal surface of the arm, forearm and hand
ï† Axillary nerve injury : fracture at the surgical neck of humerus ¢ supplies teres minor , deltoid and skin of shoulder
ï† Musculocutaneous nerve injury : innervates the flexors of the arm ¢ weakness of arm flexion at the shoulder (biceps, brachialis, coracobrachialis )¢ anesthesia of lateral forearm skin
ï† CNS locations : pyriform cortex :primary olfactory cortex ¢ postcentral gyrus : primary sensory cortex ¢precentral gyrus : primary motor cortex ¢ insula :primary gustatory cortex
ï† Friedreich™s ataxia : ataxia,tremor, kyphoscoliosis,foot deformities ¢ death by 40 yrs old ¢ AR ¢ atrophy of spinal cord “ spinocereblellar tracts, corticospinal tracts and posterior columns
Behavioral “
ï† Cooperative play : after 4 yrs ¢
ï† Regression :automatic retreat to a less mature level of behavior in times of stress
ï† Sublimation : turning socially unacceptable impulses into acceptable or more benign forms to allow their expression
ï† Minor with STD ïƒ no need to inform the parents ¢ go ahead and treat !
ï† Alprazolam is intermediate acting BSD ¢ primarily used for panic attacks
ï† Diazepam & lorazepam : status epilepticus
ï† Toilet training : not possible befor the age of 18 months
Biostatistics “
Biochemistry “
ï† PDH deficiency : pyruvate will be used in other pathways ¢ alanine & lactate will be elevated ¢ alanine aminotransferase converts pyruvate to alanine ¢ LDH converts pyruvate to lactate
ï† Leigh™s disease
subacute necrotizing encephalomyopathy) : defective form of cytochrome C oxidase ¢ symmetric necrosis that affects central arease of the nervous sytem from the thalamus to the spinal cord ¢
ï† Glucagon inhibits fatty acid synthesis by a cAMP-dependent phosphorylation of acetyl-CoA carboxylase
ï† High carbohydrate & low fat diet would stimulate fatty acid synthesis
ï† cDNA library is synthesized from the mRNA of a cell using the enzyme reverse transcriptase ¢ it is used to study the DNA and the RNA message from which proteins are transcribed
ï† Fluorescence activated cell sorting (FACS) uses antibodies coupled to fluorescent markers to determine cell surface molecules of whole cells
ï† Genomic library is the chromosomal sequence of a gene including coding and non-coding regions ¢ it is synthesized directly from the DNA of a cell and it is used to study both the coding regions & the areas such as promoters, enhancers, and introns of a gene
ï† Deletions are detected by two methods : 1) Southern Blot 2) PCR ( 3. restriction enzymes)
ï† Glutamate carboxylase : catalyzes the carboxylation of glutamic acid side chains in several clotting factors ( II, VII, IX, X, protein C, S) ¢ vitamin K acts as co-enzyme
ï† Hemolytic anemia in newborn : as a result of vitamin E “tocopherol- deficiency
ï† Vitamin B12 is required for two reactions in human body : methylation of homocysteine to methionine ¢ conversion of methylmalonyl CoA ïƒ succinyl CoA (methylomalonyl CoA mutase)
ï† Vitamin C excess can lead to : decreased absorption of B12 ¢ increased estrogen levels in women on estrogen replacement therapy ¢ kidney stones ¢
ï† Vitamin A : necessary for retinal pigments ïƒ nyctalopia
ï† Glucose transporters are integral membrane proteins with 12 spanning domains
ï† Beta-adrenergic receptors for Epinephrine have 7 transmembrane segments
ï† Hexosaminidase A hydrolyzes a bond between N-acetylglucosamine and galactose in the polar head of ganglioside GM2
ï† Propionic aciduria : deficiency in biotin ¢ propionyl CoA carboxylase
ï† Galactosemia : the only clinical significant complication is cataract
ï† Fabry™s :a-galactosidase def ¢ renal failure ¢ telangiectasias ¢ skin rash ¢ ceramide trihexoside accumulation
ï† Farber disease : ceramidase def ¢ hoarseness, dermatitis, skeletal deformations, mental retardation, hepatomegaly
ï† Niemann-Pick : def of sphingomyelinase ¢ mental retardation, hepatosplenomegaly, foam cells in bone marrow, cherry red spots in macula (40%) ¢ death by 3 yrs of age
