5/14 Mixed Flashcards
Why does an infection with N. gonorrhoeae not result in lasting immunity
Ability of bacteria to modify their outer membrane proteins by the process of antigenic variation. Antibodies generated during one infection will only be specific for that single antigenic epitope.
*Remember repeated Neisseria infections can be caused by terminal complement deficiencies leading to an inability to form MAC complex
Phenylketonuria
Most cases due to phenylalanine hydroxylase deficiency
Less commonly due to BH4 (tetrahydrobiopterin) deficiency secondary to dihydropteridine reductase deficiency
Leads to phenylalanine accumulation and low levels of serotonin and other neurotransmitters > leads to neurologic deterioration
Infraspinatus
External rotation of the shoulder
Rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis)
Hydroxyurea in the treatment of sickle cell dx
Increases fetal hemoglobin
Reserved for patients with frequent pain crises
Nucleosome structure
Composed of DNA wrapped around a core of 8 histone proteins (2 molecules each of H2A, H2B, H3, and H4).
H1 histone is located outside of the histone core and helps package nucleosomes into more compact structures by binding and linking the DNA between adjacent nucleosomes
Transport of glucose into cells
Occurs by facilitated diffusion
Moves from areas of high concentration to areas of low concentration with the help of transmembrane glucose transporter proteins (GLUT)
These carrier proteins are steroselective and have preference for D-glucose
ABG of pulmonary embolism
Hypoxemia, respiratory alkalosis (hypocapnia), bicarb is normal (acute phase)
TCA antidepressant side effects
Strong anticholinergic properties
Confusion, constipation, urinary retention
Use with caution in the elderly!
Most commonly affected tendon in rotator cuff syndrome
Supraspinatus tendon
“Empty can supraspinatus test”= abduction of the humerus in parallel to the axis of the scapula (30 d forward flexion) while in full internal rotation (thumbs pointed to the floor)
Patent Ductus Arteriosus (PDA)
Embryonic derivative of the sixth aortic arch
Biliary atresia
Progressive obstruction of extrahepatic bile ducts
Immune or viral induced
Infants present with jaundice within first 2 months of life, with dark urine and pale stools, firm hepatomegaly , elevated direct bilirubin
Biopsy: Intrahepatic bile duct proliferation, portal tract edema, and fibrosis
Caspofungin (echinocandin antifungals)
Block glucan synthesis
Suppress fungal cell wall synthesis
Most active against Candida and Aspergillus
What is the most common valve affected by infective endocarditis?
Mitral valve
Mitral valve prolapse is the most common underlying valvular disease predisposing to the development of IE
Adenomyosis
Presence of endometrial glandular tissue within the myometrium
Heavy menstrual bleeding, dysmenorrhea, uniformly enlarged uterus
Normal appearing endometrial tissue on biopsy
Thiazolidinediones (TZDs)
Decrease insulin resistance
Active peroxisome-proliferator activated receptor-y (nuclear receptor that alters the transcription of genes involved in glucose and lipid metabolism)
Drug induced lupus erythematosus
New onset lupus symptoms
ANA antibodies and anti-histone Abs
Exposure to hydralazine, procainamide, isoniazid, minocycline, quinidine
Alpha-1 anti-trypsin deficiency
Panacinar emphysema and liver disease
Obturator nerve
Descends through obturator canal
Supplies thigh ADDUCTOR muscles
Nerve injury due to compression (pelvic trauma, surgery, tumor)
Weakness on thigh adduction and sensory loss over the distal medial thigh
Right sided colon cancers
Present with features of iron deficiency anemia (fatigue, pallor) due to OCCULT blood loss
Exophytic masses
Migratory thrombophlebitis should raise suspicion for
CANCER
Visceral adenocardinomas of pancreas, colon, lung
> hypercoaguability
Trousseau syndrome
Common peroneal
Susceptible to injury at the lateral neck of the fibula caused by compression (prolonged lying during surgery, crossing the legs, leg casts)
Patients present with “foot drop”, weakness on foot dorsiflexion, eversion, toe extension
