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53 Cards in this Set
- Front
- Back
Elastase in the lungs
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-elastase is a neutral protease found in macrophage lysosomes, and in the large azurophil (primary) granules of neutrophils.
-normally, elastase release from infiltrating neutrophils and macrophages is balanced by the anti-elastase activity of serum alpha1 anti-trypsin. -excess elastase activity in the lung acini thought to be major factor in development of centriacinar and panacinar emphysema |
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Type I pneumocytes
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-comprise 95% of epithelial lining of lung
-end-differentiated squamous cells |
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Type II pneumocytes
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-type II pneumocytes secrete phospholipid species, including dipalmitoyl phosphatidlycholine (major components of pulmonary surfactant)
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Clara cells
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-Clara cells = non-ciliated secretory cells of the terminal respiratory epithelium
-secrete clara cell secretory protein (CCSP), which inhibits neutrophil recruitment and activation |
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Ophthalmopathy in Grave's Disease
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-Patient's with Graves disease can have extra-thyroid manifestations, such as infiltrative ophthalmopathy and pretibila myxedema (derm complication due to hypothyroidism)
-infiltrative ophthalmopathy characterized by edema and infiltration of lymphocytes into extra ocular muscles and connective tissue --> inflammation -high-dose glucocorticoids (e.g., prednisone) used to control severe Graves ophthalmopathy --helpful in decreasing severity of inflammation and decreasing extra-ocular volume --vs. conventional anti-thyroid drugs, which are not anti-inflammatory and therefore do not alter the ophthalmopathy |
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Cystic fibrosis inheritance
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CF is an autosomal recessive disease – defective cystic fibrosis transmembrane conductance regulatory (CFTR) gene on chromosome 7
-Probability that an autosomal recessive disease will be transmitted to a child can be calculated based on mom and dad's pedigrees -an unaffected individual with unaffected parents who has a sibling affected by an AR condition has a 2/3 chance of being a carrier for that condition. --because she is not homozygous recessive – so she has to be either homozygous dominant (1/3 chance) or heterozygous (2/3 chance, because mom and dad are both carriers). |
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-Auer rods
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-presence of rod-shaped intracytoplasmic inclusions (Auer rods) is characteristic of many forms of acute myeloblastic leukemia (AML)
-The M3 variant of AML is acute pro-myelocytic leukemia – shows many Auer rods – associated with the cytogenetic abnormality t(15:17) |
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Number needed to harm
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NNH = 1/attributable risk
-to determine attributable risk, first calculate adverse event rates in the treatment and placebo groups --this is equal to adverse events (e.g., deaths) over total subjects in this group -attributable risk difference is equal to overall attributable risk. -1/attributable risk = number needed to harm vs. number needed to treat = 1/absolute risk reduction |
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Fabry disease
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-inherited deficiency of alpha-galactosidase A
-causes accumulation of the globoside ceramide trihexoside in tissues --presentation: "sample of fibroblast cultured from patients skin lesions fibroblasts fail to metabolize ceramide trihexoside." -earliest manifestations are angiokeratomas, hypohidrosis, and acroparesthesia -without enzyme replacement, patients typically develop PROGRESSIVE RENAL FAILURE |
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Schizoaffective disorder
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-Schizoaffective disorder is characterized by symptoms of schizophrenia in presence of prominent mood symptoms
-period of at least 2 weeks of psychotic symptoms in absence of mood symptoms required for diagnosis --sample presentation: mood fluctuation with inappropriate sexual advances, wacko statements (ex-girlfriend communicating with him telepathically), with symptoms for last month. |
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Selective COX-2 inhibitors (Celecoxib) and platelet aggregation
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-Selective COX 2 inhibitors have potent anti-inflammatory effects, WITHOUT the side effects of bleeding and GI ulceration associated with non-selective COX inhibitors.
-selective COX 2 inhibitors do not impair platelet function, because platelet mostly express COX 1 |
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Acute epiglottitis
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-acute epiglottitis is a rapidly progressive infection of epiglottis – leads to severe inflammation and edema of epiglottis and larynx, with potentially acute obstruction of airway, especially during laryngoscopy.
