MODEL QS FOR FUTURE ALL INDIA PRE PG EXAM

Discussion in 'NEET 2013 All india Exam' started by Guest, Jan 25, 2010.

  1. Guest

    Guest Guest

    lung auscultation in chest pain evaluation
    assymetry of breath sounds in spontaneous pneumothorax; absent lung sounds in spontaneous pneumothorax or pleural effussion

    work-up of chest pain
    all patients should have 12-lead ECG (MI diagnostic findings are ST elevation or Q waves in 50%, ischemia findings are ST depression or T wave inversion in 35%)

    CK-MB, troponins T I C

    chest x-ray

    differential diagnosis of chest pain
    noncardiovascular: costochondritis, hiatal hernia, GERD, peptic ulcer, gallbladder disease

    cardiovascular: MI, aortic stenosis, myocarditis, pericarditis, dissecting aortic aneurysm, mitral valve prolapse

    pulmonary: embolism, pulmonary hypertension, pneumothorax

    costochondritis differentiating features
    pain exacerbated with inspiration; reproduced with chest wall palpation

    hiatal hernia differentiating features
    reflux of food, relief with antacids

    GERD differentiating features
    acid reflux, relief with antacids

    peptic ulcer differentiating features
    epigastric pain worse 3h after eating

    gallbladder disease differentiating features
    right upper quadrant pain and tenderness

    myocardial infarction differentiating features
    severe pain > 20 minutes

    aortic stenosis differentiating features
    systolic ejection murmur

    myocarditis differentiating features
    vague mild pain
  2. Guest

    Guest Guest

    Hirschsprung’s disease
    By the mid-1980s it was apparent that non-syndromic
    HD was a multifactorial disorder. Segregation studies in
    non-syndromic HD have shown that the recurrent risk in
    siblings varies from 1% to 33% depending on the sex and
    the length of the aganglionic segment in the affected child,
    as well as the sex of the sibling. The first association of a
    specific genetic defect in HD was reported in 1992 as a
    deletion in the short arm of chromosome 10. Further
    investigation revealed the location of the mutation
    between 10-Q 11.2 and Q-21.2. This overlapped the region
    of the RET proto-oncogene. Mutations of the RET gene are
    responsible for approximately half of familial cases, and
    10% of cases of sporadic HD. In non-syndromic HD, abnormalities
    have been described in three loci of the RET locus,
    which encodes for the RET receptor. It has been postulated
    that different mutations in the RET proto-oncogene predispose
    to either HD or MENII syndrome. There is evidence
    that the degree of mutation in the RET proto-oncogene is
    associated with the severity of presentation of HD.
    Approximately 15% of all HD cases are accounted for by
    mutations in the two genes RET and EDNRB. The RET polymorphic
    variance may contribute to the occurrence of
    total intestinal aganglionosis (TIA).15 HD is one of the first
    polymorphic multifactorial human diseases with a defined
    multigenic etiology to have been identified.
  3. Guest

    Guest Guest

    Antigens

    The antigens of several members of the Enterobacteriaceae, especially Salmonella and Shigella, are important; they are used for identification purposes both in the clinical laboratory and in epidemiologic investigations. The three surface antigens are as follows:

    The cell wall antigen (also known as the somatic, or O, antigen) is the outer polysaccharide portion of the lipopolysaccharide . The O antigen, which is composed of repeating oligosaccharides consisting of three or four sugars repeated 15 or 20 times, is the basis for the serologic typing of many enteric rods. The number of different O antigens is very large; e.g., there are approximately 1500 types of Salmonella and 150 types of E. coli.

    The H antigen is on the flagellar protein. Only flagellated organisms, such as Escherichia and Salmonella, have H antigens, whereas the nonmotile ones, such as Klebsiella and Shigella, do not. The H antigens of certain Salmonella species are unusual because the organisms can reversibly alternate between two types of H antigens called phase 1 and phase 2. The organisms may use this change in antigenicity to evade the immune response.

    The capsular or K polysaccharide antigen is particularly prominent in heavily encapsulated organisms such as Klebsiella. The K antigen is identified by the quellung (capsular swelling) reaction in the presence of specific antisera and is used to serotype E. coli and Salmonella typhi for epidemiologic purposes. In S. typhi, the cause of typhoid fever, it is called the Vi (or virulence) antigen.


    Specimens suspected of containing members of the Enterobacteriaceae and related organisms are usually inoculated onto two media, a blood agar plate and a selective differential medium such as MacConkey's agar or eosin–methylene blue (EMB) agar. The differential ability of these latter media is based on lactose fermentation, which is the most important metabolic criterion used in the identification of these organisms . On these media, the non–lactose fermenters, e.g., Salmonella and Shigella, form colorless colonies, whereas the lactose fermenters, e.g., E. coli, form colored colonies. The selective effect of the media in suppressing unwanted gram-positive organisms is exerted by bile salts or bacteriostatic dyes in the agar.An additional set of screening tests, consisting of triple sugar iron (TSI) agar and urea agar, is performed prior to the definitive identification procedures. The rationale for the use of these media and the reactions of several important organisms are presented in Agar Media for Enteric Gram-Negative Rods . The results of the screening process are often sufficient to identify the genus of an organism; however, an array of 20 or more biochemical tests is required to identify the species.


    Enterobacteriaceae
    All Enterobacteriaciae:

    ferment glucose with acid production

    reduce nitrates (NO3 to NO2 or all the way to N2)


    are oxidase negative

    All are aerobic but can be facultatively anaerobic

    Motile via peritrichous flagella except Shigella and Klebsiella which are non-motile

    Capsule, slime layer, or neither

    Possess fimbriae (pili)

    Complex cell wall


    The air we breathe is made up of a mixture of gases, mainly
    nitrogen and oxygen. These gases exert a combined pressure
    called the atmospheric pressure. The pressure at sea level is defined
    as 1 atmosphere, which is equal to 760 millimeters of
    mercury (mm Hg) or 14.7 pounds per square inch (PSI). When
    measuring respiratory pressures, atmospheric pressure is assigned
    a value of 0. A respiratory pressure of +15 mm Hg means
    that the pressure is 15 mm Hg above atmospheric pressure, and
    a respiratory pressure of −15 mm Hg is 15 mm Hg less than atmospheric
    pressure. Respiratory pressures often are expressed
    in centimeters of water (cm H2O) because of the small pressures
    involved (1 mm Hg = 1.35 cm H2O pressure).
    The pressure exerted by a single gas in a mixture is called the
    partial pressure. The capital letter “P” followed by the chemical
    symbol of the gas (PO2) is used to denote its partial pressure.
    The law of partial pressures states that the total pressure of a
    mixture of gases, as in the atmosphere, is equal to the sum of
    the partial pressures of the different gases in the mixture. If the
    concentration of oxygen at 760 mm Hg (1 atmosphere) is 20%,
    its partial pressure is 152 mm Hg (760 × 0.20).


    Lacunar infarcts occur in the territory of penetrating
    arteries.
    Fisher demonstrated in autopsy studies that lacunar
    infarcts are caused by two forms of arteriopathy:
    lipohyalinosis and microatheroma. Lipohyalinosis
    is a destructive small lesion in penetrating arteries
    (40–200 μm in diameter) characterized by fi brinoid
    necrosis, loss of normal wall structure, and collagenous
    sclerosis. It probably accounts for many of the asymptomatic
    smaller lacunes. Microatheroma (200–800 μm in
    diameter) can lead to occlusive thrombus and infarcts
    that tend to be larger than those associated with lipohyalinosis
    (5 mm or more in diameter) and are usually
    symptomatic
    Although the mechanism of lacunar infarction is traditionally
    held to be in situ small vessel disease, there is
    some evidence of an embolic causation in a small proportion
    of cases. Indeed, aortic arch atheroma has been demonstrated
    to be a risk factor for lacunar infarction. Whether
    this is a refl ection of diffuse cardiovascular atheromatous
    load rather than an embolic source is uncertain
  4. Guest

    Guest Guest

    NON-SHOCKABLE RHYTHMS: PEA/ASYSTOLE
    The outcome for ‘non-shockable’ rhythms is poor (ILCOR 2005b). PEA is present when organised cardiac electrical activity is present on the monitor but the pulse is not palpable. PEA and asystole may be caused by conditions that are reversible if found and treated quickly and effectively.
    Treating PEA
     Start CPR 30:2;
     Give adrenaline 1 mg IV as soon as intravascular access is obtained;
     Continue CPR 30:2 until the airway is secured. Chest compressions can be continued without pausing for ventilation when an advanced airway is in place

     Pause briefly to check the rhythm after 2 minutes;
     If organised electrical activity is seen, check the patient for signs of life and/or pulse. If signs of life and/or pulse are present, begin post-resuscitation care. If no signs of life are present, persistent PEA, continue CPR;
     Pause briefly every 2 minutes to recheck the rhythm and treat the patient as appropriate;
     Further adrenaline should be given every 3–5 minutes or alternate loops of the algorithm;
     If the rhythm changes to VF/VT, change to the shockable side of the algorithm;
     If asystole is seen on the monitor, continue CPR and recheck the rhythm every
    2 minutes. Give adrenaline 1 mg IV every 3–5 minutes.
  5. Guest

    Guest Guest

    G6PD deficiency
    Causes
    *X-linked recessive
    *Enzyme defect which cause episodic hemolytic anemia due to inability of RBC to deal with oxidative stresses
    .

