Part 6 Flashcards
Service Learning
Involves students in community service activities and applies the experience to personal and academic development resulting in equal benefit for both the student’s learning and action in the community
Pedagogy definition
The art and science of teaching using an array of teaching strategies because there is no universal approach that suits all situations to support intellectual engagement and connectedness and prommote wellbeing of students, teachers, and community
Public Health
The science and art of preventing disease, prolonging life, and promoting health through organized efforts and informed choices of society, organizations, public and private communities, and individuals
Epidemic/outbreak
Occurence in a community or region of cases of an illness, specific health related behavior, or other health related event clearly in EXCESS of normal expectancy. Both terms are used interchangeably, however epidemic usually refers to a larger geographic distribution
Pandemics definition and history
Pandemic is seen throughout the world
- 1918 500 million infected around world (spanish flu)
- 2009 19000 deaths from influenza outbreak
- 1955 Polio vaccine development
- HIV decrease in 20% since 2001
Public health approach steps (4)
1) Surveillance - what is the problem
2) Risk factor identification - what is the cause
3) Intervention evaluation - What works to fix while considering cultural and practical barriers
4) Implementation - How do you do it
John Snow
Father of modern epidemiology, studied outbreak of cholera cases in 1854 to determine what factors were contributing to that disease process
Health determinants (4) and their percentages
- Genes and biology (5%)
- Health behaviors (20%)
- Social or societal characteristics (50%)
- Health services or medical care (25%)
4 Types of disease prevention
1) Primary - prevention of a disease before it happens (Immunizations, etc.), health promotion
2) Secondary - treatment of complications of a disease to prevent it from worsening or progressing (B-blockers, drug therapy), pre-symptomatic diagnosis and treatment
3) Tertiary - Assistance mitigating an already established bad outcome (OT, PT, rehab), disability limitation, preventing CKD in diabetics
4) Quaternary - Avoidance of unnecessary medical interventions (error in medicine)
Sensitivity
Ability of a test to identify all individuals who actually are positive, including false positives (example of all spirochetes opposed to specifically syphilis)
Specificity
Ability of a test to differentiate between individuals who are positive and negative, such as ignoring false positives
The greatest predictor of health is ____, and the greatest predictor of that is _____
socioeconomic status, education
Reliability vs validity
Reliability is ability of a measure to get the same results each time regardless (precision), validity is the accuracy of the results to their truth
3 Levels of evidence
Level A - meta-analysis, high quality randomized, controlled trials that considers all important outcomes, using comprehensive search strategies Always followed
Level B - Other evidence, well designed, nonrandomized clinical trial, quantitative systematic review with well substantiated conclusions, Almost always followed
Level C - Consensus/expert opinion, only sometimes used
Level D - against providing intervention in an asymptomatic patient because the harms outweigh the benefits
Staph aureus
- Gram +
- Pustules, boils, abscess, cellulitis (red swollen skin affecting lower leg), scalded skin syndrome (babies and children), food poisoning, TSS
- Anti staph PCN or 1st gen cephalosporin
Staph epidermidis grap type, common infection type, and treatment
- Gram +
- Surgical wound infections, medical procedural infections, - Part of normal flora, causes infection on prosthetic implants as it attaches to the plastic
- Vancomycin (has resistance to PCNs)
Strep pyogenes
- Gram +
- impetigo (often in children or daycares), erysipelas (bright aised lesions on skin), pharyngitis, scarlet fever (strawberry tongue), pneumonia, cellulitis and necrotizing fasciitis (flesheating disease), TSS, acute glomerulonephritis (antibody complexes in kidney), Rheumatic fever
- PCN’s
- important human pathogen capable of producing infections and post infection diseases
Viridans strep gram type, common infections it causes, antibiotics to treat
- Gram +
- S. mutans, S. salivarius, S. Sanguis, cause dental caries and bacterial endocarditis
-Beta lactams, IV meds depending on type
Strep pneumoniae gram type, common infections it causes and treatment
- Gram +
- 80% of cases of bacteria pneumonia, also meningitis, otis media, septicemia
- B Lactams, sometimes IV needed
Enterococci gram type, common infections caused, treatment
Gram pos cocci part of normal fecal flora, can persist on fomites for a long time, common cause of nosocomial infections, sensitive to synergistic combo of B-lactam and aminoglycosides, except some resistant, including other classes like VRE
Niesseria gonorrhoeae gram type, diseases caused, treatment
- gram -
- Cause gonorrhea,, PID, and sterility in females
- ceftriaxone
Niesseria meningitidis gram type, diseases caused, treatment
- gram -
- Cause contagious spinal meningitis, hemorrhagic rash
- IV ceftriaxone
One key differentiatior between niesseria meningitidis and niesseria gonorrhoeae is the latter….
