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Digoxin toxicity Symptoms - life threatening arithymyes -anorexia -nausea -vomiting -abdominal pain -fatigue confusion weakeness -***color vision disturbance
Selective estrogen receptor modulators (SERMs) *TAMOXIFEN AND RALOXIFENE
MOA of slective estrogen receptor modulators? -Competetive inhibitors of estrogen binding -Mixed agonist/antagonist action
SERMs indications - prevention of breast cancer in high risk patients -Tamoxifen=adjunct treatment of Brest cancer -Raloxofene= post menopausal osteoporosis
SERMs adverse effects -hot flashes.--venous thromboembolism -*ENDOMETRIAL HYPERPLASIA and carcinoma ( tamoxifen only)
Tamoxifen on Lipids? Favorable effect --> decreases in total Lipids and LDL cholesterol. No change i HDL. Serum triglycerides may increase
Liver cirrhosis patient with Gynomastia arises from? HYPERESTERONISM due to = increased adernal production of androtestenedione with aromatization To ---> estrone and eventual conversion of estradiol.
HYPERRSTRENISM manfestation in Cirrosis *** SPIDER ANGIOMATA *** -> estrogen effects also on artiorloes -> also seen in Pregnanc
What are Spider Angiomata? -skin/subcutaneous vascular lesion consisting of a central arteriole surrounded by many vessels that BLANCH ON COMPRESSION Due to -> estrogen effects also on artiorloes -> also seen in Pregnancy
accumulation Of AMMONIA seen in? LIVER CIRRHOSIS
Hyperammonia in Cirrosis SYMPTOMS * Altered Mental status * Malodorous, seet, feculent Breath
Filtration Fraction equals?? FF= GFR/RPF
Para-aminohippuric acid equals Renal Plasma Flow ( RPF) *PAH Is mostly secretreted
GFR calculated using? Inulin and Creatinine (freely filtered)
Lymph drainage of *SCROTUM* Superficial Inguinal nodes
Superficial Inguinal Lymph nodes Drain ? - Anus BELOW the dentate -cutaneous lymph from umbilicus to feet
Testes Lymph drainage? Para-aoric --(retropretoneal lymph nodes)
Glans penis and superfical nodes --> lymph drain to? Deep Inguinal Nodes
COMMON ILIAC NODES lymph drainage? Internal and External Iliac Nodes -->external ilaic recieve lymph from the Deep Inguinal Lymph Nodes
Inferior Mesenteric Arteries (IMA) drain what structures? 1. Branches of IMA Such as Left colic, sigmoid, and SUPERIOR RECTAL ARTERIES = Descending and Sigmoid colon -Upper part of Rectum & their EFFERENTS DRAIN INTO pre-aortic nodes
UPPER Limb and Breast lymph Drainage? Infraclavicular Lymph Nodes
Great Saphaneous Vein PATHWAY Orginates from= medial aspect of Leg--> courses anterior to the meduak malleolus --> then travels to the medial aspect of LEG and THIGH
Great Saphenous Vein drains into? FEMORAL VEIN , In the femoral triangle near *** InferilLateral to the Pubic Tubercle **
DNA supercoil accumulation Topoisomers reduce DNA supercoiling by nickig the DBA strands
Double-strand DNA break Repair seen in? Exposure to Ionizing RADIATION
Impaired Mismatch Repair seen in? * Hereditary nonpolyposis Colorectal cancer Repair of Mismatch BASES occurs in the normal genome during DNA replication.
What supplies Arterial blood to the Liver ? CELIAC TRUNK -also supplies, spleen, stomach, abdominal esophagus, and parts of duodenum.
Increased Cells in COPD? 1. Neutrophils 2. Macrophages 3. CD-8 T lymphocytes
1. Neutrophils& Macrophages &CD-8 T lymphocytes Release what to causing damage in COPD? *Proteases --> neutrophil Elasttase, MMP9--> leading to Mucus Hypersecretion in bronchi and Alveioli Destruction.
ACUTE Choleysistis Diagnosis failed Gallbladder visualization on radionuclide Bilary scan
DISTENDED duadenum on upper GI series Gallstone ILEUS (small bowel obstruction)
ULTRASOUND of Acute Choleysistis = gallbladder wall thickening-- -Pericholeystic Fluid ** MURPHY SIGN + post
New-onset Odynophagia( hurt to eat) and Chronic GI Reflux disease suggests what? ULCER formation
INFECTIOUS Esophagitis caused by what Bugs? CMV, Candida, and Herpes simplex virus
Esophageal Stricture *Dysphagia to solid food -Esophageal obstruction -
Barretts Metaplasia -Malignant transformation->>due to chronic complication of GERD - weight loss and Dysphagia
Prostate cancer spreads to Bone how? -through PROSTATIC venous plexus --> Vertebral venkus plexus ---> Lumbrosacr Spine
T-tubles **Ensures Coordinated Contraction of the Myofibrils -depolarization signals to the Sarcoplasmic Reticulum -trigger release of Calcium
No T-tubles in Muscle fibers leads to= Uncoordinated contraction if Myofibrils
NO Troponin C and Myocin in Muscle fibe leads to= NO Conteaction jn response to Intracellular Ca
MYASTHENIA GRAVIS Autoantibodies to Acetochioline receptors in NMJ => Poor contractile force generation on Repeated Stimulation
McArdle Disease -glycogen storage diease type 4 due to defdxt in ***Myophisphorylase ->Impaired energy production during muscle contraction--> lWeakness And Cramping during Excersize -> failure of Muscle glycogen Breakdown due
KRAS moa Proto-onco gene thats encodes GTP-Bindig Protein involved in division via transduction of extracellular signals --> Epidermal Growth factor Receptors(EGFR)
KRAS mutation -increased cell proliferation , that is *RESISTANT TO ANTI-EGFR MEDS (cetuximab and panitumumab) ** metastatic COLON cancer
Platelet-Derived Growth factor *forms new blood vessels ** proliferation of Fibroblasts and smooth muscle cells ****BINDS TO Receptor Tyrosine kinase ** Mutation leads to =over-expression and uncontrolled Angiogenesis
Vascular endothelial Growth factor (VEGF) -angiogensis -LYMPH VESSEL devlopments *mutation leads to VEGG promotes Growth and metastasis of Cancers
Old lady or Giatric Patients with -->Isolated systolic Hypertension and diastolic blood pressure normal (<90) is DUE to Age related Aortic Stiffening --> decreased in complince of the Aorta and major peripheral arteries.
Pneumococcal Conjugate Vaccine Strongly immunogenic 👌🏾 because of both B and T-cell Recruiment--> they provide long lastjng antibid Titers vs he 😒polySsachride Vacine
Pneumococcal Polysaashride vaccine👎🏾 Poorly immunogenic in infants due to their Relatively Immature Humoral Antibody resppnse 👎🏾
Mallory-weiss syndrome Increased intraluminal gastric pressure due to -> ***Retching, Vomiting, other abdominal Straining
Created by: Ramzdjama



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