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What is the DOC for the prevention of venous thrombosis?
- Heparin
- DOC for the prevention of venous thrombosis especially in ppts undergoing hip and knee surgery.
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What is the MOA and use of Argatroban?
- Inhibit thrombin directly
- Use: Heparin-induced thrombocytopenia
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What is the MOA and use of Bivalirudin?
- Inhibit thrombin directly
- Use: Heparin-induced thrombocytopenia
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What is the MOA and use of Dabigatran?
- Inhibit thrombin directly
- Use: Heparin-induced thrombocytopenia
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What is the MOA and use of Lepiridin?
- Inhibit thrombin directly
- Use: Heparin-induced thrombocytopenia
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Which drugs are used in the treatment of Heparin induced thrombocytopenia?
- Argatroban
- Bivalirudin
- Dabigatran
- Lepiridin
- Inhibit thrombin directly
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What is the MOA of Ticlopidine?
Inhibit platelet aggregation by blocking ADP receptors, preventing the expression of glycoproteins IIb/IIIa on platelet surface.
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What is the MOA of Clopidogrel?
Inhibit platelet aggregation by blocking ADP receptors, preventing the expression of glycoproteins IIb/IIIa on platelet surface.
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What causes a Paradoxical embolism?
- Paradoxical embolism occurs when a thrombus from the venous system crosses into the arterial circulation via an abnormal connection between the right and left cardiac chambers e.g
- Patent foramen ovale
- Atrial septal defect
- Ventricular septal defect
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Describe the presentation of a Paradoxical embolism.
Patient with deep venous thrombosis, develops a stroke.
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Hyponatremia/ low serum sodium levels is most commonly associated with pneumonia caused by which microorganism?
Legionella
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What is the most common lab abnormality of Legionella pneumophilia?
Low serum sodium
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What is the pathology seen below?
- Telangiectasia
- -permanent dilatations of superficial capillaries and venules.
- - will BLANCH UNDER PRESSURE because the RBCs present are confined to the vasculature.
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What does the Haemophilus influenzae type b (Hib) vaccine consist of?
PRPP (polyribose-ribitol-phosphate) coupled with diptheria or tetanus toxoid.
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The Hib vaccine consists of PRP capsular polysaccharide conjugated with either tetanus or diptheria toxoid. What is the importance of protein conjugation?
- Increases immunogenicity
- Protein conjugation causes a T-cell mediated immune response leading to immunoglobulin class switching and generation of memory B-lymphocytes.
- The response would not occur with pure polysaccharide.
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Advanced maternal age is a risk factor for having a child with?
Down syndrome
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As a mother, what is the risk factor associated with having a child with Down syndrome?
Advanced maternal age >45 years
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What is the pathology seen below?
- Nuchal fold thickening- Down syndrome
- ⇧amount of fluid around the neck
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What is the pathology seen below? What is it lined with?
- Pancreatic pseudocyst
- Granulation tissue , fibrous
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What lines a pancreatic pseudocyst?
Fibrous and granulation tissue
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Vasculitis 2o to IgA immune complex deposition is characteristic of?
Henoch-Schonlein purpura
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Describe the symptoms of Henoch-Schonlein purpura.
- Skin: palpable purpura on buttocks/ legs
- Althralgias
- GI: abdominal pain
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What is the MOA and use of Propylthiouracil?
- Block thyroid peroxidase
- Inhibit the oxidation of iodide
- '' '' organification (coupling) of iodide.
- Blocks 5' deiodinase → ⇩peripheral conversion of T4 to T3
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This drug blocks 5' deiodinase.
- Propylthiouracil
- Blocks 5' deiodinase which converts T4 to T3
- NOTE: This is unique only to Propylthiouracil
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This drug decreases the peripheral conversion of T4 to T3.
- Propylthiouracil
- Blocks 5' deiodinase which converts T4 to T3
- NOTE: This is unique only to Propylthiouracil
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These drugs are used in the treatment of hyperthyroidism?
- Methimazole
- Propylthiouracil
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Which drug is used in the treatment of hyperthyroidism in pregnancy?
Propylthiouracil
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This drug cannot be used in the treatment of hyperthyroidism during pregnancy because it it teratogenic .
Methimazole- causes aplasia cutis
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What is the difference between Propylthiouracil and Methimazole in terms of their MOA?
- Methimazole + Propylthiouracil:Block thyroid peroxidase
- Inhibit the oxidation of iodide
- '' '' organification (coupling) of iodide.
- Propylthiouracil:
- Blocks 5' deiodinase → ⇩peripheral conversion of T4 to T3
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Patient who has hyperthyroidism undergoes medical therapy on antithyroid medications later present with fever and throat pain. What is the most likely diagnosis and what is the best next step in management of this patient?
- Agranulocytosis - Neutrophils<500mL
- WBC count with differential
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Why is Methimazole contrainidicated in the treatment of hyperthyroidism in pregnant women?
It is a teratogen- causes Aplasia cutis
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This antithyroid medication is known to cause hepatotoxicity.
Propylthiouracil
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When should the first dose of the diptheria-pertussis-tetanus vaccine be administered to infants?
- 2 months of age.
- In areas of endemic disease, this vaccine can be given as early as 4-6 weeks of age, but not earlier.
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How does the lingual nerve innervate the tongue?
The lingual nerve, a branch of the mandibular division of the trigeminal nerve (CN V3) provides sensation (pain, touch, temperature, pressure) to the anterior 2/3 of the tongue.
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This nerve provides sensation (pain, touch, temperature, pressure) to the anterior 2/3 of the tongue.
Lingual/ mandibular branch of the trigeminal nerve (CNV3)
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What innervates the palatoglossus muscle of the tongue?
Vagus nerve CN 10
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What is the action of glitazones?