ï† Von Gierke™s disease : glucose 6-phosphatase def ¢ glucose 6P trapped in the liver cell is degraded to lactate & pyruvate ïƒ released into serum ¢ high serum lactate + high serum pyruvate
ï† Ketone bodies : acetone, acetoacetate , b-hydroxybutyrate ¢ produced by the liver by beta oxidation of free fatty acids ¢ occurs as follows :insulin deficiency ïƒ activated lipolysis ïƒ increased plasma free fatty acids ïƒ increased hepatic fatty acids ïƒ accelerated ketogenesis
ï† Malate shuttle : used to transport cytoplasmic NADH into mitochondria
ï† Southwestern blotting :involves DNA-protein interactions. ¢ a protein sample is subjected to electrophoresis, transferred to a filter, and exposed to labeled DNA
ï† UDP glucose phosphorylase :important in glycogen synthesis ¢ glycogen synthase is the rate limiting step in glycogen synthesis
ï† Alkaptonuria :def of homogentisic acid oxidase (degradation of tyrosine) dark urine ¢ dark connective tissue ïƒ ear cartilage may appear bluish
ï† Northern Blot : best test to determine whether a gene is expressed in a particular cell type
ï† DNA sequencing & Southern Blot examine the DNA of the cell
ï† Biochemical testing is usually used to detect a defective enzyme or a reduced amount of normal enzyme ¢ used in the detection of carriers of AR diseases such as Tay Sachs, sickle cell, thalassemias
ï† Vitamin C def : perifollicular hemorrhages, ecchymoses , splinter hemorrhages, hemorrhages into muscle
ï† Von Gierkes™s lab : increased lactate , cholesterol, TG, and uric acid
ï† Wernicke™s : ataxia (= difficulty walking), dementia, paralysis of lateral gaze (= opthalmoplegia) ¢ thiamine deficiency
ï† Transaminases require pyridoxal phosphate (vitamin B6)
ï† Thiolase converts acetoacetyl-CoA into acetyl CoA
ï† Abetalipoproteinemia : absence of apo-proteins ¢ leads to fat malabsorption ¢ complete absence of chylomicrons ¢ patient™s RBC™s are deformed (acanthocytosis)
ï† Glycine is not hydroxylated ¢ abundant in fibroblasts ¢ constitutes every third aminoacid in collagen structure
ï† Proline is hydroxylated ïƒ hydroxyproline ¢
ï† Serine, threonine, tyrosine can be phosphorylated post-translationally
ï† Cystathionine synthetase :catalyzes the conversion of homocysteine ïƒ cystathionine ïƒ cystein ¢ if enzyme is deficient ïƒ homocysteine accumulates, is methylated ïƒ methionine ¢ patients with homocystinuria are vulnerable to thrombotic episodes
Genetics “
ï† Fragile X : enlarged testes + mental retardation ¢ expansion of CGG trinucleotide repeat located on X chromosome
ï† Edwards syndrome : trisomy 18 ¢ rocker bottom feet, micrognathia, mental retardation, 2nd and 5th finger over 3rd and 4th , congenital heart disease, death within a month
ï† Patau syndrome : trisomy 13 ¢ mental retardation, cleftlip/palate, polydactyly, rocker bottom feet
ï† Smith Lemli Opitz syndrome :ambiguous genitalia ¢ failure to metabolize 7 dehydrocholesterol to cholesterol ¢ pyloric stenosis ¢ syndactyly
ï† Mosaic in trisomy 21 : 1% of children ¢ some of their cells are normal ¢ these individuals show only a mild expression of the trisomy 21 phenotype
ï† Locus heterogeneity : refers to the situation in which the same phenotype is caused by defects in different genes ¢ commonly seen in syndromes resulting from failures in a complex pathway, such as hearing ¢ - deaf parents produce nomrla hearing children,suggesting that the parents have defects in different genes. The children are heterozygous at both loci and so have normal hearing
ï† Pleiotropy : is observed in retinoblastoma ¢ carriers may develop other cancers such as osteosarcoma ¢ inactivation of Rb suppressor gene in chromosome 13
ï† SXD disorder with 60% penetrance ¢ daughters have 60% chance to be affected
Histology / Cellular Biology “
ï† Major basic protein : found in eosinophils ¢crystalline core of granules in eosinophils ¢destruction of parasites ¢ eosinophils contain also : histaminase, arylsulfatase
ï† Histamine is produced by basophils & mast cells ¢ eosinophil secretes histaminase
ï† Circulating RBC™s : 60 days life span
