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sulfasalazine PRODRUG, enzymatic activation by colonic bacteria
sulfasalazine first-line oral therapy for Chron's is oral aminosalicylates. Sulfasalazine is the prototype drug of this genre. composed of two entities: Mesalazine- aka 5-aminosalicylic acid (5-ASA) and sulfapyridine.
peptic ulcer with perforation signs of peritoneal inflammation (rebound tenderness, guarding, rigidity) epigastric pain, pain and nausea after eating
L2 ureteropelvic junction. between renal pelvis & ureter. common site of obstruction seen in Nephrolithiasis , other sites - ureterovesical junction, calyx of the kidney the crossing of the ureter with the iliac vessels near the pelvic brim
Distributive shock increase C5a and C3a (anaphylatoxins) ---> mast cells degranulation ---> histamine ---> widespread arteriolar vasodilation ---> increased CO widespread arteriolar vasodilation---> warm, dry skin widespread arteriolar vasodilation ---> decrease SVR MIXED VENOUS BLOOD IS HIGH - BLOOD FLOW IS TOO FAST FOR EXCHANGE OF O2
Hypovolemic shock Hemorrhage, dehydration, burns RX; IV fluids vasoconstriction by catecholamines --> Cold, clammy <PCWP (preload) , >SVR (afterload) , <CO
Obstructive shock Cardiac tamponade, pulmonary embolism, tension pneumothorax vasoconstriction by catecholamines --> Cold, clammy > or < PCWP (preload) , >SVR (afterload) , <CO
parainfluenza croup, stipple sign on lateral x-ray. level of trachea
calcitonin receptor on osteoclast RX; osteoporosis, hypercalcemia
IL1 A.K.A osteoclast activation released from osteoblast when PTH binds to its receptor stimulates osteoclast. estrogen puts a check on it
alcohol blocks conjugation of folate in the jejenum folate deficiency
extravascular hemolysis versus intravascular extravascular - unconjuagted bilirubun --> bound to albumin -jaundice - Splenic macrophages intravascular - decrease haptoglobin - hemoglobinuria - IgM - liver macrophages intravascular - Quinidine as a hapten (IgM attaches to it) - complement activated (+) direct coombs test
dysfunctional spleen splenectomy - howell jolly bodies - pneumococcal infections
atypical lymphoctes CMV, EBV, PHENYTOIN, TOXOPLASMOSIS.
Silicosis Upper lobe egg shell calcification on chest X-ray Fibrosis > risk of tuberculosis —interupts phagolysome formation
Hereditary Fructose intolerance Aldolase B deficiency - fructose 1 phosphate gets trapped in cells —> decrease phosphate - jaundice, vomiting, hypoglycemia, cirrhosis
Streptococcus agalactiae CAMP factor PYR (-) Beta hemolysis ; complete hemolysis Hippurate (+) Neonates can develop septicemia, pneumonia, and meningitis
Streptococcus agalactiae + test Intrapartum (onset of Labour - delivery) penicillin as prophlylaxis
Lesch-Nyhan syndrome X linked recessive —> decrease in hypoxanthine-guanine phosphoribosyltransferase (HGPRT). neurological problems such as learning disabilities, spastic cerebral palsy, and self-mutilation,
Several members of a family have a recessive mutation in the gene encoding carbonic anhydrase II Osteopetrosis - Carbonic anhydrase-deficient osteoclasts are unable to produce H+ ions -Failure of normal bone resorption due to defective osteoclasts -thickened, dense bones that are prone to fracture Deficiency of carbonic anhydrase --> renal tubular acidosis type II - failure of proximal tubular resorption of bicarbonate. -hypokalemic metabolic acidosis - urine ph <5.5
Osteopetrosis Overgrowth of cortical bone fills marrow space pancytopenia, - extramedullary hematopoiesis. - cranial nerve impingement and palsies due to narrowed foramina bone-in-bone, “stone bone”
Fanconi syndrome Proximal renal tubular acidosis (type 2) risk for hypophosphatemic rickets (in Fanconi syndrome
unable to open his mouth, tight spasms of his muscles of mastication man has suffered an acute dystonic reaction, which is a recognized side effect of treatment with typical neuroleptics. treatment in his case is with benztropine, - a muscarinic antagonis
Familial hypocalciuric hypercalcemia (FHH) autosomal dominant --> inactive mutations in the calcium-sensing receptor (CaSR). - G coupled protein -on the parathyroid glands and in the loops of Henle inactivation reduces negative feedback from Ca2+ and subsequently leads to elevated PTH or normal PTH. - mild hypercalcemia
21 pt woman with itchy burning sensation in vagina and dysuria, examination show foul smelling greenish discharge Trichomoniasis,sexually transmitted disease by protozoon Trichomonas vaginalis, strawberry cervix”
woman with 1st trimester preeclampsia right upper quadrant tenderness and multiple bilateral ovarian cyst on pelvic ultrasound no hirsutism on PE Theca-lutein cyst -Due to gonadotropin stimulation -or human chorionic gonadotropin (HCG) can result in simultaneous growth, enlargement and luteinization of multiple ovarian follicles Associated with choriocarcinoma and hydatidiform moles.