    G6PD deficiency
    Signs and Symptoms
    *Generally African-americans
    *Pts are usually healthy
    *Occur under oxidative stress from infection
    drug exposure
    .

    G6PD deficiency
    Classic Lab findings
    *Between episodes blood is Normal
    *During episode reticulocytosis and increased serum indirect bilirubin
    .

    G6PD deficiency
    Complications
    *Severe cases may produce chronic hemolytic anemia
    .

    G6PD deficiency
    Typical Tx
    *No treatment except avoidance of known oxidant drugs

    What is the definition of Glucose 6 Phosphate Dehydrogenase Deficiency?
    - inherited, sex linked ( band Xq28)
    - metabolic disorder of RBCs
    - enzyme defect that causes hemolysis of RBCs

    What is the pathophysiology of Glucose 6 Phosphate Dehydrogenase Deficiency?
    - G6PD is the first enzyme in the pentose phosphate pathway of glucose metabolism (main role is to metabolizes gluthathione)
    - Glutathione is an antioxidant crucial for protection of hgb and membrane
    - If glutathione is too low, oxygen will not bind and cell wall will break down causing hemolysis

    What is the most common metabolic disorder of the RBCs?
    G6PDD
    - affecting 35 million worldwide
    - tropical and subtropics of the Eastern Hemisphere
    - most affected are African and Mediterranean
  6. Guest

    Guest Guest

    Intravascular Hemolysis
    The RBCs are lysed within the blood vessel such as by mechanical damage of a heart valve, or because of complement fixation as in paroxysmal nocturnal hemoglobinuria.
    The hemoglobin is released into the blood and immediately bound by haptoglobin for clearance in the liver.
    If the hemolysis is too much, haptoglobin get consumed and extra hemoglobin set free in the circulation (that's why hemoglobinemia).
    This free hemoglobin reaches the kidney and get's filtered and then reabsorbed in the form of Iron.
    Again if hemolysis is beyond the reabsorptive capacity of the renal tubules, hemoglobin will appear in the urine (hemoglobinuria, and urinary hemosiderin appears).
    Because the fact that RBSs are lysed in the blood, its LDH is released into the circulation raising it's levels. (recall that LDH is mainly a cytoplasmic enzyme that's why it's available in the nucleus-free mitochondria-free RBC).
    Schitiocytes are essentially broken up and fragmented RBCs.

    Extravascular Hemolysis
    RBCs are coated with antibodies or have abnormal shape of membrane or abnormal inclusion (such as Heinz bodies in G6PD) and so they are attacked prematurely by the liver and spleen phagocytes.
    The engulfed hemoglobin is converted into iron for recycling and the globine portion becomes billirubin later.
    So as no hemoglobin is released into the circulation, no haptoglobin is consumed and no hemoglobinemia or uria is observed.
    As the RBC is not lysed in the circulation, no LDH is elevated.
    Sometimes, the phagocytes spit up the RBCs back again after chewing up some membrane and therefore we may see spherocytes in the peripheral blood smear. Differentiate the two main cause of spherocytosis by doing osmotic fagility (positive in congenital spherocytosis) and DCT (positive in AutoImmune Hemolytic Anemia).
  7. DrXango

    DrXango Guest

    how people see this site i dont understand.

    there is nuthing systemic here.
    posts are crowded..how to find a thread
  8. Guest

    Guest Guest

    PCR is a what method for amplifying a selected segment of DNA sequence?
    in vitro

    PCR enables to produce how much of DNA in few hours using very small quantity of the sample?
    millions of copies

    What 2 things are PCR's major advantages in amplifying the DNA?
    1) sensitivity
    2) speed

    There are 5 steps used in PCR:

    The 1st step is:

    1) DNA is heated to do what 2 things to the strands?
    denature

    separate

    There are 5 steps used in PCR:

    The 2nd step is:

    2) Two pieces of what are what to the flanking segments of the template, one for each strand at its 3’ end?
    primers are annealed

    There are 5 steps used in PCR:

    The 3rd step is:

    3) What synthesizes new what using single strand DNA template and the annealed primer?
    DNA polymerase

    DNA strands

    There are 5 steps used in PCR:

    The 4th step is:

    The three events, namely what three are repeated 20 to 30 times to get many copies of DNA?
    (i) strand separation
    (ii) primer annealing
    (iii) new strand synthesis

    There are 5 steps used in PCR:

    The 5th step is:

    Each cycle does what to the no. of copies formed?

    Heat stable what is used to repeat these cyclic procedure in a machine?
    doubles

    Taq DNA polymerase dNTPs
  9. Guest

    Guest Guest

    In transplantation, describe the types of recipients and the types of donors
    - Recipient
    • Pre-emptive (in renal transplantation)
    • or on dialysis
    - Donor
    • Deceased (cadaveric)
    → heart beating (brain dead)
    → non-heart beating
    • Living donor
    → related (blood relative)
    → unrelated (not blood relative, could be spouse)
    → non-directed, altruistic

    Define allograft, autograft, xenograft, and syngeneic
    - Allograft = genetically different members of same species
    - Autograft = to same individual
    - Xenograft = between species
    - Syngeneic = genetically identical individuals (usually mice)

    What is a minor histocompatibility antigen?
    Antigen that can cause rejection, but not part of MHC/HLA, and weaker response than majors

    Describe some of the barriers to transplantation
    - Technical and other issues
    • cutting, sewing, healing
    • recipient co-morbidity (20-30% would not survive the operation)
    • organ availability
    • adverse effects of drugs
    - Rejection

    What drives the rejection response?
    Essentially the same process as some normal immune responses
    • Innate
    • Cellular (T cells) = most important
    • Humoral (antibodies)

    What is HLA (MHC)?
    - Cell surface molecule
    - Class 2 HLA drives immune responses
    • Found on ‘antigen presenting cells’
    - Two protein chains
    • variable region at ‘top’
    • capable of binding short protein fragments called antigens
    → can be derived from breakdown of self proteins
    → can be derived from invading organisms

    Radiation Therapy for Brain Metastasis
     Metastasis to the brain is the most common intracranial tumor in adults.
     The most common sites of primary are lung, breast, melanoma, kidney, and colon.
     Common symptoms include headache, neurological defi cit, and seizures.
     Parameters to predict prognosis include recursive partitioning analysis (RPA),
    score index for radiosurgery (SIR), and graded prognostic assessment (GPA).
     Standard treatment for patients with multiple metastases is whole-brain radiotherapy.
     For patients with single brain metastases, surgical resection followed by wholebrain
    radiotherapy can improve intracranial tumor control as compared with
    surgical resection alone, although no survival benefi t has been demonstrated.
     For patients with one to four brain metastases, stereotactic radiosurgery (SRS)
    with or without whole-brain radiotherapy may be off ered, although the latter
    approach will result in an increased risk of intracranial failure, without impacting
    survival.
     Compared with 30 Gy in ten fractions, none of the other whole-brain radiotherapy
    regimens yields additional benefi ts.
     Neurocognitive defi cits can be caused by the presence of brain metastases,
    intracranial tumor progression, whole-brain radiotherapy, and chemotherapy
    (“chemobrain”).
  10. Guest

    Guest Guest

    What is radiation?
    The emission of energy through space or matter
    What is ionizing radiation?
    radiation that creates an ion pair, when an electron is removed or added, potentially damaging cells in tissue

    What are the 2 main types of radiation?
    Particulate: beta, alpha
    Electromagnetic: gamma, x-ray
    Which is more damaging to living tissue?
    particulate