Sensory loss over the lateral leg and dorsolateral foot
Rx of Heparin overdose
Protamine
Treats bleeding due to heparin toxicity
Rx: spasticity-related complications caused by MS
Paraparesis, urge incontinence, thoracic sensory level
Baclogen (agonist of GABA-B), Tizanidine
3rd part of the duodenum
Courses horizontally across the abdominal aorta and inferior vena cava at the level of the third lumbar vertebra
In close association with the uncinate process of the pancreas and the superior mesenteric artery/vein (superior mesenteric vessels lie anterior to the duodenum at this location)
Ivabradine
Selectively inhibits the funny sodium channels (If), prolonging the slow depolarization phase (4) and slowing the SA node firing rate
Negative chronotropic effect with no effect on cardiac contractility (inotropy) or relaxation
Caudal regression syndrome
Agenesis of sacrum and lumbar spine
Flaccid paralysis of legs, urinary incontinence
Related to poorly controlled maternal diabetes
Medications with anticholinergic properties
Antihistamines
Tricyclic antidepressants
1st low potency anti-psychotics (chlorpromazine)
2 gen antipsychotic clozapine
Antiparkinsonian drugs (benztropine, trihexyphenidyl)
Belladonna alkaloids (atropine)
The suspensory ligament of the ovary
Contains the ovarian artery, vein, lymphatics, and nerves
Ovarian artery is a major blood supply to the ovary and must be ligated during an oophorectomy to prevent heavy bleeding
Oocyte arrest in meiosis over time
Primary oocytes are completely developed in female embryos by the fifth month of gestation, at which point they are arrested in prophase of meiosis I
Normal menstrual cycle hormones stimulate the primary oocyte to resume differentiation. Prior to fertilization, secondary oocytes are arrested in metaphase of meiosis II
Suppurative parotitis
Risk factors: decreased salivary flow (anticholinergics, calculi, neoplasms, dehydration, intubation)
Micro: staph aureus, anaerobes
Presentation: firm, erythematous pre/postauricular swelling
Trismus, dysphagia, fever, chills
Elevated serum amylase without pancreatitis
Protein A MOA of staph aureus
Forms part of the outer peptidoglycan layer of S. aureus
Binds with the Fc portion of IgG antibodies at the complement binding site to prevent complement activation
Impaired opsonization and phagocytosis
Zenker Diverticulum
Caused by abnormal spasm or diminished relaxation of the cricopharyngeal muscles during swallowing (cricopharyngeal motor dysfunction)
Methotrexate side effects
Toxicity to oral and GI mucosa (ulcerations), hair follicles (alopecia), and BM (pancytopenia), hepatotoxicity, pulmonary fibrosis, increased risk for opportunistic infections
Parasitic killing by eosinophils
IgE and IgG on parasite trigger eosinophil degranulation and release of cytotoxic protein (major basic protein) and ROS
Antibody-dependent cell-mediated cytotoxicity
SE of Clozapine
Aganulocytosis (>neutropenia)
Seizures
Myocarditis
Metabolic Syndrome
***Make sure to monitor: absolute neutrophil count
Listeria Monocytogenese
Requires intact cell-mediated immunity
Flecainide
Class Ic antiarrhythmic
Rx: supraventricular tachycardias (a. fib)
Bind fast Na channels, blocking inward Na current and prolonging QRS
Slowest to dissociate > use-dependence (Na blocking effects intensify as the heart rate increases due to less time between action potential for the medication to dissociate)
Dissemination intravascular coagulation in obstetrics
Placental damage > release of tissue factor from placenta into maternal circulation > activation of intravacular coagulation > circulating microthrombi > organ ischemia, fibrinolysis (+ D-dimer), platelet consumption, coag factor consumption > bleeding
Prostatectomy potential consequence
Injury to prostatic plexus (in the fascia surrounding the gland) can cause erectile dysfunction (innervates the corpora cavernosa of the the penis)
Treatment of congenital adrenal hyperplasia
Administer low doses of exogenous corticosteroids to suppress ACTH (adrencorticotropic hormone) secretion. By removing excessive ACTH stimulation, exogenous corticosteroids can decrease androgen production by the adrenal cortex