ï† Peroxisomes : single membrane bound organelles ¢ important in alcohol detoxification & long chain fatty acid metabolism ¢ Degradation of ethanol to acetaldehyde occurs in humans in both peroxisomes & smooth endoplasmic reticulum (P450) ¢ aldehyde dehydrogenase “blocked by disulfiram- occurs in mitochondria
ï† Sialic acid : is a terminal glycosylation product added to proteins (usually those destined for secretion) in the Golgi apparatus
ï† P450 :located in SER ¢in chronic alcoholism ïƒ growth
ï† Spleen : white pulp ïƒ contains collections of lymphocytes arranged around a central artery in a configuration called the periarterial lymphatic sheath (PALS).germinal centers may occur within the sheath in reaction to antigen exposure ¢ red pulp ïƒ consists of splenic cords and splenic sinuses, filters the blood
ï† Ito cells: found in the perisinusoidal space (space of Disse) Ito cells are hepatic adipose cells and provide primary storage site for vitamin A
ï† Kupfeer cells :are found in liver sinusoids and belong to the mononuclear phagocytic system ¢greatly increased function after splenectomy ¢ final breakdown of senili RBC™s
ï† Hemosiderin, a denatured form of ferritin, appears microscopically as yellow brown granules in cytoplasm ¢
ï† Masson™s trichrome is a connective tissue stain ¢ blue :nuclei ¢ green : connective tissue ¢ red :blood
ï† Karyorrhexis : pattern of nuclear degradation ¢ pyknotic nucleus undergoes degradation followed by complete lysis ¢ this pattern is common in neutrophils present in acute inflammation
ï† Liquefactive necrosis :abcess ¢ CNS infarct
Microbiology / Immunology “
ï† Neonate with widespread granulomas = Listeria monocytogenes (granulomatis infantiseptica)
ï† Neisseria gonorrhea transmitted via birth canal ¢ opthalmia neonatorum
ï† Chediak “Higashi : small doses of vitamin C may effectively treat this disorder
ï† Sporothrix schenkii : hyphae with rosettes of conidia : transmission form ¢ unequal budding yeast found in clinical speciment from a patient with sporotrichosis ¢ Rx : KI or itraconazole
ï† Tinea pedis /athlete™s foot :colorless, branching hyphae with cross walls and arthroconidia ¢ rx : topical azole
ï† Malassezia furfur : pityriasis versicolor ¢ short curved hyphae, and round yeasts = œ spapghetti and meatball œ ¢
ï† Common variable immunodeficiency : decreased number of plasma cells ¢ NORMAL number of B-cells ¢ low levels of all antibody classes ¢ lymph node architecture is unaltered in common variable immunodeficiency
ï† Giardia lamblia : infects the small intestine ¢ if biopsy : crescent shaped protozoa ¢ if smear : flagellated organism with face like appearance ¢ prolonged diarrhea ¢ may have low serum IgA ¢ river streams in mountains ïƒ giardia
ï† Entamoeaba histolytica : affects the large intestine ¢ may liver abcess
ï† Scalded skin syndrome : Staphylococcus aureus ¢ exfoliative toxin ¢ splitting of the epidermis at the level of the stratum granulosum, causing global denudation of the skin
ï† Impetigo & post-streptococcal glomerulonephritis : group A b hemolytic streptococci ¢eroded pustules covered by honey colored crusts
ï† IgA deficiency
ome patients with IgG2 deficiency also have IgA deficiency and may develop anaphylaxis if given IgA-containing blood products
ï† C4 deficiency : SLE like syndrome
ï† DiGeorge : tetany (facial muscles first sign ïƒ Chvostek™s sign) ¢absent thymus ¢low set ears recurrent candidal infections
ï† Hyper IgM syndrome : high IgM, low all other classes ¢ helper T cells defect in surface protein CD40L that interacts with CD40 on B-cell surface ¢often form antibodies to neutrophils,platelets, and tissue antigens
ï† Ataxia telangiectasia :prominent telangiectasias around the eyes ¢ AR ¢ chromosomal breakage syndrome ¢ increased number of translocations ¢ chromosome 11 related
ï† Molluscum contagiosum :cytoplasmic inclusions in the epidermal cells are pathognomonic ¢ babies & AIDS ¢ poxvirus
ï† Mycobacterium & Treponema cause chronic meningitis ¢ lymphocytic infiltrate
