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What is the mode of action of Bismuth/Sucralfate?
- binds to ulcer and allows reestablishment of alkaline environment over the ulcer
- use in Ulcer healing/Traveler's diarrhea
What is achalasia?
results in what?
- Loss of myenteric plexus in the muscularis layer
- Failure of relaxation of the Lower esophageal Sphincter-LES
Drugs with anti-muscarinic effects?
- Anti-Histamines-1st generation
Who are the normal vaginal tract colonizers?
- Gram + --- Lactobacilli, Corynbacterium, Group B strep
- Gram - ---E.coli
- Candida Albicans
What vaginal pH is conducive to Candida Overgrowth(vaginosis) and to bacterial overgrowth (vaginitis)?
- Vaginosis-----Acidic pH
- Vaginitis--Basic pH --Trichomons Vaginalis/Gardnerella Vaginalis
3 causes of Candida vaginal Infection?
- antibiotic use
- contraceptive use
- immunosuppression--corticosteroid therapy, DM, other immunosuppression
Fibrinoid Necrosis is characteristic of what Hypersensitivity?
Allergic reaction can produce what 2 different Hypersensitivities?
- III--Ag-Ig complexes causing activation of complement and low C3 levels (serum sickness)--vasculitis, arthralgia, glomerulonephritis, Urticaria
1st Branchial Arch failure to migrate causes what?
Tracher Collins---facial abnormalities, Mandibular Hypoplasia
Which part of the duodenum is adjecent to the SMA?
3rd part of duodenum
Neurofibromas of Neurofibromatosis are derived from what cells?
Shwann Cells--Neural Crest Derivative
Difference between NF1 and NF2?
- NF1--Optic gliomas, PHeochromocytoma
- NF-2- Bilateral Acoustic Shwannoma
Inhibin, HcG, Estriol, AFP levels in Down's Syndrome?
- Estriol and AFP are low
- Inhibin and Beta hcg are high
What esle on the EKG is prolonged with prolonged QT interval?
WHat drugs prolong QT interval?
- Class- Class I
- Three- TCA
- Fucking -Fluoroquinolones
- Cardiotoxicity -Class III
What crystals make up Gout particles?
- GOUT--Needle shaped crystals-negatively bifringent
- PSEUDOGOUT--Rhomboid shaped crystals--positively Bifringent
Pancoast tumor can have what 4 side effects?
- Horners Syndrome
- SVC syndrome
- Shoulder pain, dyspnea, hiccups due to Phrenic nerve irritation
What are the 4 drugs taht interact with Digoxin?
- Quinidine--displaces digoxin from tissue binding sites
- K--hypokalmeia causes toxicity and digoxin toxicity causes hyperkalemia
- Mg-used to treat Digoxin toxicity
Anti-emetic used for Diabetic Gastroparesis and Chemotherapy induced Nausea?
What property of drug metabolism decreases most significantly with age?
renal clearance which could be followed by increased Creatinine
What Hypertensive drugs predispose to tolerance development?
Continuous use of what drugs causes decreased sensitivity of the vascular blood vessels to the drug?
What are the 3 features of Freidrich's ataxia?
You wouldn't want someone ataxic to have an HPK knife
- Pes cavus
- Hypertrophic Cardiomyoopathy (cause of death)
Which is the statin causing highest occurences of Myopathy?
Simvastatin for Skeletal muscle
What is the mode of action of Fibrates?
- increases Lipoprotein Lipase
- decreases activity of 7 alpha hydroxylase--i.e decreases conversion of cholesterol to bile acids
How does increased body weight and fibrates constitute a risk for cholesterol development in women?
high estrogen from the fatty tissues induces cholesterol formation and fibrates inhibit conversion of cholesterol to Bile acids via 7 alpha hydroxylase..increased cholesterol content and cholesterol stone precipitation
Osteomyelitis affects what part of the long bone?
Metaphysis for OsteoMyelitis
What are the glycogen storage diseases?
- Von Gierkes-Glucose-6- Phosphatase
- Pompe--alpha 1-4 glucosidase--heart
- Cori--- debranching enzyme
- MacCardle--- muscle phosphorylase
What hormone should be evaluated to confirm menapause?
FSH-- will be high
Shwannomas can arise from what cranial nevers?
all of them except optic nerve which is an extension of the brain
What 2 enzymes when elevated indicate a disrupted integrity of the biliary tract?
- gamma glutamyl transferase
- alkaline phosphatase
What is the major Jones criteria for RF?
- Joints--migratroy polyarthritis
- Neurologic-syndhenhams chorea
- Erythema marginatum
- Subcutaneous nodules
Drug (androgen receptor agonist) used to treat infertility?
What are the levels of LH, FSH, testosterone in PCOS?
- LH and Testosterone are high
- FSH is low
Differentiate between Acute Interstitial nephririts, Acute tubular necrosis and Papillary necrosis?
D/D for all 3? i.e what is seen in each?
- Acute interstitial nephritis due to a drug allergy-eosinophilia
- Acute tubular necrosis-ischemia or toxins- Granular "muddy" brown casts--RBC casts
- Papillary necrosis--chronic ischemia as in sickle cell -gross hematuria/proteinuria
5 causes for hyperkalemia?
- 1- Acidosis
- 2-Beta blockers
- 3- Digoxin
- 4-Cell lysis
- 5- Insulin deficiency
4 Causes for Hypokalemia?
- 2- Beta agonists
- 3- Alkalosis
- 4- Hypo-osmolarity
S/E of Mannitol?
Use of Mannitol?
Increased ICP or Intra ocular pressure
Pharmacologic intervention for Altitude Sickness?
2 diuretics for glaucoma?
4 loop diuretics?
- Ethacrynic Acid
Toxicity of Loops?
- Allergy (sulfa)
- Nephritis -Interstitial (eosinophilia)
S/E of Thiazides?
WHat is the deficiency in RTA
- Type I-distal-cant excrete H--alkalatic urine and calcium kidney stones and hypokalemia
- Type II- can't reabsorb HCO3--hypophosphatemic rickets and hypokalemia
- Type IV-hypoaldosteronistm--hyperkalemia and acidic urine due to inability to excrete NH4 in PCT
Which is renally excreted, digoxin or digitoxin?
Digoxin-so must decrease dose in renal impairment
Lipoid Nephrosis is also called what?
Minimal Change Disease
Which nephrotic disorder has spike and dome appearance of immune complexes?
Tram track splitting of Glomerular Basement membrane is seen in what?
Membrano proliferative glomerulonephritis type I