UWorld: 5-9

Acute stress:
-Shock
-Burns
-Sepsis
-Trauma
-Intracranial injury (head trauma in MVA)

Likely due to impaired oxygenation

Curling: Ulcers in proximal duodenum in assocn with severe trauma/burns

Cushing: Ulcers arising in esophagus, stomach, duodenum in pts w/high intracranial pressure (very prone to perforation)

Sickle Cell
Dactylitis (painful swelling of hands/feet) due to vasoocclusion of small bone/BM

Hemolysis of sickle cell results in:
-elevated indirect bilirubin
-elevated Lactate DH
-Decrease in HAPTOGLOBIN (bc binds free Hgb)

Sickle Cell-->autosplenectomy

Risk of infection with encapsulated bacteria

Cholinesterase inhibitor

NMDA receptor antagonist--used in AD (overstimuln of glutamate may contribute to AD syx)

Antioxidant properties are protective

Vitamin E = alpha-tocopherol

Used when suspicion of interruption in HPA feedback loop.

Metyrapone blocks cortisol synthesis by 11-beta hydroxylase (11-b-deoxycortisol-->cortisol)

This should stimulate ACTH secretion, which would signal the adrenal gland to make cortisol.

Since cortisol production blocked, would expect increased 11-deoxycortisol (measured as 17-hydroxy-corticosteroids in urine)

Elevated 17-hydroxy-corticosteroid secretion indicates a normal HPA axis.

Cortisol binds steroid receptor in cytosol, steroid/hormone receptor complex enter nucleus. Increases transcription of enzymes involved in gluconeogenesis (formation of glucose from fat and protein)

Tyrosine kinase on CELL SURFACE

Growth hormone binds membrane-bound receptor

Activates JAK kinase-->STAT activation

Increases gluconeogenesis by increasing lipolysis and gluconeogenesis in liver.

Epi/NE binds membrane-bound, G-protein-coupled receptors.

-->cAMP, Phospholipase C-->Inositol Triphosphate, Diacylglycerol

Leads to inc'd glycogeneolysis

JUST LIKE GLUCAGON!!

Cannot release patient until he/she is sober.

Patients who are temporarily incapacitates should not be allowed to make important health care decisions.

aa-tRNA synthetase mediates attachment of amino acid to 3' end of tRNA

Each aa/tRNA pair has a specific AA-tRNA synthetase

Leucine will be incorrectly incorporated into polypeptide chain in proline's place

No amino acid proofreading during protein translation

Hydrocele

During embryogenesis, testis descends through inguinal canal
Draws diverticulum of peritoneum into scrotum during descent (diverticulum = PROCESSUS VAGINALIS)

Communication between processus vaginalis and peritoneum obliterated, and tissue covering testis/epididymis now known as TUNICA VAGINALIS

Congenital hydrocele results when processus vaginalis remains patent, allowing fluid rom peritoneum to accumulate in scrotum.

ADPKD:
Manifests later in life. Microscopic cysts present at birth, but are too small to be detected by abdominal u/s. Over the years, cysts enlarge and compress renal parenchyma.

ARPKD: presents at birth or during first years with b/l flank masses. Detected by u/s.

Intimal tear

Free ribosomes: exist in cytoplasm, synthesize cytosolic proteins, proteins needed by organelles

Bound ribosomes (in RER)--synthesize secretory, membrane-bound, and lysosomal proteins.

RER: synthesize secretory, membrane-bound, lysosomal proteins. Subsequent modification, folding, transfer.

SER: lacks surface ribosomes; functions in lipid synthesis, carbohydrate metabolism, detoxification

End-stage interstitial lung disease like pulmonary fibrosis, hyaline membrane dz

Pulmonary embolism

GFR/RPF

Dehydration leads to decreased renal plasma flow (RPF)
Decreased glomerular filtration rate (GFR)

Compensatory activation of renin-Ag mechanism leas to constriction of efferent arteriole (outgoing) to maintain GFR

FF, which is equal to GFR/RPF, will increase because RPF drops proportionately more than GFR due to aforementioned compensatory mechanism.

300!! not 100!!!

Macula Densa (right before DCT)

Systemic HTN
If prolonged-->pulmonary HTN and RHF

HIV viral outer envelope protein gp120 binds CD4 and CCR55 (a chemokine receptor).

If cells do not express CCR5 on membrane, HIV binds CD4 but is unable to enter cell.

Deletion of both alleles of genes encoding CCR5 (homozygous CCR5 deletion) renders individual resistant to HIV infection. If heterozygous, can be infected with HIV, but develop syx later than pts w/2 copies of CCR5 gene.

