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What do organophosphate
bethanechol, carbachol, pilocarpine methacholine
Neostigmine, pyridostigmine, edrophonium, phsostigmine, & echothiophate
all have in common
- They all cause
- Excitation of skeletal muscle & CNS
A schizophrenic on a neuroleptic presents complaining of urinary retention what is the best treatment for this patient?
The neuroleptic is acting as an antimuscarinic(such as atropine, benztropine, scopolamine, or ipratropium)
- The treatment is a direct cholinergic agonist: Bethanechol
- - For postoperative and neurogenic ileus and urinary retention.
A patient has facial angiofibroma, ash-leaf spots of skin depigmentation, history or seizures, and mental retardation. What 3 neoplasms is this patient at most risk of developing?
This patient has tuberous sclerosis.
- cardiac rhabdomyoma
Describe the effects of competitive and non-competitive inhibitors on potency and efficacy
Competitive inhibitors increase the Km which leads to a decrease in potency.
Non-competitive inhibitors decrease the Vmax which leads to a decrease in efficacy.
What end product does metyrosine inhibit?
- Metyrosine inhibits tyrosine hydroxylase which does:
- tyrosine to LDOPA
- later -> dopamine -> NE(end product)
What do the receptors H1, a1, V1, M1, & M3 have in common?
- They are all Gq proteins-> phospholipase C -> PIP2 ->:
- IP3 ->inc [Ca] in
- DAG -> protein kinase C
What type of channels does hexamethonium affect?
- Hexamethonium is a Ganglionic blocker of nicotinic origin.
- Nicotinic receptors are ligand gated Na+/K+ channels
- (include Nm and Nn)
What are the differences between Norepinephrine and isoproterenol?
- NEP: a1, a2 > B1
- Causes increase in Blood pressure and reflex bradycardia
- Isoproterenol: B1 = B2
- Causes decrease in blood pressure(B2 vasodilation) and reflex tachycardia
What are the findings associated with acute close angle glaucoma?
- Abrupt onset of pain, nausea, colored halos, rainbows around lights.
- Red teary eye with hazy cornea and fixed, mid-dilated pupil( not reactive to light) that is firm to palpation.
A nerve innervates the brachioradialis, extensors of the wrist and fingers, and supinatorsand triceps.
What deficienies would you expect to see?
Radial nerve (C5-T1)
- Wrist drop
- loss of brachioradialis reflex
- loss of tricep reflex and function
- loss of sensation of posterior arm
- loss of sensation of posterior forearm
- Loss of sensation of lateral , posterior hand
Saturday night palsy: weak wrist and finger extension, weak brachioradialis reflex, BUT normal triceps.
A person can not flex their 4th and 5th finger. What other deformities should be seen?
This is the ulnar nerve
- Cannot adduct thumb
- cannot abduct or adduct fingers
- loss of sensation of medial hand
What nerve is responsible for
1. Loss of ability to flex digits 1-3
2. inability to oppose thumb
3. wasting of the thenar eminence
An exotoxin that blocks the release of the inhibitory neurotransmitter glycine.
What organism is it from?
What toxin is it?
What does it cause?
- It is from cloustridium tetanus
- It is a tetanospasmin
- It causes spastic paralysis (opisthotonus and risus sardonicus)
What are the toxins of Staph Aureus and what do they cause?
- a toxin - hemolysis
- B toxin- sphingomyelinase
- Hemolysin- hemolysis
- leukocidin - destroys leukocytes
- Enterotoxin A-E - food poisoning -> vomiting & diarrhea
- TSST-1 - release of cytokines -> toxic shock syndrome
- Epidermolytic/exfoliative - eptithelial cell lysis -> scalded skin syndrome
What stain do you use to see pneumocystis jiroveci?
Which bacteria have a positive quellung reaction?
- A psoitive Quelling reaction means that the bacteria has a capsule
- Some Killers have nice shiny bodies
- Strep. pneumoniae
- H. influenza
- N. meningitidis
- Group B streptococcus
stains purple on gram stain
optochin sensitive and bile soluble
What is are the problems encountered with the bacteria that is:
Purple on gram stain
GROUP A: Streptococcus pyrogenes
- Pharyngitis, cellulitis, impetigo
- Scarlet fever, toxicshock-like syndrome
- rheumatic fever, acute glomerulonephritis
- endocarditis, necrotizing fasciitis, sepsis
What bacteria will not stain with gram stain?
- Treponema (DAF)
What bacteria is located in the teeth and can cause subacute endocarditis in patient with pre-existing endothelial damage if allowed to enter into the blood?
- Viridians Streptococcus
- - S. mutans
Gram (+) bacteria is the most common cause of osteomyelitis?