-presentation: rapidly progressing fevere, severe sore throat, drooling, progressive airway obstruction (with stridor) -this illness is most often caused by H. influenza type b, but the Hib vaccine has dropped incidence of this disease considerably. --However, H. influenza type b can still cause disease in unimmunized or improperly immunized patients (and occasionally in fully immunized patients) |
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Host defense against mycobacterial infections
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-defense against mycobacterial infections depends on interactions between macrophages and T cells.
-interferon gamma, a pleoitropic Th1 cytokine, is a key factor in elimination of these infections. --macrophages infected with mycobacteria produce interleukin 12 --> stimulates T cells and natural killer cells to produce IFN-gamma --IFN-gamma then binds to its receptor, leading to receptor dimerization and activation of Janus kinases 1 and 2. --this results in nuclear signaling, via STAT1 and transcription of IFN-gamma-related genes, which promote mycobacterial killing by phagocytes. -IFN-gamma also enhances viral and parasitic resistance, by increasing expression of MHC and intrinsic disease factors |
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Deficiencies in IFN-gamma receptors (AR)
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-autosomal recessive deficiencies in IFN-gamma receptor (or other pathway elements) result in disseminated mycobacterial disease in infancy or early childhood, including disseminated infection by the BCG vaccine strain (for TB) if administered.
-once identified, patients require lifelong treatment with continuous anti-mycobacterial antibiotics |
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Right heart failure without clinically apparent edema
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-right heart failure increases central venous pressure (CVP), which leads to a rise in capillary hydrostatic pressure, net plasma filtration, and interstitial fluid pressure.
-as interstitial fluid pressure increases, so does lymphatic drainage, which can COMPENSATE FOR MODERATE ELEVATIONS IN CVP and prevent development of clinically apparent edema -however, large CVP elevations can overwhelm lymphatic reabsorptive capacity, leading to development of overt edema. |
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Acute vs. chronic mitral regurgitation
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-patients with acute mitral regurg have near-normal left atrial (LA) compliance.
--so they tend to develop marked pulmonary hypertension and pulmonary edema (due to back flow) -vs. patients with chronic mitral regurgitation acquire adaptive increase in left atrial volume and compliance --they are therefore less prone to pulmonary hypertension and edema (won't develop acute pulmonary edema), but they are more prone to atrial fibrillation and mural thromboembolism |
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Pulmonary hypertension due to reactive vasoconstriction in the lungs
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-left ventricular dysfunction can lead to increased pulmonary arterial pressure due to reactive vasoconstriction (secondary to pulmonary venous congestion)
-mech: rise in hydrostatic pressures causes capillary leak and subsequent pulmonary edema --this edema causes alveolar collapse and results in decreased ventilation, which in turn causes hypoxemia --reactive vasoconstriction occurs to shunt blood toward areas where ventilation is less compromised --this results in pulmonary arterial hypertension, with resultant increase in after load (which causes right-sided heart failure). -reactive changes in the pulmonary vasculature (e.g., endothelial dysfunction causing further vasoconstriction) also contribute to pulmonary hypertension |
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Lunate bone
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-can be identified on hand x-ray as the more medial of the two carpal bones that articulate with the radius.
-lunate lies immediately medial to the scaphoid bone "So Long To Pinky, Here Comes The Thumb" Scaphoid, lunate, triquetrium, pisiform hamate, capate, trapezoid, trapezium |
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Deep brachial artery and radial nerve
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-when midshaft of humerus is fractured, there is significant risk or injury to the radial nerve and deep brachial artery (these run together!).
