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Lepromatous - weak immunity, nodules, plaques bilat thruout body esp hands, fingers, forearms, face(leonine facies, resemble lion, loss of eyebrows, nasal collapse)Tx - long-term dapsone (PO) or w/ rifampin or clofazimine Dapsone SE - hemolysis, methemoglobinemia Dx - pheochromocytoma Clonidine - alpha-2-R agonist normally suppresses rel catecholamines fr adrenal glands but ineffective for pheochromocytoma Confirm dx - CT/MRITx - resection w/ alpha-blocking meds (phenoxybezamine - irreversible alpha blocker), BB only if adequate alpha blockade achieved bc unopposed alpha stim can lead to dangerous INC BP0-4 h normal4-12 h hypereosinophilia12-24 h neutrophilic infiltration, beginning of coag necrosis2-4 days eextensive NT infiltration, extensive coag necrosis5 days granulation, macrophages6-8 wks contracted scarsummer/fall, prodrome (fever, chills, NV, HA) followed by encephalitis (seizures, somnolence, obtundation, asymmetrical reflexes, Babinski, coma)Nonfatal encephalitis in kids, occurs usually summer/fallmacrolide (erythromycin)MOA - motilin agonist (secreted by gastric, intestinal & colonic enterochrommaffin & Mo cells; controls motility during fasting state via MMCs; acts on G-protein R, INC motility stomach/intestings SE - NVDCNS & GI neutrotransmitter - cause signif intestinal secretion electrolytes (and water), relax intestinal smooth mm & sphincters, inhib gastric acid secretion, dilate peripheral BVDz - diarrhea, hypokalemia, low gastric acid, dehydrationprod by gastric G cells in response to peptides and aa, stomach distention, vagal stim Zollinger-Ellison syndrome (gastrinoma) - excess gastric acid, arise in DUODENUM (less likely in pancreas where it's more malig)Dx - INC gastrin, give IV secretin (normal gastric cells inhib by secretin), tumor localted w/ US or radionuc octreotide scanning Tx - acid suppression w/ PPI (omeprazole), surg exploration Rifampin - hepatotoxicity* (follow LFTs), orange-red body fluids, MOA - inhib RNA poly (P450 inducer)INH - peripheral neuropathy (give B6), MOA - inhib mycolic acid syn (P450 inhibitor)Pyrazinamide - nongouty, arthralgia Ethambutol - color-blindness, optic neuritis, MOA - obstruct cell wall Streptomycin - ototoxicity & nephrotoxicity, bind 30S, inhib protein syn Type 1 - bone, tendons, skin, fascia, dentin, cornea, ex Osteogenesis imperfecta - multiple fx after min trauma, blue sclerae, hearing loss, dental imperfection Type II - cartilage, vitreous body, nuc pulposis, ex achondrogenesis - lethal neonatal disorder (large head, short neck, lung hypoplasia, short limb)Type III - skin, BV, uterus, fetal, granulation tissue, ex Ehler-Danlos syndrome (EDS) - hyperelastic skin, hypermobile jt, easy bruising, transluscent skin, scoliosis, pes planus, assoc w/ berry aneurysm, MVP, organ rupture, also - Marfan syndrome Type IV - basement membrane (kidney, lung alveoli, ears, eyes), epidermis basal lamina, ex Goodpasture's (RPGN, pulm dz), Alport's syndomre - hematuria, progressive GN, sensorineural hearing loss, cataracts Type VII - fibrils at dermoepidermal jxn, ex.