ï† Enterococcus faecalis : cause UTI™s “often nosocomial & classically in ICU- ¢ do NOT produce nitrites from nitrates ¢
ï† Nitrites + :usually a gram negative organism (enterobacteria) such as Klebsiella, pseudomonas, E.Coli, Enterobacter sp. ¢
ï† Omcogenesis in HPV : cervical intraepithelial neoplasia is associated with HP infection (types 16,18) ¢ produce E6 & E7 proteins inhibiting p53
ï† Progressive multifocal leukoencephalopathy : JC virus (papova virus) ¢ infects oligondendroglial cells in the brain ¢ eosinophilic inclusions ¢ AIDS-defining ¢ only white matter affected
ï† Subacute sclerosing panencephalitis ¢ may follow previous measles infection ¢ gray matter & white are affected ¢ occurs usually before the age of 18
ï† Yersinia pestis & plague : any previously healthy person in the Southwestern US who develops septic shcok or sever pulmonary disease shold be evaluated for plague
ï† Aspergilloma may be formed by tuberculosis, tumor, bronchiectasis ¢ surgically resection ¢antibiotics are ineffective
ï† Syngeneic graft : transfer of tissue between genetically identical individuals (identical twins)
ï† Allograft /homograft : graft between genetically different members of the same species
ï† Xenograft : e.g pig heart valve
ï† C5a & IL 8 most powerful chemotactic factors for neutrophils ¢ LTB4 also
ï† IgG subclass 2 is directed against polysaccharide antigens and is involved in the host defense against encapsulated bacteria
ï† C 3 nephritic factor = IgG autoantibody that binds to C 3 convertase making it resistant to inactivation ¢ persistently low serum complement levels ¢ Type II MPGN
ï† Scalded skin syndrome (Staphylococcus aureus phage II group ) : involves the very superficial squamus cells just beneath the granular layer
ï† Type II hypersensitivity : are mediated by IgG or IgM antibodies to fixed cell bound antigens ¢ this response may lead to cell destruction or cell dysfunction ¢ important in the pathogenesis of transfusion reactions, graft rejection, Graves disease, myasthenia gravis
ï† Type III hypersensitivity :formation of circulating immune complexes ¢ may precipitate in small blood vessels ïƒ fix complement and incite an inflammatory reaction ¢ glomerulonephritis, vasculitides, collagen vascular diseases
ï† Type IV hypersensitivity
ensitized T lymphocytes ¢ either CD4+ (helper) T lympocytes or CD8+ (cytotoxic) T lymphocytes take part in this response ¢ granulomas
ï† IFNγ produced by T1 helper cells instructs macrophages to become epithelioid cells
ï† Aspirin-induced asthma : inhibition of cyclooxygenase/ but not lipooxygenase ïƒ decreased ratio between PG™s (bronchodilators) and leukotrienes (bronchoconstrictors)
ï† Germ tube test :diagnostic test for candida albicans
ï† Cervical exudates ïƒ gram negative diplococci within neutrophils = Neisseria gonorrhea 1000%
ï† Cervical exudates ïƒ gram negative cocci : 1) neisseria gonorrhea 2) acinetobacter (normal flora) ¢ use DNA probe to distinquish
ï† Leptospirosis : abrupt onset of headache (98%) , fever, chills, conjunctivitis, muscle aches, GI symptoms, rash, hypotension ¢ this phase lasts 3-7 days ¢ asymptomatic period ïƒ recurrence of fever & generalized symptoms
ï† Neisseria gonorrhea arthritis : patients are continuously susceptible to reinfection b/c of antigenic variation of the pili
Molecular biology “
Pathology “
ï† Subcortical leukoencephalopathy (Binswanger™s disease) : diffuse loss of deep hemispheric white matter ¢ associated with hypertension ¢ widespread gliosis
ï† Yolk sac tumor a.k.a = infantile embryonal carcinoma/= endodermal sinus tumor : b/c of presence of endodermal sinuses that resemble primitive glomeruli ¢ cytoplasmic granules that contain alpha fetoprotein. ¢ can be used as a serum marker for recurrent disease
ï† Still™s disease : a.ka juvenile rheumatoid arthritis ¢ affects children younger than 16 yrs old , 1-3 yrs of age ¢ female predominance ¢fever, splenomegaly, general lymphadenopathy, leukocytosis ¢ rheumatoid factor is usually negative ¢ if + ïƒ poorer prognosis
