test #16 4.4 Flashcards
why does infxn w/ neisseria gonorrhoeae not result in lasting immunity?
modify outer membrane proteins by antigenic variation. Abs made in infxn – specific for single specific antigenic epitope.
kawasaki disease
vasculitis of medium-sized arteries
most serious complication of kawasaki disease?
coronary artery aneurysm.
symptoms of kawasaki
(1) persistent FEVER (2) bilateral CONJUNCTIVITIS (3) LYMPHADENOPATHY (4) CUTANEOUS involvement: (a) oropharyngeal: erythema of palatine mucosa, fissured erythematous lips, “strawberry” tongue (b) peripheral extremities: edema of hands * feet, erythema of palms and soles, desquamation of fingertips (periungual). (c) generalized rash: polymorphous (usu urticarial) erythemtaous rash beginning on extremities and moving to trunk (centripetal speed).
serious complication: coronary artery aneursym
which vasculitides are associated w/ mononeuritis multiplex (peripheral neuropathy of multiple individual nerves)
(1) granulomatosis w/ polyangiitis (2) polyarteritis nodosa
caudal regression syndrome. associated w/ & (3) signs
uncontrolled maternal diabetes. babies w/ agenesis of sacrum & occasionally lumbar spine –> (1) flaccid paralysis of legs, (2) dorsiflexed contractures of feet, (3) urinary incontenience
range of caudal regression syndrome
isolated anal atresia to sirenomelia (mermaid syndrome)
sirenomelia
mermaid syndrome, can result from caudal regression syndrome. legs fused together
cocaine on pregnancy
vasoconstriction: insufficient blood flow to developing fetus –> spontaneous abortion, intrauterine growth retardation, placental abruption, and/or prematurity
an URI that can negatively impact baby (gestation)
rubella (TORCHES). transmitted respiratroy. MR and congenital heart defects.
vitamin A overdose in pregnancy results in…
craniofacial abnormalities, posterior fossa CNS, auditory defects, abnormalities of great vessels (similar to DiGeorge)
vitamin A overdose in pregnancy in baby mimics?
DiGeorge
strict vegetarians (esp vegans) are at risk for which nutritional defeciencies?
(1) iron and (2) B12
tramadol
(1) very weak opiod agonist; also inhibits 5-HT and NE reuptake (2) (SNRI). mult ntx: tram it all w/ tramadol. use for chronic pain
positive predictive value
of those two test positive, how many are true positives.
a/a+b
validity of a test measured by
specificity and sensitivity
95% of gas gangrene caused by.. how?
Clostridium perfringes. toxin: phospholipase, cell death –> tissue damage, necrosis, reduction of blood supply. organism metabolizes carbohydrates –> generate gas.
clostridium perfinges causes (2)
(1) gas gangrene w/ penetration (2) transient watery diarrhea LATE-onset food poisoning, ingestion of spores in reheated meat dishes. late bc spores must germinate
early onset food poisoning (2) vs. late onset (1)
early-onset: preformed toxin (1) s. aureus (2) b. cereus.
late onset: c. perfringes (must germinate)
(2) bacteria associated w/ polyarthritis
(1) septic arthritis: gonorrhea (2) Group A strep
culture agar for cornybacterium diptheriae (2)?
(1) cysteine-tellurite agar, dark BLACK, slightly iridescent. (2) Loffler’s medium – cytoplawsmic metachomatic granules after stain w/ aniline dye.
how does maconkey prevent the growth of gram positives?
bile salts
colistin / polymyxin kills what? spares?
kills most gram negatives, but spares neisseria.
blood agar w/ bile & hypertonic saline used to..
differentiate enterococci (e. faecalis, e. facium; can grow in both) from nonenterococci group D strep (strep bovis / equinus)
Nonenterococcal group D strep grows in..