Mycoplasma pneumoniae has no peptidoglycan wall; only has phospholipid bilayer cell membrane.

Shares antigens with human RBCs and when body mounts response against Ag's, also lyses RBCs, leading to anemia.

Antibodies causing RBC destruction = COLD AGGLUTININS

Sulfonamides
Anti-Malarial agents

Lepromin skin test will be positive in patients with tuberculoid leprosy because they exhibit a strong CD4+ Th1 cell-mediated response to M. leprae

Lepromatous leprosy characterized by weak cell-mediated response; lepromin skin test usually nonreactive in patients with lepromatous leprosy because of weak cell-mediated response. Patients look like lepers w/leonine facies or loss of fingers.

Zidovudine (a retroviral reverse transcriptase inhibitor) during pregnancy

Congenital rubella syndrome

White pupils = cataracts

Prophylaxis:
Live attenuated vaccine of children at 12-15 mos, and again at 4-6 years of age

Live attenuated vaccine of non-pregnant women of childbearing age

Remember: you don't know mom's phenotype, so have to do some extra work:

Mom has 2/3 chance of being a carrier.

Considering that, the child has a 1/3 chance (2/3 * 1/2)

Need 1 bassal long-acting insulin and 1 short-acting insulin to cover post-prandial hyperglycemia.

best basal, long-acting = glargine insulin (Lantus)--1 shot per day

(before this NPH was the best option, but required 2 shots per day)

Best short-acting insulin = aspart and lispro--VERY RAPID ONSET; 3 shots at mealtime

(Before this had regular insulin)

Anticonvulsant; works by inhibiting sodium channels

AE: LIFE THREATENING RASH IN CHILDREN

TiaGABine
Anticonvulsant; inhibits GABA uptake

Anticonvulsant; Increases brain GABA concentration

Blocks Na channels and enhances effect of GABA

Sample size

Second study likely has smaller sample size (dec'd power)

PSVT (drug of choice!)

Rapidly cleared; half life of less than 10 seconds

AE: chest burning (bronchospasm), flushing, high grade block

Note: Used for chemical stress tests!

DNA-dependent RNA polymerase that incorporates short RNA primers into replicating DNA

USES URACIL!!!

DNA polymerase then uses the RNA primer (3' end) as starting point for synthesis. Needs this primer to start!

Unwinds DNA at replication fork

DNA Polymerase I:
synthesizes DNA strands 5'-->3'; 5'-->3' and 3'-->5' exonuclease activity (former for RNA primers and damaged DNA; latter for mismatched nucleotides in daughter strand)

DNA Polymerase III: Synthesizes DNA 5'-->3', has 3'-->5' exonuclease activity to fix mismatched nucleotides in newly formed daughter strands

Joins ssDNA fragments during DNA replication and repair

IV pyelogram shows kidney joined at lower poles-->HORSESHOE KIDNEY

When fusion of lower or upper poles of kidney occurs, central part (isthmus) gets trapped by the IMA during ascent.

No, left kidney is slightly lower than right kidney.

High free fatty acids and triglycerides induces insulin resistance and decrease insulin secretion.

Thoracocentesis should be performed ABOVE 7th rib, midclavicular line, the 9th rib midaxillary line, 11th rib posterior scapular line.

Insertion of needle BELOW a rib risks injuring intercostal nerve, artery, vein.

Insertion of needle at 10th rib, midaxillary line risks puncturing the liver.

Insertion of needle any rib above 7/10/11 guidelines risks puncturing the lung.

DM II

Due to islet amyloid polypeptide secreted by beta cells (IAPP).

Constrictive pericarditis (note pericardium is filled with thick fibrous shell)-->leads to heart failure by restricting ventricular filling

PRODUCES KUSSMAUL'S SIGN--paradoxical rise in height of JV pressure during INSPIRATION.

Rapid diastolic ventricular filling w/large volume of blood. (ventricular volume overload)

And/or when there's reduced ventricular compliance (diastolic dysfunction)

BM replaced by fat cells and fibrous stroma

Note: No splenomegaly present!

Myopathy
Rhabdomyolysis (rapid breakdown of skeletal muscle)-->kidney failure

CYP450 INHIBITORS (PICK EGS)

Watershed infarct occur between zones of perfusion of anterior and middle cerebral arteries.

They appear as WEDGE-SHAPED areas of necrosis on surface of cerebral convexities, lateral to interhemispheric fissure.

Occur in global cerebral ischemia, or ischemic-hypoxic encephalopathy (not due to a single thrombus).

Anorexia nervosa

Low body fat means lose cyclic LH surge, thus:
Dec'd LH
Dec'd FSH
Dec'd Estradiol