    What is coherent or classical scatter?
    photon is absorbed by electron causing it to change direction
    how much radiation does this account for?
    5%

    What is photoelectric effect?
    Incident photon penetrates inner shell electron causing it to leave atom causing it to be replaced by next shell electron releasing energy
  11. Guest

    Guest Guest

    What is photoelectric effect?
    Incident photon penetrates inner shell electron causing it to leave atom causing it to be replaced by next shell electron releasing energy

    What is characteristic radiation?
    when k shell electron is removed and replaced by l shell electron that specific amount of energy released is specific to that element

    What is pair production?
    high energy photon (at least 1.2 MeV) causes a pair of electrons to be created: 1 neg and 1 positive(positron or antimatter). this does not last long and emits a specific radiation signature.
    what scan is this process used in?
    PET scan

    What is Compton effect?
    Removal of outer shell electron resulting in low energy radiation. this is what causes scatter in radiographs
  12. Guest

    Guest Guest

    What i s m inimal r esidual d isease?
    Minimal residual disease (MRD) describes the lowest level of
    disease detectable using available methods . Previously, light
    microscopy, cytogenetic analysis and fl ow cytometry were
    standard techniques used for the detection of residual malignant
    cells in the blood and marrow of patients after treatment.
    However, the sensitivities of these methods do not
    allow identifi cation of low levels of disease, nor do they allow
    accurate quantitation of malignant cell numbers. Since these
    residual malignant cells may be the source of ultimate
    relapse, there has been great interest in developing molecular
    techniques for the detection of residual tumor. For many
    years Southern blot hybridization was the gold standard for
    the detection of DNA sequence alterations at specifi c genetic
    loci, but it has now been superseded by PCR amplifi cation
    of DNA sequences. Because of the power of PCR technology,
    we are now able to detect one residual malignant cell in a
    background of up to 1 million normal cells. Molecular
    targets for PCR - based approaches include chromosomal
    translocations and antigen receptor (immunoglobulin and
    T - cell receptor) gene rearrangements.
  13. Guest

    Guest Guest

    Velocities in myelinated nerves range from 40 to 70 m/sec. Unmyelinated axons, in
    contrast, are much slower – in the range of 1–5 m/sec. Unmyelinated axons do not conduct
    through saltatory conduction but have voltage-dependent channels uniformly throughout
    the nerve. The speed of nerve conduction is largely contingent upon the amount of time it
    takes for voltage-dependent channels to open. As unmyelinated nerves have a far greater number of channels per length of nerve, they conduct at less than one-tenth the speed of
    a myelinated nerve.
    The most important points to remember about myelin are:
    ● Myelin helps nerves propagate an action potential faster.
    ● The myelin sheath functions as insulator of the axon.
    ● In myelinated nerves, depolarization occurs only at areas devoid of myelin (nodes of
    Ranvier) resulting in saltatory conduction.
    ● Conduction velocity is directly related to internodal length and efficiency of myelin
    insulation.
  14. Guest

    Guest Guest

    What is characteristic of Hemophilia A?
    soft tissue hematomas and hemarthroses

    Severe Hemophilia A:
    1-presents when?
    2-infants develop what during delivery?
    3-what happens during circumcision?
    4-early and excessive what occurs?
    5-other s/s
    1-presents with bleeding during the first year of life
    2-intracranial hemorrhage during delivery
    3-significant bleeding during circumcision
    4-early and excessive bruising, hematomas, hemarthrosis and fever
    5-hematuria, intracranial hemorrhage, epistaxis, hemopytysis, PUD

    Moderate Hemophilia A
    1-presents when?
    2-what happens with known trauma?
    3-what happens post op?
    1-presents later in life
    2-hemarthroses and hematoma with known injury
    3-excessive bleeding post op

    Mild disease and Carrier state of Hemophilia A
    1-may go what?
    2-what happens after surgery?
    3-if factor 8 activity is above 50% what may happen/
    1-unrecognized
    2-excessive bleeding after trauma or sx
    3-may have no symptoms even after trauma or sx
  15. Guest

    Guest Guest

    Factor VIII is highly sensitive to proteolytic processing after
    secretion, and only a small fraction of circulating FVIII is in
    the single - chain form: the majority consists of heavy chains of
    variable length (consisting of the A1 and A2 domains together
    with variable lengths of B domain) linked noncovalently to
    light chains consisting of the A3, C1, and C2 domains.
    Expression of active recombinant FVIII lacking the entire
    length of the B domain has confi rmed that this domain is
    unnecessary for activation of the protein or procoagulant
    function : a cleavage after R759 (probably by thrombin)
    during coagulation serves to remove it. In contrast, the FV B
    domain is important for normal activation of the cofactor.
    The function of FVIII is to accelerate the activation of FX
    by FIXa on a suitable phospholipid surface, thus amplifying
    the clotting stimulus many - fold, and specifi c proteolytic cleavages
    between the domains both activate and inactivate the
    cofactor . It is clear that the active form (FVIIIa)consists of a heterotrimer of an A1 – a1 chain linked by a metal
    cation - dependent bond to the A3 – C1 – C2 chain; with the
    A2 – a2 chain held by electrostatic association between the A1
    and A2 domains. Inactivation and loss of procoagulant function
    occurs through either spontaneous dissociation of A2 – a2
    or proteolysis of FVIIIa by activated protein C (aPC).
  16. Guest

    Guest Guest

    What is Hodgkin's Lymphoma?
    A cancer involving the spleen and lymphatic system. (1932 - Thomas Hodgkin's first described)

    What binucleate or multinucleated giant cells were described in 1898 & 1902; there presence now is critical in a Hodgkin's diagnosis
    Reed-Sternberg cell - has bilobed nucleus w/ 2 large, prominent nucleoli that give an Owl's eye appearance.

    What percentage of these malignant Reed-Sternberg cells are accounted for in the tumor's total cell population?
    0.1 - 10% - this is what makes Hodgkin's Lymphoma unique

    What is a Hodgkin's tumor mostly composed of?
    Most of tumor is inflammatory cells & fibrosis - d/t cytokine release

    The univerally accepted WHO histologic classification system for HL is based largely from what other classification system?
    Rye Classification - divides HL into 2 broad classes

    What are the 2 broad classes of HL in the Rye classification system?
    1. Classical Hodgkin's Lymphoma (cHL)
    2. Nodular Lymphocyte predominant Hodgkin's lymphoma (NLPHL)

    What type of cells does NLPHL consist of?
    Large multilobed nuclei termed
    "popcorn cells".

    T or F: cHL cells are hallmarked by the Reed-Sternberg cells
    True
  17. Guest

    Guest Guest

    Binswanger's disease is a form of multi-infarct dementia caused by damage to the white brain matter. White matter atrophy can be caused by many circumstances including chronic hypertension as well as old age. This disease is characterized by loss of memory and intellectual function and by changes in mood. These changes encompass what are known as executive functions of the brain. It usually presents itself in 54 and 66 years of age, and the first symptoms are usually mental deterioration or stroke.

    It was described by Otto Binswanger in 1894, and Alois Alzheimer first used the phrase "Binswanger's disease" in 1902. However, Olszewski is credited with much of the modern-day investigation of this disease which began in 1962Hypertension and old age are likely risk factors. It is believed that the disease is caused by chronic cerebral hypoperfusion associated with arteriosclerosis of the deep penetrating arteries (cerebral medullary arteries) in the white matter. In addition, breakdown of the blood–brain barrier of these small vessels occurs and is associated with extravasation of proteases, complements, immunoglobulins, and cytokines into the perivascular parenchymal space. Consequently diffuse degeneration of white matter myelin and axons ensues.
  18. Guest

    Guest Guest

    when is the maximal deficit from a stroke experienced?
    within a few minutes after the event.

    a defect in the ability to produce or understand language
    aphasia

    pins and needles?
    parasthesia

    the preferred diagnostic imaging tool for a suspected stroke patient
    CT scan

    quick (time is important)

    detects hemorrhage well (Fe in blood)

    requires little patient cooperation

    what type of MRI is used for stroke patients?
    T2-weighted MRI
    returns a tissue/water signal
    easily identified lesions
    NOT good for determining acute treatment
    good for a post-hoc inspection
  19. Guest

    Guest Guest

    What disease are chlamydia responsible?
    trachoma, lymphgranuloma venereum, nongonococcal urethritis, mucopurulent cervicitis, pelvic inflammatory disease, ornithosis, psittacosis, pneumonia

