Other Flashcards
Hirshprung Disease
absence of ganglia that regulate peristalsis
problem w/ neural crest cell migration
Spore-forming bacteria
Bacillus anthracis & cereus, clostridium perfringens, botulinum & tetani, & Coxiella burnetti
Drugs that INDUCE cytochrome P450
=> decrease effectiveness of the metabolized drug
- Phenobarbitol/all barbiturates
- Rifampin
- Carbemazepine
- Phenytoin
- Griseofulvin *also: chronic EtOH abuse
Drugs that INHIBIT cytochrome P450
=> decreased metabolism of cyp450 dependent drugs
- Cimetadine
- Fluoxetine
- Antibiotics: Isoniazid, Erythromycin
- Antifungal/virals: Ketoconazole, Ritonavir
- Grapefruit juice
Case:
HIV + patient, with diffuse neuro Sxs (headache, stiff neck, fever…).
What is the DDx (& assoc. treatment)?
1. Toxoplasmosis (w/ ring-enhancing lesions on MRI)
Tx: pyrimethamine & sulfasiazine #2. Primary CNS Lymphoma (B cell infiltrate & EBV DNA in CSF) #3. Cryptococcus (diffuse)
Tx: Amphotericin B
Bacteria that causes infective endocarditis and is associated with colon cancer
Streptococcus BOVIS
Case:
Patient presents w/ mitral regurgitation and history of chorea in childhood.
Cause?
Strep pyogenes => Rheumatic fever!
= molecular mimicry problem after resolved strep infection.
Acutely: fever, chorea
Chronic/long-term: mitral regurgitation OR mitral stenosis
Causes of Renal Papillary Necrosis
(Sx = gross hematuria, w/ a predisposing factor below)
- Sickle cell disease OR trait
- Diabetes
- Severe obstructive pyelonephritis
- Analgesic nephropathy (ie: NSAIDs)
Bacillary Angiomatosis vs. Kaposi’s Sarcoma
Bacillary angiomatosis: benign, capillary skin papules.
- w/ AIDS, from bartonella.
Kaposi’s Sarcoma: malignant, endothelial on skin OR mouth/GI/Resp.
- w/ HHV-8 & HIV
Sturge Weber disease
Congenital disease of capillaries.
- “port wine stain” on face
- ipsilateral leptomeningeal angiomatosis => intracerebral AVM
- seizures, early glaucoma
“Monday Disease” for Nitroglycerin exposure
develop tolerance during week of exposure (less vasodilation), but LOSE tolerance over weekend
=> tachycardia, dizziness, headache w/ re-exposure
Meds for lowering lipids (class name, biggest effect, major SEs)
All decrease LDL.
#1. Statins: (–l HMG CoA reductase) decrease LDL *rhabdomyolysis
2. Niacin: increase HDL, *flushing, hyperglycemia/urate
3. Bile acid resins: block bile reabs. *gallstones
4. Ezetimibe: block cholesterol reabs.
5. Fibrates: upreg. LPL = decrease TGs! *myositis, LFTs up, gallstones
Niacin Deficiency
“3 Ds” –> Diarrhea, Dementia, Dermatitis
= Vit B3 def., common in EtOH abuse
* needed as coenzyme for NAD & NADPH
Kussmaul Sign
= paradoxical RISE in JVP during inspiration,
indicates Constrictive Pericarditis
(also likely to hear “pericardial knock” later than S3)
Signs and causes of Infectious Arthritis
“STD”
S- Synovitis, T- tenosynovitis, D- Dermatitis
*often migratory, asymmetric Sxs!
Causes: S. aureus, Strep, Gonorrhea (“gonococcal arthritis”)
Potential causes of avascular necrosis/osteonecrosis
- trauma
- high-dose corticosteroids
- alcoholism
- sickle cell disease
* usually @ femoral head.
Disease associated with Elevated ACE serum levels
Sarcoidosis!
wide-spread, immune-mediated non-caseating granulomas
Secondary causes of hypoxia => clubbing
- Lung disease (esp. supurative): lung cancer, TB, CF, bronchiectasis, pulm. HTN, empyema, etc.
- Heart disease: tetralogy of fallot/other congen. heart defects, bacterial endocarditis
- Other: IBD (crohns/Ulc. colitis), hypERthyroidism, malabsorption
1 most noxious toxin of Clostridium perfringens
Lecithinase, aka: “Alpha toxin” or Phospholipase C
-> splits phospholipid molecs
=> cell lysis & RBC hemolysis, edema, tissue necrosis
Metabolism mech for drugs associated with drug-induced lupus
(example drugs: hydralazine, procainamide)
N-Acetylation by the Liver (phase II)
*slow acetylators have greatest risk of developing drug-induced lupus.
*anti-histone Ab = most specific for drug-induced Lupus
Triad of Sxs/complications in Congenital Rubella infection
- “white pupils” (= congenital cataracts)
- Sensorineural hearing loss
- PDA/congen. heart defects
*prevent by vaccinating NON-pregnant women of child-bearing age!
(w/ live attenuated vaccine)
toxins of Pseudomonas aeruginosa
- gram + rod => “ecthyma gangrenosum” (purple cut. lesions, esp. if lacking humeral immunity)
1. Exotoxin A –l protein synthesis
2. Elastase –> blood vessel destruction
3. Phospholipase C –> degrades cell membranes
4. pyocyanin: makes ROS
Odds Ratio vs. Relative Risk calculations
Odds ratio: (#Tx & disease/#Tx & no disease)/(#disease and NO Tx/#no Tx & no disease) = “(AxD/BxC)
aka: (%Tx w/ outcome)/(%not Tx w/ outcome)
Relative risk: (#Tx & outcome/all Tx)/(#noTx & outcome/all NOT Tx)
mycobacterium avium
Mycobacterium (not TB),
causes disease in healthy OR immunosuppressed pts.
Sxs: hepatosplenomegaly & elevated AlkPhos, fever, weight loss, diarrhea… *clear chest Xray (vs. granulomas if TB)
**grows best at 41C! Prophylactic Tx w/ azithromycin (esp. if CD4 <50)
