Flashcards in 7 Deck (65)
How many half-lives does it take for a drug infused at a constant rate to reach 94% of steady state? What variables determine the half-life of a drug? (FA15 p243) (FA16 p237)
about 3.3 half-lives (90%, 4-5 to reach steady state)
2 half lives: 75%
half life (t1/2) = (0.7 x Vd)/CL
-volume distribution and clearance
Describe the anatomical layers of the penis
deep (Buck's) fascia
2 corpora cavernosa (dorsal/top)
1 corpus spongiosum (ventral/bottom) -urethra inside
What is the mechanism of action of penicillin? Is it a bacteriostatic or bactericidal antibiotic? (FA15 p180) (FA16 p170)
bacteriocidal, binds PBPs (PCN binding proteins) and blocks cell wall synthesis via inhibiting PTG cross-linking
What is the adult remnant of each of the following fetal structures? (FA15 p271, 569) (FA16 p264, 573)
￼Processus vaginalis (male)
Gubernaculum (female): round ligament of uterus + ovarian ligament
￼Processus vaginalis (male): tunica vaginalis
Foramen ovale: fossa ovalis
￼Notochord: Nucleus pulposus
A 37-year-old patient with refractory peptic ulcer disease undergoes an esophagogastric duodenoscopy (EGD). Biopsies of the duodenum reveal hypertrophied submucosal glands. What are these glands? What are Peyer’s patches? How can these structures help you identify the location from which a histological specimen was taken? (FA15 p345, 360, 356) (FA16 p341, 357, 352)
Brunner glands (HCO3−-secreting cells of submucosa) (*duodenum*) :hypertrophy implies PUD, etc.
Peyer patches (lymphoid aggregates in lamina propria, submucosa) (*ileum*), MALT
A person eating fugu sashimi in Japan is at risk for what toxicity? What is the mechanism of this toxicity? (FA15 p252) (FA16 p250)
Highly potent toxin that binds fast voltage-gated Na+ channels in cardiac and nerve tissue, preventing depolarization (blocks action potential without changing resting potential).
Causes nausea, diarrhea, paresthesias, weakness, dizziness, loss of reflexes. severe: coma, respiratory arrest, CV collapse
You are performing a well-child examination on a 4-year-old girl. The patient was recently adopted after being removed from the biological mother for abandonment. What changes might you see in your evaluation? What are the effects seen in an infant when there is long-term deprivation of affection? (FA15 p506) (FA16 p510)
Long-term deprivation of affection results in: Failure to thrive, Poor language/socialization skills, Lack of basic trust, Anaclitic depression (infant withdrawn/ unresponsive)
The 4 W’s: Weak, Wordless, Wanting (socially), Wary.
Deprivation for more than 6 months can lead to irreversible changes.
Severe deprivation can result in infant death.
-malnutrition and hygiene/dental issues
Which antifungal drugs cause gynecomastia and by what mechanism? Which diuretic drug causes gynecomastia and by what mechanism? (FA15 p191, 554) (FA16 p182, 558)
ketoconazole: inhibition of testosterone synthesis via inhibiting desmolase (cholesterol-->pregnenolone), also weak testosterone receptor antagonist
spironolactone: antiandrogen, ^conversion of testosterone-->estradiol (causing gynecomastia) and blocks testosterone synthesis; testosterone receptor antagonist
A 25-year-old woman presents to the clinic with severe pelvic pain that is always associated with menses. What diagnosis is characteristic of this type of pain and often results in infertility? What is the classic finding on the ovary that is associated with this diagnosis? (FA15 p588) (FA16 p594)
"chocolate cyst" ovary (endometrioma); normal-sized uterus
What are the early cyanotic heart diseases? What are the late cyanotic heart diseases? (FA15 p288- 289) (FA16 p282-283)
early: R-->L shunts; "blue babies"
5 T's: Truncus arteriosus (1 vessel), Transposition (2 switched vessels), Tricuspid atresia (3=Tri), Tetralogy of Fallot (4=tetra), TAPVR (5 letters)