-radial nerve innervates most of the forearm extensors at elbow, and most of hand extensors at the wrist. --"that was a RAD X-games, bro" -radial nerve also innervates extrinsic extensors of the digits (the brachioradialis and supinator muscles), and provides cutaneous sensory innervation to dorsal (back of) hand, forearm, and upper arm. -along with midshaft fractures of the humerus, supracodylar fractures (above elbow) are also associated with injury to brachial artery |
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Ulnar nerve injury
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-ulnar nerve injury classically causes a "claw hand" deformity
-ulnar nerve can be injured either near the medial epicodyle of the humerus, or in Guyon's canal near the HOOK OF THE HAMATE and pisiform bone in the wrist -"U battled Hook in Guyon's canal" |
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FSH in menopause
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-Elevated serum FSH level confirms menopause – can be used if diagnosis is uncertain
-although LH level will also be elevated, this is a later and les spromient phenomenon -menopause is normal event of aging – caused by age-related exhaustion of ovarian follicles -estrogen production in post-menopausal females drops significantly as ovaries becomes less active. -Follicle-stimulating hormone (FSH) levels then increase because of loss of inhibition of estrogen feedback* -absence of menstrual cycles for 6 months with associated hypo-estrogenic symptoms (hot flashes, atrophic vaginitis) is highly suggestive of menopause. -measuring serum FSH is reliable way to confirm --generally FSH levels will be higher than 30 U/L --while LH levels also rise, this occurs later in menopause, making it a less sensitive test than FSH |
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Cross-sectional study
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-in a cross-sectional study, exposure and outcome are measured simultaneously at a certain point of time ("snapshot study")
-vs. other study designs in which a certain time period separates exposure from outcomes measured |
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Tryptase in anaphylaxis
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-anaphylaxis is due to widespread mast cell degranulation
-although histamine is the major effector of anaphylaxis, tryptase is also released in excess --since tryptase is an enzyme relatively specific to mast cells, it is often used as a marker of mast cell activation. |
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Mast cell degranulation (mechanism)
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-degranulation of mast cells is accomplished by cross-linking of multiple membrane-bound IgE antibodies by a specific antigen.
-this results in IgE-Fc receptor aggregation on the mast cell surface, with subsequent degranulation |
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alpha-ketoglutarate dehydrogenase
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-Krebs enzyme
-converts alpha-ketoglutarate to succinyl CoA, and forming one NADH -requires "Tender Loving Care For Nancy" -Thiamine, Lipoic acid, CoA, FAD, NAD+ -Since alpha-ketoglutarate dehydrogenase requires thiamine as a cofactor, giving glucose to thiamine-deficient patients (e.g., alcoholics), will result in Wenicke encephalopathy --Wernicke encephalopathy occurs due to increased thiamine demand --present with acute confusion, opthalmoplegia (intra-ocular muscle weakness), and ataxia |
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Rheumatoid factor
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-RA is an autoimmune disease triggered by an unknown antigen
-cartilage components serve as auto-antigens, activating CD4+ T-cells, which in turn stimulate B-cells to secrete rheumatoid factor. -rheumatoid factor is an IgM antibody specific to the Fc component of self IgG |
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Oranophophate poisoning
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-exposure to certain insecticides can causes organophosphate poisoning
-resultant CHOLINESTERASE INHIBITION is long and profound because organophosphates bind IRREVERSIBLY to cholinesterase -this causes a state of cholinergic excess, marked by excessive salivation, lacrimation, diaphoresis, urinary incontinence, diarrhea, emesis, miosis, and bradycardia -DUMBELSS -defecation, urination, miosis (tiny pupils), bradycardia, emesis, lacrimation, salivation, sweating |
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Atropine
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-atropine is an anti-cholinergic agent
-used pharmacologically to block post-junctional acetylcholine receptors -atropine is the antidote for organophosphate poisoning. -atropine toxicity causes symptoms that are opposite cholinergic effects (constipation, midriasis, dry mouth, etc.) |
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Hepatic steatosis
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-hepatic steatosis is nonspecific condition, characterized by triglyceride accumulation within the hepatocellular cytoplasm