What are the roles of IL-5
- Promote B cell growth an differentiation
- Promote growth and activation of eosinophils
- Enhances synthesis of IgA
In an experiment with mice a gene was altered and it led to the mice not being able to build an adaptive immune response. Which gene was altered?
There is arrest in the development of B and T cells which is the cause of a mutation in the recombination activating gene complex (or RAG 1 and 2)
Which immunoglobulin isotype:
- comprises 70-75% of the total immunoglobulin pool
- crosses the placenta and confers immunity to neonates in the first few months of life
- Is distributed evenly between the intravascular and extravascular pool
Describe 2 main characteristics of IgA
Can occur as a dimer
Predominantly in mucoserous secretions such as saliva, colostrum, milk, tracehobronchial secretions, and genitourinary secretions.
What is the ham test and what is it used for?
Ham test puts RBC cells in a low pH to see if they lyse.
Test for Paroxysmal Nocturnal Hemoglobinuria -> chronic intravascular hemolysis because they lack PIG-A which binds the proteins responsible for protecting the RBC from complement attack.
What is the difference between type II hypersensitivity and type III?
Type II involves antibody attacking the body's own receptor via complement and macrophages (autoimmune)
Type III invovles a complex between antigen and antibody depositing into the host tissue and causing damage via complement and macrophages. (not really autoimmune)
A young child presents with tetany from hypocalcemia and candidiasis resulting from immunosuppression. What cell type is deficient?
- This is Digeorge syndrome
- T cells are defctive
- Cardiac abnormality
- Abnormal facies
- Thymic aplasia (endoderm origin)
- Cleft palate
What immunodeficiencies involve a defect in the T cells?
Thymic aplasia (Digeorge syndrome- no T cell maturation)
Severe combined immunodeficiency (early stem cell differentiation defect- adenosine deaminase deficiency)
Chronic mucocutaneous Candidiasis (T cell dysfunction vs Candida Albicans)
What are the characteristics of Wiskott Aldrich Syndrome?
- Thrombocytopenia and purpura
- Recurrent pyogenic infections
Low IgM but high IgA
What immunodeficiency disease presents with
Recurrent cold Staph aureus abscesses
Coarse facial features (doughy skin )
a hyper IgE syndrome (high IgE and eosinophils)
T cell disorder -> deficient IFNy -> PMN can not respond to chemotactic stimuli
In primary biliary cirrhosis what are the antibodies targeted against?
What structures are derived from the surface ectoderm?
- hair, nails
- mammary glands
- anterior pituitary
- inner ear
- teeth enamel
What are Homeobox genes and what alters them?
HOX genes code for transcription regulators for skeletal morphology.
Retinoic acid alters HOX gene expression
When and how would you check for lung maturity of an infant?
- In the third trimester via amniocentesis.
- A lecithin:sphingomyelin ratio > 2.5 = mature lungs.
- Infant has sufficient surfactant to survive outside the mothers womb.
- If the ratio was < 2.5 then:
- Bethamethasone or dexamethasone would have to be administer to increase surfactant production
Terbutaline (B2 agonist), nifedipine (ca blocker), or indomethacin(NSAID) would be administered in order to delay labor.
Ventricular septal defect
Tetralogy of fallot
persistent truncus arteriosus
transposition of the great vessels
have in common
They are all defects of the spiral septum which originates from the neural crest cells.
What structures arise from the Left horn of sinus venosus
and the right horn of sinus venosus.
L horn-> coronary sinus
R horn-> smooth part of the right atrium
What arises from the 6th aortic arch?
Proximal part of the pulmonary arteries and ductus arteriosus
What is the treatment for an infant who presents with cyanosis, tricupsid regurgitation, and upon imaging a dilated right atrium and hypoplastic right ventricle?
This is Ebstein's anomaly which is associated with maternal use of lithium in the first trimester.
TX: PGE, digoxin, diuresis, and propanolol for supraventricular tachycardia.
What heart defects are associated with congenital rubella?
- Persistant ductus arteriosus
- pulmonary artery stenosis
- septal defects
What problems are offspring of diabetic mothers at higher risk for?
- Transposition of great vessels
- LGA -> clavicle fracture-> erb duchenne palsy
What is an omphalocele?
- An abdominal wall defect with the following defects:
- extruding viscera covered in peritoneum and amnion
- liver is often protruding
- 50% have other anomalies associated.
A patient has ovaries, no testes, but male genitalia.
- ACE inhibitors
- Alkylating agents
- Folate antagonist
- Iodide (excess or shortage)
- thalidomide (flippers)
- vitamin A