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143 Cards in this Set

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Which bacteria are encapsulated?
What test acn be used to detect encapsulated bacteria?
Some Killers Have Nice Shiny Bodies:
Strep pneumo
Neisseria
Salmonella
H flu (B)
Klebsiella

Detect w/Quelling
Drug of choice for anaphylactic shock
Epi
Drug of choice for cardiogenic shock
Dobutamine
Drug of choice for septic shock
Norepi (alpha 1>>beta-1)
Hyperacute rejection:
Mechanism
Time Frame
Pre-formed anti-donor Ab's; minutes
A
Acute rejection:
Mechanism
Time Frame
Cell-mediated immunity; weeks
Chronic rejection:
Mechanism
Time Frame
Ab-mediated vascular damage; months to years
Which antibiotics are used for narrow-spectrum anaerobic coverage?
Metronidazole
Clindamycin
What portion of the brachial plexus is injured in Erb-Duchenne Palsy?

Symptoms?
C5-C6 nerve roots

Syx: arm is in adduction, medial rotation, pronation
Adrenergic receptor type and effect of ligand binding on:
Vascular smooth muscle
low dose-beta-2
high dose-alpha-1
Adrenergic receptor type and effect of ligand binding on:
Renal vasculature
D1--vasodilaiton
Adrenergic receptor type and effect of ligand binding on:
Heart
beta-1--inc'd HR and contractility
Adrenergic receptor type and effect of ligand binding on:
Pulmonary bronchioles
beta-2: bronchodilation
Adrenergic receptor type and effect of ligand binding on:
Presynaptic neurons
alpha-2--inhibit NE release
Adrenergic receptor type and effect of ligand binding on:
Pupillary sphincter
alpha1--mydriasis
Adrenergic receptor type and effect of ligand binding on:
Kidney JG cells
beta-1--renin release
Adrenergic receptor type and effect of ligand binding on:
beta-cells of pancreas
alpha-2--inhibit insuline release
Adrenergic receptor type and effect of ligand binding on:
alpha-cells of pancreas
alpha-2--inc'd glucagon release
Adrenergic receptor type and effect of ligand binding on:
Liver
beta-2--inc'd glycogenolysis and gluconeogenesis
Elastic skin
Joint hypermobility
Elhers-Danos Syndrome
Enlarged, hard, left supraclavicular LN
Virchow's node--visceral malignancy (stomach cancer)
Strawberry tongue
Scarlet fever
Kawasaki dz
TSS
Resting tremor
Rigidity
PD
Rash on palms and soles
Secondary Syphilis

Rocky Mtn Spotted Fever

Coxsackie A virus (hand-foot-mouth dz)
Cytokines released by Th1 vs Th2
Th1--IL-2, IFN-gamma
Th2--IL-4,-5,-10
3 different G proteins and downstream effects?

Which receptors used for each G protein?
Gq: QC
Activcates phospholipase C-->generates IP3-->inc'd intracell Ca2+
Also->generates DAG-->activates protein Kinase C

Receptors: HAVe 1 M&M; H1, alpha 1, V1 (vasopressin), M1, M3

Gs protein:
Stimulates adenylyl cyclase
Generates cAMP from ATP
cAMP activates Protein Kinase A

beta1, beta2, D1, H2, V2

Gi Protein:
Inhibits adenylyl cyclase
Dec'd cAMP
dec'd Protein kinase A

MAD2's:
M2, alpha-2, D2
Drug category:

-ane
inhaled anesthetics
Drug category:

-azine
phenothiazine neuroleptics--anti-emetics
Drug category:

