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others: t pedis (feet), cruris (groin/jock itch), capitas (scalp), manuum (hand), faciale (face), barbae (beard) - monomorphic fungal infection cased by Microsporum, Trichophyton, Epidermophyton fungi. Dx - KOH stain Tx - "-zazoles"MOA - inhib ergosterol syn Use - systemic mycoses (blastomyces, coccidiodes, histoplasma), superficial fungal infections (ringworm), Candida albicans (oral thrush)SE - gynecomastia, DEC libido, hair loss (M), amenorrhea (F)Immunocompetent w/ oral thrush - Tx: nystatin mouthwashhypocalcemia, INC phosphorous, lower limit of normal PTH, Chvostek's sign (facial nn tapping cause facial mm contraction), Trousseau's sign (BP cuff on arm causes carpopedal spasms), perioral parathesias, seizures, depression, anxiety INC concen req for Rx to prod half its maximal effect (EC50).Thus, addition of competitive antag DEC POTENCY of drug (shifts response curve to right)ex. Tx - opiate intoxication (pupil constriction, resp depression, coma)progesterone antag - Mifepristone (RU 486) - abortifacient Progesterone - responsible for stim endometrial glandular secretions, spiral aa development, DEC myometrial excitability, uterine smooth mm relaxation, prod thick cervical mucusosmotic fragility test.high risk lymphoma & leukemia MC skin malignancy, little mets risk, palisading histo, no precursor lesion, skin CA on upper lip and hairline, men, INC w/ age, sun exposure, translucent/pearly papule w/ telangiectasia, rolled-up edges "rodent ulcer"gouty arthritis Cause - deposit of urate crystals in joint fr excess uric acid in blood (tumor lysis syndrome fr radiation tx)Uric acid - final breakdown product of dietary & endogenous purines.Purines broken down by hypoxanthine/xanthine Prophylaxis - allopurinol or rasburicase1) underexcretion of uric acid fr kidney: chronic kidney dz, diuretics (INC urate reabsorp), aspirin & niacin (complete w/ uric acid for excretion)2) INC dietery intake of purines - meat/Et OH (occurs at night couple hrs after meal)3) deficiency HGPRT - Lesch-Nyhan syndrome: x linked reces, necessary for recycling of purines, presents at infancy, mental retard, aggression, choreoathetosis (dance-like, twisting), self-mutilation, seizures, urate nephropathyfibroadenoma - MC breast tumor in women 15-35 yo; benign, firm, round, smooth, rubbery, MOBILE, most freq in upper outer quadrant breast Dx - US: disting cystic or solid, confimred w/ fine needle or core needle bxmultiple myeloma - malig plasma cells Dx - monoclonal light chain casts in urinelytic bone dz = bone pain, hypercalcemia MC renal dz in MM = myeloma cast nephropathy, excessive delivery of light chains (tamm-horsfall protein = uromodulin) that overwhelms ability of renal tubules for reabsorp Tubular casts block distal nephron & asc loop of Henle --boys 10-14, affects long bones of LE, scapula, ribs, pelvis, localized persistant pain & swelling, noticed after minor trauma Xray - destructive lesion w/ poorly defined margins "moth-eaten" and "onion peel" look (layers of reactive bone prod by periosteal rxn)osteoma Osteomata - skull, mandible, sinuses, auditory canal, long bones Xray - radiolucent nidus surrounded by cortical thickening Histo - nidus of osteoid & woven bone interconnected w/ trabeculae & surrounded by fibrous CT & sclerotic bone rxnplantar fasciitis - inflamm where plantar fascia inserts onto calcaneal tuberosity Tenderness at calcaneal tubercle and passive dorsiflex Xray - bony heel spur Tx - ice, rest, stretch, NSAIDs, orthoses, night splints Morton neuroma - fibrosis/degen of common digital nn that travels bet web spaces of toes (esp 3rd & 4th metatarsals) fr repetitive