dystrophic epidermolysis bullosa (DEB) - blistered skin after minor trauma, mitten-like deformities (infancy)Frabry dz - X linked recess, cardiac/renal dz, peripheral neuropathy (glove/stocking distrib), angiokeratoma (purple-red skin lesions), DEC vision Note auto recess: Krabbe, Gaucher, Niemann-Pick, Tay-Sachs acidosis; susceptible to Ca urinary stones bc alkaline urine promotes stone formation Type II - prox tubule can't reabsorb HCO3; caused by multiple myeloma & amyloidosis - INC delivery HCO3 to distal nephron results in INC K secretion Type IV - MC, ALD deficiency or antag of ALD - disrupt Na reabsorp & K/H secretion in collecting tubule, ex Addison dz - ALD deficiency; unique - hyperkalemia1.8, high dex supp test - DEC CORT by at least 50%Note: Cushing syndrome - adrenal tumor or ectopic ACTH-prod tumor and doesn't respond to dex supp test, Dx - 24 h urine - INC free CORT, Tx - tumor resection, glucocorticoid rep anticholinergic effects (mydriasis-dilated pupil, cycloplegia-loss acccomodation, cutaneous vasodilation, bronchodilation, DE salivry, supp thermoreg sweating Use - Parkinson's, motion sickness, opthalmologic disorders, asthma, COPD, poisoning by muscarinic agonists (organophosphates, mushroom, "nerve gases")megaloblastic anemia, hypersegmented NT (also d/t folic acid defic)Eventually have neuro sx, but not present initially INC serum methymalonic acid (MMA), homocysteine levels, B12 normal/DEC (Note - folic acid has normal MMA, both have INC homocysteine)lithium - Epstein's anomaly - downward displacement tricuspid valve, cyanosis, palpitation, exertional dyspnea, S3/S4 systolic murmur, ECK - R atrial hypertrophy, assoc w/ Wolff-Parksinson-White syndrome Thalidomide - malformed arms/legs (phocomelia)Lisinopril - fetal hypo TN, anuria, oligohydramnios, IGR (intrauterine growth restric)Streptomycin - deafness Doxycycline - stained teeth, abnorm bone growthtricyclic antidepressant - imipramine, benzodiazepine - clonazepam MOA - shorten sleep stages 3-4 (when sleep walking occurs)Use - pts w/ freq episodes, prone to injury Usually kids 4-10 (but can at any age)200 msec, QRS complex following P wave is diagnostic, asymptomatic, no Tx Mobitz type 1 (Wenckebach) - PR-int lengthens bet each cardiac cycle until beat dropped, asymptomatic, no Tx Mobitz type 2 - dropped beats at reg intervals (every other beat), consistent PR interval when QRS follows P wave (2:1, 3:1), can progress to 3rd degree AV block, Tx - pacemaker3rd degree block (complete heart block), P waves "march along" w/ no meaningful relation to QRS complex, Tx - pacemaker Note: If 3rd deg block caused by neg chronotropic Rx (BB, digoxin, CCB) - stop Rx, or by infection (Lyme dz - tx infection)central pontine myelinosis (CPM) - occurs if pt chronically exposed to hyponatremia - loss of osmolytes in brain in order to prevent cerebral edema Correction can occurs faster than creation of osmolytes --Bipolar I - full blown mania (spending spree, indescretions) /- depression Bipolar II - MDD hypomania Rapid-cycling bipolar - 4 episodes MDD, mania, hypomania, mixed w/in 12 mon Cyclothymic - hypomania mild depression alternating for at least 2 yrs Pure mania: 1 wk w/ at least 3 of DIG FAST - distractability, insomnia, grandiosity, flight of ideas, activity INC, sleep deficit/sexual indiscretion, talkativenesssquamous cell carcinoma Dx - sheets & islands of neplastic epidermal cells ("keratin pearls"), rarely mets, Tx - resection Can arise fr actinic keratoses (premalig lesion) or Bowen's dz (squamous cell CA in situ)Treponoma pallidum - syphillisprimary stage - painless chancre, enlarged LN2ndary stage - maculopapular rash (soles/palms/trunk), contagious Tertiary - yrs to decades later - granulomas ("gummas") thruout body, neuro & aortic sx Tx - penicillin G - block cross-linking of peptidoglycans in cell wall Rapidly progressive GN (RPGN) - progressive decline of renal fxn over days-mons Type 1 - anti-GBM Abs (Goodpasture's), Tx - plasmapheresis, steroids Type 2 - post-infectious glomerulonephritis, lupus nephritis, Ig A nephropathy Type III - Wegener dz or microscopic polyangiitis (pauci-immune)Other Tx - steroids, cytotoxic agentsganglion-blocking drugs - hexamethonium, pentolinium, mecamylamine & trimethaphan MOA - inhib postgang transmission, block all autonomic outflow, DEC secretion of all bodily fluids, orthostatic hypo TN, impotence, visual disturbanthracotic pigment - Coal Worker's pneumoconiosis (anthracosis in high pop cities, coal workers)brown dumbbell-shaped