-pathogenesis of alcohol-induced hepatic steatosis appears related mostly to DECREASE IN FREE FATTY ACID OXIDATION, --occurs secondary to excess NADH production by the two major alcohol metabolism enzymes (alcohol dehydrogenase, and aldehyde dehydrogenase) -contributing pathogenetic factors include impaired lipoprotein assembly and secretion, and an increase in peripheral fat breakdown. -fatty tissue will microscopically demonstrate cytoplasmic vacuoles as the lipid is dissolved during histologic processing. -in frozen sections, lipids can be demonstrated by staining with oil red O or Sudan black |
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Lecithinase (alpha toxin)
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-lecithinase (alpha toxin) is the main toxin produced by C. perfringens
-function is to degrade lecithin, a component of cellular phospholipid membranes --> membrane destruction, cell death, and widespread necrosis/hemolysis. |
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Breast cancer drugs
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-Anastrozole: selective inhibitor of aromatase (enzyme that converts androgens to estrogens)
-Ketoconazole: --antifungal agent that decreases androgen synthesis by inhibiting multiple enzyme pathways involved in synthesis of androgens -Trastuzumab --inhibits epidermal growth factor and HER2/neu pathways --> apoptosis of breast cancer cells -vs. activation of the HER2/neu receptor – causes activation of tyrosine kinase |
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Bacillus anthracis virulence factors
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-two main virulence factors of Bacillus anthraces
--anti-phagocytic poly-y-D-glutamic acid capsule --anthrax exotoxin – timeric toxin composed of protective antigen EDEMA FACTOR, and lethal factor -Bacillus anthracis edema factor is an edentate cyclase that causes massive increases in intracellular cAMP --> neutrophil and macrophage dysfunction with tissue edema -this mechanism of action is simlar to that of adenylate cyclase toxin, produced by Bordetella pertussis |
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Diagnosing infection of Treponema pallidum (syphilis)
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-common means of diagnosing infection with Treponema palladium involves screening and confirmatory tests.
-screening tests are known as RPR and VDRL, and confirmatory test is known as the FTA-ABS, which detects for antibodies against Treponema (a spirochete) |
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Listeria monocytogenes
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-Listeria monocytogenes = gram positive rod that produces a very narrow zone of beta-hemolysis on blood agar
--shows tumbling motility --can be cultured at low temperatures (allows bacteria to contaminated refrigerated food) -INTACT CELL MEDIATED IMMUNITY IS ESSENTIAL FOR ELIMINATION of this bacterium from the body --"virus, fungus, listerius" --neonates up to 3 months of age are especially vulnerable, as their cell-mediated immunity is not yet fully developed. --also susceptible are immunocompromised, elderly, and pregnant patients |
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Eosinophil action
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-important for eradicating parasitizing infections (e.g., helminths) from body
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Deficient humoral immunity
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-patients with pure humoral immune defects (e.g., X-linked agammaglobulinemia of Bruton) are at increased risk of bacterial infections by Streptococci and Staphylococci
--but have normal responses to infections combated by cell-mediated immunity (Listeria, viruses, fungi) |
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Mast cell functions
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-mast cells contribute to defense against parasites
-also importnat in allergic responses, esp. hypersensitivity reactions -mast cells don't confer immunity to intracellular pathogens |
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Complement deficiencies
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-Patients with inherited deficiencies of terminal complement components (C5b-C9) are unable to form the membrane attack complex (MAC) and are predisposed to recurrent NEISSERIA infections
"I would complement you on that nice infection, but I can't" |
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Pick's disease
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-rare cause of dementia
-characterized by destruction of frontal lobes (i.e., frontal cortex) -behavioral abnormalities seen – apathy, socially inappropriate behavior -manifests with progressive dementia, behavioral disinhibition, and speech difficulties, including dysarthria (problems with muscles that control speech), aphasia (language problems), echolalia (automatic repetition of words) |
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Diazepam
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-long-acting benzodiazepine
-used as anxiolytic (anxiety drug) --sedative --anticonvulsant --muscle relaxant (can stop spasticity caused by upper motor neuron disorders MS, strokes, spinal cord trauma, as well as tetanus) -Chlorpheniramine – first-generation anti-histamine that causes sedation – should NOT be used with diazepam. |
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Pyelonephritis dx
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-WBC casts are formed in tubules – PATHOGNOMONIC for acute pyelonephritis when accompanied by systemic manifestations of febrile illness.