    Obligate Intracellular parasites, gram -, cytoplasmic/outer membranes, lack peptidoglycan, disulfide cross linked proteins (pg-like), nonmotile, coccobacilli, divide by binary division, energy parasites
    Chlamydia

    What is the developmental cycle of chlamydia?
    Elementary Body - extracellular survival
    reticulate Body - intracellular multiplication
    Stain Both wit Giemsa

    Chlamydia are adapetd to intracellular environment, survive _____, inhibits ____ _____, and avoid ______ enzymes
    Phagocytosis
    DNA Synthesis
    lysozyme

    C. psittaci, C. trachomatis, C. pneumoniae

    Which one is Glycogen +
    C. trachomatis
  20. Guest

    Guest Guest

    ›› Hepatocytes are arranged in plates between the portal space and the central vein.
    ›› Hepatocytes are polarized cells with an apical membrane facing the bile canaliculus and a basal side facing the sinusoid.
    ›› Hepatocytes in adults are frequently polyploid.
    ›› Hepatocytes play a central role in lipid, cholesterol, and glucose metabolism.
    ›› Hepatocytes are responsive to acute phase signals and massively increase the synthesis of specific proteins.
    ›› Hepatocytes regulates iron metabolism and secrete hepcidin.
    ›› Hepatocytes are not only targets for hormones such as insulin and glucagons, but synthesize hormones such as IGF-1 and, during the fetal life, EPO.
    ›› Hepatocytes are equipped with numerous transporters.
    ›› Hepatocytes excrete into the bile conjugated bile salts, conjugated bilirubin and phospholipids.
    ›› Hepatocytes excrete into the bile copper.
  21. Guest

    Guest Guest

    Which bone is most often fractured at birth? The clavicle
    What is the most common shoulder dislocation? Anterior (95%)
    A pt cannot actively abduct her shoulder. What injury does this suggest? Rotator cuff tear
    Why is a displaced supracondylar fracture of the distal humerus in a child considered an emergency? This fracture often results in injury to the brachial artery or the median nerve. It can also cause compartment syndrome
    What are the signs and symptoms for compartment syndrome involving the anterior compartment of the leg? Pain on active and passive dorsi-flexion and plantar-flexion of the foot, and hypesthesia paresthesia of the first web space of the foot
    How is a scaphoid fracture diagnosed? The initial radiograph frequently appears normal. If the patient has tenderness in the anatomical snuffbox or pain with axial loading of the thumb, a scaphoid fracture should be presumed and the hand splinted. A follow-up radiograph 10-14 days after the injury may then reveal the fracture.
    What is the most feared complication of a scaphoid fracture? Avascular necrosis. The more proximal the fracture, the more commonly avascular necrosis occurs

    Clavicular Fracture
     Most common bone fracture during delivery.
     Complete fracture symptoms involve decreased or absent movement,
    gross deformity of clavicle, tenderness on palpation, and localized crepitus.
     Greenstick (partial) fractures have no symptoms and the diagnosis is
    made at 7 to 10 days because of callus formation.
  22. Guest

    Guest Guest

    • Molecular diagnostic methods remain most valuable for the characterization of infectious agents that are difficult or impossible to detect and identify using conventional methods.
    • When combined with modern serology, flow cytometry, and powerful tools such as electron microscopy and mass spectrometry, molecular techniques have markedly improved our capabilities to provide rapid (same day) and accurate detection of many emerging (new) and re-emerging pathogens as well as pathogens commonly encountered in medical practice.
    • Molecular diagnostic methods are becoming more practical and cost-effective and the benefits to patient care are more widely recognized; however, this is still an expensive technology requiring skilled personnel and reimbursement issues are problematic.
    • Fluorescent in situ hybridization technology uses fluorescent dyes linked to nucleic acid probes to produce a ‘phylogenetic stain’, allowing simultaneous detection and identification of an organism and at the same time preserving the organism's morphology and spatial localization in the tissue or clinical material
    • Commercial polymerase chain reaction (PCR) product development has focused primarily on systems for detection and quantitation of specific viral infections, detection of Mycobacterium tuberculosis and the leading agents of sexually transmitted diseases (Chlamydia trachomatis and Neisseria gonorrhoeae).
    • The adaptability of real-time PCR has expanded the number of pathogens detectable by commercial systems to include the drug-resistant pathogens methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci as well as selected emerging and re-emerging pathogens.
    • A newly proposed nucleic acid amplification test (NAAT) should be validated by comparison with a sensitive culture and at least one validated PCR or other NAAT assay that targets a different gene or a different sequence of the same gene.
    • In addition to assay performance, it is suggested that specimen throughput and volume requirements, limit of detection, ease of execution, instrument work space, and costs of reagent disposal all be considered when selecting a viral load assay.
    • When applied in the settings of viral central nervous system infection and in acute respiratory tract infections in children, multiplex PCR has been shown to increase the diagnostic yield, reduce inappropriate antimicrobial therapy, promote more focused pathogen-specific therapy, facilitate the implementation of infection control precautions, and contribute to overall improved patient outcome.
    • The availability of improved sequencing techniques, broader and more reliable databases, and more readily available kits and software, makes 16S rRNA sequence analysis a competitive alternative to routine microbial identification techniques for some groups of organisms
  23. Guest

    Guest Guest

    SUPERFICIAL FIBROMATOSES—FACT SHEET
    Definition
    ▸▸ Benign, recurring but nonmetastasizing, infiltrative, fibroblastic
    proliferations arising in the palmar or plantar soft tissues
    Incidence and Location
    ▸▸ R elatively frequent
    ▸▸ Palmar and plantar locations
    Morbidity and Mortality
    ▸▸ Benign, recurring lesion
    ▸▸ Dupuytren disease may be bilateral (50% of cases)
    ▸▸ Superficial fibromatoses may coexist in different locations in the
    same patient
    ▸▸ Possible association between superficial fibromatoses and trauma,
    alcoholism, or other diseases (diabetes, epilepsy, chronic lung
    disease, among others)
    ▸▸ No association with deep fibromatoses

    CYTOMEGALOVIRUS (CMV)
     Common—occurs in 1% of newborns.
     Newborn disease is associated with primary maternal infection with a
    50% chance of infection.
     In those affected, only 5% have neurologic deficits.
     Infection occurs in 1% of pregnancies with recurrent or reactivated infection.
     CMV transmitted intrapartum, through infected blood or through
    breast milk, is not associated with neurologic deficits.
     Clinical features include intrauterine growth retardation (IUGR), low
    birth weight, petechiae and purpura, jaundice and hepatosplenomegaly,
    microcephaly, chorioretinitis, and intracranial calcifications.
     Late manifestations like learning and hearing deficits can occur in 10%
    of clinically inapparent infections.
  24. Guest

    Guest Guest

     One theory proposed to explain the emergence of IBD as a disease of western or developed nations through the
    middle of the 20th century has been the “hygiene hypothesisâ€. This hypothesis posits that IBD (and other chronic
    immune diseases) emerged in the developed world, concurrent with a marked enhancement of personal and societal
    hygiene and decrement in infant mortality. This meant that there emerged a loss of tolerance to organisms that might
    otherwise be encountered in childhood, in a dirtier environment, which leads to aberrant immune responses when
    those organisms or mimicking antigens are presented at an older age.
     The hygiene hypothesis can apply to the emergence of late of IBD in the developing world where the developing world
    is now encountering more and more IBD, as it becomes “cleanerâ€. Other environmental and societal factors in the
    developed world include westernization of diets and the broader introduction of western medicines including
    antibiotics and vaccines.
     Data from the past decade from developed countries have revealed that the incidence rate of Crohn’s disease has
    overtaken that of ulcerative colitis. In areas where the incidence rate of ulcerative colitis is still higher, the trends are
    suggesting increasing rates of Crohn’s disease. In developing countries ulcerative colitis is the predominant form of IBD.
     There seems to be a rising incidence of isolated colonic disease among Crohn’s disease phenotypes, begging the
    question as to whether the emergence of a greater incidence of Crohn’s disease over ulcerative colitis was real or
    whether much of the former high rates of ulcerative colitis encompassed misdiagnosed colonic Crohn’s disease.
     Clues to disease etiology are more likely to arise from studies in pediatric and developing world populations where
    dietary and environmental impact may be more evident than in studies from developed nations with longstanding
    burdens of IBD.
  25. Guest

    Guest Guest

    Choanal atresia is a congenital malformation of the nasal airway in which no communication exists between the nasal cavity and the nasopharynx. This anomaly occurs in 1 in 5000 to 8000 live births (female-to-male ratio of 2:1); atresia may be bilateral (67%) or unilateral (33%), complete or incomplete, completely bony (30%) or a combination of bone and membrane (70%). Most cases of choanal atresia are isolated malformations, but association with other deformities can occur in the CHARGE syndrome (a congenital syndrome that includes coloboma, heart disease, atresia of choana, retarded development, genital hypoplasia, and ear anomalies). In addition, syndromes with midface hypoplasia and nasal stenosis may manifest in a similar fashion.