rods in macrophages - asbestosishyphae & yeast - aspergillus, bastomyces, histoplasma, coccidiodes Caseating granuloma - TBNoncaseating granuloma - sarcoidosis (bilat hilar LAD)diabetes, open fractures, IVDAS/S - edema, warmth, tenderness to palpation, late presentation, DEC ROM, INC ESRMCC - S aureus - Gram pos coccus, catalase & coagulase pos MCC in DM, foot wounds - Pseudomonas - gram neg bacilli MCC in sickle cell pts - Salmonella - Gram neg bacillus, non-lactose fermenting-pam & -lam: diazepam, lorazepam, clonazepam, midazolam Use - sedative, hypnotic, anxiolytic, anticonvulsant, mm relaxant MOA - enhance GABA, depress CNSTx - Flumazenil - competitive benzo-R antag, binds GABA-R but doesn't activ them, DEC benzo POTENCYcongenital rx defect1) cleft lip/palate2) flipper-like hands3) spinal defects4) Epstein's anomaly5) microcephaly, smooth filthrum, cardiac septal defect, small palpebral fissure, midfacial hypoplasia, micropthalmia Influenza - genetic drift/shift, hemagglutin (viral entry), neuraminidase (release) virulence Elderly, kdis, immunodeficient at risk for secondary pneumonial bacterial superinfection Tx w/in 48 hrs - oseltamavir, zanamivir neuramindase-inhibitorsautoimmune, excess colalgen depsoit thruout body, esp skin, GI tract, lungs, kidneys, sclerodactyly, ANA Abs (sensitive), anti-centromere ab (specific for CREST syndrome, a variant of scleroderma, better prog), anti-DNA topoisomerase I ab (anti-Scl ab - most specific)platinum-based alkylating agent Use - solid tumors (breast, lungs, GI, head, neck, GU sys)MOA - prevent DNA syn, excreted thru kidney SE - nephrotoxicity, neurotoxicity (esp peripheral neuropathy & tinnitis/high freq hearing loss), myeolosuppression Ascaris lumbricoides (nematode - giant roundworm) - MC helminth in world (2nd MC in US after Enterobius)Can cause: pneumonitis - when larvae reach lungs get dyspnea, wheezing, chest pain & GI blockage - NV, jaundice, abd pain, distention Tx - bendazole or pyrantel pamoate Life cycle - eggs ingested, rel larvae go into GI mucosa, travel thru blood to lungs, coughed up and swallowedbenign, firm, resectable brain tumor arise fr arachnoid layer of meninges, MCC primary benign brain tumor, doesn't invade brain, Sx are result of mass effect; seizures, focal dysfxn, change in mental status Serous cystadenocarinoma - 50% ovarian CA, bilat, papillary projections, psammoma bodies Mucinous cystadenocarcinoma - mucus-secreting, can cause pseudomyxoma peritonei (rupture/mets; mucin in peritoneum)Clear cell tumor (rare endometroid) - resembles endometrium All epi ovarian malig can have INC CA-125Serous cystadenoma - cystic tumor lined by fallopian tube looking epi Mucinous cystadenoma - multilocular cysts lined by columnar epi, secrete mucin Brenner tumor - rare, resembles bladder transitional epi, surrounded by fibrous stroma Thecoma - lipid containing cells fibroblasts, estrogen secreting Fibroma - spindle-shaped fibroblasts, assoc w/ Meigs syndrome (triad of ovarian fibroma, ascites, hydrothorax)Granulosa-theca cell tumor - estrogen-secreting --Fluphenazine - hyper PRL (menses irreg, galactorrhea, sexual dysfxn)...
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repair & scarring in form of reactive gliosis (fills physical space of damaged neurons that can't regrow after injury, ex resected tumor space)rate of elim proportional to drug concen (constant fraction/percent elim per unit time)Rx DEC exponentially over time (ex. after 3 hrs it becomes 0.5, next 3 hrs 0.25, etc)Most Rxs follow this Note: if Rx infused, takes 4-5 HL to reach steady state concen infertility M - epididymitis M/F - Reiter's syndromem (can't pee, see, climb tree)Neonatal pneumonia (staccato cough), conjunctivitis Serotypes A-C Trachoma (blindness in Asia/Africa)Serotypes L1-3 lymphogranuloma venerum (elephantiasis)Carcinoid syndrome - secretes serotonin (diarrhea, heart valve damage), histamine (flushing, wheezing, pruritis), kallikrein (flushing), mets causes abd pain Dx - CT scan or somatostatin-R scintigraphy to localize tumor Tx - resection, octreotide (*TOC if unresectable)loop diuretics - furosemide, bumetanide, torsemide Use - edema d/t HF, nephrotic syndrome, cirrhosis, hyper Ca, HTN; effective in pts w/ low GFRSE - "OH DANG": Ototoxicity, Hypo K , Dehydration, sulfonamide-related Allergic rxn, interstitial Nephritis, Gout CA inhibitor - acetazolamide, dichlorphenamide, methazolamide Use - glaucoma (by DEC prod aqueous humor), edema, urinary alkalinization, met