pt with punched out lytic lesions on xray and hypercalcemia multiple myeloma -Monoclonal plasma cell (“fried egg” appearance) -IgG (55%) or IgA (25%) - osteoclast activating factor (IL 1) ---> lytic lesions M spike on serum protein electrophoresis Ig light chains in urine (Bence Jones protein
Amyotrophic lateral sclerosis (ALS) Neurodegenerative disorder affects both upper , lower motor neurons, sparing sensation RX; Riluzole is a drug that blocks glutamate transmission Muscle atrophy and fasciculations (lower motor neuron) -positive Babinski, hyperreflexia, and “clasp-knife” rigidity (upper motor neuron lesions)
pt with pain in her right ear, copious discharge , with granulation tissue at external auditory canal, and pain with chewing food, malignant otitis externa (also called necrotizing external otitis). - risk in diabetes mellitus. - long-term immunosuppression - infection with the human immunodeficiency virus Pseudomonas aeruginosa aerobic; motile, catalase ⊕, gram ⊝ rod. Non-lactose fermenting. Oxidase ⊕.
malignant melanoma s100, HMB45 Ipilimumab targets CTLA-4 ---> activates the cytotoxic T lymphocytes, to attack the tumor cells.
Follicular lymphoma 14,18 (Ig heavy chain, BCL2) Bcl-2 inhibits apoptosis painless “waxing and waning” lymphadenopathy.
Mantle cell lymphoma - 11,14 - cyclin D1 - CD5 Very aggressive,
Marginal zone lymphoma 11,18 chronic in ammation (eg, Sjögren syndrome, chronic gastritis [MALT lymphoma]).
fibroadenoma women < 35 years old. , well-defined, mobile mass . - increase size and tenderness with estrogen no risk of cancer benign stroma
intraductal papiloma fibroepithelial tumor within lactiferous ducts, behind nipples bloody or serous discharge Slight risk for cancer. benign
Phyllodes tumor large mass of connective tissue and cysts with “leaf-like” lobulations post menopausal benign but might be malignant.
Fibrocystic change premenstrual breast pain or lumps; - bilateral and multifocal. - Nonproliferative lesions, simple cysts ( fluid- filled duct dilation, blue dome) Terminal duct lobular unit - sclerosing adenoma; - epithelial hyperplasia
epithelial hyperplasia cells in terminal ductal or lobular epithelium. risk of carcinoma with atypical cells.
sclerosing adenoma; acini, stromal fibrosis, associated with calcifcations. Slight risk for cancer.
Pt with history of chronic alcoholism cells with highly eosinophilic irregularly shaped hyaline bodies close to the nucleus patient has alcoholic hepatitis with Mallory bodies Mallory bodies are derived from cytokeratin - damaged keratin filament
Cytokeratin an intermediate cytoskeletal filament - unique to epithelial cells of ectodermal or endodermal origin. In an embryo, hepatocytes differentiate from the endoderm.
Hepatic steatosis Macrovesicular fatty change may be reversible with alcohol cessation.
Alcoholic cirrhosis - Regenerative nodules surrounded by fibrous bands (bridging fibrosis) in response to chronic liver injury - portal hypertension, end-stage liver disease. - irreversible injury Sclerosis around central vein
RNA DEPENDENT DNA POLYMERASE Reverse transcriptase
Cardiogenic shock Acute MI, HF, valvular dysfunction, arrhythmia RX;Inotropes, diuresis vasoconstriction by catecholamines --> Cold, clammy >PCWP (preload) , >SVR (afterload) , <<CO
Created by: beccao