⇧insulin sensitivity by binding to peroxisome proliferator activated receptor gamma (PPAR-gamma)
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What is the action of Pioglitazone?
⇧insulin sensitivity by binding to peroxisome proliferator activated receptor gamma (PPAR-gamma)
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What is the action of Rosiglitazone?
⇧insulin sensitivity by binding to peroxisome proliferator activated receptor gamma (PPAR-gamma)
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What is the action of Thiazolinediones?
⇧insulin sensitivity by binding to peroxisome proliferator activated receptor gamma (PPAR-gamma)
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These drugs increase insulin sensitivity by binding to peroxisome proliferator activated receptor gamma (PPAR-gamma).
- Glitazones/ Thiazolinediones
- Pioglitazone
- Rosiglitazone
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What are the side effects of Glitazones?
- Weight gain, edema
- Hepatotoxicity
- Heart failure
- ⇧risk of fractures
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Fluid retention, with resultant weight gain and edema, is common side effect of which diabetes drug?
Glitazones- weight gain and edema
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Lactic acidosis is a common complication of which diabetes drug?
Metformin
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What cellular receptor does the cytomegalovirus bind to?
Cellular intergrins
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Which cellular receptors does the Epstein-Barr virus bind to upon infection?
CD2/ CD21- B cells
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Which cellular receptors does the Rabies virus bind to upon infection?
Nicotinic acetylcholine receptor
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What cellular receptor does the Rhinovirus bind to upon infection?
ICAM1 (CD54)
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Label the diagram below.
- 1. Mital valve opens
- 2. Ventricular filling
- 3. Mitral valve closes
- 4. Isovolumetric contraction
- 5. Aortic valve opens
- 6. Ventricular ejection
- 7. Aortic valve closes
- 8. Isovolumetric relaxation
- 9. Stroke volume
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What does a change in the dashed line below mean? What can cause such a change?
- ⇧ ventricular PRELOAD.
- The rightward shift of the ventricular filling indicates a larger than normal volume is being placed into the ventricule during diastole.
- This can occur during any state of fluid overload:
- Renal failure
- Congestive heart failure
- Infusion of intravenous fluids- e.g. normal saline infusion
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What does a change in the dashed line below mean? What can cause such a change?
- Increased contractility
- e.g. Dobutamine infusion
- Higher pressures would be reached during the ventricular ejection phase and a greater volume of blood would be ejected during contraction.
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What does a change in the dashed line below mean? What can cause such a change?
- Increased afterload
- E.g Clamping of aorta
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Where are astrocytes derived from?
Neurectoderm
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Where are microglia derived from?
Monocytes in the bone marrow
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Where are oligodendrocytes derived from?
Neurectoderm
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Small elongated nuclei, many short branching processes are characteristic of which neuroglia?
Microglia
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Small round dark nuclei surrounded by pale halo are characteristic of which neuroglia?
Oligodendrocytes
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Person undergoes neuronal shrinkage and intense cytoplasmic eosinophilia. If the person survives, what would the area demonstrate?
Glial hyperplasia- proliferation of astrocytes in an area of neuron degeneration is called gliosis.
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What are the side effects of Spironolactone?
- Hyperkalemia
- Gynecomastia
- Decreased libido
- Impotence
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What are the side effects of Triamterene?
- Hyperkalemia
- Nausea, vomiting, dizziness
- Leg cramps
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What is the role of platelets in the pathogenesis of Atherosclerosis?
- Platelet-derived growth factor (PDGF) is released by locally adherent platelets, dysfuncitonal endothelial cells and macrophages to promote migration of SMOOTH MUSCLE CELLS.
- Platelets also release TGF-B which is chemotactic for smooth mucle cells and induces collagen production
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In the pathogenesis of atherosclerosis, what causes migration of smooth muscle cells from the media into the intima?
-
Infection with this microorganism occurs via the inhalation of spores that commonly contaminate animal hides.
Coxiella burnetti- Q fever
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What are the actions and use of Dobutamine?
- β1>β2, α
- ⇧Cardiac output (Inotropic > Chronotropic)
- USE: Heart failure, cardiac stress testing
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What is the action and use of Norepinephrine?
- α1>α2>β1
- Use: Hypotension (but ⇩renal perfusion)
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What is the DOC for the treatment of anaphylaxis?
Epinephrine
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Consecutive readings of a patients blood pressure are 75, 110, 80, 90, 75 and 110 mmHg. Calculate the median.
- Step 1: Arrange in order: 75 75 80 90 110 110
- Step 2: Cancel off one at each end until you get to the middle: 75 75 80 90 110 110
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What causes Beta thalassemia?
- POINT MUTATIONS in:
- Splice sites- abberent splicing of pre-mRNA
- Promotor sequences- premature chain termination during mRNA translation
-
This is the most common thalassemia in patients of Meditteranean descent.
Beta-thalassemia
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What does immunizaton with diptheria toxoid induce?
Production of circulating IgG against the exotoxin B subunit, effectively preventing the disease.
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What is status epilepticus?
- Recurrent/ continuous generalized tonic-clonic seizures that last more than 30 minutes, without a return to consciousness.
- Violent shaking
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What are the first-line drugs for management of status epilepticus?
- Benzodiazepines (Lorazepam, Diazepam)*more rapid onset of action
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How do we treat Status epilepticus?
- 1st step: Benzodiazepines (Diazepam, lorazepam)
- 2nd step: Simultaneously load with Phenytoin (to prevent recurrence of seizures.
- If still seizing- start phenobarbital.
- Still seizing- intubate and give general anesthesia.
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This epilepsy drug blocks outgoing K+ current on multiple levels.
Valproic acid
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This epilepsy drug blocks NMDA receptors.
Valproic acid
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