    ▪ Bilateral choanal atresia is more common than unilateral and manifests as acute respiratory distress at birth.
    ▪ In bilateral cases, the airway is secured by intubation or oral airway and a CT scan is performed to plan surgical repair.
    ▪ Endoscopes and endoscopic instruments, along with the development of small drills, have improved the ease and success of transnasal repairs.
    ▪ The transpalatal repair remains an excellent option for difficult cases and transnasal surgical failures.
    ▪ The application of mitomycin C has become a useful adjunctive therapy in preventing restenosis of the choana.
    ▪ Most surgeons favor the use of postoperative stenting of the choana for 4 to 6 weeks, to maintain patency and help prevent restenosis
  26. Guest

    Guest Guest

    What are the infectious modes of transmission of HIV?
    When infected blood, semen, or vaginal secretions are deposited onto mucous membrane or into the blood.

    What are some non infectious routes of HIV spread which can be mistaken for infectious ones?
    Sweat, saliva, urine, feces : all are not infectious UNLESS contaminated with blood.

    Which is a more efficient route of transmission male to female or vice versa?
    male to female transmission is 7x-9x more efficient that female to male

    What is the most frequent mode of transmission of the HIV virus?
    sexual ( unprotected ) 75%-85%

    What are the modes of transmission via the blood route and which one is the most common?
    IVDA**
    transfusions
    needlesticks

    HIV can cross the placenta spreading the virus from the mother to the infant. T/ F?
    False, HIV doesnt cross the placenta. Infections occur at time of birth.

    What are some ways to prevent the spread of HIV via blood and sexual routes?
    sexual: reduce high risk behaviour such as anal sex and promiscuity. Use condoms if having sex at all.

    Blood: avoid IVDA, if still using then at least use a different needle every time and if not possible, wash with bleach.

    Healthcare workers take precautions

    How do you prevent the spread of the virus from mother to infant?
    ART anti retroviral therapy
    avoid breast feeding

    How is HIV screening preformed?
    ELISA ---> if positive then do confirmatory test Western Blot

    What are the two forms of HIV and their associations with AIDS?
    HIV-1: associated with AIDS in most of world
    HIV-2: associated with AIDS in western Africa

    How is genetic information carried in HIV?
    RNA
  27. VeenAbinay

    VeenAbinay Guest

    For the question on the amount of carbs in the plasma membrane of RBC, i'd go with the lowest number (5%). Summarizing net references, RBC plasma membrane consists of 50% proteins and 50% lipids.

    And Lithium is the mood stabilizer in the classical sense...
  28. VeenAbinay

    VeenAbinay Guest

    Frustration is tolerated by the ego.
  29. VeenAbinay

    VeenAbinay Guest

    Chondroitin -6- sulphate increses with age.

    Gastroplenic ligament is derived from dorsal mesogastrium, not ventral...
  30. Guest

    Guest Guest

    Epidural Hematoma

    An epidural hematoma results from ongoing arterial bleeding which progressively compresses a portion of the brain resulting in a rapid progression of neurologic symptoms. The classic history is that of an immediate posttraumatic loss of consciousness followed by a "lucid" interval (often lasting hours) during which the patient may either awaken fully or at least show improvement in the level of consciousness, followed by a rapid neurologic deterioration. The treatment for most acute epidural hematomas is immediate surgical evacuation, ideally done in the operating room by a neurosurgeon. Under rare circumstances where a neurosurgeon is not immediately available, an ED burr hole may be lifesaving.

    Subdural Hematoma

    A subdural hematoma results from the tearing of the veins which bridge from the cerebral cortex toward a major dural venous sinus over a cerebral convexity. The venous bleeding takes place slowly, thus patients frequently present with a less than catastrophic decline in mental status and level of consciousness. However, large lesions can obviously result in profound neurologic damage and require emergent neurosurgical evacuation.

    Jejunal and Ileal Atresia

    Jejunal or ileal atresia occurs in 1 in 300 to 5000 live births (higher in certain familial cases), with no sex preponderance. Associated anomalies may include Down syndrome, gastroschisis, malrotation, or cystic fibrosis.

    Jejunal atresia and ileal atresia are thought to be the result of ischemic necrosis caused by a focal mesenteric vascular accident, which may be initiated by a variety of events including volvulus and intussusception. Multiple atresias are seen in 6% to 21% of cases. Microcolon may accompany ileal atresias. Signs and symptoms of intestinal obstruction result and may be associated with significant proximal small bowel dilation and perforation.

    Surgical repair involves end-to-end anastomosis with the distal section. Multiple atresias may be repaired in this way with attention to preserving final intestinal length, although dense clusters may best be treated by resection of the entire affected bowel. Tapering of dilated proximal bowel may be necessary.

    Long-term total parenteral nutrition is likely to be needed if significant resection has occurred, at least until the remaining bowel undergoes compensatory adaptation. At present, the survival rate is approximately 90%, and the prognosis depends on the length and location of residual bowel and availability of total parenteral nutrition. The association with gastroschisis worsens the prognosis
  31. Guest

    Guest Guest

    most common causes of ABO incompatibility
    clerical error

    The three leading causes of transfusion-related death
    ABO incompatibility, transfusion-related acute lung injury, and sepsis caused by bacterial infections.

    In the setting of massive transfusion, assuming maintenance of isovolemia and the absence of a consumptive coagulopathy, critical dilution of clotting factors and platelets is likely to occur when?
    after an average replacement of 140% and 230% of blood volume, respectively

    infection w/ which virus poses the greatest risk w/ transfusion?
    Hepatitis B

    greatest risk of sepsis w/ platelets or w/ blood products?
    The incidence of sepsis is substantially greater with platelet than RBC administration because the former are stored at room temperature.

    antibodies that fix complement and commonly produce immediate intravascular hemolysis
    those against A, B, Kell, Kidd, Duffy, and Ss antigens. Rh antibodies (i.e., anti-D, anti-Cc, and anti-Ee), although typically not complement binding, are also capable of causing serious acute hemolytic reactions
  32. Guest

    Guest Guest

    what happens when ABO incompatible blood enters the blood stream?
    antigen-antibody complexes activate Hageman factor (factor XII), which in turn acts on the kinin system to produce bradykinin. The release of bradykinin increases capillary permeability and dilates arterioles, both of which contribute to hypotension. Activation of the complement system results in the release of histamine and serotonin from mast cells, resulting in bronchospasm. Thirty to 50% of patients develop DIC.

    What happens to released Hb from ABO incompatibility rx?
    Initially it is bound to haptoglobin and albumin. When those binding sites are saturated, it circulates unbound until it is excreted by the kidneys.

    why does renal damage occur w/ incompatibility rxns?
    Blood flow to the kidneys is reduced in the presence of systemic hypotension and renal vasoconstriction. Free Hb in the form of acid hematin or red cell stroma may damage renal tubules. Antigen-antibody complexes may be deposited in the glomeruli. If the patient develops DIC, fibrin thrombi will also be deposited in the renal vasculature, further compromising perfusion and/or causing acute cortical necrosis, which is frequently irreversible
  33. Guest

    Guest Guest

    signs and symptoms of acute hemolytic rxn?
    fever, chills, nausea and vomiting, diarrhea, and rigors. The patient is hypotensive and tachycardic (bradykinin effects) and may appear flushed and dyspneic (histamine). Chest and back pains occur and have been attributed to cytokine release. The patient is often restless, has a headache, and a sense of impending doom

    at which point does hemoglobinuria occur?
    Hemoglobinuria will occur if plasma Hb rises above the renal threshold (about 25 mg/dL).

    what to do w/ acute hemolytic rxn in OR?
    stop infusion, check the administered blood, take blood sample and check for hemolysis. maintenance of systemic blood pressure, preservation of renal function, and the prevention of DIC.
    Serum haptoglobin level, plasma, and urine Hb and bilirubin assays. Determine coagulation status of the patient
  34. Guest