….does NOT produce a capsule
Moraxella catarrhalis gram type, common infections it causes, treatment
- Gram -
- Infection of respiratory system, middle ear, eye, CNS, joints
- Treatment depends on results of sensitivity testing
Bacillus anthracis gram type, disease caused, treatment
- gram +
- anthrax (woolsorter’s disease - inflammation, edema, hemorrhage), Normally found in livestock
- PCN
Clostridium perfringens gram type, diagnosis, treatment
- Gram +
- Enterotoxin, food poisoning, gangrene, shock
- IV zosyn
Zosyn (piperacillin and tazobactam) drug class and use
a combo of a penicillin and a beta-lactamase inhibitor used for serious infections given IV
Clostridium tetani gram type, common disease caused, treatment, note about organism
- Gram +
- Tetanus exotoxin causing tetanus
- IV metronidazole
-spores have tennis racket appearance
Clostridium botulinum gram type, disease caused, treatment
- Gram +
- Botulinin toxin resulting in paralysis/paresis
- antitoxin treatment
Clostridium difficile gram type, common diseases caused, treatment
- Gram +
- Cytopathic exotoxins from antibiotic induced pseudomembranrous colitis
-oral vancomycin
Lipopolysaccharide (LPS)
virulence factor released by gram neg bacteria causing inflammation in tissues by inducing cells to secrete proinflammatory mediators (cytokines, prostaglandins)
E. coli gram type, common diseases caused
- gram -
- UTI, gastroenteritis
Klebsiella pneumoniae gram type and common diseases it causes
- gram -
- pulmonary disease, nosocomial UTI, epidemic diarrhea of newborn
Serratia marcescens gram type and common infections caused
- gram -
- Nosocomial UTI, bacteriemia, lower respiratory tract infections
Vibrio cholerae gram type, common diseases caused, treatment
- gram neg
- Human cholera diarrhea syndrome
- fluid resuscitation and antibiotics sometimes including macrolides, fluorquinolones, or tetracyclines
Helicobacter pylori gram type, diseases caused, treatment, notes about it
- gram -
- acute gastritis and gastric ulcers, chronic gastritis
- triple therapy (clarithromycin, amoxicllin and PPI) or quadruple therapy (metronidazole, tetracycline, PPI, and bismuth subsalycylate
- releases urease to protect self from stomach acid
Bacteroides fragilis gram type, common infections, treatment and fun fact
- gram -
- Peritonitis, gynecologic infections, endocarditis
-Often metronidazole - may acount for 99% of fecal flora
Pseudomonas aeruginosa gram type, common infections, treatment
- gram -
- nosocomial infections from long term antibiotic treatment
- often zosyn, fluorquinolones orally
Haemophilus influenzae gram type, common infections caused, treatment
- gram -
- respiratory and meningeal infections in children
- ampicillin or chloramphenicol
Haemophilus ducreyi gram type, disease caused, treatment
- gram -
- chancre on genitals (soft unlike syphilis)
- Bactrim
Bordatella pertussis gram type, disease caused, treatment
- gram - coccobacilli
- whooping cough (three stages, catarrhal stage cough, paroxysmal stage explosive cough, convalescent)
- tetracyclines, macrolides
- vaccine available
Chlamydia trachomatis gram type, disease caused, treatment
- gram neg
- trachoma leading to blindness, inclusion conjunctivitis, genital infections, venereal disease
- tetracycline
- sexual activity very similar to gonorrhea
Chlamydia psittaci gram type, disease caused, treatment
- gram neg
- pneumonitis frquently carried by bird feces
- tetracycline
Rickettsia rickettsii grma type, disease caused, treatment
- gram -
- rocky mountain spotted fever (maculopapular rash,) high fever
- tetracycline
- transmitted via ticks
Cornyebacterium diphtheriae gram type, disease caused, treatment
- gram +
- diptheria (sore throat, neck swelling, airway closur)
- antitoxins
- immunization is part of DPT vaccine
Timeline day 0 (embryonic age)
- Day 0 is fertilization forming a zygote in distal third of fallopian tube
- Division into morula (ball of cells will become placenta and embryo, each cell is totipotential)
- Division into blastocyst (blastocele (cavity) containing embryoblast, trophoblast at other pole form placenta)
Timeline week 1 (embryonic age)
-up to week 1 implantation on uterine wall of blastocyst
All or nothing concept of pregnancy
During the first 3 weeks any insult will result in immediate miscarriage, or there will be no impact on the wellbeing of the fetus, no in-between
Timeline week 2 (embryonic age)
- Bilaminar disk formation, evolution of embryoblast to bilaminar blastocyst with cell layers epiblast and hypoblast (primitive ecto and endoderms) sandwiched between 2 cavities - amniotic cavity and yolk sac
- Trophoblast divides into cystotrophoblast (inner single cell layered) and syncytiotrophoblast (thicker outer layer releases hGC to prevent menstruation)
“I just missed my period, what is embryonic age and gestational age?”