ï† Henoch Schonlein purpura : preceded by an URI ¢ vasculitis, arthritis, purpura, GI pain & blood in stool , kidney ïƒ nephritic syndrome
ï† Kawasaki™s disease : fever, conjunctivitis, erosion of oral mucosa, lymphadenopathy, rash , coronary & aortic vasculitis ïƒ death
ï† Fibrinous pericarditis : post MI ¢ loud pericardial friction rub, chest pain,fever, symptoms of CHF
ï† Caseous pericardtitis ïƒ TB
ï† Conn™s syndrome : hyperplasia of zona glomerulosa ¢ hypertension secondary to sodium retention ¢ hypokalemia ¢decreased serum rennin (negative feedback of increased blood pressure on rennin secretion)
ï† Secondary aldosteronism :increased levels of rennin ¢ due to renal ischemia
ï† Dermatitis herpetiformis : associated with celiac sprue ¢ type III hypersensitivity reaction ¢ immunocomplexes igA + complement
ï† Discoid lupus erythematosous : localized cutaneous form of SLE ¢ type III hypersensitivity reaction
ï† Urticaria : IgE mediated ¢ type I hypersensitivity
ï† ASD :prominent right ventricular cardiac impulse ¢ systolic ejection murmur heard in the pulmonic area & along the left sternal border ¢ fixed splitting of the 2nd heart sound
ï† Melasma :irregular patches of hyperpigmentation on the face ¢occurs in pregnancy ¢ may not regress
ï† Primary sclerosing cholangitis : beaded appearance on ERCP of biliary tree ¢
ï† Osteosarcoma : XRay : bone destruction /soft tissue with œsunburst appearance œ / Codman™s triangle (=periostal elevation) ¢ Histo : anaplastic cells with osteoid
ï† Exostoses (=osteochondromas), debaceous cysts, dermoid tumor™s, colonic polyps = Gardner™s
ï† Lymph node structure & disease :
a. Viral infection “ expansion of germinal centers without loss of normal architecture
b. AIDS “ progressive transformation of germinal centers ¢ not paracortical hyperplasia
c. Lymphomas “ destroy the architecture of the lymph node
ï† Complete hydatiform mole : elevated b-hCG ¢grape like cystic structures filling the uterus ¢ no embryo ¢ the genotype of a complete hydatiform mole is purely paternal (XY), caused by fertilization of an egg that has lost its chromosomes ¢ danger : choriocarcinoma
ï† Partial moles : triploidy / tetraploidy ¢ fertilization of an egg with two different sperm ¢ one with X & one with Y
ï† AFP : hepatocellular carcinoma ¢ yolk sac tumors ¢ embryonal tumors in men
ï† Irritable bowel syndrome : alternating constipation / diarrhea ¢ more common in young females ¢ no organic changes are evident
ï† Hypoaldosteronism :decrease in serum sodium increase in serum K+ ¢ retain of H+ ions ïƒ metabolic acidosis with low serum bicarbonate
ï† Bernard Soulier disease : prolonged BT ¢ normal PLT ¢ dysfunction in glycoprotein Ib-IX complex ¢ only treatment in acute emergency : transfusion of PLT™s
ï† Henoch-Schonlein : URI + purpura + abdominal pain + hematuria + child
ï† Cryoprecipitate would help in a case of vWF disease
ï† Hyaline droplets (dark staining droplets ) are found in the epithelium of PCT in cases of proteinuria
ï† Spongiosis : intercellular edema of the epidermis ¢ fluid accumulates between the cells, pulling the apart
ï† Adult form of aortic coarctation
tenosis distal to the left subclavian artery ¢ collateral circulation by intercostal & internal mammary artery ¢notching of inferior margins of ribs ¢
ï† Infantile form of aortic coarctation is associated with patent ductus arteriosus
ï† Aortic stenosis : systolic hypotension throughout the body ¢ recurrent syncope ¢ hypertrophe / dilatation of LV
ï† Takayasu arteritis : a.k.a pulseless disease ¢ vasculitis of the aortic arch and its branches ïƒ stenosis of these arteries ¢ signs & symptoms of ischemia to the upper part of the body ¢ radial pulses are weak/ absent = pulseless disease
ï† Vascular proliferating skin lesions :hemangiomas ¢ Kaposi ¢ bacillary angiomatosis
ï† Malignant mixed mullerian tumor : tumor with 2 components : stromal & epithelial (endometrial glands) ¢ both are malignant but only the epithelial metastizes ¢ stromal component may contain metaplastic components such as cartilage & bone
