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RNA polymerase I
5%
5/109
RNA polymerase II
73%
80/109
RNA polymerase III
Prokaryote RNA polymerase
2%
2/109
Topoisomerase
6%
7/109
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The patient likely ingested Amanita phalloides (death cap mushroom) which has caused fulminant hepatic necrosis. Alpha-amantin, found in the death cap mushroom, inhibits eukaryotic RNA polymerase II. Alpha-amantin is found in death cap mushrooms and inhibits eukaryotic RNA polymerase II. Ingestion of the death cap mushroom results in a clinical picture of drug-induced hepatic necrosis with severe liver failure. AST/ALT values are often in the thousands, and the patient can present with hyperbilirubinemia, hepatic encephalopathy, coagulopathy, acidosis, and hepatorenal syndrome. A similar picture of drug-induced hepatic necrosis can also be seen with halothane, valproic acid, and acetaminophen. Incorrect Answers: Answer 1 & 3: Alpha-amantin does not inhibit RNA polymerase I and III. Answer 4: Rifampin inhibits prokaryote RNA polymerase. Answer 5: Topoisomerase is inhibited by fluoroquinolones. Bullet Summary: Amanita phalloides (death cap mushroom) inhibits RNA polymerase II, which can lead to drug induced hepatic necrosis and fulminant liver failure.
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