Notes from world 1

denniskwinn's version from 2015-04-26 04:19


Question Answer
most immediate effects of marijuana useRapid heart rate and conjunctival injection
Minors can consent to treatment for ____ without parental consent or notification ( )pregnancy, STD, birth control, drug and alcohol addiction
beta blockers in CHF patients specifically carvedilol, decreases heart failure progression by slowing the ventricular rate and decreasing peripheral resistance (afterload) as well as decreasing all-cause mortality in patients with CHF but they should not be initiated in patients with unstable heart failure. Carvedilol is unique among beta-bIockers in that it nonspecifically antagonizes BI and B2 adrenergic receptors as well as Al adrenergic receptors.
Furosemide and CHF mortality high doses of loop diuretics have been shown to be associated with increased mortality.
respiratory tract lining changes in structure and function as it progresses distallyBronchi have a pseudostratified columnar ciliated epithelium with goblet cells and submucosal mucoserous glands and cartilage. Bronchioles, terminal bronchioles, and respiratory bronchioles generally lack goblet cells, glands, and cartilage. By the level of the terminal bronchioles, the airway epithelium is ciliated simple cuboidal. Epithelial cilia persist up to the end of the respiratory bronchioles .
Ethambutol is noted for causing (side effect) optic neuritis that results in color blindness, central scotoma, and decreased visual acuity. This adverse side effect may be reversible with discontinuation of the drug.
An Increase in lung cancer incidence and mortality has been seen in women over the last four decades
laboratory identification process of H. influenzaedemonstration of the requirement of X (hematin) and V (NAD+) factors for growth. This can be accomplished by growing H. influenzae in the presence of S. aureus and demonstrating the "satellite phenomenon" where H. influenzae grow only near the beta· hemolytic S. Aureus colonies because they produce the needed X and V factors
four situations where disclosure of patient information without the consent of the patient is allowable1. When child, elder or spousal abuse is suspected, 2. When a patient has sustained gunshot or stabbing injuries. 3. When a patient is diagnosed with a reportable communicable disease and 4. When a patient threatens to kill or physically harm someone else during their interaction with the physician and has a reasonable ability to carry out this threat in the near future.
prevention of neonatal tetanusis to ensure that all pregnant women have been vaccinated with the tetanus toxoid, to allow transfer of protective IgG antioxin antibodies across the placenta to the fetus.
ACE inhibitor cough characterized as dry, nonproductive, and persistent. - cause is accumulation of bradykinin. substance P. or prostaglandins. ARBs should not cause cough.
Renal calculi factorsIncreased concentrations of calcium. phosphate. oxatate. and uric acid promote crystallization. whereas increased citrate and high fluid intake help prevent calculi formation.
A holosystolic murmur that increases in intensity on inspirationtricuspid regurgrtation. - other hoIosystolic murmurs (which are secondary to mrtral regurgrtation or ventricular septal defect) do not typically increase in intensity during inspiration.
Duodenal ulcers are not associated with an increased risk of carcinoma in tile same location. In contrast. esophageal. gastric. and colorectal cancers are frequently identified as ulcerative lesions on endoscopy.
Thiazohdinediones (TZDs) exert their glucose-lowering effect by improving insulin resistance, an effect achieved by binding to peroxisome proliferator activated receptor gamma (PPAR-gamma). As the glucoselowering effect ofTZDs requires an a~eration in gene transcription and in protein synthesis, a meaningful reduction in glucose levels takes days to weeks after commencing TZD therapy. The main side effect of TZDs is fluid retention, weight gain (from fluid), and the preciprtation of congestive heart failure. Typically, fluid retention is worse when TZDs are used concurrently with insulin.
Imipramine in bipolarTCA when used in the depressive phase of bipolar disorder is likely to cause a rapid switch to mania.
Neuroleptic malignant syndrome presentationtypically consists of four primary features: (1) hyperthermia. (2) extreme generalized rigidity. (3) autonomic instability. and (4) altered mental status
Beta·adrenergic blockersreduces blood pressure and cardiac work - when noncardioselective agents are used, adverse effects like bronchoconstriction (dose-dependent) may be seen.
Lamotrigine used mainly for the treatment of refractory partial seizures, also effective for the management of generalized tonic·clonic seizures and the treatment of bipolar disorder.
lamotrigine side effects associated with hypersensrtivity reaction that manifests as a skin rash - in children requires discontinuation immediately.
Seizures that involve only one area of the body"partial."
Simple seizure no associated impairment of consciousness during or after the event.