Week 2 embryonic age, week 4 gestational age
Zygote definition
Union between sperm and egg, quickly begins divisions into morula
Morula definition
Ball of cells that will become placenta and embryo, divided from a zygote, each cell is totipotential
Blastocele definition
Part of a blastocyst, fluid filled cavity that forms from a morula and will house an embryoblast
Embryoblast definition
Part of a blastocyst, early embryo formed from a morula and contained in a blastocele
Trophoblast definition
Part of a blastocyst, early placenta formed from a morula surrounding a blastocele
Blastocyst definition
Continuation from a morula, houses a blastocele containing an embryoblast, and a trophoblast layer of cells surounding
Bilaminar blastocyst definition
Continuation from blastocyst contains inner hypoblast and outer epiblast layers out of the embryoblast
Amniotic cavity definition
Forms around the epiblast to create a fluid filled cavity to house the embryoblast in a bilaminar blastocyst
Yolk sac definition
Forms extending out of the hypoblast to eventually give rise to the umbilical cord in a bilaminar blastocyst
Cystotrophoblast definition
Division from the trophoblast into a single inner cell layer in a bilaminar blastocyst, will be important for implantation
Snynctiotrophoblast definition
Division from the trophoblast into a thick outer cell layer in the bilaminar blastocyst, releases hCG to maintain high progesterone levels in the mother to prevent menstruation and maintain pregnancy
What occurs in week 3-8 (embryonic age) and why is this the most susceptible time?
-Organogenesis occurs, most susceptible because 90% of birth defects will occur here
Timeline week 3(embryonic age)
- Gastrulation (transition from blastocyst to a gastrula)
- Primitive streak (structure forming posterior side, determines site of gastrulation and bilateral symmetry), notochord (becomes nucleus pulposis of intevertebral disks), and neural plate (basis for nervous system) form here, as well as division of the hypo/epiblasts into ecto/meso/endoderms
Gastrulation definition
Transition of a blastocyst into a multilayered gastrula
Primitive streak definition
Stucture of the gastrula forming posterior side that determines site of gastrulation and creates bilateral symmetry
Notochord definition
Structure of the gastrula forming nucleus pulposis of intervertebral disks
Neural plate definition
Structure of gastrula forming nervous system basis (and dermatome distribution)
Ecto/meso/endoderm form…
- Ecto forms epithelium and nervous system
- Meso forms bone, muscle, cartilage, blood
- Endo forms excretory strutures, GI, respiratory, urinary
Folate deficiency at week 3 (embryonic age) can cause this developmental disorder
Spinal bifida upon neural plate formation
Timeline week 4 (embryonic age)
- Heartbeat, 4 chambers, 4 limb buds, 4 branchial arches (gill like structures that give rise to features of the head and neck)
- tongue lungs GI and diaphragm development too
Critical period for autism spectrum disorder, ventricular septal defect, and tricuspid atresia
Week 4-6 (embryonic age)
Critical period for limb defect
Week 4-5 (embryonic age)
Critical period for cleft lip defect
Week 5-6 (embryonic age)
Timeline weeks 5-7 (embryonic age)
-gonad differentiation, kidney, bladder, rectum formation
Timeline week 8 (embronic age)
fetal movement, strong resemblance to baby
Critical period for external genitalia formation
Week 8 (embryonic age)
At what time can you tell the sex of the fetus?
