test #38 4.28 Flashcards
triple test (maternal serum)
- AFP
- estriol
- hCG
between weeks 16-18
abnormal values –> ultrasound
if no abnormalities found –> amniocentesis
AFH in triple test? elevated? low?
synthesized by fetal liver, GI tract, and yolk sac (early gestation only).
maternal serum aFP levels increase w/ gestation age
elevated:
- dating error (underestimation)
- neural tube defects
- anterior abdominal wall defects (omaphalocele, gastrochisis)
- multiple gestatoin
decrease: Down’s syndrome
most common cause of elevated AFP in triple test?
dating error (underestimation of gestational age).
confirm w/ ultrasound
estriol levels in triple test? decreased levels suggest?
reflect placental and fetal function (both necessary for synthesis)
decrease:
1. placental insufficiency
hCG in triple test? increased levels associated w/?
synthesized by trophoblastic tissue.
increased levels:
- multiple gestation,
- hydatidiform mole,
- choriocarcinoma
- down’s syndrome
placental abnormalities & intrauterine growth retardation are associated w/ decreased..
estriol
placental insufficiency!
infection, pain, and sleep deprivation all increase..
blood glucose!
stress: increase catecholamines
decreased insulin, increase glycogenolysis, increased gluconeogenesis
isolation (defense mechanism
removing disturbing feelings from an event.
combat veterans who describes friends dying in cold and distant tones. isolating the fear and sadness from event
bifid carotid pulse w/ brisk upstroke “spike & dome” associated w.
hypertrophic obstructive cardiomyopathy
collapse in pulse, followed by secondary rise
three cytogenetic abnormalities that can lead to downs syndrome
- trisomy 21: meotic nondisjunction (usu mama)
- unbalanced robertsonian translocations (2-3%)
- normal number of chromosomes, but extra arm of chromosome 21 is attached to another chromosome - mosaicism: one w/ normal genotype, one with trisomy 21
- postfertilization mitotic error
uniparental disomy
when fetus inherits two copies of homologous chromosomes from one parent and no copy from other parent
(occurs in complete hydatidiform mole)
consider when child inherits a recessive condition when only 1 parent is carrer
heterodisomy and isodisomy
heterodisomy: uniparental disomy in meiosis I
isodisomy (homozygous): in meiosis II or postzygotic duplicatino of one & deletion in one
cytokines involved in asthma
IL4: class-switch to IgE
IL5: recruit eosinophils
IL10: block Th1, encourage Th2
charcot-leyden crystals
asthma sputum: eosinophil membrane protein
TGF-beta is important for..
tissue regeneration and repair
anti-inflammatory cytokines
IL-10 and TGF-beta
loss of CNIII to the eye results in.. (3)
somatic:
1. ptosis (levator palpebrae)
2. down & out (only maintain superior oblique and lateral rectus)
- loss of iris spincter
(fixed dilated) - loss of acommodation
describe light pathway (reflex)
afferent in one eye:
ipsilateral optic nerve -> bilateral post optic chiasm -> bilateral pretectal area -> bilateral edingerwestphal nucleus
efferent:
bilateral edingerwestphal nucleus -> travel w/ oculomotor n -> bilateral ciliary ganglion -> bilateral pupillary sphincter
2 ways to get lung abscess
- aspiration of oropharyngeal contents (most common)
2. right sided endocarditis -> septic emboli
Marcus Gunn pupil
defect in CN II
“swinging flashlight test”
affected eye will have consensual pupillary constriction, but will appear to ‘dilate’ when light is on affected eye
– can’t detect light
differentiate lesion in LGN and optic tract
both will have contralateral hemianopsia
optic tract: has Marcus Gunn pupil (loss of direct pupillary constriction w/ light)
LGN: light reflex should be fine (does not go through LGN, instead straight to pretectal -> edingerwestphal -> ciliary ganglion -> iris sphincter
Marcus-Gunn pupil in optic nerve lesion? optic tract?
optic nerve: marcus gunn pupil when light is shone into affected eye (IPSILATERAL relative afferent pupillary defect)
optic tract: marcus gunn pupil when light is shone on eye CONTRALATERAL to side of lesion.
bc nasal fibers contribute more to prectal afferents. optic tract will have more contralateral ‘nasal’ fibers. less afferents
both have contralateral homonymous hemianopsia
rabies virus is..
killed vaccine
Live vaccines (6)
live! small yellow chickens get vaccinated w/ mmr and sabin’s polio! it’s INcredibly
- smallpox
- yellow fever
- VZV chicken pox
- MMR (measles, mumps, rubella)
- sabin’s polio (IgA and IgG)
- infuenza intranasal