    Guest Guest

    TERTIARY PERITONITIS
    With a startling mortality of 20% to 50%, the diagnosis and treatment of tertiary peritonitis has remained a source of intense research for two decades (2). Tertiary peritonitis, or intraabdominal infection persisting beyond a failed surgical attempt to eradicate secondary peritonitis, represents a blurring of the clinical continuum, often characterized by the lack of typically presenting signs and symptoms. Nevertheless, prompt diagnosis is essential for cure, and given the grim propensity of this complication to strike already critically ill patients— rapidly devolving into multi-organ system failure—the intensivist should be equipped with the necessary knowledge to suspect, confirm, and treat this serious illness.
    Early Recognition
    The gradual postoperative transitional period between a diagnosis of secondary and tertiary peritonitis causes the clinical presentation of tertiary peritonitis to be quite subtle. Moreover, because patients are frequently sedated, intubated, or otherwise incapacitated, history and physical exam in the early stages of disease are often an insensitive means to a diagnosis. Therefore, the physician must pay particular attention to those secondary peritonitis patients whose conditions place them at risk, including malnutrition and the several variables detailed under the acute physiological and chronic health evaluation score (APACHE) II scoring system such as age, chronic health conditions, and certain physiologic abnormalities while in the ICU
  35. Guest

    Guest Guest

    TERTIARY PERITONITIS
    Radiologic tools, then, become a mainstay of the physician’s investigation. Two such studies, gallium-67 (Ga-67) scintigraphy and computed tomography (CT) scan, are commonly used for the detection of intra-abdominal infection. On the whole, CT is generally the preferred choice. At 97.1% accuracy, it is the more accurate of the two, with an enviable specificity of 100%. Isotope scans suffer in terms of accuracy for the postoperative patient because of falsepositive uptake in areas of surgical injury. Moreover, CT has the potential to contribute both diagnostically and therapeutically in the care of patients, as will be discussed later. Finally, CT may be done on demand, whereas Ga-67 scintigraphy requires one to two days for concentration of the isotope at the site of infection. Scintigraphy, however, is not entirely without its own merits.
    With a sensitivity of 100% relative to 93.7% for CT, it is superior for uncovering early infection prior to the development of discreet fluid collections. Also, it is worth considering that in centers where indium-111 (In-111) and technitium-99m (Tc-99m) exametazine-labeled leukocyte scans are available, a higher level of scintigraphy accuracy may be attained, albeit at greater expense. Furthermore, as an incidental advantage, nucleotide scanning has been known to reveal extra-abdominal infections such as pneumonia and cellulitis that might imitate tertiary peritonitis (5). Therefore, one might consider this as a second option for the relatively stable patient, in which CT has failed to provide a definitive answer but signs and symptoms persist. Other studies, such as plain film, are impaired by the nonspecific finding of intra-peritoneal free air and other features that might normally be expected in the postoperative patient
  36. Guest

    Guest Guest

    Human Papillomavirus
    Carcinomas of the anogenital tract, particularly cancer of the cervix, account for almost 12% of all cancers in women, and so represent the third most frequent gynecological malignancy in the world (44). It is well established that chronic infection of cervical epithelium by human papilloma viruses (HPVs) is necessary for the development of cervical cancer. HPV DNA has been demonstrated in more than 99% of all tumor biopsy specimens, with high-risk HPV16 and HPV18 being most prevalent (45). HPVs are double-stranded DNA viruses that infect basal and suprabasal layers of stratified epithelium. The early genes, which include E1, E2, E4, E5, E6, and E7, code for proteins involved in viral DNA replication, transcriptional control, and cellular transformation. Late genes encode the major viral capsid protein, L1, and a minor capsid protein, L2. It has been demonstrated that E6 and E7 expression is required for the immortilization of primary cells as well as for maintenance of the transformed state (46,47). E6 and E7 expression delay keratinocyte differentiation and stimulate cell cycle progression, allowing the virus to utilize host DNA polymerases to replicate its genome. Specifically, the E6 protein has been shown to bind to p53 and target its degradation by the proteasome (48). p53 is a central transcription activator that regulates responses to stress and DNA damage.
  37. Guest

    Guest Guest

    60) The red man syndrome, which is a complication of vancomycin administration, can usually be avoided by slowing the rate of drug infusion or by premedicating with diphenhydramine.
    61) A petechial-purpuric rash in a glove-and-stocking distribution should raise the possibility of infection with parvovirus B19.
    62) Perinatal asphyxia accounts for less than 15% of cases of cerebral palsy.
    63) Because primary and secondary apnea are indistinguishable in newborns, the initial clinical response should be identical in the delivery room.
    64) Hyperbilirubinemia is generally not an indication for the cessation of breast-feeding but rather for increasing its frequency.
    65) Sepsis is in the differential diagnosis of virtually every neonatal sign and symptom.
    66) Breast feeding lowers the risks of necrotizing enterocolitis and nosocomial sepsis.
    67) Ten percent of febrile infants with documented urinary tract infections have normal urinalyses; this emphasizes the importance of obtaining a urine culture if clinical risk factors are present
  38. Guest

    Guest Guest

    * Treatment of RDS starts with prevention, getting baby to term and giving mother steroids to help mature the babies lungs. Can treat newborn with surfactant, ventilate if needed, give fluids if needed, antibiotics if needed.
    * Complications include pneumothorax, plugging, intraventricular hemorrhages, sepsis, pulmonary interstitial emphysema, chronic lung disease (bronchopulmonary dysplasia).
    * Transient tachypnea of the newborn (TTN), similar to RDS symptoms but with a term baby. Associated with a rapid second stage of labor or Cesarean section as baby does not get the birth squeeze that helps production of surfactant. Baby will have tachypnea, may require a little oxygen, fairly clear x-ray, tends to go away in a few days.
    * Meconium aspiration syndrome has symptoms of respiratory distress but with history of meconium-stained amniotic fluid. Seen in term babies. Rupture membranes with meconium is a clue, meconium under the baby’s
    fingernails or around the umbilicus is another clue. CXR is typical of aspiration pneumonia. Meconium is like thick pudding, supposedly sterile but can cause pneumonitis and air-trapping if it get into the lungs.
    * Air-trapping in the lungs leads to hypoxia. This causes vasodilation everywhere in the body except the lungs. In the lungs, hypoxia causes vasoconstriction, leading to shunting. In newborn, the shunting goes through a patent ductus arteriosus or foramen ovale. This causes more deoxygenated blood to go out into the body, causing more hypoxia, further vasoconstricting the pulmonary vessels, which can cause persistent fetal circulation or primary pulmonary hypertension of the newborn.
  39. Guest

    Guest Guest

    Rheumatic Fever
    RF affects 1–4% of children with untreated streptococcal pharyngitis and is a major cause worldwide of acquired cardiovascular disease, with an incidence of 100–200 per 100 000 children in countries where RF is endemic (Guilherme et al. 2000; Olivier 2000). Although the incidence of RF in developed countries is usually low (1–2 per 100 000), the disease occurs with marked frequency amongst the economically deprived native communities of New Zealand and Australia. RF can also cause outbreaks in affluent communities: an eightfold increase in RF incidence occurred across Utah and other states within the United States in the late 1980s, leading to carditis in over 90% of cases (Veasy et al. 1987; Bisno 1991). Rheumatic heart disease follows acute RF in 30–50% of cases (Majeed et al. 1992; Guilherme et al. 2000). The so-called rheumatogenic S. pyogenes serotypes have been associated with outbreaks of RF (M1 and M18 in the United States and M1, M3 and M5 in the United Kingdom),
    although RF can be associated with a broad range of strains. Epidemiological study is hampered because isolates are rarely available for typing (Veasy et al. 1987; Colman et al. 1993). Study of the pathogenesis of RF has focused on the role of streptococcal M protein. Cases with arthritis not meeting the acknowledged criteria for RF are often designated as poststreptococcal reactive arthritis