-tidine
H2RA
Drug category:
-tropin
Pituitary hormone
Drug category:
-chol
Cholinergic agonist
Drug category:
-bendazole
Antiparasitic drugs
Drug category:
-azepam
Benzodiazepene
Drug category:
-conazole
Anti-fungal
Drug category:
-tryptyline
TCA
Drug category:
-zosin
alpha1-antagonist
Drug category:
-stigmine
AchE-inhibitor
Drug category:
-dipine
CCB
Identify mature defense mechanism:
voluntarily choosing not to think about a bad piece of news
Suppression
Identify mature defense mechanism:
Using comedy to express feelings of discomfort
Humor
Identify mature defense mechanism:
Arsonist donates money to fire department
Altruism
Identify mature defense mechanism:
Using aggression to succeed in business ventures
Sublimation
Identify mature defense mechanism:
realistically planning for future inner discomfort
Anticipation
Identify mature defense mechanism:
consciously postponing an inner conflict until a big project if completed
Suppression
Identify mature defense mechanism:
redirecting impulses to a socially favorable object
Sublimation
Identify immature defense mechanism:
not acknowledging a piece of bad news, as though it was never said
Denial
Identify immature defense mechanism:
involuntary withholding of a feeling from conscious awareness
Repression
Identify immature defense mechanism:
Veteran describes horrific war details without emotion
Isolation
Identify immature defense mechanism:
Child abuser was himself abused as a child
Identification (doing to others what was done to you)
Identify immature defense mechanism:
Man yells at his family when he has a bad day at work
Displacement
Identify immature defense mechanism:
Closet homosexual hates homosexuals because of the way they make him feel
Projection
Identify immature defense mechanism:
Using intellectual processes to avoid affective expression
Intellectualization
Identify immature defense mechanism:
Belief that all people are either all good or all bad
Splitting (borderline pts)
Identify immature defense mechanism:
Expression aggression through passivity, masochism, and turning against self
Passive aggressive
Identify immature defense mechanism:
Changing ones character or personal identity to avoid emotional distress
Projection
Identify immature defense mechanism:
Returning to earlier level of maturation to avoid conflict at current maturation level
Dissociation
Identify immature defense mechanism:
Offering explanation for unacceptable belief/attitude/behavior
Regression
Identify immature defense mechanism:
Believing external source is responsible for unacceptable inner impulse
Rationalization
Identify immature defense mechanism:
Thought that is avoided is replaced by unconscious emphasis on opposite
Reaction formation
Identify immature defense mechanism:
Converting mental conflicts into bodily symptoms
Somatization (conversion, etc.)
Identify immature defense mechanism:
Temporarily inhibiting thinking but continuing to build more tension
Blocking (schizophrenic pts)
Identify immature defense mechanism:
Avoiding interpersonal intimacy to resolve conflict and obtain gratification
Schizoid fantasy
Identify immature defense mechanism:
Extreme forms can result in multiple personalities
Dissociation
Identify immature defense mechanism:
Chronically giving into impulse to avoid tension from unexpressed unconscious wish; tantrums
Acting out
65 year-old asks husband to stay in hospital overnight with her because she's afraid to be alone.

Defense mechanism?
Regression--turning back maturational clock and going back to earlier modes of dealing with world (bedwetting, crying)
Which defense mechanism underlies all other defense mechanisms?
Repression--involuntary wittholding of an idea or feeling from conscious awareness (pressing bad thought into unconscious; forgetting a traumatic experience)
60 year-old man admitted for chest pain jumps out of bed and does 50 push-ups to show nurses he has not had a heart attack.

Defense mechanism?
Denial
Infant deprivation effects:
What is it?
Symptoms?
Long-term deprivation of affection:
-Dec'd muscle tone
-Poor language skills
-Poor socialization skills
-Lack of basic trust
-Anclitic depression
-Weight loss
-Physical illness

Severe deprivation-->infant death
Signs of physical abuse on child
Abuser epidemiology
Healed fractures on x-ray
Cigarette burns
Subdural hematomas
Multiple bruises
Retinal hemorrhage/detachment (shaken baby)

Usually female and primary caregiver
Signs of sexual abuse on child
Abuser epidemiology
Genital/anal trauma
STDs
UTIs

Abuser usually known to victim, usually male
Signs of regression in children
Children regress to ounger patterns of bhvr under conditions of stress (physical illness, punishment, birth of a new sibling, fatigue)

Signs of regression: bedwetting in previously toilet-trained child when hospitalized
Methylphenidate:
MOA
Use
Amphetamine; increases pre-synaptic NE vesicle release

Use in ADHD
Dextroamphetamine:
MOA
Use
Ampethamine; increases pre-synaptic NE vesicle release

Use in ADHD
Atomoxetine:
MOA
Use
NE reuptake inhibitor

ADHD
When are stimulants such as amphetamines indicated?
ADHD
Narcolepsy
Obstructive sleep apnea
Major depressive disorder
Conduct disorder:
What is it?
Repetitive and pervasive behavior violating rights of others

After 18 years of age diagnosed as antisocial (anti-society, really) personality disorder

Ex: animal abuse
Oppositional defiant disorder:
What is it?
Enduring pattern of hostile, defiant behavior toward authority, but don't disobey rights of others
Autism:
Characteristic features
"Living in his own world"
Syx evident prior to age 3
Lack of responsiveness to others, poor eye contact, absence of social smile

Impaired communication, language delay, repetitive phrases

Repetitive, ritualistic habits (spinning around, hand flapping)

Fascination with specific, mundane objects (vacuum cleaners, sprinklers)

Below normal intelligence (usually)
Asperger's Syndrome:
Characteristic features
Milder form of autism

Char'd by all-absorbing interests, repetitive behavior, problems w/social relationships

Children are of normal intelligence
No verbal, cognitive deficitsThis is x-linked dominant; males die in utero. Disease of women!