ï† Endometrial carcinoma is derived form epithelial glandular component of endometrium ¢ abnormal bleeding is the usual presentation ¢
ï† Small parietal lobe abcesses : septic emboli from infective endocarditis
ï† Albinism & associated skin cancer : squamus cell carcinoma (multiple)
ï† Rheumatoid nodules are composed histologically of areas of fibrinoid necrosis surrounded by palisading epithelioid cells
ï† Thalassemia & sickle cell anemia do not usually present until about the 6 months of age ,when fetal hemoglobin production ceases
ï† Celiac disease : limited to proximal small bowel ¢ anti-gliadin antibodies ¢ granular deposits of IgA and C3 in dermal papillary tips ¢ gluten free diet as Rx ¢ tropical sprue affects the entire small bowel ( ETEC infection) ¢
ï† Basal cell carcinoma : œpearly papules on sun exposed skin ¢ almoste never metastize ¢ palisading of the cell nuclei ¢
ï† Resistance to thyroid hormone (Refetoff™s syndrome ): mutation in thyroid hormone receptor gene ¢ affects also the cells in pituitary ïƒ œno negative feedback ïƒ increased plasma TSH ïƒ increase in serum T4
ï† Low T3 syndrome (euthyroid sick syndrome) occurs with certain systemic illnesses such pneumonia or septicemia,afterm major surgery and with malnutrition or starvation ¢ decrease of 5™ monodeiodinase activity ¢ decreased levels of T3
ï† Addison™s disease : decreased secretion of cortisol, aldosterone and adrenal androgens ¢ hypotension may be present b/c arterioles are less responsive to the constrictor effects of catecholamines in the absence of cortisol ¢ hyperkalemia & hyponatremia due to lak of cortisol
ï† Nelson™s syndrome : usually post-adrenalectomy for Cushing ¢ extreme hyperpigmentation due to hypersecretion of ACTH from pituitary adenoma that is no longer being restrained by the supressibve effect of cortisol
ï† Head & neck (particularly nose,nasopharynx and orbit is the most frequent site for embryonal rhabdomyosarcoma ¢ other sites are the genitourinary tract
ï† Hereditary factor XIII deficiency :presentation at birth when the umbilical stump bleeds excessively ¢ factor XIII is necessary to stabilize clot formation ; in its absence clots will rapidly lyse ¢ spontaneous abortion in women is common
ï† Complications of MVP :atrial thrombosis, caclcification, infective endocarditis, emboli to the brain, rupture of chordae, mitral regurgitation,,arrythmias, and premature ventricular contractions
ï† Conn™s syndrome : hypertension, hypernatremia, hypokalemia, low rennin levels, metabolic alkalosis
ï† Vitamin K dependent factors : II (prothrombin), VII, IX, X, C, S ¢ deficiency in protein C would cause thrombosis NOT bleeding ¢ check hemorrhagic skin necrosis by warfarin
ï† Prostatic hyperplasia : periurethral zone
ï† Reye™s syndrome : fatty liver with encephalopathy ¢ Hx : viral illness, severe vomiting, irritability, hepatomegaly, elevation of serum ammonia ¢ aquired mitochondrial abnormality ¢may occur also without exposure to salicylates ¢ esp after influenza and cickenpox ¢ mortality rate 50%
Pharmacology “
ï† DMARDS for RA : MTX ¢ azathiprine ¢ penicillamine ¢hydroxycholroquine ¢ chloroquine ¢ organic gold compounds ¢ sulfasalazine
ï† Glucocorticoids SE : hypocalcemia, fluid retention, hypokalemia, hyperglycemia, hypernatremia , adrenal suppression, muscle weakness & atrophy, gastrtits, Cushingoid state, immunosuppression, hypertension, psychosis , osteoporosis, glaucoma, cataract
ï† N acetylcyteine : mucolytic used in CF to thin mucous ¢splits disulfide linkages between these mucoproteins ïƒ â†“ mucous viscosity
ï† Dextromethorphan is a cough depressant
ï† Pentamidine : used in HIV patients with PCP
ï† Metoclopramide
timulates motility of intestinal tract ¢ contraindicated in patients with bowel obstruction ïƒ danger for perforation
ï† Anticholinergic drugs : may precipitate attacks of narrow angle glaucoma b/c muscarinic receptors on the papillary constrictor muscle of the iris are blocked ¢ TCA™s “ imipramine, amitryptiline, nortriptyline, desipramine, clomipramine,doxepine- can do that !