    Haemophilus ducreyi
    Haemophilus ducreyi is the aetiological agent of the sexually transmitted disease soft chancre. This is rarely encountered in resource-rich countries. However, it is more prevalent in resourcepoor countries and is more particularly associated with prostitution. A major feature of infection is the potentiation of HIV transmission and possible modification of the disease in HIV-infected people (Nasio et al., 1996; Lewis, 2003).
    The incubation is approximately 2 weeks. The main disease manifestations are painful genital ulcers from a few mm to 2 cm in size with a defined margin that start as an erythematous papule. The margin may be ragged in some cases and has a grey base which is relatively friable and bleeds. Inguinal lymphadenopathy occurs in most cases and in half they will suppurate and discharge spontaneously.
    Diagnosis is essentially clinical. The organism is fastidious and difficult to grow without highly specialized media and prolonged culture. Nucleic acid amplification using PCR offers the best prospect for a reliable laboratory diagnostic test for this infection (Lewis, 2003). Treatment is with antibiotics. The following regimens are recommended by the CDC or WHO: azithromycin 1 gm as a single dose orally, ciprofloxacin 500 mg PO twice a day for 3 days, cephtriaxone 250 mg IM in a single dose, amoxicillin clavulanate (500/125 mg) PO three times a day for 7 days and trimethoprimsulfamethoxazole (TMP-SMX) two tablets twice a day for 7 days.
  40. Guest

    Guest Guest

     Graves’ disease is an autoimmune condition characterized by thyroid overactivity, eye changes (Graves’ infiltrative ophthalmopathy or more specifically ‘orbitopathy’) and skin changes (pretibial myxoedema and finger clubbing, known as thyroid acropachy). The three components may occur in isolation, in any combination or never. Their clinical courses are usually independent and unpredictable. Skin changes are rare. Note that ‘myxoedema’ was an old term for thyroid underactivity. It is now a term reserved for the skin changes that sometimes occur in Graves’ disease.
     In all hyperthyroid patients (even if iatrogenic), sympathetic overactivity leads to retraction of the upper lid with widening of the gap between the upper and lower lids when the eyes are open (the palpebral fissure). Increased exposure of the cornea and conjunctiva leads to grittiness and soreness of the eyes.

     In Graves’ orbitopathy, which can occur without hyperthyroidism, autoimmune-mediated infiltration of the contents of the orbit and periorbital tissue leads to non-pitting and boggy soft tissue swelling, with increased volume of extraocular muscles, connective tissue and fat. This pushes the globe of the eye forward and can interfere with the function of the extraocular muscles, optic nerves and eyelids, reducing protection afforded by the tear film and leading to double vision and even blindness. Hyperthyroid patients tend to be sweaty, tremulous, anxious and sometimes rather aggressive. Proximal myopathy (weakness of the thigh and arm muscles) makes their muscles ache and although tired, sleeping is often difficult. Appetite is increased, weight tends to decrease and stools are often softened but not frankly diarrhoeal. Fertility is reduced, and menstrual periods become lighter or stop altogether. Patients often find that their short-term memory is impaired, and it becomes difficult sometimes for them to make rational decisions.
    In addition to sore eyes, the patient may complain of fast palpitations. If present, a thyroid bruit (the sound of blood rushing through the highly vascular, overactive gland) is a useful sign because it excludes thyroiditis and exogenous thyroid hormone as causes of hyperthyroidism.
  41. Guest

    Guest Guest

    The first chemical signal controlling the cell cycle was discovered in studies of amphibian oogenesis. Oocyte maturation begins with the first meiotic division, when the germinal vesicle (the oocyte nucleus) breaks down and chromosomes and spindle fibers first appear at one pole of the oocyte. In a key experiment, cytoplasm taken from oocytes during germinal vesicle breakdown was injected into immature oocytes. Condensed chromosomes quickly appeared in the injected oocytes. A protein called MPF (maturation promoting factor) was purified from the older oocytes. MPF was later found in developing frog embryos, where its levels fluctuated, peaking just before the embryonic cells began mitosis. Thus, MPF also controls mitosis as well as meiosis and is often called mitosis-promoting factor. MPF consists of cyclin and cyclin-dependent kinase (cdk). Cyclin-bound cdk catalyzes phosphorylation of other cellular proteins. Levels of cdk were shown to be constant in the cell, while cyclin levels rose and peaked late in G2, explaining why MPF activity is highest during mitosis and why mitotic cells induce nuclear breakdown and chromosome condensation when fused to nonmitotic cells
  42. Guest

    Guest Guest

    Detection of Parathyroid Gland Abnormality
    ■ 1. Ultrasound
    ■ Detects 80–85% of abnormal parathyroid glands located near the thyroid
    ■ Most important use is guiding fine needle aspiration biopsy for cytology
    ■ Parathyroid carcinomas tend to have a more heterogeneous internal architecture than adenomas
    ■ 2. Computed tomography or magnetic resonance imaging
    ■ Generally required to detect abnormal parathyroid tissue at ectopic sites such as the thymus (10–15%), the posterior mediastinum (5%), the
    carotid sheath, and the retroesophageal or parapharyngeal region
    ■ 3. Radionuclide dual phase technetium imaging (Technetium 99m-sestamibi [ Tc99m-MIBI ])
    ■ Detects parathyroid adenomas and hyperplasia (sensitivity 83%; 75% specificity) and is more sensitive than ultrasound (sensitivity 65%).
    The combination of this technique with ultrasound improves sensitivity and specificity.
  43. Guest

    Guest Guest

    virulence factor of staph aureus - binds Fc-IgG, inhibiting complement fixation and phagocytosis
    protein A

    superantigen that binds to MHC II and TCR, resulting in polyclonal T cell activation
    TSST - (staph aureus)

    what makes coagulase?
    staph aureus

    antibody to what enhances host defenses against strep pyogenes?
    M protein

    group A beta-hemolytic strep?
    strep pyogenes

    what detects recent strep pyogenes infections?
    ASO titer

    associated with rusty sputum, sepsis in sickle cell, and splenectomy?
    strep pneumo

    most common cause of meningitis, otitis, pneumonia, sinusitis?
    strep pneumo

    what gives immunity to strep pneumo?
    IgG antibodies to surface acidic polysacc
  44. Guest

    Guest Guest

    What are the three posttranscriptional modifications?
    1. 7-methyl guanine cap on the 5' end
    2. Addition of the poly(A) tail to the 3' end
    3. Removal of introns

    What AA is the major carrier of nitrogen byproducts from most tissues in the body?
    Glutamine

    What two AAs have a pKa of 4?
    Aspartic acid and glutamic acid

    How many acetyl CoAs per glucose enter into the TCA cycle?
    2 acetyl CoA per glucose, producing 12 ATPs per acetyl CoA, resulting in a total of 24 ATPs produced from glucose (via acetyl CoA) enter the TCA cycle

    What topoisomerase makes ssDNA cuts, requires no ATP, relaxes supercoils, and acts as the swivel in front of the replication fork?
    Topoisomerase I (Relaxase)

    In prokaryotes, what is the name of the RNA sequence that ribosomes bind to so translation can occur?
    Shine-Dalgarno sequence

    Name the pattern of genetic transmission: both M and F are affected; M-to-M transmission may be present; both parents must be carriers; the trait skips generations; two mutant alleles are needed for disease; and affected children may be born of unaffected adults?
    Autosomal recessive
  45. Guest

    Guest Guest

    What are the essentials of diagnosis for acute renal failure?
    Increase in BUN (azotemia) or serum creatinine
    Oliguria

    What are the general signs and symptoms of acute renal failure?
    azotemia which may lead to n/v, malaise, altered sensorium
    arrhythmias with hyperkalemia
    rales on pulmonary exam with hypervolemia
    abdomnal pain/ileus
    platelet dysfunction therefore bleeding
    asterixis and confusion

    What are the signs and symptoms occur with prerenal renal failure?
    increased thirst
    decreased urinary output
    orthostatic hypotension (hypovolemic)

    What is the most common cause of acute renal failure?
    Prerenal
    - dehydration, diuresis, hemorrhage, decreased CO, pancreatitis, burns, decreased perfusion
  46. Guest

    Guest Guest

    What are the intrinsic causes of acute renal failure?
    ATN (MC)
    NSAIDS
    aminoglycosides

    What are the lab findings associated with acute renal failure?
    elevated BUN/creatinine
    hyperkalemia
    EKG: peaked T waves, QRS widening
    Anemia
    Hyperphosphatemia
    Hypocalcemia
    Leukocytosis or leukopenia

    A patient has acute renal failure and track marks. What do you suspect?
    Endocarditis

    A patient has acute renal failure and hearing loss. What do you suspect?
    history of NSAIDS

    A patient has acute renal failure and leg pain. What do you suspect?
    rhabdomyolysis
  47. Guest

