5/21 Mixed Flashcards
Strep pneumoniae vaccine
-give to young children and elderly
Pneumococcal polysaccaride vaccine is an unconjugated vaccine that induces a relatively T-cell independent response
The pneumoccocal conjugate vaccine contains polysaccharide material attached to a protein antigen which allows for a more robust T-cell dependent resposne
Thoracic outlet syndrom
Compression of the lower trunk of the brachial plexus in the scalene triangle, the space bordered by the anterior and middle scalene muscles and the first rib.
Symptoms include upper extremity numbness, tingling and weaknessDue to anomalous cervical rib, scalene muscular anomalies, injury (repetitive overhead arm movements, trauma)
The gonadal arteries arise from
The abdominal aorta
Turner’s Syndrome
Lymphedema (bilateral non-pitting edema of hands and feet) and cystic hygromas (posterior neck mass composed of cystic space sepatated by connective tissue)
Short stature, primary amenorrhea, and aortic anomalies are the other important clinical features
Femoral pulses are diminished = coarctation of the aorta
Inflammation
Passage of circulating inflammatory leukocytes into the inflamed tissue
Steps involved: margination, rolling, activation, tight adhesion, crawling, transmigration
Transmigration is mediated by adherence to platelet endothelial cell adhesion molecule 1 (PECAM-1)
Allopurinol effects on azathioprine
Xanthine Oxidase (XO) catalyzes 1 of 2 major azathioprine-inactivating pathways Allopurinol competitively inhibits XO, which results in increased conversion of azathioprine to its active metabolite
Zinc finger motifs
Composed of chains of amino acids bound together around a zinc atom via linkages with cysteine and histidine residues
They recognize specific DNA sequences and are used by many transcription factors to bind DNA and alter activity of target genes
Intracellular receptors that bind steroids, thyroid hormone, and fat soluble vitamins act directly as transcription factors and contain zinc-finger binding domains
Mannitol
Osmotic diuretic that works by increasing plasma or tubular fluid osmolality
Increased plasma and fluid osmolality causes extraction of water from the interstitial space into the vascular space or tubular lumen, with subsequent diuresis
In the brain, water redistribution from the tissues into the plasma helps reduce edema and intracranial pressure in the setting of cerebral edema
One of the more severe toxicities of aggressive osmotic diuretics is pulmonary edema
Microglia
Move to the area of ischemic infarct approximately 3-5 days after the onset of ischemia and phagocytize the fragments of neurons, myelin and necrotic debris
A cystic space replaces the necrosis and astrocytes form a glial scar along the periphery
Chronic Aortic regurgitation
Leads to an increase in left ventricular end-diastolic volume (preload) and wall stress, with resultant ECCENTRIC hypertrophy. The gradual increase in left ventricular chamber size increases total stroke volume and helps maintain cardiac output
CONCENTRIC HYPERTROPHY: Pressure overload
ECCENTRIC HYPERTROPHY: Volume overload
Brain Natriuretic Peptide (BNP)
Causes vasodilation (decreased preload) and diuresis Both ANP and BNP activate guanylate cyclase, which induces an increase of intracellular cyclic GMP
Clostridium difficile contact precautions
Hand washing with soap and water, gown for any patient contact, and non-sterile gloves that should be changed after contact with contaminated secretions.
Alcohol-based hand sanitizers do not kill the bacterial spors
Obesity hypoventilation syndrome
Characterized by chronic fatigue, dyspnea, difficulty concentrating, and evidence of hypoventilation (partial pressure of carbon dioxide > 45 while awake)
It is one of the important causes of hypoxemia with a normal alveolar to arterial oxygen gradient
Tumor lysis syndrome
Can develop during chemo for cancers with rapid cell turnover (poorly differentiated lymphomas and leukemas), substantial tumor burden, or high sensitivity to chemotherapy
It is characterized by hyperphosphatemia, hypocalcemia, hyperkalemia, hyperuricemia
Prevention often involves hydration and the use of a hypouricemic agents such as allopurinol and rasburicase
Isosorbide dinitrate
Low bioavailability due to extensive first-pass hepatic metabolism prior to release in systemic circulation (requires a higher dose)
Sublingual nitroglycerin is absorbed directly from oral mucosa into the venous circulation and has a higher bioavailability
