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73 Cards in this Set
- Front
- Back
- 3rd side (hint)
Chemotherapy associated with tingling of hands and feet
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Vincristine (or any of vinca alkaloids)
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Draw the cancer cell cycle and describe the events that occur and where certain drugs act.
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Disseminated Intravascular Coagulopathy:
Pathophys |
Complication of gram-negative bacterial sepsis, acute pancreatitis, and burn injury
In gram-neg sepsis, results from activation of coagulation cascade by bacterial endotoxina, causing formation of microemboli Lab tests will show prolonged PT, PTT, dec'd fibrinogen, factors V and VIII |
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Describe the effect of epinephrine, phenylephrine, and dopamine (low dose) on:
SBP DBP HR Contractility Renal Blood Flow |
Remember: D1 receptors in renal and mesenteric vasculature cause vasodilation and inc'd blood flow.
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How does low dose dopamine differ in its effects from high dose dopamine?
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Low Dose: Only activates beta-1 and D1 receptors (D1 inc vasodilation to kidneys)
High Dose: Act on alpha-1 receptors-->can cause generalized vasoconstriction! |
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19 year-old female
Recurrent otitis media s/p MVA Blood transfusion with O negative PRBCs Patient develops diffuse itching, rash, bronchospasm Diagnosis, Pathophys What happened? |
Patient has selective IgA deficiency; thought to occur due to failure of B cells to switch from IgM to IgA. Infections due to encapsulated bacteria (SHiN). May also see recurrent GI infections.
Patients with selective IgA deficiency often form IgG ab's directed against IgA (anti-IgA antibodies); when transfused w/blood or blood products containing small amts of IgA, pts may develop ANAPHYLAXIS. |
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Carbon tetracholoride poisoning:
Molecular pathophys |
CCl4 oxidized by P450 of liver
Becomes free radical CCl3 and induces lipid degradation and H2O2 formation (LIPID PEROXIDATION) Results in hepatocyte necrosis |
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What are the GI and CNS effects of somatostatin?
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CNS: dec'd release of GH
GI: dec'd release of CCK (***gallstone alert***), glucagon, insulin, gastrin |
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What role does metalloproteinase play in determining the likelihood that atheroma would rupture?
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Plaque stability depends on mechanical strength of fibrous cap.
Inflammatory macrophages in intima may reduce plaque stability by secreting metalloproteinases, which degrade collagen (remodeling of fibrous cap) |
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23 year-old male
2 day history of fever, HA, confusion Bilateral hemorrhagic necrosis of temporal lobes Diagnosis What other symptoms would you expect ot see? |
HSV-1 encephalitis
Would also see aphasia, olfactory hallucination, and personality changes (amygdala involvement) |
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Endogenous compound that binds mu receptors after noxious stimuli
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beta-endorphin
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A
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What compounds share a molecular origin with beta-endorphin?
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Beta-endorphin is derived from POMC, so it's also related to ACTH and MSH
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2 year-old male
Urine turns black on way to laboratory Diagnosis Biochemical pathophys |
Alkaptonuria
Accumulation of homogentisic acid in urine imparts black color after undergoing oxidation. |
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What would be the effect of dobutamine infusion on a pressure-volume loop?
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What would be the effect of clamping the abdominal aorta on a pressure-volume loop?
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What would be the effect of loss of contracting myocardial mass on a pressure-volume loop?
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What would be the effect of normal saline infusion on a pressure-volume loop?
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Inc'd ventricular preload. Rightward shift of ventricular filling portion of graph indicates a larger than normal volume is being placed into ventricle during diastole. Can occur during any state of fluid overload (renal failure, CHF, infusion of IV fluids)
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Lithium:
Side Effects What tests must be ordered periodically? |
Hypothyroidism
Nephrogenic Diabetes Insipidus Need to order TSH and renal function (lithium is exclusively excreted by the kidneys!) Also it's a teratogen and can cause Ebstein's anomaly. |
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2 year-old male
Cherry red macular spot Foamy histiocytes |
Sphingomyelinase deficiency (Niemann-Pick)
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Temporal bone fracture
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Epidural hematoma due to tear of Middle Meningeal Artery
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Describe the following for epidural hematomas, subdural hematomas, and subarachnoid hemorrhages:
Blood vessel involved Location of bleeding (between which structures) Clinical manifestation Presentation on CT scan |
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Describe the steps required for eosinophils to be targeted against schistosomiasis.