Week 10 (embryonic age)
6 cells of connective tissue
1) Fibroblasts - produce fibers and ground substance
2) Macrophages - WBC phagocytose foreign material
3) Neutrophil - suicide bomber
4) Plasma cells - release antibodies
5) Mast cells - secrete histamine and heparin inhibit clotting and dilate blood vessel
6) Adipocytes - store triglycerides
Pectoralis major function, insertion, nerve
Function: Flexion of humerus at shoulder, adduction of humerus at shoulder, medial rotation of humerus at shoulder
Insertion: clavicle and sternum to intertubular groove of humerus
Nerve: medial and lateral pectoral nerves
Pectoralis minor function, insertion, nerve
Function: Protraction of scapula at scapulothoracic joint, elevate ribs, depress scapula a scapulothoracic joint
Insertion: ribs 3-5 to corocoid process of scapula
Nerve: medial pectoral nerves
Deltoid function, insertion, nerve
Function: Flexion, extension, medial rotation, lateral rotation, abduction of humerus at shoulder joint
Insertion: clavicle/acromion to deltoid tuberocity of humerus
Nerve: axillary
Teres major function, insertion, nerve
Function: adduction, medial rotation, and extension of humerus at shoulder joint
Insertion: Lateral border of scapula to intertubular groove of humerus
Nerve: subscapular
Coracobrachialis function, insertion, nerve
Function: adduction of humerus at shoulder joint
Insertion: corocoid process to medial humerus
Nerve: musculocutaneous
Supraspinatus function, insertion, nerve
Function: Abduction of humerus at shoulder joint
Insertion: supraspinous fossa of scapula to greater tubercle of humerus
Nerve: suprascapular
Infraspinatus function, insertion, nerve
Function: Extension of humerus at shoulder joint
Insertion: infraspinous fossa of scapula to greater tubercle of humerus
Nerve: suprascapular
Teres minor function, insertion, nerve
Function: adduction of humerus at shoulder joint
Insertion: lateral scapula to greater tubercle of humerus
Nerve: axillary
Subscapularis function, insertion, nerve
Function: adduction of humerus at shoulder joint
Insertion: subscapular fossa to lesser tubercle
Nerve: subscapular nerve
Biceps brachii function, insertion, nerve
Function: supination of radius at elbow, flexion of forearm at elbow, flexion of humerus at shoulder
Insertion: radius to corocoid (short head) or glenoid fossa (long head)
Nerve: Musculocutaneous
Brachialis function, insertion, nerve
Function: flexion of forearm at elbow
Insertion: humerus to ulna
Nerve: musculocutaneous
Triceps brachii function, insertion, nerve
Function: extension of forearm at elbow, adduction of humerus at femur
Insertion: Inferior glenoid (long head) posterior humerus (lateral and medial head) to olecranon process
Nerve: radial nerve
Anconeus function, insertion, nerve
Function: extension of forearm at elbow
Insertion: lateral epicondyle of humerus to olecranon process
Nerve: radial
Brachioradialis function, insertion, nerve
Function: flexion of forearm at elbow
Insertion: radial styloid process to lateral epicondyle of humerus
Nerve: radial
Brachioradialis function, insertion, nerve
Function: flexion of forearm at elbow
Insertion: radial styloid process to lateral epicondyle of humerus
Nerve: radial
Pronator teres function, insertion, nerve
Function: pronation of forearm at elbow
Insertion: medial epicondyle of humerus to radial shaft
Nerve: median
Supinator function, insertion, nerve
Function: supination of forearm at elbow
Insertion: lateral epicondyle of humerus to radial shaft
Nerve: dorsal interosseous (radial nerve)
Flexor carpi radialis function, insertion, nerve
Function: flexion of hand at wrist, radial deviation of hand at wrist
Insertion: medial epicondyle to metacarpals
Nerve: median
Flexor carpi ulnaris function, insertion, nerve
Function: flexion of hand at wrist, ulnar deviation of hand at wrist
Insertion: medial epicondyle to metacarpals
Nerve: ulnar
Palmaris longus function, insertion, nerve
Function: flexion of hand at wrist (barely relevant)
Insertion: medial epicondyle to palmar aponeurosis
Nerve: median
Flexor digitorum profundus function, insertion, nerve
Function: flexion of hand at wrist, flexion of phalanges at DIP and PIP, and MP joints
Insertion: interosseous ulna to distal phalanges digits II-V
Nerve: Median nerve
Flexor pollucis longus function, insertion, nerve
Function: flexion of the first digit at the IP joint
