Block 31 Flashcards
cystic mass at the lower spine that is covered with skin and sometimes tuft of hair.
Meningocele and meningomyocele.
- meningocele consists of spinal meninges that protrude through the vertebral arch defects.
- meningomyocele has portions of the spinal cord or cauda equina within the protrouding meningeal sac.
- neural tube defect is defined as failure of closure of neuropore by 4 weeks.
- anterior neural tube defects is assoicated with anencephaly
- posterior is associated with spina bifida occulta, meningocele and meningomycoele
Hep E general features
Unenveloped
SsRNA
Fecal oral route
Causes fulminant hepatitis in pregnancy
Edematous and erythmatous plaque with mild central pallor is indicative of
Wheal, allergic reaction
Peripheral arythema is flare
(Wheal and flare reaction)
Status epilepticus
Single seziures that lasts >5 min or the occurance of multiple discrete seziures with incomplete recovery of consciousness between episodes.
- common causes include structural brain injury, infection , metabolic abnormalities and medication non compliance in individual with known epilepsy.
- IV lorazepam, potentiates the effect of inhibitory GABA in CNS. Its the first drug of choice in treatment of status epelipticus
- IV phenytoin is long acting sodium channel blocker that is administred concurrently to prevent recurrence of seziures.
Mechansim of common antisezures drugs
- Blocks Na channels: phenytoin, carbamazepine
- Blocks Na and increases GABA: valproic acid
- Increases GABA(a) action: benzodiazepine, and phenobarbital
- modulate GABA and glutamate release: levetiracetam.
- Blocks thalamic T type Ca channels : ethusoximide.
Alpha 2 adrenergic stimulation leads to
- Sympathetic outflow
- Decrease insulin release
- Decrease lipolysis
- Platelet aggregation
- Decrease aqueous humor production
Epithelial cells covered with gram variable rods on mount microscopy
Clue cell - bacterial vaginosis.
P, auriginosa and C,diphteriae toxins
Both exotoxin A and diphteria toxins. Although they are structually different, they both ribosylate and inactivate EF-2, halting human cell protein synthesis and causing cell death.
Diastolic heart failure
Is a common cause of acute demopensated HF. Its characterized by normal LVEF and end diastolic volume in the setting of increased LV filling pressures.
- diastolic dysfunction can be due to conditions that decrease LV compliance, such as impaired myocardial relaxation or increased intrinsic ventricular wall stiffness (eg, amyloid deposition).
- this patient most likely has long standing hypertension leading LV wall hypertrophy, which can impair myocardial relaxation and increase intrinsic wall stiffness.
- LV diastolic pressure id determined by the blood volume in the LV cavity and compliance of the LV. Conditions that reduced ventricular compliance lead to increased LV end diastolic pressure (LVEDP) at the same LVED volumes.
- this causes an upward shift in the pressure volume curve (point a->b).
- as diastolic dysfunction worsens, LVEDP continues to rise as the heart attempts to maintain a near-normal stroke volume and cardiac output.
- decompensation occurs when the increased LVEDP, causes pulmonary edema and dyspnea.
Periodic acid schiff reaction
Is used in histochemical staining because the periodic acid oxididezes carbon-carbon bonds, forming aldehydes that produce a brilliant magenta color upon reacting with fuchsin sulfurous acid.
- as a result, the PAS stain is particularly effective at highlighting polysaccharide of the fungal cell wall, mucosubstances secreted by epithelia and basement membrane.
- the glycoprotein that present in the cell walls of the gram positive actinomyceete trophyrma whippelii appears magneta with PAS and diastase resistance, which makes this stain an excellent choice when microoscipically evaluating small bowel mucosa for whipple disease.
Clasp knife spasticity
Charactrized by initial resistance to passive extension followd by a sudden release of resistance.
- this form is seen in UMN lesions and results from lack of upper motor neuron inhibition on the spinal strech reflex arc.
- UMN can affect any part of the pyramidal motor system including corticospinal cord, medulla, pons and midbrain, the internal capsule and precentral gyrus.
- patients with internal capsule stroke commonly have pure motor weakness affecting contolateral, arm , leg and lower face.
Latissimus dorsi
Large thoracolubar muscle that contribute to forecful movement of the humerus. It originates in a broad area spanning from the iliac crest and lumber fascia to the spinous processes of T7-T12 and lower ribs.
-its innervated by thoracodorsal nerve and involved in internal rotation of the arm
Check what true pelvis means
True pelvis
Long term Kidney changes in case of BPH
Parenchymal pressure atrophy, this is due to retention and retrograde flow to the kidney.
-increased BPH —> urinary retention —> bladder wall hypertrophy —> ureters, renal pelvis and calyces dilates and deform —> hydronephrosis —> renal parynchema atrophy and scarred
Suprachiasmatic nucleus is involved in
Circadian rhythm regulation and pineal gland function.
Jet lag syndrome
- associated with long flight that cross severl time zones, symptoms include insomnia, daytime drowsiness and decrease work performance
- GI symptoms and malaise also common
- caused by dyssynchrony between body circadian rhythms and envirnomental rhythm.
Nocardiosis
-gram positive rod, partially acid fast and aerobic
-its endemic in soil from disease from inhalation or traumatic inovulation into skin
-immunocompromised or elderly patients
-clinically presents with
1. Pneumonia - similar to TB
2. CNS- brain abscess
3 cutaneous involvement
Treated with :
- trimethoprim-sulfamethoxazole.
-surgical drainage of abscess.
tetanospasmin mechanism
- neurotoxin, spores are commonly found in soil and may contaminate injured tissue, classically puncture wounds from soil contaminated objects.
- the low oxygen tension and high availabilty of nutrients in puncture wound provides a localized anaerobic envirnoment for the germination of spores, growth of vegetative cells and production of toxin within bacterial cells.
- toxin gain access to motor neuron axon —> retrograde transport to spinal cord and medulla. (Organ remains at the local wound site, its the toxin that does).
Psoriasis complication
Psoriatic arthritis
Nail changes : yellow brown discoloration, pitting ,thickening or crumbling
Inflammatory disorder of the eye : conjunctivitis, blepharitis or uveitis.
Prenicious anemia leads to
- Decreased IF —> low B12 —> megaloblastosis
- Decreased secretion of hydrochloric acid causes elevated intraluminal PH that leads to increase of gastric secretion by gastic G cells.
Ramleteon
Melatonin agonist, is one of the few medication with demonstrated safety and efficacy in older adults.
-it binds with high affinity to melatonin receptors in suprachiasmatic nucleus, it has few side effects and no dosage adjusment is necessary in geriatric patients.
Syphillis - treatment
- penicillins work by covalently binding and inhibiting transpeptidase. This enzyme catalyze the final cross linking step in peptidoglycan cell wall formation. The joining of amino acid in the third position of a peptidoglycan molecule to the terminal D-alanine D-alanine of another peptidoglycan molecule.
- the structual similarity of penicillins to D-alanine D-alanine facilitate in their binding to transpeptidase.
- when transpeptidase is inhibitied, cell wall synthesis ceases and cell wall degradation by bacterial autolysins proceeds unchecked.