late: L-->R shunts; "blue kids"
VSD>ASD>PDA; also Eisenmenger syndrome
causes K+ to shift OUT of cell (inducing hyperkalemia)
Digitalis (blocks Na+/K+ ATPase)
Lysis of cells (e.g., crush injury, rhabdomyolysis, cancer)
High blood Sugar (insulin deficiency)
Patient with hyperkalemia? *DO LAβS*
causes K+ to shift into cells (inducing hypokalemia)
￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼β-adrenergic agonist (Na+/K+ ATPase) Insulin (Na+/K+ ATPase)
Insulin shifts K+ into cells
e-lyte disturbance: Nausea and malaise, stupor, coma, seizures
e-lyte disturbance: U waves on ECG, flattened T waves, arrhythmias, muscle spasm
e-lyte disturbance: Tetany, seizures, QT prolongation
e-lyte disturbance: Tetany, torsades de pointes, hypokalemia
e-lyte disturbance: Bone loss, osteomalacia (adults), rickets (children)
e-lyte disturbance: Renal stones, metastatic calcifications, hypocalcemia
e-lyte disturbance: decreased DTRs, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia
e-lyte disturbance: Stones (renal), bones (pain), groans (abdominal pain), thrones (urinary frequency), psychiatric overtones (anxiety, altered mental status), but not necessarily calciuria
e-lyte disturbance: Wide QRS and peaked T waves on ECG, arrhythmias, muscle weakness
e-lyte disturbance: Irritability, stupor, coma
consequences of renal failure
Dyslipidemia (especially triglycerides)
Uremia—clinical syndrome marked by ^ BUN: Nausea and anorexia, Pericarditis, Asterixis, Encephalopathy, Platelet dysfunction
Na+/H2O retention (HF, pulmonary edema, hypertension)
Growth retardation and developmental delay
Erythropoietin failure (anemia)
ACE inhibitor SEs
Cough, Angioedema (contraindicated in C1 esterase inhibitor deficiency), Teratogen (fetal renal malformations), ^Creatinine (decreased GFR), Hyperkalemia, and Hypotension. Avoid in bilateral renal artery stenosis, because ACE inhibitors will further decrease GFR-->renal failure.
drugs that cause gynecomastia
"Some Drugs Cause Awesome Knockers"
For what conditions is hyperbaric oxygen therapy particularly helpful?
CO poisoning-->carboxyhemoglobin (binds Hgb w. 200x more affinity than O2)
the bends (decompression sickness)
arterial gas emboli
gas gangrene (C. perfringens)
What is the pressure in the potential spaces of the body including the pleural cavity, the joint spaces, and the pericardial cavity?
negative, facilitates diffusion of fluids in
pleural cavity: -7 to -8 cm H2O
joint spaces: -3 to -5 cm H2O
pericardial cavity: -5 to -6 mmHg
If stroke volume determines cardiac output, and contractility determines stroke volume, what determines contractility? (FA15 p273) (FA16 p267)
Catecholamines (^activity of Ca2+ pump in
sarcoplasmic reticulum)/sympathethic stimuation
^extracellular Na+ (dec. activity of Na+/Ca2+ exchanger)
Digitalis (blocks Na+/K+ pump-->intracellular Na+-->dec. Na+/Ca2+ exchanger activity-->^intracellular Ca2+)
β1-blockade (dec. cAMP) HF with systolic dysfunction
Hypoxia/hypercapnia (dec. Po2/^Pco2)
Non-dihydropyridine Ca2+ channel blockers (verapamil, diltiazem)
decreased IC Ca2+, ^EC Na+ (opposite digoxin/digitalis)
A 48-year-old man presents to your office with a persistent cough that has become bloody. Chest x- ray reveals a coin lesion within the lung parenchyma. Further workup reveals that the patient has the most common type of lung cancer in nonsmokers. Which cancer is this? What other lung cancers are not associated with smoking? Which lung cancers are associated with smoking, and where are they located, centrally or peripherally? (FA15 p619) (FA16 p626)
other non-smoking cancers: bronchioloalveolar adenocarcinoma, malignant mesothelioma (pleural)
others: small cell (oat cell), squamous, large cell, non-small cell, bronchial carcinoid tumor
smokers: small cell, squamous; "sentrally" located