alkalosis, epilepsy, mtn sickness SE - met acidosis, neuropathy, ammonia toxicityenlarged clit/ambiguous genitalia, blind-ending vagina, palpable masses in inguinal canals or labial folds;normal internal male genitalia but ext female genitalia at birth w/ secondary virilization at puberty, serum testot: DHT ratio 5-alpha-reductase deficiency - absent DHT necessary for normal male ext genitalia & 2ndary sex charac Y chromosome - Wolffian ducts (testes, epididymis, seminal vesicle, vas def)At puberty - LH surge cause INC testot --masculinization at infancy, female pseudohermaphrodism, hypo TN, vol depletion, hypovolemic shock in newborn d/t salt wasting17-hydroxyprogeseterone accum and converts to androstenedione (testot precursor)Porphyria cutanea tarda (PCT) - MC porphyria Tx - phlebotomy, avoid sunlight, Et OH, tobacco, Fe, estrogenscutaneous/liver abnorm, chronic blistering, vesicles, bullae on sun exposed skin, malesexacerbated by Fe supp, Et OH, P450 inducers, smokers, exogenous extreogenacute mtn (altitude) sickness Tx - acetazolamide (carbonic anhydrase inhibitor) - prevent HCO3 reabsorp at prox tubule, DEC H2O resabsorp, cause Na HCO3 diuresis Accelerates body's normal response to resp alkalosis fr high altitude SE - metabolic acidosisclosed-angle glaucoma - optic nn damage fr DEC angle bet iris & cornea Note: open angle glaucoma - damage of trabecular meshwork, obstructed flow to canal of Schlemm, painless, but still shows optic disk cupping tells both eyes to constrict pupil, but affect side cannot perform task while unaffected side can No pupillary constriction in either eye - optic nn (CN II) or retina injured Pupillary dilation in both eyes (hydriasis) - damage to oculomotor nn, loss of constricting parasympathetics fr both Edinger-Westphal nucmusculocutaneous nn (C5-7) injury "burners injury" or "stingers injury"burning pain, numbness, tingling Cause - depression of shoulder by forceful flexion of neck away fr involved side (football/rugby tackles)ulnar nn injury (C8, T1); passes thru Guyon's canal - hypothenar, ADDuctor pollicus (adduct thumb), dorsal/palmer interossei, 2 medial lubricals 7 sensory to dorsal/palmar hand, 5th digit, medial half 4thnegative birefringence (look like yellow needles on synovial fluid), sudden, nocturnal pain, men, affects metatarsophalangeal jt of great toe (podagra), ankles, knees; tender, swollen, warm joint INC serum uric acid, INC ESRend-stage untreated hypothyroidismd/t cessation of thyroid rep tx, precip by stroke, MI, infection, GI hemorrhage, trauma, excessive hydration, diuretic, sedative rx S/S - social withdrawl, lethargy, drowsiness, confusion, hypothermia, AMS, hypo Na, hypercapnia Tx - ventilatory support, T4 & steroid rep, water restriction (correct hypo Na)Note: myxedema - non-pitting edema of face/hands d/t GAG)Hypothyroidism Etio: autoimmune (Hashimoto's) cretinism (d/t severe iodine defic in utero), subacute thyroiditis (self-limited after flu-like illness), Riedel's thyroiditis (thyroid tissue fibrosis), iatrogenic (thyroidectomy or radioiodine tx), Rx-induced (fr lithium or amiodarone)Yersinia pestis - gram neg, facultative-anaerobic enterobacteriaceae, non-lactose fermenting, non-motile, glucose-fermenting, oxidase-neg, catalase-pos, coagulase-pos, SW US deserts Transmit by flea bite (dogs/rodents)Bubonic plaque - high fevers, enlarged LN, hemorrhagic suppurative buboes, conjunctivitis Tx - isolation, abx (aminoglycosides, FQs or tetracyclines)direct thrombin inhibitor (lepirudin, bivalirudin, argatroban, dabigatran)MOA - disrupt thrombin after it's alrdy bound to clot Use - pts who cannot tolerate heparin or had heparin-induced thrombocytopenia (adverse rxn)*fibrinolytic (clot buster) - t PA, streptokinase, urokinase Use - dissolve alrdy formed clot in acute MI, ischemic stroke, massive PESE - bleeding Do non-contrast CT to r/o hemorrhagic stroke (don't use in these pts)isotonic - constant mm tension, change in mm lengthconcentric - mm shortenseccentric - mm lengthensisometric - operater/pt have same force, neither shortening/lenghtening (ME)isolytic - operator's force overcomes contraction of mm causing it to lengthenisokinetic - mm shortens & lengthens at constant speed (professional swimming)african american males, Mediterranean INC erythrocyte sensitivity to oxidative damage, triggered by:antimalarials (primaquine)anti-TBsulfonamidesnitrofurantoinviral/bacterial infectionsfava beans (favism)Mycobacterium leprae - acid-fast (also Nocardia)Tuberculoid Hansen's dz - leprosy1.