toe flex/extension RUNNERSTx - NSAIDs, heat/ice, low-heeled cushioned shoes w/ wide box cardiac arrhythmias (bradycardia, sinus arrest, v tach, v fib, asystole)Note: KCl used in death penalty to stop heart Tx - calcium gluconate - temp cardioprotective vs arrhythmias Albuterol (B agonist), insulin - drive K intracellularly (acute tx)**Hydration, Na polystyrene - definitive tx Dialysis if above failsmonoclonal Ab that binds to HER-2-R - overexpressed on aggressive breast CA cellsproto-oncogene on chrom 17 that encodes HER-2 (tyrosine kinase) amplifies ability of CA cells to respond to CA promoting signaling; trastuzumab blocks this process SERM - also Raloxifene MOA - stim estrogen in uterus (lead to endometrial hyperplasia), but blocks estrogen in breast Use - estrogen-R breast CA, osteoporosis Raloxifene - does not have endometrial agonist effect hyperestrogenism:young - precocious pubertyadults - irreg menses or postmenopausal bleeding d/t endometrial hyperplasia Hallmark - Call-Exner body** (follicles filled w/ eosinophilic fluid) or "coffee been" nuclei or rosette of cellsserous cystadenocarcinoma - type of malig OVCA of surface epithelial origin, includes:mucinous, endometrioid, transitional cell, clear cell, Brenner tumors Risk factors - nulliparity, early menarche/late menopause, fam Hx Suspect BRCA1/2 mut if 1 family member had breast/OVCAPsammoma bodies also seen in papillary thyroid CAyolk sac tumor (type of malig ovarian germ cell tumor), aka endodermal sinus tumoracute abd signs if there's degen/rupture F - ovary, M - testes Malig germ cell tumor: dysgerminoma (INC LDH)yolk sac tumor (INC AFP)immature teratoma Reflects extent Rx dristrib in extravasc tissue as opposed to plasma If Rx distrib in tissue = HIGHER Vd*Note Vd can exceed known vol of all body compartments combined if distrib primarily in tissue (ie chloroquine - malaria) --somatostatin analog - "off switch" for GIUse - bleeding esophageal varices *DOC, gastrinoma or glucagonoma, acromegaly MOA - inhib serotonin rel (Tx met carcinoid tumor) & almost all GI hormones (gastrinn, VIP, serotonin, insulin, glucagon, motilin), inhib GHSE - N, abd pain, constipation OR diarrhea, abnorm glucose tolerance, flatulence Spironolactone - K sparing diuretic, prevent excretion K (can lead to hyper K )SE - gynecomastia, testicular atrophy, amenorrhea Note - CHF d/t DEC CO & DEC renal perfusion which acitv RAAS sys & INC absorb Na, Cl, H2O in kidney --1. support to neurons: nutrients (lactate), homeostasis (K metab), removal NT (glutamate), physical support3.mannitol - DEC ICP (INC ICP causes NV, HA, fixed dilated pupils, papilledema)MOA - osmotic diuretic - draws water into renal tubule by osmosis, outside kidney it draws water fr tissue into blood Severe INC ICP causes Cushing's triad (HTN, bradycardia, irreg breathing)**SE: hyponatremia, pulm edema MOA - inhib topoisomerase II (prevent DNA repair), ability to intercalate (insert itself) bet DNA base pairs (blocking DNA syn), & ability to generate free radicals (cause cellular damage)MOST IMP SE: CARDIOTOXICITY -- dilated cardiomyopathy, CHF (elev JVP, DEC ejection fraction, pulm edema), severe alopecia deposits as Ca oxalate in various tissues1-3 hrs - confusion, ataxia, hallucination, sllurred speech, coma Next - cardiopulm sx, met acidosis - NV, hyperventilation, HTN, tachycardia, pulm edema, resp distress24-72 h - urinary ca oxalate crystals w/ oliguric/anuric renal failure Tx - Na bicarb, ethanol, hemodialysis, fomepizole Note: anion gap = serum Na - (HCO3 Cl), if SABA, others - terbutaline, metaproterenol, pirbuterol, levalbuterol, fenoterol MOA - stim B-2 adrenoceptors in airway, DEC intracell Ca, hyperpol