ï† Decrease of blood levels of a drug : 1 half life ïƒ 50 % ¢ 2 half lifes ïƒ 25 % left in blood ¢ 3 half lifes ïƒ 12,5 % left ¢ 4 half lifes ïƒ 6,25% left in blood ¢ levels decrease by half every half life
ï† Retarded ejaculation : can be improved by admin a SSRI ¢ fluexitine, sertraline,citalopram, paroxetine.
ï† Î²-blockers are used in treatment of hypertrophic cardiomyopathy ¢ β1-blockers : atenolol, betaxolol, esmolol, acebutolol, metoprolol
ï† Bretylium : class III anti-arrythmic ¢ indicated for treatment of ventricular fibrillation and ventricular tachycardia
ï† Digoxin :used in atrial fibrillation ¢ atrial flutter ¢ CHF
ï† Lidocaine : class Ib antiarrythmic ¢ used in Rx of ventricular tachycardia
ï† Ventricular tachycardia : amiodarone ¢ bretylium ¢ lidocaine
ï† Succinylcholine : depolarizing skeletal muscle relaxant ¢ can cause hyperkalemia ¢ PR prolongation , widening of QRS , peaked T waves
ï† Acute interstitial nephritis : caused by ibuprofen, indomethacin, methicillin, cephalothin, sulfonamides,thiazides, furosemide, cimeridine,methyldopa ¢Clinical : ARF ( ↑ BUN, creatinine 0,6-1,2 ) fever, maculopapular rash, EOSINOPHILIA !, periorbital edema, wheezing
ï† Acarbose : delays glucose absoption from GI
ï† Metformin : causes lactic acidosis ¢ increases the binding of insulin to its receptor
ï† Oxybutynin : inhibits muscarinic action on smooth muscle (antimuscarinic action) ¢ Rx for bladder instability “ incontinence, persistent urinary urgency-
ï† Betanechol : used in urinary retention to contraction of detrusor muscle ¢
ï† Gabapentin : used to treat neuropathic pain in diabetic patients ¢ antiepileptic
ï† Primidone : anticonvulsant ¢ has two active metabolites 1) ohenobarbital 2) phenethylmalonamide ¢ associated with cross- hypersensitivity to Phenobarbital
ï† T3 therapy : increases serum T3 levels ¢ but NOT serum T4 b/c T3 is not converted peripherally to T4 ¢ TSH will be low due to feedback inhibition by T3 ¢ decrease of TSH causes also decrease in T4
ï† Salicylate intoxication : dizziness, tinnitus, hearing impairment , nausea, vomiting, hyperventilation , flushing, sweating, metabolic acidosis ¢ agents that acidify urine , such as NH4Cl are known dramatically decrease salicylate excretion and subsequently increase salicylic acid blood levels ¢ Rx : sodium bicarbonate, sodium lactate
ï† Jimson weed contains anti-muscarinic agents ¢ in overdose : agitation,mydriasis, hot dry skin, tachycardia , decreased bowel sounds
ï† Stimulants : best way to differentiate stimulatnt overdose from anticholinergic overdose is the skin ¢ sweaty ïƒ stimulants ¢ dry ïƒ anticholinergics
ï† Opioid intoxication : sleepiness, lethargy, miosis, cool skin , hypoventilation, hypotension, bradycardia, decreased bowel sounds ¢
ï† Cefoperazone : 3rd generation cephalosporin ¢can cause vitamin K deficiency ¢ disulfiram like reaction with alcohol ¢ DOC in people with impaired renal function b/c 60% is eliminated by the biliary route
ï† Ticarcillin : β”lactamase sensitive ¢ causes a large salt load ïƒ salt retention and hypokalemia
ï† Carbidopa blocks a pyridoxal dependent decarboxylase located in the mucosa of the GI tract and in systemic circulation
ï† Heparin is the most common cause of drug induced thrombocytopenia ¢risk for development thrombocytopenia increases as the duration of therapy increases (more than 10days e.g) ¢ no skin necrosis
ï† Warfarin & hemorrhagic skin necrosis : associated protein C deficiency in the patient ¢ presents on 3rd- 10th day of therapy ¢ may lead to necrosis of skin (typically on breast, thighs, and buttocks) ¢ heterozygote carriers for protein C become homozygote when given warfarin in 6~8 hrs when the half life of previously γ-carboxylated protein C disappears.Now the patient is hypercoagulable ¢ warfarin is used for prophylaxis and treatment of thromboembolic complications associated with cardiac valve replacement and atrial fibrillation, as well as the prophylaxis and treatment of venous thrombosis and pulmonary embolism ¢
