Paresthesias
abnormal sensation (e.g., tingling, prickling, "pins and needles")
false positives and false negatives
placenta accreta
A
... [Show More] rare disorder in which the placenta is directly adherent to the myometrium (without penetrating) instead of the decidua basalis. Results in delayed separation and/or placental retention as well as postpartum hemorrhage. The most important risk factors for placenta accreta are a previous C-section and placenta previa.
-risk factors include: prior uterine instrumentation (including ceserean delivery), increased maternal age, placenta previa, and pultiparity.
given the high risk of morbidity and mortality, elective surgical delivery at 34 to 36 weeks is recommended.
leiomyomata uteri
(uterine fibroids)
benign tumors of the uterus, which can present with abnormal uterine bleeding and pelvic pain.
however, they are more common in older women and are associated w an irregular shaped uterus on physical exam.
Monobactams
inhibit transpeptidation by inhibiting penicillin-binding protein 3
antimycin A
inhibits complex III of the electron transport chain
cyanide, monoxide, azides -- electron transport chain inhibitors
inhibit complex IV
normal alveolar-arterial gradient (a/A gradient)
5-10 mmHg
Baclofen
a GABAb receptor agonist, which hyperpolarized muscle cells and relieves muscle spasticity
Bacteroides fragilis
an anaerobic, gram-negative bacillus and a normal component of the gastrointestinal microbiota.
it only results in infections when displaced from the colon, such as following surgery, rupture, or trauma, where is has the potential to cause bacteremia, intra-abdominal infections, peritonitis, and subcutaneous abscesses.
Bacterial vaginosis
is caused by the vaginal overgrowth of Gardnerella vaginialis, a gram-variable, facultative anaerobe.
It presents with gray, thin, malodorous vaginal discharge, a vaginal pH greater than 4.5, a fishy odor upon KOH testing, and clue cells on microscopy
Glucagonoma
a rare functional malignancy that secretes glucagon, which raises blood glucose.
Glucagon acts on hepatocytes via a cAMP pathway activating protein kinase A that ends in the activation of glycogen phosphorylase, with release of glucose monomers in the serum.
When glycogen stores are exhausted, the body relies on the breakdown of fat through beta oxidation of fatty acids to provide energy.
-- occurs in mitochondria of the cell
Carnitine acetyltransferase
a transmembrane protein found on the surface of mitochondria in liver, muscle, and brain, and catalyzes the bond between acyl-CoA and carnitine, which permits the long-chain fatty acid to translocate into the mitochondria matrix where beta-oxidation (breakdown of fatty acid) can occur.
Renal tubular acidosis
A normal anion gap (hyperchloremic) metabolic acidosis in the presence of normal or almost normal renal function. The various types of RTA include proximal tubular bicarbonate wasting (type II), distal tubular acid secretion (type I), very rarely carbonic anhydrase deficiency (type III), and aldosterone deficiency/resistance (type IV). Renal tubular acidosis arises as a result of defects in the tubular transport of HCO3- and/or H+. Most forms of RTA are asymptomatic although, rarely, life-threatening electrolyte imbalances can occur.
Salicylate poisoning
initially results in a respiratory alkalosis from the stimulation of respiratory centers causing hyperventilation.
Subsequently, it results in the development of a delayed anion gap metabolic acidosis secondary to its decoupling effects on the electron transport chain, resulting in increased anaerobic metabolism and the production of lactate and ketoacids.
ansa cervicalis
a loop of nerves in the anterior neck that originate from the spinal nerve roots C1-C3.
the inferior root is formed by the fibers of C2 and C3 and provides branches to the inferior portion of the omohyoid, stenothyroid, and sternohyoid muscles.
the phrenic nerve
arises from the cervical roots C3-C5 and provides motor innervation to the diaphragm.
it also provides sensory innervation to the mediastinal pleura and the pericardium
phrenic nerve injury can occur during cardiothoracic surgery or thoracic or cervical trauma and can lead to diaphragmatic paralysis.
developing 20-month old child can typically walk up stairs (and may be able to run), stack several blocks, and use 100 or more vocabulary words, and play pretend.
aggressive, impulsive behavior is not uncommon, and cooperative play does not typically develop until the age of 4 years.
Osteoarthritis
the most common disease of joints in humans.
It affects 60% to 80% of adults over the age of 65.
it is characterized by global degeneration of a joint with fraying, fibrillation, and degradation of cartilage, thickening of the subchondral plate w sclerotic bone, and SUBCHONDRAL CYSTS due to inflammation of synovial fluid into the bone.
Arthrocentesis typically demonstrates few leukocytes, normal appearance, and normal glucose.
jejunum
possesses several characteristic features, including prominent plicae circularis, which lends the jejunum an increased mucosal surface area and feathered appearance w oral contrast material
-also demonstrates a large caliber, thicker muscular walls, longer vasa rectae, and fever arcades
congenital adrenal hyperplasia
results from a defect in adrenal steroid biosynthesis.
its most common form, 21-hydroxylase deficiency, presents with salt-wasting in infants or precocious puberty in children.
it also causes the virilization of XX fetuses, elevated levels of 17-hydroxyprogesterone, hypotension, and hyperkalemia.
tx: exogenous administration of mineralcorticoids and glucocorticoids
Sex determining region of Y
A region of the Y chromosome gene that encodes for the SRY protein (also known as testis-determining factor, or TDF), which is a transcription factor that suppresses ovarian development and regulates male sex determination at around 6 weeks of gestation.
the intracranial compartment is a fixed, rigid space, and any lesion that occupy space in it may displace normal brain parenchyma, causing midline shift and mass effect.