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When parasite enters bloodstream, it is bound by free IgE
Resultant Ag-Ab complex binds IgE Fc receptor (on heavy chain) of eosiniophil On binding, eosinophil releases MBP and other granules to destroy parasite This is an example of antigen-dependent cellular cytotoxicity. |
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What cells employ antibody-dependent cellular cytotoxicity?
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Eosinophils
Macrophages NK Cells |
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How does eosinophils regulate Type I hypersensitivity reaction?
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Eosinophilic granules contain histaminase, an enzyme that degrades histamine (helps reduce severity of atopic symptoms).
Also contain leukotrienes and peroxidases that facilitate inflammn. |
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What steps are required for immediate hypersensitivity reactions?
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Antigen/Allergen-binding of more than one membrane-bound IgE (antibody crosslinking)
This stimulates degranulation of MAST CELLS and BASOPHILS, which release histamine, bradykinin. |
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Which staph is associated with prosthetic valves and joints?
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S. epidermidis
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This staph strain is sensitive to novobiocin.
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S. epidermidis
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Pharyngitis
Conjunctivitis Cervical LAD Cause |
Adenovirus
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Croup
Virus and class |
Parainfluenza of paramyxoviridae
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Caliciviridae:
Example and its presentation |
Norwalk virus--epidemic outbreaks of viral gastroenteritis
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Drunk driver starts lecturing against drunk driving.
Coping mechanism? |
Reaction formation
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When thinking about harming someone, patient is suddenly nice to that person.
Coping mechanism? |
Undoing
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Describe the following for epidural hematomas, subdural hematomas, and subarachnoid hemorrhages:
Blood vessel involved Location of bleeding (between which structures) Clinical manifestation Presentation on CT scan |
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Describe the clotting cascade and include where certain anti-platelet drugs act.
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Note: ADP and TXA are released once platelets have become activated. They act to activate other platelets.
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28 year-old male
Experiences fever, muscle rigidity after major surgery Skin is mottled Diagnosis Pathophys Lab values Treatment |
Malignant hyperthermia syndrome
Ryanodine receptors are calcium channels on surface of sarcoplasmic reticulum in skeletal muscle They release small amts of calcium in cytoplasm of muscle fiber during contraction Abnormal ryanodine receptors release large amounts of Ca after exposure to anesthetic. Excess free Ca2+ in cytoplasm of muscle fibers stimulates ATP-dependent uptake by sarcoplasmic reticulum. Excessive consumption of ATP generates heat; loss of ATP along with high temperature induces muscle damage. Rhabdomyolysis leads to release of K+, myoglobin, and creatine kinase. Treat with DANTROLENE to block ryanodine receptors and prevent release of Ca into cytoplasm. |
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Target cells:
Associated with liver disease, thalassemia, Fe def anemia |
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alpha- vs beta-thalassemia:
Populations affected Pathophys |
alpha-thalassemia: Southeast Asians
beta-thalassemia: Mediterranean Mutations result in defective mRNA processing leading to deficiency of certain protein chains required for hemoglobin synthesis. Beta-thalassemia minor is typically asyx. |
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Hgb 10.0 mg/dL
MCV 70 fl HbF 5% |
Microcytic anemia with elevated HbF-->Thalassemia
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What are the forms of amyloid deposits in the brain (in AD)?
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Amyloid deposits:
Senile plaques (core = beta-amyloid) Amyloid angiopathy: damage media and adventitia of cerebral vessels; cause thickening of basal membrane, stenosis of lumen Note that these can e seen in brains of healthy elderly individuals. |
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What drug should be given after SAH?
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Calcium channel blockers
Namely nimodipine (cerebral selective drug) Note: SAH is due to vasospasm, so due to an unknown mechanism, CCB helps. |
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This nerve courses between the biceps and coracobrachialis.
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MCN
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This nerve courses between the flexor carpi ulnaris and flexor digitorum profundus.
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Ulnar
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This nerve courses between the digitorum superficilais and flexor digitorum profundus.
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Median
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This nerve courses between the olecranon and the medial epicondyle of the humerus.
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Ulnar
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This nerve courses between the supinator and head of the radius.
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Radial
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What are the categories of antimetabolites? Which drug goes in each category?
Drug of choice for CLL? HCL? |
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This antimetabolite is resistant to degradation by adenosine deminase.
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Cladribine (drug of choice for Hairy Cell Luekemia)
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Giardia
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Which organisms can cause infection with as few as 1 cell?
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Giardia lamblia
Entamoeba histolytica |
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Which organisms can cause infection with as few as 10 cells?
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Shigella flexneri
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Which organisms can cause infection with as few as 500 organisms?