ï† Aminoglycosides & nonoliguric RF : some patients develop a non-oliguric form of renal failure when treated with aminoglycosides such as gentamycin ¢ elevation of creatinine ¢
ï† Cephalothin/Methicillin interstitial nephritis : fever + rash + acute renal failure + eosinophilia
ï† Central pontine myelinolysis : demyelination affecting the central region of basis pontis ¢ in severe malnourished & dehydrated alcoholics ¢ from rapid correction of hyponatermia
ï† Hydrocarbon exposure ïƒ scrotal carcinoma
ï† Zolpidem : non-benzodiazepine ¢ hypnotic agent
ï† Buspirone : non-benzodiazepine ¢anxiolytic ¢ devoid of sedative ,hypnotic,anticonvulsant and muscle relaxant properties
ï† Obsessive compulsive disorder : clomipramine (TCA) or SSRI (e.g fluexitine)
ï† Nortriptyline ïƒ hyperplrolactinemia (methyl dopa, phenothiazines also)
ï† Diabetic with sulfa allergy : contraindicated sulfonylureas (chlorpropamide, tolbutamide,glyburide,glipizide)
ï† Methamphetamine : indirect- acting agonist ¢ acts inducing dopamine, NE, and 5HT release ¢ dopamine is believed to play an important role in the reward system of the brain and is thought to be a significant factor in the reinforcing effects of stimulants ( area involved in reward system : ventral tegmental area of midbrain to the nucleus accumbens of the forebrain)
ï† Hydrocortisone suppositories : indicated for treatment of distal ulcerative colitis ¢ sulfasalazine is also used in treatment of UC
ï† Metronidazole gold standard for pseudomembranous colitis ¢ vancomycin is another option
ï† Hyoscyamine : anticholinergic ¢ Rx : irritable bowel syndrome ¢ administered before the meal
ï† Prednisone for treatment of acute flare ups of Crohn™s
ï† Megestrol acetate & leuprolide : for prostate cancer ¢ GnRH analogs
ï† Cyclobenzaprine : centrally acting skeletal muscle relaxant ¢ structurally related to tricyclic antidepressants ¢ is has anticholinergic side effects ( blurred vision, urinary retention, constipation,tachycardia etc)
ï† Baclofen :centrally acting skeletal muscle relaxant ¢ inhibition of both monosynaptic and polysynaptic reflexes ¢ indicated for treatment of spasticity resulting from multiple sclerosis or secondary to spinal cord injuries ¢ also Rx for trigeminal neuralgia ¢ fatigue & hypotension
ï† Traveler;s diarrhea Rx : most cases of traveler™s diarrhea are caused by ETEC, Shigella species and Campylobacter jejuni ¢ treat with fluoroquinolones ( ciprofloxacin,ofloxacin, norfloxacin) ¢ TMP/SFX is used for children !
ï† Mebendazole : used for elminths such as Enterobius, Trichuris trichiura, Ascaris lumbricoides
ï† Diabetic with hypertension : ACE inhibitors ¢ ca2+ blockers
ï† Cefazolin & Cefadroxil : 1st generation cephalosporins ¢ used surgical prophylaxis
ï† SIADH & drugs : carbamazapine ¢ vincristine,vinblastine ¢ cyclophosphamide ¢ chlorpropamide ¢ TCA
ï†
Physiology “
ï† Glycoprotein hormones : EPO, LH, FSH, hCG, TSH ¢ bind at cell surface receptors ↑ cAMP levels
ï† Catecholamine hormones : epinephrine, norepinephrine, dopamine
ï† Oligopeptide hormones : endorphins, ADH, oxytocin, TRH, GnRH, SS, CCK, secretin, VIP, GIP
ï† Polypeptide hormones : PTH, calcitonin, insulin, glucagons, pancreatic polypeptide, gastrin, ACTH, IGF™s, EGF, FGF, NGF
ï† Baroreceptor reflex (patient stands up from supine condition) :patient stands up ïƒ less blood to brain ïƒ less firing to baroreceptors ïƒ sympathetic stimulation ïƒ increase in HR, conduction velocity and myocardial contractility ïƒ constriction of all arterioles ïƒ â†‘ TPR ïƒ sympathetic stimulation of renal vasculature ïƒ decrease in renal blood flow ïƒ constriction of large veins ïƒ increases venus return to the heart ïƒ â†‘ preload
ï† Transcutaneous electrical nerve stimulation is a method used to lessen severe,chronic pain by overly stimulating the involved neurons ¢ gate theory of pain
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