mixed deck 04/21 Flashcards
overuse of diuretics can lead to contraction alkalosis
overuse of diuretics or any other causes of volume loss lead to compensatory increase in aldosterone production. aldosterone causes retention of sodium and water and a loss of potassium and hydrogen ions by the kidneys.
- this causes a contraction metabolic alkalosis
- typical lab findings will be a high pH, a high HCO3 and a high pCO2
panic attack episodes
hyperventilation
- decreases the pc02 and causes a respiratory alkalosis
- acute condition so no metabolic compensatory
Petazocine and butorphanol are unique in that they are PARTIAL mu opiod receptor agonists. but
when used in combination with morphine or other opiods, they can competitively inhibit mu receptors and product antagonisist effects reducing opiod analgesic effects, this can lead patients to withdrawal symptoms
C. trachomatis is an intracellular pathogen that has a cell wall, but the cell wall is unique in that
it lacks peptidoglycan!!!
so b-lactam drugs are no use! and (cephalosporins, penicillins)
instead use macrolide like azithromycin or tetracylcines
note ureaplasma urealyticum also lacks a cell wall
Amphoterible B binds to ergosterol of fungal cell membranes to excert its antifungal effects, however it can bind what to some degree?
cholesterol
this is what causes the toxicity to human tissues
ex) nephrotoxicirt, hypoklemia, hypomagnesiemia, anemia, thrombophlebetis at site of injection, acute infusion related reactions like fever, chills, rigors and hypotension
azoles inhibit or induce CP450?
inhibit!
fluconazole, itraconazole
griseofulvin used for dermatophytes only binds to
microtubular proteins as the mechanism of action
inferior MI –> RCA , which perfuses the AV and SA node, this can lead to bradycardia.
to treat the bradycardia, use atropine an anticholinergic which will decrease the vagal tone. Watch out for sideeffectsL
CNS: sedation
EYE: mydriasis (dilated pupils), cycloplegia (paralysis of accommodation). Recall there are M3 for ciliary muscle and constrictor pupillage which do accomodation and constriction respectively.
-this can lead to a narrowing of the anterior chamber angle and diminished outflow aqueous humor –> angle-closure glaucoma
heart: tach
secretions: decrease
bladder: detruser relaxation, delays voiding
bronchi: bronchodilation
what anticholinergic which can cause CNS sedation can be used for motion sickness?
scopolamine
What anticholinergic which works on CNS sedation is used for Parkinsons disease?
Benztropine
what anticholinergic, specifically an antimuscarin can be used for bronchodilation?
ipratropium
H1 receptor antagonist diphenyhydramine can be used for allergic rhinitis, but dont forget it has
anticholinergic effects too of muscarinic receptors –> decreased secretions. Decreased sweat gland secretions can result in fever and compensatory cuteneous vasodilation
-inhibition of pupillary constrictor and ciliary muscles
Staph foreign body infections?
S.epidermis!!!
- release an extracellular polysacchidre matric that encases the bacteria!
- BIO FILM!
Which organisms can make biofilms?
staph epidermidis
step mutans and step sanguinis (viridins)
pseudomonas aeruginosa
nontypable hemophilus influenza
examples of encapsulated bacteria?
streptococcus pneumoniae
haemophilus influenza type B
Neisseria meningitidis
antiphospholipid antibody syndrome immune hypercoagulability
-antiphospholipid antibodies (lupus anticoagulant/or anticardiolipid antibodies)
venous thromboembolism, arterial thromboembolism, or frequent fetal loss.
-prolongue aPTT
Paraneoplastic syndromes occur due to tumor cells producing substances that frequently induce an autoimmune reaction and cause damage and deferenation of healthy organs and tissues
- examples are lambert-eaton myasthenic syndrome
- paraneoplastic cerebellar degeneration
localized amyloidosis (confined to a single specific organs)
cardiac atria: atrial natriuretic peptide (senile)
thyroid gland: calcitonin (medullary carcinoma)
pancreatic islets: islet amyloid protein (amylin)
cerebrum/cerbral blood vessels: B-amyloid protein (alzheimers)
pituitary gland: prolactin
Immune globulin light chains cause multi-organ amyloid deposition in primary systemic amyloidosis
hyperparakeratosis
describes the retention of nuclei in the stratum corneum, which signals incomplete keratinization
hypergranulosis
describes excessive granulation in the startum granulosum of the epidermis and is seen in conditions such as lichen planus
the major histologic finding in patients with contact dermatitis
spongiosis
epidermal accumulation of edematous fluid in the intercellular spaces
-delayed hypersensitivity langerhand cells MHC II to CD4 T helped cells, to bring T cells in
eczematous dermatitis
erythematous, paulovesicular, weeping, encrusted lesions that may evolve into thickened, scaly plaques
-atopic dermatitis, drug related eczematous dermatitis, photo-eczematous dermatitis, primary irritant dermatitis
anaplastic tumor characteristics
- loss of polarity, complete disruption of normal architecture
- nucleo pleomorphism and cellular plemorphism (shapes and sizes)
- high N:C ration, that are often deep staining (hyper chromatic) with abundant, coarsely-clumped chromatin and large nucleoli
- mitotic figures
- giant multinucleated tumor cells
Bronchial epithelial cells can produce keratin pearls after a phenotypic switch from columnar epithelium to squamous epithelium.
this is metaplasia
pneumonia
bronchopneumnia - patchy inflammation of a number of lobules
interstitial: inflammatory infiltrate is confied to alveolar walls
lobar: inflammatory process involves an entire lung lobe
Lobar pneumonia typically follows 4 stages
congestion (first 24 hours)
- lobe is red, heavy, boggy
- histo vascular dilation, alveolar exudate contains mostly bacteria
red hepatization (2-3days)
- love is red, firm ( liver-like consistency)
- histo, alveolar excudate contains erythrocytes, neutrophils and fibrin
gray hepatization (4-6days)
- gray-brown firm lobe (pale and firm)
- histo: RBC disintegrate, alveolar exudate contains neutrophils and fibrin
resolution:
lobe restoration of normal architecture
histo enzymatic digestion of exudate
internal juglar vein
drains the brain and superficialface and neck
external jugular vein
drains the scalp and portions of the lateral face
the subclvian vein is a continuation of the axillary vein
both drain blood from the upper extremity
SVC syndrom
-SVC is obstructed, which would have hface, neck, chest and both arms would be involved
the brachicephalic vein drains the ipsilateral external jugular vein and subclavian veins
-this would cause a one side SVC syndrome
the right brachiocephalic vein also drains the right lymphatic duct-drians the lymph from the right upper extremity, the right face and neck and the right hemithorax and the right upper quadrant of the abdomen
the left lymph is from left thoracic duct does the rest of the body
Gram-negative sepis is due to release of endotoxin LPS from bacterial cell walls. LPS is heat stable, and has three regions O antigen, core pollysacharide and lipid A
Lipid A is the toxic component
-it causes activation of macrophages leading to the widespread release of IL-1 and TNF alpha, which cause the signs and symptoms of septic shock, fever, hypotension, diarrhea, oliguria and vascular compromise and finally DIC
mulluscum contagiosum is caused by sexually transmitted poxvirus
DS and linear DNA
-characterized by white, umbilicated papules on the penis, vulva or groin