-WBC casts also seen with acute interstitial nephritis, but clinical presentation is different, as patients have only low-grade fever and do not experience painful urination. -vs. pyuria and bacteruria – non-specific, and found in both upper and lower UTIs |
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6-mercaptopurine degradation
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-6-mercaptopurine is mainly degraded in liver by xanthine oxidase
-allopurinol (an inhibitor of xanthine oxidase) can increase concentration of 6-mercaptopurine significantly -both 6-mercaptopurine and 6-thioguanine are pro-drugs that require activation by HGPRT |
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Malabsorption workup
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-malabsorption = syndrome of impaired intestinal digestion and absorption
-Sudan III stain of stool identifies fecal fat – used to screen for malabsorption -stool sample is appropriate next step in patient with symptoms of malabsoprtion |
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Sodium valproate – use
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-sodium valproate (or just valproate) is drug of choice for patients with absence seizures and associated tonic-clonic seizures
-ethosuximide is also effective against absence seizures, but does not suppress tonic-clonic seizures |
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Verapamil – axn and side effects
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-Verapamil is a calcium channel blocker
-has most effect on heart – nifedipine is most selective for peripheral vasculature – diltiazem has intermediate effect -most frequent adverse reactions seen with verapamil are constipation and gingival hyperplasia -also seen are bradycardia, and AV nodal block (1-2% of patients) |
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Burkitt lymphoma dx
-presentation: African immigrant with rapidly enlarging jaw mass -mass biopsy shows numerous mitotic figures and apoptotic bodies |
-histo: Burkitt lymphoma has a "starry sky" appearance due to presence of macrophages and apoptotic bodies in a "sea" of medium-sized lymphocytes
-rates of mitts and apoptosis in the cancerous tissue are high -almost all cases of Burkitt lymphoma are associated with TRANSLOCATIONS OF THE C-MYC GENE on chromosome 8, usually onto the Ig heavy chain region of chromosome 14 – t(8:14) |
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Polycythemia vera
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-clonal myeloproliferative disease of pluripotent hematopoietic stem cells
-characteristic features: increased RBC mass, increased plasma volume, and LOW erythropoietin levels -most patients with polycythemia vera have the JAK2 V617F mutation --> hematopoietic stem cells more sensitive to growth factors -only red cells are increased, so a better term for the disease is "secondary erythrocytosis" |
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Cholelithiasis in women who are pregnant or using oral contraceptives
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-estrogen-induced cholesterol hypersecretion and progesterone-induced gallbladder bypomotility are responsible for increased incidence of chilelithiasis in women who are pregnant of using oral contraceptives
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Bullous pemphigoid
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-bullous pemphigoid is characterized by auto-antibodies to the HEMIDESMOSOMES along the basement membrane of the dermal-epidermal junction
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Gibbs free energy
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-if free energy of products of a reaction is lower than that of the substrates, the sign of "change in G" will be negative
--this indicates that the reaction FAVORS PRODUCT FORMATION -if free energy of the products is higher than that of the substrates, change in G will be positive --> reaction favors substrate (not product) formation |
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Dietary fructose metabolism
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-dietary fructose is phosphorylated in the liver to F-1-P, then rapidly metabolized because it bypasses PFK-1, the rate-limiting enzyme of glycolysis
-other sugars enter glycolysis BEFORE this rate-limiting step --> metabolized more slowly than fructose due to regulation by PFK-1. |
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Gallstones
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-brown pigment stones typically arise secondary to infection of biliary tract, which results in release of BETA-GLUCURONIDASE by injured hepatocytes and bacteria
-presence of beta-glucouronidase enzyme contributes to hydrolysis of bilirubin glucuronides, thus increasing the amount of unconjugated bilirubin in bile, and predisposing to bilirubin stones. |
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High altitude exposure
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-high altitude exposure that lasts more than a few days will result in hypoxemia, with chronic respiratory alkalosis
-corresponding decrease in serum bicarbonate levels is reflective of renal compensation -sample values: PaO2 = 60 mmHg, PaCO2 = 20 mmHg, Plasma HCO3- = 15 mEq/L |