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Notes 3

-incrwased HR and CO with preservation of arterial partial pressures of O2 and CO2 are most
consistent with the integrated cardiorespiratory response to exercise.
-beta-endorphin is one endogenous opioid peptide that is derived from proopiomelanocortin (POMC).
POMC is a polypeptide precursor that goes through enzymatic cleavage and modification to produce
only beta endorphins, but also ACTH and MSH. the fact that beta-endorphin and ACTH are derived
from the same precursor suggest that there may be a close physiological relate ship between the
stress axis and the opioid system.
-simvastatin decreased and cholestyramine increase hepatic cholesterol production.
-combination of these drugs above results in a net decrease in hepatic cholesterol synthesis and
plasma LDL level. Agents that increase hepatic cholesterol synthesis. (fibrates and bile acid-binding
agents) are associated with an increased risk of gallstones.
-malignant HTN produces hyperplastic arteriolosclerosis, which consists of homogenous, onion-like,
concentric thickening of the walls of arterioles. this morphologic pattern results from laminated SMC
and reduplicated basement membranes.
-homogenous deposition of eosinophilic hyaline material in the intimal and media of small arteries and
arterioles characterize hyaline arterioloscheloris, which is trtypically produced by long-standing
nonmalignant HTN and/or diabetes.
-urge incontinence, or overactive bladder syndrome, is caused by uninhibited bladder contractions
(detrusor instability). it results in a sense of urgency accompanied by an involuntary loss of urine. if
behavioral therapy alone is unsuccessful, pharmacologic therapy with an antimuscuranic drug
(targeting M3 receptors) an help improve symptoms. these agents should be used with caution in
elvderly, as they may cause confusion and functional decline.
-Nicotinic cholinergic receptors are found on postganglionic neurons in sympathetic and
parasympathetic ganglia and on skeletal muscle cells at the neuromuscular junction. drugs that block
skeletal muscle nicotinic receptors, such as Tubocurarine, are often used during general anesthesia to
induce paralysis.
-Nefedepine cause speripheral vasodilation which may result in reflex tachycardia. therefore this
antihypertensive drug is useful for patients with bradycardia.
-verapamil and diltiazem are cardiac specific are often used as therapies for rate control in atrial fib
with rapid ventricular response due to their ability to slow conduction through the atrioventricular
node.
-aortic regurgiation is associated with widening of the pulse pressure.
-right sided endocarditis involving the tricuspid valve commonly occurs in IV drug users and is often
due to s. aureus. specifically, infective endocarditis can cause tricuspid regurgitation, which is
identified as an early systolic murmur heard over the left lower sternal border that is accentuated by
inspiration.
-the left gonadal (testicular or ovarian) vein drains into the left renal vein, commonly leading to leftsided varicoceles in males with obstruction of the left renal vein. the right gonadal vein drains directly
into the inferior vena cava.
-speeln, a mesoderm-derived organ that originates from the dorsal mesentery. the spleen receives its
blood supple from the splenic artery, which is a branch of the celiac trunk, the primary artery of the
foregut.
-liver, endoderm-derived foregut structure that forms from a diverticulm of the primitive gut tube
within the ventral mesentery. its main arterial supply is the proper hepatic artery, a branch of the celiac
trunk.
-2/3 of transverse colon is considrered part of the midgut, and the last 1/3 of the handgun. supplied
by the SMA, whereas IMA supplies the distal 1/3 transverse colon.
-infection with mycoplasma pneumonia can result in the formation of cold agglutinins. other illnesses
resulting in cold agglutinin formation include EBV infection and hematologic malignancy. cold
agglutinins are antibodies specific for red blood cells tat only cause agglutination, or clumping, of red
blood cells at low temperatures.
-Finasteride, a 5a recuctase inhibitor, used to treat hair lord (anterior frontal scalp which is due to
inhertited trait).