BILE but not hypertonic saline
Bordet-Gengou medium for…
Bordetella pertusus (whooping cough)
mental status exam testing: comprehension
follow multistep command
mental status exam testing: concentration
months of year backward; serial 7s, world backwards
mental status exam testing: visual-spatial
draw a clock face
score of 24 or < on mini-mental state exam
dementia
acute opioid tolerance mediated by?
uncertain, but phosphorylation of opioid receptors by protein kinase
chronic opioid tolerance?
increased adenylyl cyclase activity or NO levels
morphine tolerance?
glutamate mediated! NMDA receptor activation –> increased phosphorylation of opioid receptors & NO levels. (ketamine & dextromethorphan can block opiod tolerance)
what is required for the binding of glutamate to NMDA receptors?
glycine – co-agonist for glutamate. NECESSARY
pheochromocytoma rule of 10 (4)
10% occur as a part of hereditary syndrome (MEN2A and B, VHL). 10% bilateral. 10% malignant. 10% extraadrenal
involuntary head bobbing
sign of widened pulse pressure (peak systolic - end diastolic pulse pressure)
piriform recess
small cavities that lie on either side of laryngeal orifice. bounded medially by aryepiglottic folds. laterally by thyroid cartilage and thyrohyoid membrane. lead food into esophagus.
diversion of food from tracheal during swallowing
food diverted by epiglottis laterally through piriform recesses into esophagus
what n. courses superficially (under mucosa) in piriform recess?
internal laryngeal n (branch of superior laryngeal n CN X). afferent limb of cough reflex (sensation form mucosa superior to vocal cords)
recurrent laryngeal n & external laryngeal n? internal laryngeal?
recurrent & external: carry motor fibers involved in vocal cord fxn. internal: only sensory to larynx & epiglotis
fish bone / chicken lodged in piriformis. what n at risk? what reflex?
internal laryngeal (branch of superior laryngeal CN X). impair cough reflex
does irritation of larynx / epiglottis cause cough or gag?
COUGH
cough reflex
induced by upper respiratory tract irritation. afferent: X. efferent: X. afferent: internal branch of superior laryngeal. efferent: recurrent / external branch of superior.
gag reflex
afferent: glossopharyngeal CN IX. efferent limb: vagus CN X.
glossopharyngeal n. salivation pathway.
parasympathetics from glossopharyngeal onto otic ganglion. postganglioncs travel via auricotemporal n. to parotid.
therapeutic radiation initiates cell death by (2)
(1) DNA double strand breakage (2) formation of free radicals (from ionization of water – cause cellular and DNA damage). particularly hurts rapidly dividing cells
DNA crosslinking caused by (chemo)..
alkylating agents
DNA damage from exposure to UV radiation?
pyrimidine-pyrimidine dimers
among drugs of abuse, which is most likely to induce violent behavior?
PCP
fatalities associated w/ PCP abuse usu associated w..
TRAUMA, not from intoxication itself.
PCP causes.. (4)
(1) belligerence (2) loss of coordination (3) NYSTAGMUS (4) acute brain syndrome: disorientation, poor judgement, memory loss). can cause seizures too. DIE FROM TRAUMA
cocaine intoxication can cause
MI
seizures and strokes are common neurologic sequelae
cocaine & amphetamines
bath salts
amphetamines
statin side effects
myopathy and hepatitis. associated w/ liver function test abnormalities. monitor LFTs!
monitoring LFT w/ statin guidelines
LFT before starting. no need for routine monitoring unless signs of liver dysfxn develop (fatigue, malaise, anorexia). hepatotoxicity usu 3 months of starting statin therapy.
statins ought be used w/ caution in..
patients on other adrenal enzyme inhibitors (ketoconazole, aminoglutethimide)
sign of hepatoxicity on statins
fatigue, malaise, anorexia
3 portacaval anastomoses. clinical manifestation: portal circulation –> systemic circulation
(1) esophageal varices: left gastric vein –> esophageal vein (2) hemorrhoids: superior rectal vein –> middle/inferior rectal veins (3) caput medusae: paraumbilical veins –> superior & inferior epigastric veins
TIPs procedure
transjugular intrahepatic portosystemic shunt. shunt portal vein to hepatic vein percutaneously.
middle colic vein
drains transverse colon
right gastroepiploic vein
drains venous blood from lower parts of the anterosuperior and posteroinferior surface of stomach. runs from left to right along greater curvature of stomach