Syx apparents at ages 1-4, followed by regression, loss od dev't, MR, loss of verbal abilities
Mid-line hand wringing
Rett's Disorders:
Characteristic features
This is x-linked dominant; males die in utero. Disease of women!

Syx apparents at ages 1-4, followed by regression, loss od dev't, MR, loss of verbal abilities
Mid-line hand wringing
Childhood disintegrative disorder:
What is it?
Marked regression in multiple area of functioning after at least 2 years of apparently normal development

Ex: loss of expressive or receptive language skills, social skills, bowel/bladder control
When a young monkey is separated from its mother, it becomes withdrawn, socially isolated, and grooms poorly.

What is the human equivalent of this problem?
Anaclitic Depression
Identify childhood psychiatric disorder:

Impulsive and inattentive
ADHD
Identify childhood psychiatric disorder:

Females only, loss of previously acquired purposeful hand skills between 6-30 months
Rett Disorder
Identify childhood psychiatric disorder:

Impairments in social interactions, communications, play, repetitive behaviors
Autism
Identify childhood psychiatric disorder:

Impairment in social interaction (but not avoidance), no language delay
Asperger's
Identify childhood psychiatric disorder:

Stereotyped hand movements
Rett's disorder
Identify childhood psychiatric disorder:

Ignoring basic rights of others
Conduct disorder
Identify childhood psychiatric disorder:

Hostility, annoyance, vindictiveness, disobedience, resentfulness
Oppositional defiant disorder
Identify childhood psychiatric disorder:

Multiple motor and vocal tics
Tourette's syndrome
Identify defense mechanism:

7 year-old avoids going to school to say at home with parent
Separation anxiety disorder
Trichotillomania:
What is it?
Presentation
Compulsive nervous hair pulling, common in young girls

Presentation reveals unusual patterns of broken hairs of varying length (wine brush feel)

Tx: Education!
Anorexia vs Bulimia
Anorexia nervosa:
Excessive dieting ±purging; intense feat of gaining weight, body image distortion; <85% ideal body weight

Bulimia: binge eating ±purging: followed by self-induced vomiting, laxatives, diuretics, emetics
Body weight within normal range!
Electrolyte changes seen in bulimia (emetic variant)
Hypokalemia
Hypochloremia
Metabolic alkalosis
Enlarged parotid glands
Mother found laxatives in patient's closet
Bulimia
How does binge eating disorder differ from bulemia?
Binge eating disorder:
No purging
Expression of deeper psychological problems
Many have negative feelings toward food
How does compulsive eating disorder differ from bulimia?
NO purging
Type of OCD
Much time is spent thinking and fantasizing about food
What is gender identity disorder?
Persistent cross-gender identification
Transvestism vs Transsexualism
Transvestism: paraphilia; wearing clothes (VEST) of opposite sex (cross dressing)--done for purpose of sexual arousal (not trying to identify with gender)

Transsexualism: desire to live as opposite SEX, oftehn through surgery or homones
NT disorders with depression
Dec'd NE
Dec'd 5HT
Decd' DA
NT disorders with anxiety
Inc'd NE
Dec'd GABA
Dec'd 5HT
NT changes with Alzheimer's dementia
Dec'd ACh
NT changes with HD
Dec'd GABA
Dec'd Ach
NT changes with schizophrenia
Inc'd DA
NT changes with PD
Dec'd DA
Inc'd 5HT
Inc'd ACh
What is delirium?
2 most common causes
Waxing and waning level of consciousness with acute onset

Rapid dec in attention span and level of arousal, hallucinations, illusions, disturbances

2 most common causes:
UTIs
Drugs--anti-cholinergics (mad as a hatter). often reversible.
What is dementia?
Gradual dec in cognition with no change in level of consciousness; memory loss

Usually irreversible
What is pseudodementia?
Depression presenting like dementia in elderly patients.

Ex: if patient consistently loses keys, and complains to MD about possible dementia, the patient DOES NOT have dementia. pts with dementia would not be aware of losing keys over and over. more likely to be depression.
72 year-old patient not able to recall 3 objects on mini-mental.

When asked what he'd do if he smelled smoke in a movie theater, he replies he would yell "fire."

When asked what a table and chair have in common, he replied they both have 4 legs and are made of wood.

Family reports for last year, someone has had to stay with him at all times for his own safety.

He stays awake all day and sleeps well at night.
Dementia

Yelling fire is socially inappropriate--would expect to look around to identify source of smoke.

4 legs and made of wood = concrete thinking--would expect an abstract answer, like "furniture"
72 year-old patient brought to clinic by family because of strange behaviors over past week.