Tuberculoid - good immunity, mild, one or multiple skin nodules, thickened peripheral nn, local loss sensation, not likely to transmit dz2.
Rocky mtn spotted fever - Rickettsia Rickettsii; spring/summer; tick vector (mostly dermacentor); found east of Rockies - dogs/rodents, Tx - doxycycline2. Syphillis (Treponema pallidum)mm weakness, L sided hemiparesis in face, arm, leg.
Overeaters Anonymous has approximately 6,500 meetings in over 80 countries.mannitol - DEC ICP (INC ICP causes NV, HA, fixed dilated pupils, papilledema)MOA - osmotic diuretic - draws water into renal tubule by osmosis, outside kidney it draws water fr tissue into blood Severe INC ICP causes Cushing's triad (HTN, bradycardia, irreg breathing)**SE: hyponatremia, pulm edema MOA - inhib topoisomerase II (prevent DNA repair), ability to intercalate (insert itself) bet DNA base pairs (blocking DNA syn), & ability to generate free radicals (cause cellular damage)MOST IMP SE: CARDIOTOXICITY -- dilated cardiomyopathy, CHF (elev JVP, DEC ejection fraction, pulm edema), severe alopecia deposits as Ca oxalate in various tissues1-3 hrs - confusion, ataxia, hallucination, sllurred speech, coma Next - cardiopulm sx, met acidosis - NV, hyperventilation, HTN, tachycardia, pulm edema, resp distress24-72 h - urinary ca oxalate crystals w/ oliguric/anuric renal failure Tx - Na bicarb, ethanol, hemodialysis, fomepizole Note: anion gap = serum Na - (HCO3 Cl), if SABA, others - terbutaline, metaproterenol, pirbuterol, levalbuterol, fenoterol MOA - stim B-2 adrenoceptors in airway, DEC intracell Ca, hyperpol smooth mm d/t INC K influx (can lead to hypokalemia), DEC myosin activity ==inhib hepatic syn of vit K dep clotting factors (II, VII, IX, X) - block extrinsic pathway, also protein C, S, ZTx - prophylaxis/Tx of thrombosis & thromboembolism (esp afib, cardiac valve rep, DVT, PE, prev MI)Monitor PT and INR (2-3); high INR --MOA - inhib syn of thromboaxane A2; prevent platelet aggreg Use - primary prophylaxis for Acute MI; also analgesic, antipyretic, anti-inflamm SE: gastric ulcer, bleeding, anemia, Reye's syndrome (kids get acute encelphalopathy & fatty liver), tinnitis fever, hypo TN, inflamm, coag Alt C' pathway & coag pathway (DIC) activateedheat stable, rel IL-1, 6, 8 (fever), TNF-alpha (hemorrhagic tissue necrosis), nitrous oxide (hypo TN/shock), platelet activ factor (hypo TN)hyperviscosity, thrombocytosis HA, vertigo, pruritis after shower, thrombosis signs, splenomegaly, pleothora of face, INC RBC mass, INC EPO in response to INC RBC, INC H/H, WBC, platelets, leukocyte alkaline phosphatase, bilirubin, B12polycythemia vera - malig prolif of RBCs in bone marrow erythromelalgia - red, burning ext relieved by aspirin & cold temp; worse w/ warmth Complications - CVA, MI, DVT, PETx - hydroxyurea, chronic phlebotomy Primary/PV: low EPO, high RBC, normal Sa O2Hypoxia/Secondary: high EPO, HIGH RBC, low Sa O2 (or normal if d/t tumor)Relative: low plasma vol intoxicated pts "sat night palsy," using crutchesweakness of wrist/finger extensors, can't supinate forearm, loss of thumb abduction (abd pollicus longus), sensory dorsolat hand, dorsal 1st, 2nd, 3rd digitacute tubular necrosis - caused ischemia (hypo TN, shock), meds (NSAIDs antimicrobial), radiocontrast, rhabdomyolysis, transfusion rxnshard to disting fr prerenal dz (dehydration - normal microscopy, FENa erythroblastosis fetalis - hemolytic dz of newborn d/t Rh isoimmunization (Rh (-) mom exposed to fetal RBC that are Rh and dev Abs to fetal Rh ("D") Ag.