inhertited trait).
-Hereditary non-polyposis colon cancer (HNPCC) is also referred to as Lynch syndrome. it leads to
occurrence of colonic adenocarcinomas at a young age (<50 years old), along with predisposition for
extra intestinal malignancies. Mutations of DNA mismatch repair genes are responsible for this
syndrome.
-dysthmic disorder is a chronic, low-intesity mood disorder that responds well to antidepressant
medications. its symptoms are less severe that those of major depressive disorder, but they may be
present for at least 2 years before the diagnosis can be made.
-in Major depressive disorder, theres suicide associated with it.
-lactic acidosis occurs in pts with septic shock because of tissue hypoxia, which results in impaired
oxidative phosphorylation and the shunting of pyruvate to lactate following glycolysis. hepatic hypo
perfusion also contributes to the buildup of lactic acid, as the liver is the primary site of lactate
clearance.
-elderly pts with dementia or hemiparesis may also have dysphagia, which is a risk factor for
aspiration pneumonia. dependent lung condolidation is commonly seen in aspiration pneumonia.
-dermatomyositis is an autoimmune disorder that
-Arginine is an enzyme of the urea cycle that produces urea and ornithine from arginine.
-intrathoraic spread of bronchogenic carcinoma may lead to compression of the superior vena cava,
causing impaired venous return form the upper part of the body. sign and symptoms include dyspnea,
facial swelling, and dilated collateral veins in the upper trunk.
-Glaucoma, a disease due to increased intraocular pressure, develops due to decreased outflow or
increased production of aqueous humor. Timolol and other beta-blockers decrease aqueous humor
production by the ciliary epithelium.
-cholinomimetics promote ciliary muscle contraction, causing the lens to become more convex.
-Cholinergic agonists (Pilocarpine and Carbachol) cause mitosis by promoting contraction of the
sphincter of iris. this cuauses the anterior chamber angle to become wider; this makes the tubular
meshwork more accessible to outflow of aqueous humor.
-durgs-induced parkinsonism is a type of extrapyramidal symptoms cause by the medication that
block D2 receptors. management strategies include decreasing or discontinuing the oending
medication and treatment with Bentropine or Amanatadine. Levodopa and dopamine agonists are
contraindicated for antipsychotic-induced parkinsonism as they can precipitate psychosis.
-anatomic or functional vesicoureteral reflux is virtually necessary for the development of acute
pyelonephritis. cause by gram neg rods.
-carpal tunnel syndrome is caused by median nerve compression. it is the m c example of
compression (entrapment) neuropathy and is associated with repetitive wrist movements. carpal
tunnel syndrome is also associated with hypothyroidism, diabetes mellitus, rheumatoid arthritis and
dialysis-associated amyloidosis.
-pts with type 1 diabetes mellitus are prone to developing other autoimmune endocrinopathies
including Hashimoto thyroiditis, gives disease, and primary renal insuciency (additions disease).
electrolyte abnormalities in pts with primary adrenal insuciency include (hyponatremia,
hyperkalemia, hyperchloremia, and non-anion gap metabolic acidosis).
-diphenoxylate is an opiate anti-diarrheal structurally related to meperidine. it binds to mu opiate
receptors in the GI tract and slows motility. low therapeutic doses for potent anti-diarrheal eects
without euphoric eects. since higher doses can lead to euphoria and wphysical dependence, the
drug is combined with atropine at therapeutic doses to discourage abuse.
-Anti-CD3 antibodies such as muromonab-CD3 (OKT3) inhibit T-lymphocutes, which is useful in the
treatment of acute rejection in patients with kidney, heart, ad liver transplants.
-nocturnal upper airway obstruction (manifested by snoring) and episodic nocturnal apnea
characterize obstructive sleep apnea, a condition associated with systemic hypertension. prolonged,
untreated obstructive sleep apnea can also cause pulmonary hypertension and right heart failure.
-major adaptive immune mechanism that prevent reinfection with the influenza virus include antihemagglutinin IgG antibodies in circulation and mucosal anti-hemagglutinin IgA antibodies in the
nasopharyx.
-pulmonary hypertension in patients with scleroderma as a result of damage to the pulmonary

-pulmonary hypertension in patients with scleroderma as a result of damage to the pulmonary


arterioles. it manifests with an accentuated pulmonary component of the second heart sound and
signs of right-sided heart failure.
-paroxysmal breathlessness and wheezing in a young pt that is unrelated to ingestion of aspirin,
pulmonary infection, inhalation of irritants, stress and/or exercise should raise a strong suspicion for
extrinsic allergic asthma. classic sputum findings include eosinophils and charcot-leyden crystals.
eosinophils are recruited and activated by IL-5 secreted by TH2 type helper T-cells.
-In pulmonary abscess, tissue damage and resultnt abscess formation is primarily caused by
lysosomal enzyme release from neutrophils and macrophages.
-Picornaviruses family includes the rhinovirus and enterovirus genera. Rhinoviruses are acid-labile and
there cannot colonize the GI tract or cause gastroenteritis. enteroviruses are relatively acid stable and
can therefore pass through the stomach to colonize or infect the GI tract.
-csf flows from the third ventricle to the 4th ventricle via the cerebral aqueduct of sylvius. obstruction
at the level can cause dilated lateral and third ventricles with a normal sized fourth ventricle.
obstruction at the foramen of monro would cause enlargement of only the aected lateral ventricle,
while obstruction at the foramen of mangendie and luschka causes enlargement of all 4 ventricles.
-characteristics of a drug such as high molecular weight, high plasma protein binding, high charge,
and hydrophilicity tend to trap the drug in the plasma compartment resulting in a low Vd (3-5L).
-Atrial nariuretic peptide is secreted by atrial cardiomyocytes in response to atrial stretch induced by
hypertension or hypervolemia. ANP actions include peripheral vasodilation and increased urinary
excretion of sodium and water. ANP binds to the natriuretic peptide receptor A (NPR-A) on cell
membranes, activating guanylate cyclase and forming cyclic GMP.
-rhe genetic code is degenerate meaning that there are more codons (61) than amino acids (20). each
tRNA molecule is a specific for a given amino acid. Many tRNA anticodons can bind to a few dierent
codons coding for the same amino acids. this is called wobble phenomenon.
-trochlear nerve palsy is characterized by vertical diplopia.
-