smooth mm d/t INC K influx (can lead to hypokalemia), DEC myosin activity ==inhib hepatic syn of vit K dep clotting factors (II, VII, IX, X) - block extrinsic pathway, also protein C, S, ZTx - prophylaxis/Tx of thrombosis & thromboembolism (esp afib, cardiac valve rep, DVT, PE, prev MI)Monitor PT and INR (2-3); high INR --MOA - inhib syn of thromboaxane A2; prevent platelet aggreg Use - primary prophylaxis for Acute MI; also analgesic, antipyretic, anti-inflamm SE: gastric ulcer, bleeding, anemia, Reye's syndrome (kids get acute encelphalopathy & fatty liver), tinnitis fever, hypo TN, inflamm, coag Alt C' pathway & coag pathway (DIC) activateedheat stable, rel IL-1, 6, 8 (fever), TNF-alpha (hemorrhagic tissue necrosis), nitrous oxide (hypo TN/shock), platelet activ factor (hypo TN)hyperviscosity, thrombocytosis HA, vertigo, pruritis after shower, thrombosis signs, splenomegaly, pleothora of face, INC RBC mass, INC EPO in response to INC RBC, INC H/H, WBC, platelets, leukocyte alkaline phosphatase, bilirubin, B12polycythemia vera - malig prolif of RBCs in bone marrow erythromelalgia - red, burning ext relieved by aspirin & cold temp; worse w/ warmth Complications - CVA, MI, DVT, PETx - hydroxyurea, chronic phlebotomy Primary/PV: low EPO, high RBC, normal Sa O2Hypoxia/Secondary: high EPO, HIGH RBC, low Sa O2 (or normal if d/t tumor)Relative: low plasma vol intoxicated pts "sat night palsy," using crutchesweakness of wrist/finger extensors, can't supinate forearm, loss of thumb abduction (abd pollicus longus), sensory dorsolat hand, dorsal 1st, 2nd, 3rd digitacute tubular necrosis - caused ischemia (hypo TN, shock), meds (NSAIDs antimicrobial), radiocontrast, rhabdomyolysis, transfusion rxnshard to disting fr prerenal dz (dehydration - normal microscopy, FENa erythroblastosis fetalis - hemolytic dz of newborn d/t Rh isoimmunization (Rh (-) mom exposed to fetal RBC that are Rh and dev Abs to fetal Rh ("D") Ag.Rh - mom becomes "sensitized"Tx - anti-Rh (D) Ig prevent Rh dz; confers passive immunity, binding fetal cells in maternal circ & prevent sensitization HMG-Co A reductase inhibitor (-statin)MOA - DEC LDLTx - atherosclerosis - INC stability lesions, DEC vasc inflamm & oxidative stress SE - diarrhea, nasopharyngitis, arthralgia, elev LFT, myositis, rhabdomyolysis no stim at neuromusc end plate that allows entry of Na into skeletal mm to cause contraction Dx - Tensilon test (edrophonium - short acting Tx - Ach E inhibitor (neostigmine, pyridostigmine, edrophonium)MOA - block methylation of d UMP (deoxyuridine monophosphate)Thymidylate synthetase - catalyze methylation rxn that yields d TMP fr d UMP5-FU - cytotoxic Use - solid organ CA (colorectal, gastric, pancreatic, breast), skin (basal cell CA)1.
reservoir: monkeys Tx - self-limiting; live attenuated vaccine avail to travelers of S america & Africa 50, RESTING tremor ("pill-rolling" goes away when performs task, worsens w/ emotional stress), "masked face," bradykinesia, cogwheel rigidity (ratchet-like jerking when testing tone in UE while pt clenches opposite fist), micrographia (small handwriting)Graves dzfemales, mid age, HLA DR3 and B8, precip by stress, infection, excess iodine, childbirth.opthalmopathy & exopthalmos (protruding eyes, eye mm weakness), pre-tibal myxedema (non-pitting edema), swelling/clubbing digits, diffuse goiter, thyroid scan - INC diffuse radioiode uptake Tx - BB (DEC adrenergic effects & peripheral conversion), anti-thyroid (methimazole or PTU) - inhib thyroid hormone syn; if unresponsive to rxs --Tinea corporis...This article was co-authored by our trained team of editors and researchers who validated it for accuracy and comprehensiveness.