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Campylobacter jejuni
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45 year-old female
Point tenderness above scapular spine, lateral epicondyle, medial fat pad of knee, bilaterally Diagnosis |
Fibromyalgia
Mech UNK, likely heightened pain sensitivity or pain misperception |
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Morning stiffness of neck, shoulder, pelvic girdle
Weight loss Fever Elevated ESR |
Polymyalgia rheumatica
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What musculoskeletal disorder is associated with temporal arteritis?
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Polymyalgia rheumatica
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How does PTH increase bone resorption?
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Causes osteoblasts to increase production of RANK-ligand and Monocyte CSF (stimulate osteoclastic precursors to differentiate into bone-resorbing, mature osteoclasts)
Also decreases release of osteoprotegrin (decoy receptor for RANK0L) |
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35 year-old male
Generalized motion restriction, shaking of righ thand Admitted to hospital three weeks ago after hearing voices Diagnosis Treatment |
Was likely given a DA antagonist for psychosis-->drug-induced Parkinsonism
Tx: Ach-blocking drugs such as benztropine |
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When are levodopa and bromocriptine contraindicated in treatment of Parksinson's?
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When it's drug-induced!
Drug-induced PD likely due to DA antagonists (bc of psychoses); giving Levodopa or Bromocriptine will increase DA activity and may precipitate psychosis. |
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Why don't women lactate during pregnancy?
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high circulating levels of E and PG prevent lactogenesis (via PL) while also promoting breast growth.
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CEA
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colorectal cancers
pancreatic cancers |
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CA 19-9
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Pancreatic cancer
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Serum-AFP
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HCC
Nonseminomatous germ cell tumor (Yolk cell tumor) |
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CA-125
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Ovarian epithelial tumor
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What cells utilize bisphosphoglycerate mutase?
Why? |
Erythrocytes
Bigphosphoglycerate mutase converts 1,3-Bisphosphoglycerate to 2,-3-bisophosphoglycerate (2,3-DPG) This enables RBCs to increase O2 delivery to peripheral tissues in presence of lower blood O2 [ ]. Produces no net ATP. Remember: RBCs don't have mitochondria and can't regenerate energy from citric acid cycle. Use an alternate glycolytic pathway. |
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What is Horner's syndrome?
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Ipsilateral ptosis, miosis, anhydrosis (lack of sweating)
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69 year-old male
Smoker Recent hemoptysis Weakness of right hand Pain beneath right scapula and in right arm Diagnosis Pathophys |
Hemoptysis in elderly smoker-->Bronchogenic carcinoma
Tumor arises in SUPERIOR SULCUS and can invade multiple neck structures, causing: ipsilateral Horner's (ptosis, anhydrosis, miosis) Rib destruction Atrophy of hand muscles Pain in distribution of C8, T1, T2 Hand atrophy |
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Tumor arising in superior sulcus
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Pancoast Tumor
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54 year-old male
Difficulty rising from a chair Diagnosed with lung cancer Increase in muscle response on repetitive motor nerve stimulation Diagnosis Pathophys |
Lambert-Eaton Syndrome:
Due to antibodies attacking pre-synaptic calcium channels |
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Compare myasthenia gravis with Lambert-Eaton syndrome in terms of:
Symptoms Associations/Risks Pathophysiology Tensilon test results Nerve stimulation studies |
Note: Tensilon inhibits breakdown of ACh.
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Diagnosis
Complications |
Multiple linear, striated areas within medullary pyramids reminiscent of a paintbrush-->Medullary Sponge Kidney
Unknown mechanism, BUT patients are at risk of KIDNEY STONES. |
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Diagnosis
Pathophys Complications |
Myxomatous changes in media of large arteries = CYSTIC MEDIAL DEGENERATION
Note basket weave pattern of elastic fibers and separation of elastic and fibromuscular components by cleft-like spaces filled with ECM (arrow) This is associated with Marfan's and predisposes patients to aortic aneurysm. |
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Myxomatous changes of arteries
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Cystic medial degeneration-->AORTIC ANEURYSM (just like in Marfan's)
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Beginning with normal epithelium and ending with adenocarcinoma, list the steps and associated mutations in development of colon cancer.
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Normal epithelium
MUTATION TO APC Early adenoma MUTATION TO K-RAS (increasing size of polyp due to unregulated cell growth) MUTATION TO P53 AND DCC Adenocarcinoma (malignant transformation requires these two genes to be mutated!) |
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26 year-old male
Pleuritic chest pain Sharp pain in back and neck What nerve allows for this? |
Phrenic
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Which leukotriene stimulates neutrophil migration?
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Leukotriene B4
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