Complex seizuresloss of memory and postictal state
Carbamazepine usesmanagement of generalized tonic-clonic seizures, mood stabilizer in bipolar disorder, and to reduce neuropathic pain
Highly soluble anesthetichigh arteriovenous gradient (high tissue uptake) and low onset of action (more gas is needed to saturate the tissues). Anesthetic gas with low solubility. to the contrary. has a low arteriovenous gradient and rapid onset of action.
Multivitamin and parkinsonsB6 increases the peripheral metabolism of levodopa. which decreases its effectiveness.
Akathisia movement disorder characterized by inner restlessness and an inability to sit or stand in one position - can be a complication of antipsychotic therapy. Diagnosis is often missed because the movements and restlessness are misinterpreted as worsening psychotic behavior→ increased dose and exacerbation of the disorder.
Second-generation antihistaminesfexofenadine have minimal sedative and antimuscarinic effects.
Serotonin syndrome neuromuscular excitation (hyperreflexia, myoclonus. and rigidity). autonomic stimulation (hyperthermia. tachycardia. diaphoresis. and tremor). and altered mental status (agitation and confusion). most commonly occurs when selective serotonin reuptake inhibitors (SSRls) are given in conjunction with other agents suCh as monoamine oxidase inhibitors (MAOls) or tryptans. It may also Occur with a single agent if an excess dose is taken.
esmolol or nitroprussideused to treat hypertension associated w/ serotonin syndrome, but antihypertensive agents with longer half-lives such as propranolol should be avoided due to the risk of developing hypotension and shock
Flumazenilantidote for benzodiazepine overdose
Naloxonethe antidote for narcotic overdose,
Cyproheptadinean antihistamine with anti-serotonergic properties that can be used in the treatment of the serotonin syndrome,
Acetylcysteinethiol used to treat acetaminophen overdos - reduces hepatic damage in these cases.
Sodium bicarbonatemost effective agent in treating TCA-associated cardiac abnormalities.
Alpha·receptors and beta receptors and insulin secretion Alpha inhibit and beta· receptors stimulate. . Pretreatment w/ an alpha·blocker would result in predominance of beta-effects.
Physostigminetertiary amine - can reverse both the CNS and peripheral symptoms of severe atropine toxicity. The anticholinesterase agents neostigmine and edrophonium have a quaternary ammonium structure that limits CNS penetration.
Absence seizures a type of generalized nonconvulsive seizure characterized by episodes of loss of awareness (typically S:10 sec) associated with a 3 Hz generalized spike and slow wave EEG pattern, followed by abrupt return to full consciousness, The drug of choice for treatment is ethosuximide or sodium valproate,
Finasteride and tamsulosin useful for BPH and should not cause urinary retention.
Duloxetine dual serotonin and norepinephrine reuptake inhibitor and is promising for the treatment of painful diabetic polyneuropathy.
heterocyclics or SSRls and BPHshould be used with caution as they may cause urinary retention.
absence and associated tonic-clonic seizures treatmentSodium valproate is the drug of choice
Barbrturates inducethe hepatic microsomal enzymes. increasing warfarin metabolism and reduCing its anticoagutant activity.
Lithium SEcan cause nephrogenic diabetes insipidus and hypothyroidism. Lithium is also a teratogenic and can cause Ebstein's anomaly.
Traditional high potency antipsychoticsHaloperidol. nuphenazine. pimozide - more likely to cause extrapyramidal symptoms and less likely to cause anticholinergic and antihistamine side effects.
Traditional low potency antipsychoticsChiorpromazine. thioridazine- more likely to cause anticholinergic and antihistamine side effects.
Atypical antipsychoticsCIozapine. risperidone. olanzapine. quetiapine
Pralidoxime only medication that reverses both muscarinic and nicotinic effects of organophosphates by "restoring" cholinesterase from its bond with these substances.
H1 blockers useful in the treatment of allergy - decrease the activity of this receptor by increasing the proportion of inactive receptors, via a process known as reverse blockade
Side effects of antimuscarinics blurry vision, dry mouth, palpitations, urinary retention and constipation,
Motion sickness prevention Antimuscarinic agents and antihistamines with antimuscarinic action
Atropine is indicated for the treatment of bradycardia - decreases vagal influence on the SA node. A common side effect of is increased intraocular pressure - may preciprtate closed angle glaucoma in susceptible individuals.