Insertion: radius to distal phalanx digit 1
Nerve: median
Flexor digitorum superficialis function, insertion, nerve
Function: flexion of phalanges at PIP and MP joints and flexion of hand at wrist
Insertion: radius to middle phalanges digits II-V
Nerve: median
Extensor carpi radialis brevis function, insertion, nerve
Function: extension of hand at wrist, radial deviation of hand at wrist
Insertion: lateral epicondyle to metacarpals
Nerve: radial
Extensor carpi radialis longus function, insertion, nerve
Function: extension of hand at wrist, radial deviation of hand at wrist
Insertion: lateral epicondyle to metacarpals
Nerve: radial
Extensor digitorum function, insertion, nerve
Function: extension of phalanges at MP joint
Insertion: lateral epicondyle to distal phalanges II-V
Nerve: radial
Abductor pollocis longus function, insertion, nerve
Function: abduction and extension of digit I at MP joint
Insertion: posterior trapezium and radius to metacarpal I
Nerve: radial
Extensor pollocis longus function, insertion, nerve
Function: Extension of digit 1 at MP joint
Insertion: shaft of ulna to distal phalanx 1
Nerve: radial
Extensor pollocis brevis function, insertion, nerve
Function: extension of digit 1 at MP joint
Insertion: shaft of radius to proximal phalanx 1
nerve: radial
Extensor carpi ulnaris function, insertion, nerve
Function: extension of hand at wrist
Insertion: lateral epicondyle to 5th metacarpal
Nerve: radial
Extensor digiti minimi function, insertion, nerve
Function: extension of digit 5 at the MCP joint
Insertion: lateral epicondyle to distal phalanx of digit 5
Nerve: radial
Extensor indices function, insertion, nerve
Function: extension of digit 2 at the mcp joint
Insertion: posterior ulna to distal phalanx of digit 2
Nerve: radial
Certain decongestants and BPH
sudafed or other vasopressors can tighten the muscles in the prostate and the bladder neck worsening symptoms of retention
how many days after scope to hold nsaids
7 days
Aminoglycocides general notes
Narrow spectrum antibiotics, used primarily against gram neg bacilli aerobes, cannot be absorbed from GI and entering CSF and therefore must be given parenterally, can damage kidneys and inner ear
Aminoglycosides mechnaism of action
Disrupt bacterial protein synthesis by binding 30S ribosimal unit, causing abnormal or decreased protein synthesis, rapidly bactericidal
This drug class half lives decrease dramatically with kidney disfunction, and therefore it is essential to reduce dosage or increase dosing interval in patients with disease
aminoglycosides
Aminoglycosides common adverse effects
- Ototoxicity, disruption of balance
- nephrotoxicity, proteinuria, serum creatinine and BUN elevation (reversible)
- neuromuscular blockade (flaccid paralysis and respiratory depression)
Fluoroquinolones general notes and ADRS’s (5)
Narrow spectrum antibiotic used often for UTI’s, side effects usually mild, potentially tendon rupture and mental health effects and peripheral neuropathy and contraindicated in anuerysm patients due to increased risk of rupture, photosensitivity
Pneumoniae carinii (jirovecci) definiton
Rare, opportunistic fungal lung infection commonly seen in HIV/AIDS patients indicative of the disease
5 classes of HIV drug treatment
1) Fusion/entry inhibitors
2) Non-nucleotide reverse transcriptase inibitors
3) Nucleoside analogues
4) Integrase inhibitors
5) Protease inhibitors
MIC and MBC definitions
Minimum inhibitory conc. to stop microbial growth, want at least this conc. from dosage to be achieved, minimum bacteriocidal conc. is lowest conc that produces a 99.9% decline in number of bacterial colonies, want to shoot for this
How is sickle cell, thalassemias, and G6PD deficiency an evolutionary advantage?
Sickle cell protects against malaria (plasmodium falciparum) by impairing ability of parasite to manipulate adhesins so they become sticky against capillary walls, thasallemias decreases hemoglobin, G6PD deficiency causes blood cell breakdown prematurely, all are protective against malaria
List the 4 virulence factors
1) adhesins
2) invasins
3) evasins
4) toxins
7 criteria to be pathogenic
1) enter host
2) establish and adhere
3) acquire nutrients
4) avoid immune defenses
5) replicate
6) disseminate
7) transmit to new host
Currant jelly sputum makes you think of this organism
Klebsiella
Grape smelling drainage makes you think of this organsim
Pseudomonas