    Guest Guest

    Germ Cell Tumors

    In Japan, it has been the practice to first irradiate a pineal tumor thought to be a germinoma with 20 Gy (“the radiation testâ€), and then, if the tumor regressed, to continue radiotherapy. If there was no reduction in tumor size, only then wassurgical excision to be considered.167 Over time, aggressive surgical resection has proven itself to be an important determinant of survival, as evidenced in the largest single series of patients (number 153) reported by the University of Tokyo.102Among patients with known germinomas, combined surgical resection and radiotherapeutic intervention improved 10Y-OS rates from 69% to 93%.102 The typical radiotherapy prescription today consists of a primary tumor dose of 50 to 55 Gy, with 36 Gy to the neuraxis. Subsequent controversy regarding the treatment of germinomas has centered on the issues of dosimetry and the indication for craniospinal radiotherapy. As germinomas of the CNS proved to be as radiosensitive as those of the testis, it was shown that those without evident CSF dissemination could be controlled with involved field radiotherapy alone.
    A number of reports investigating the role of chemotherapy in the management of GCT have been encouraging
    The practice of the University of Tokyo has been to rank GCT patients by relative risk: (i) mixed germinoma and teratoma, (ii) mixed GCT with predominance of germinoma or teratoma with some “pure malignant tumor†(embryonal carcinomas, endodermal sinus tumors, and choriocarcinomas), and (iii) mixed tumors with predominance of “pure malignant tumor.†Surgery and radiotherapy produce a 10Y-OS rate of 91.7% among germinoma patients. In the intermediate prognostic group, combination chemotherapy (cisplatin-vinblastine-bleomycin, cisplatin-etoposide, or carboplatin-etoposide) and EBRT has been shown to significantly reduce the risk of disease recurrence when compared to irradiation alone (P = .049). The high-risk patients did relatively better with chemotherapy than with only EBRT, although the difference was not statistically significant

    Infant Brain Tumors
    Tumor types vary according to age as well (Duffner et
    al., 1986). Although medulloblastomas are the mostcommon malignant tumor in children 0–14 years of age,
    ependymomas vary in frequency with age. They are the
    second most common malignant tumor in children <2
    years of age, but are relatively unusual in children after
    the age of 5.Long-term survival among infants with malignant tumors has been approximately 24%, in comparison those with “benign†tumors fare better (73%).175 While effective at disease control, the neurotoxicity of irradiation is unacceptable. In one study of 78 infants, 80% of those treated with surgery and chemotherapy had a satisfactory functional outcome in contrast to those who required irradiation prior to 24 months of age (42%). Only 21 of 39 survivors had little or no neurologic/cognitive deficit.175 An early study among babies with MG, supratentorial PNET, and anaplastic EPD showed an encouraging response rate to cisplatinum-etoposide with a median survival of 34 monthsThe “Baby POG†protocol design consisted of alternating cycles of cyclophosphamide-vincristine and cisplatinum-etoposide.107 This combination yielded “very encouraging†results among infants with MA and DPG, which exceeded the responses seen at the time among older children treated with postoperative EBRT alone (PFS 20%), irradiation with CCNU–vincristine−prednisone, or the Eight in One regimen before and after EBRT Experience with Eight in One combination, the VETOPEC regimen (vincristine-etoposide-cyclophosphamide for four courses, followed by sequential administration of cyclophosphamide-vincristine, cisplatin-etoposide, and carboplatin-etoposide), and the more recently reported BBSFOP Protocol (seven cycles of three drug pairs: carboplatin-procarbazine, cisplatin-etoposide, cyclophosphamide-vincristine) is shown None of these has emerged as clearly superior.

    Exogenous Pathway
    Dietary fatty acids and monoglycerides, along with dietary and biliary cholesterol, are incorporated into micelles in the intestinal lumen by the action of bile acids. The micelle structure allows intestinal lipid to be absorbed from the lumen into intestinal enterocytes. Fatty acids and monoglycerides are absorbed by passive diffusion, whereas cholesterol is delivered into the enterocyte by a process involving a cholesterol transport protein located in the brush border of the enterocytes lining the lumen of the small intestine. Cholesterol delivered into the enterocyte is subsequently attached to a fatty acid by the enzyme acyl coenzyme A:cholesterol acyltransferase2 (ACAT2), forming cholesteryl ester. This esterification reaction traps cholesterol inside the enterocyte, and prevents it from being pumped back out into the lumen of the intestine. The passively absorbed fatty acids and monoglycerides are reassembled into triglycerides within the enterocyte. The cholesteryl ester, triglyceride, apolipoprotein (apo) B-48, and other apolipoproteins (e.g., A-I, A-II, C-II, C-III, E) are then packaged together in the enterocyte to form triglyceride-rich lipoproteins called chylomicrons. The enterocytes secrete chylomicrons into terminal lymphatics, which transport them into larger and larger lymph vessels, and ultimately into the thoracic duct. From the thoracic duct, the chylomicrons enter the systemic circulation.
  48. Guest

    Guest Guest

    ■ Interventional pain procedures are an adjunct to pharmacologic therapy for cancer pain.
    ■ One of the simplest methods to relieving myofascial pain is to treat a trigger point.
    ■ Botulinum toxin injection is used as a treatment for spasticity, musculoskeletal pain, muscle spasms, migraines, neuropathic pain, and other disorders.
    ■ Acupuncture treatments have been gaining acceptance in the medical profession as a modality to treat cancer pain and other related symptoms.
    ■ Neurolysis can be performed with freezing, heating, or chemical techniques with either phenol or alcohol preparations.
    ■ Due to technological improvements in image quality, ultrasonographic guidance for pain procedures has become increasingly common.
    ■ As patients with cancer have oral or intravenous opiate regimens that are escalating and/or having significant side effects, physicians may choose to deliver medications neuroaxially.
    ■ The role for epidural steroid injections in radicular pain is to facilitate earlier pain relief and an earlier return to full function.
    ■ The main indications for use of spinal cord stimulators in the United States is lumbar radiculopathy, complex regional pain syndrome, and failed back syndrome.
    ■ Kyphoplasty and vertebroplasty have been studied most extensively in stabilizing compression fractures from osteoporosis, but have also been used to treat fractures resulting from osteolytic metastasis, myeloma, vertebral osteonecrosis, and hemangioma.
  49. Guest

    Guest Guest

    LYSOSOMAL STORAGE DISORDERS

    History
    ■ Chronic progressive symptoms, not acute decompensation
    ■ Failure to thrive
    ■ Short stature
    ■ Developmental delay
    ■ Loss of developmental milestones & progressive neurological deterioration
    ■ Nonimmune hydrops
    ■ Seizures (w/ oligosaccharidoses & sphingolipidoses)
    ■ Consanguineous parents
    ■ Ashkenazi Jewish heritage for some
  50. Guest

    Guest Guest

    Immunodeficient Children

    Congenitally immunodeficient children should not be immunized with live-virus (oral polio vaccine [OPV], MMR, VAR, MMRV, yellow fever, or live-attenuated influenza vaccine [LAIV]) or live-bacteria vaccines (BCG or live typhoid fever vaccine). Depending on the nature of the immunodeficiency, other vaccines are safe, but may fail to evoke an immune response. Children with cancer and children receiving high-dose corticosteroids or other immunosuppressive agents should not be vaccinated with live-virus or live-bacteria vaccines. This contraindication does not apply if the malignancy is in remission and chemotherapy has not been administered for at least 90 days. Live-virus vaccines may also be administered to previously healthy children receiving low to moderate doses of corticosteroids (defined as up to 2 mg/kg/d of prednisone or prednisone equivalent, with a 20 mg/d maximum) for less than 14 days; children receiving short-acting alternate-day corticosteroids; children being maintained on physiologic corticosteroid therapy without other immunodeficiency; and children receiving only topical, inhaled, or intraarticular corticosteroids.


    Contraindication of live-pathogen vaccines also applies to children with HIV infection who are severely immunosuppressed. In general those who receive MMR should have at least 15% CD4 cells and a CD4 lymphocyte count equivalent to CDC immunologic class 2. MMR for these children is recommended at 12 months of age (after 6 months during an epidemic). The booster dose may be given as early as 1 month later, but doses given before 1 year of age should not be considered part of a complete series. VAR vaccination is also recommended for HIV-infected children with CD4 cells preserved as listed above. OPV, which is contraindicated, is no longer recommended in the United States. The ACIP recommends routine vaccination for all children only with IPV. Thus immunodeficient children should no longer be exposed to OPV through household contacts. MMR and VAR are not contraindicated in household contacts of immunocompromised children.

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