Jimson Weed (datura stramonium) poisoningcaused by alkaloids that possess strong anticholinergic properties, atropine poisoning is similar - Blockade of visceral muscarinic receptors produces the following effects: Heart: diminished vagal tone at the SA node causes relative tachycardia. . .Blood vessels: vasoconstriction via muscarinic receptor blockade in endothelial cells results in decreased NO synthesis. In spite of this effect. atropine poisoning is associated with cutaneous flushing: the pathogenesis of this effect is unknown. . . GI: delayed gastric emptying. decreased intestinal motility. and secretion. . . Respiratory: bronchodilatation. . . GU: urinary retention via detrusor relaxation and contraction of the external urethral sphincter. . . Secretions: decreased lacrimation (dry eyes). salivation (dry mouth) and sweating (dry and hot skin). Atropine decreases one's ability to sweat, contributing to hyperthermia. . . Eye: mydriasis (dilated pupils) and cycloplegia (inability to focus on the near objects, blurry vision). . . CNS: hallucinations, agitation and delirium.
mnemonic for the clinical manifestations of atropine poisoning"blind as a bat, mad as a hatter, red as a beet, hot as a hare. dry as a bone, Bloated as a toad (the bowel and bladder lose their tone). and the heart runs alone."
Atropine poisoning treatmentcholinesterase inhibitors (physostigmine, Neostigmine).
Penicillins and cephalosporins function by binding to penicillin-binding proteins such as transpeptidases.
LH stimutates the theca interna cells of the ovarian follicle to produce androgens. Aromatase within the follicle's granulosa cells subsequently converts these androgens to estradiol under FSH stimulation. The theca externa cells serve as a connective tissue support structure for the follicle.
Mucopurulent cervicrtis with cervical motion tendernessPID caused by N. gono or Chlamydia trachomatis. PID can potentialty lead to ectopic pregnancy and infertility due to salpingitis leading to scarring of the fallopian tubes if not treated appropriately.
bacterial vaginosisGardnerella vaginalis - alterations in the normal vaginal flora (loss of lactobacilli and overgrowth of mixed anaerobic organisms) produce a gray discharge and a "fishy' odor that becomes more prominent with addition of potassium hydroxide (the whiff test), Wet mount microscopy of the discharge characteristically shows clue cells, which are vaginal squamous epithelial cells covered in small dark particles G.vagina/is organisms).
Bacterial vaginosis treatment oral metronidazole, though topical regimens may also be used.
Tricuspid endocarditis in IV drug users S. Aureus, P. Aeruginosa - patients can develop multiple septic emboli in lungs. Pulmonary infarcts are almost always hemorrhagic doe to the dual blood supply to the lungs (pulmonary and bronchial arteries).
Cryptococcus neoformans in HIV (+) patientsmeningoencephalitis
latex agglutination testused to detect antibodies, such as those produced in response to the rubella virus or the rheumatoid factor. May be used for Rickettsia, coccidioidomycosis, though numerous sources of interferences (e.g., large immune complexes and high protein concentrations) lessen the utility of the latex agglutination (LA) test in most situations. There is an excellent LA test for cryptococcus
Hepatitis vertical transmission Neonates born to HBsAg-and HBeAg-positive mothers are at high risk of chronic infection, experience fast HBV replication. and demonstrate mild hepatic injury histologically.
Interferons a and II produced by a wide variety of eukaryotic cells in response to viral infection, they act as cytokines on neighboring cells stimutating them to synthesize antiviral proteins that impair viral protein synthesis.
C. diff Toxin Aattracts neutrophils causing mucosal inflammation. loss of water into the gut lumen and diarrhea. as well as mucosal death.
C. Diff Toxin Bthe cytotoxin, causes actin depolymerization. loss of cellular cytoskeleton integrity, cell death and mucosal necrosis.
Observer bias occurs when the investigator's decision is affected by prior knowledge of the exposure status.
Biliary stones in somatostatinoma due to Reduced gallbladder contractility in response to decreased cholecystokinin
Homeobox genes code for DNA·binding transcription factors that play an important role in morphogenesis.
Improperly fitted crutchescan cause radial nerve injury = weakness of all forearm, wrist and finger extensors ("wristdrop"),
Beta blockers and RAASmediated through sympathetic stimulation of beta-1 receptors located on juxtaglomerular cells. Beta blockers like inhibit renin release by blocking the beta-1 receptor mediated pathway → ↓ angiotensin I. angiotensin II. and aldosterone levels. Beta blockers do not effect ACE activity. they do not effect bradykinin levels.
primary abnormality in Pagets disease increase in osteoclastic bone resorption.