She has been agitated, takes many naps during the day, occasionally urinates on herself, and has poor appetite. She is unable to complete a mini-mental because of poor ability to focus her attention.
Delirium
Temporal lobe atrophy-->AD
Neurofibrillary tangles-->AD
Most common cause of dementia in the elderly
AD
Memantine:
MOA
Use
NMDA receptor antagnoist-->prevents excitotoxicity

AD
Donepezil:
MOA
Use
ACHe inhibitor

AD
Galantamine:
MOA
Use
ACHe inhibitor

AD
Rivastigmine:
MOA
Use
ACHe inhibitor

AD
Pick's Disease:
Characteristic features
Dementia, aphasia, parkinsonian aspects; personality changes
Tau protein
Pick's Disease
Lewy Body dementia:
Characteristic features
Parkinsonian with dementia and hallucinations
When are Lewy bodies seen?
AD
Lewy Body dementia
PD
Cretutzfeldt-Jakob disease:
Characteristic features
Rapidly progressive (weeks to months) dementia with myoclonus.

DUE TO PRIONS
Perception in absence of external stimuli
Hallucination

Ex: seeing light that is not actually present
Misinterpretation of actual external stimuli
Illusion

Ex: seeing light and thinking it's the sun
False beliefs not shared with other members of culture that are firmly maintained despite obvious proof to the contrary
Delusion

Ex: thinking CIA is spying on you
Disorder in form of thought
Loose associations (way ideas are tied together)
Schizophrenia:
Characteristic features
Delusions (auditory), illusions
Disorganized speech
Flat affect (social withdrawal)
Alogia--lack of speech, poverty of speech
Poor grooming

At least 6 months of symptoms!

Inc'd risk of suicide!
Whit is a brief psychotic disorder?
Syx of schizo (delusions, hallucinaitons, disorganized speech, flat affect) for <1 month; usually stress related
What is schizophreniform disorder?
Syx of schizo (delusions, hallucinaitons, disorganized speech, flat affect) for 1-6 monhts
What is schizoeffective disorder?
At least 2 weeks of stable mood w/psychotic syx plus major depressive, manic, or mixed (both) episode--bipolar or depressive
Treatment of schizophrenia
Antipsychotics--azines, heloperidol
Antipsychotics:
High potency vs Low potency
-Why is this important?
-Drugs for each category
High potency neuroleptics have more extrapyramidal side effects and less anticholinergic side effects (delusional, dry as a bone, etc.)
High potency: haloperidol, fluphenazine, thiothixene

Low potency: more likely to have anticholinergic side effects, less likely to have extrapyramidal side effects

Low potency: thioridazine, chlorpromazine
Neuroletpics:
Suffix
MOA
AEs
-azines
Block D2 receptors to inc cAMP

AEs:
Extrapyramidal system side effects--muscle spasm, neck twisting, dystonia, tardive dyskinesia

Dec'd DA-->dec'd PL inhibition-->galactorrhea

Block muscarinic (dry mouth, constipation), block alpha (hypotn), block histamine (sedation) receptors
What is neuroleptic malignant syndrome?
excess muscle contraction-->rigidity, break down muscle tissue-->myoglobinemia-->myoglobinuria (can cause renal failure)
Positive vs Negative Symptoms of schizophrenia:
General
Treatment
Positive: excess/distortion of normal symptoms (delusions, hallucinations, thought disorders)

Tx w/antipsychotics (neuroleptics): haloperidol, -azines

Negative: diminishment/absence of normal function (flat affect, poor grooming)

Treat with atypical antipsychotics: olanzapine (can also be used for OCD< ANX, depression), clozapine, risperidone
How do atypical antipsychotics differ from the typical antipsychotics?
Atypicals have fewer extrapyramidal and anticholinergic side effects; however, have greater weight gain (block histamine)

Clozapine must be watched clozely (agranulocytosis)

Atypicals can be used to tx both positive and negative syx of schizophrenia
Define schizotypal disorder.
interpersonal awkwardness--odd thoughts/appearance

strange people
Define schizoaffective disorder.
schizophrenia syx + plus a mood disorder
Define schizoid disorder.
Voluntary social withdrawal, go live in woods

No pyshchosis
Define schizophreniform disorder.
Schizo syx for less than 6 mos, more than a month
What are the clinical features of neuroleptic malignant syndrome?

How is it treated?
muscle rigidity
autonomic instability
myoglobinuria
hyperpyrexia
mental status change (early)

Tx w/DA agonist like bromocriptine
Patient with mild dementia is hospitalized for MI.

Nurse asks if she can give sleep medicine or diphenhydramine.

What do you give?
Do not give diphenyhydramine bc has anti-cholinergic side effects! Will make pt delirious.

Can give anti-depressant (trazodone) or can give haloperidol (fewer anti-chol syx)
Multiple personality disorder is currently known as _______.
Dissociative identity disorder