THERAPEUTIC HYPERVENTILATION and resulting hypocapnia cause cerebral vasoconstriction, which results in decreased cerebral blood flow and intracranial pressure.
Interleukin-12 (IL-12) and interferon-gamma
activate the two primary cells responsible for granuloma formation in patients with mycobacterium tuberculosis infection.
Tension pneumothorax
occurs when air is able to enter the pleural space but is prevented from exiting.
leading to an increasing amount of air trapped in the pleural space w subsequent collapse of the lung parenchyma and mass effect on the mediastinum.
it is characterized by respiratory distress, tracheal deviation, hypotension, decreased breath sounds, and hyperresonant percussion on physical exam
Muscle necrosis leads to rhabdomyolysis, myoglobinuria, and acute renal failure.
Evaluation for Rhabdo reveals red or brown urine and urinalysis is positive for blood due to the presence of myoglobinuria without microscopic evidence of red blood cells.
pressure tracing -- mitral regurg
could be due to rupture of the chordae tendineae
medially, the precentral gyrus contains neurons that control the lower extremity.
laterally, the precentral gyrus controls the contralateral face. ??? look up
after a cerebral infarction,
neurons undergo liquefactive necrosis and are replaced by a glial scar consisting of proliferated astrocytes.
the glial scar forms approximately 2 weeks after the initial ischemic event
Bartonella bacilliformis
a gram-negative coccobacillus found in Peru, Ecuador, Colombia, and some parts of southern Florida that cause bartonellosis (Carrion disease) or Oroya fever in the acute phase of infection and verruga perunana in the chronic phase.
It is transmitted by sandflies
Babesiosis tx
Atovaquone plus Acithromycin
recall Atovaquone =
Atovaquone-proguanil --> An antimalarial drug used for the treatment of chloroquine-resistant P. falciparum infection and for malaria prophylaxis. Can cause gastrointestinal discomfort.
the hemidesmosome
an intricate complex of proteins whose ultimate function is to anchor the basal keratinocytes of the epidermis to the dermis at the derma-epidermal junction
epidermolysis bullosa
A rare, heterogeneous group of congenital and/or genetic blistering skin disorders that occur during infancy and childhood. The severity of the lesions, extent of mucosal involvement, and site of cleavage (intraepidermal/subepidermal) differ depending on the specific subtype. A common feature in all forms of epidermolysis bullosa is the induction of blisters by minor trauma and exacerbation in warm weather.
Behcet disease
An immune-mediated vasculitis that can involve blood vessels of all sizes (i.e., small, medium, and large) and may affect both the arterial and venous vessels. It commonly presents as oral and genital ulceration and uveitis.
Hypogammaglobulinemia
A decrease in the serum concentration of immunoglobulins. Etiologies include nephrotic syndrome, drug-induced reactions, acquired humoral immunodeficiencies, and congenital immunodeficiencies.
Craniosynostosis
results from the premature fusion of cranial bone sutures, leading to asymmetric growth in the area of remaining, unfused sutures, skull shape deformity results, which is both cosmetic and physiologically problematic due to constriction of the CNS
bregma suture
Lambdoid Suture
CRP (C-reactive protein)
an acute phase reactant protein that is synthesized in the liver.
CRP functions as an opsonin & aids in the targeting of cells for phagocytosis and in the fixation of complement.
Serum CRP serves as a non-specific inflammatory marker and can be useful in the diagnosis and monitoring of a variety of inflammatory diseases.
Zollinger-Ellison Syndrome
stems from a gastric-secreting tumor located typically within the pancreas or duodenum that results in excessive production of acid by the gastric parietal cells.
patients develop recurrent, chronic duodenal or jejunal ulcers, which can present with abdominal pain, diarrhea secondary to malabsorption, and possible hematemesis, melena, or hemotochezia.
Immunohistochemical labeling of neoplastic cells will reveal positive staining for gastrin
VIPoma
vasoactive intestinal polypeptide
rare tumors often associated with MEN1 (3 Ps) that presents with profound watery diarrhea, electrolyte disturbances (eg: hypokalemia, hypercalemia), acholorhydria, alkalosis, flushing, and vasodilation
Treatment:
Tumor resection
Octreotide (inhibits VIP secretion)
Pelvic parasympathetic nerves in the pelvic nerve plexus......
function to excite and contract the bladder via muscarinic acetylcholine receptors where sympathic nerves mediate relaxation of the internal urethral sphincter via alpha1-adrenergic receptors, leading to normal urination.
damage to the pelvic nerve plexus can affect both bladder contraction and internal urethral sphincter relaxation, leading to overflow incontinence
the external urinary sphincter is innervated by.........
the pudendal nerve.
the pudendal nerve supplies sensory neurons to the external genitalia along w somatic skeletal motor fibers to pelvic muscles [Show Less]