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103 Cards in this Set
- Front
- Back
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L1, L2, L3, L4, L5 inncervations
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L1- upper anterior thigh, iliopsoas
L2- iiliospoas, quadries, adductiors, middle thigh L3- iliospoas, quads, adductiros, lower anterior thigh L4- anteriortibialis, quads, patellar relex, emdial malleolus L5- extensor hallucis longus, dorsum of the foot S1- peroneus long and brevis, gastrocnemius, Achilles, lateral malleolsus |
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McMurray test
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test extension with valgus strain and external rotation for MCL, varus strain and internal rotation for LCL
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femoral head angulation and Q angle
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femoral head angulation over 135 coxa valgum under 120 coxa varum
Q angle line between ASIS and patella and tibial tubercle through patella, > 12 is valgum, < 10 is varum |
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pronation of the foot means
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dosiflexion, eversion and abduction of the foot
fibular head moves anterior |
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supination of the foot
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cause fibular head to move posterior, plantarflexion, inversion and adduction
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Compartment syndrome of leg
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lateral- hyperpronation, pain in lateral malellous
superficial posterior- shin splints Deep posterior- pain medial and anterior to mid tibia, strain of posterior tibial tendon, flexor digitorum longus Anterior most common- hard tender anterior tibilais, lateral shin splints |
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Triad of knee injury
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ACL, MCL, medial meniscus, struck on lateral knee with valgus stress
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Patelarfemoral syndrome
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storng vasutus lateralis and weak vasuts medialus, wide Q angle, lateral deciation of patella causes wear on posterior surface, pain climbing stairs
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Facts to know for ankle motion
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more stable in dorsiflexion, chronic irriration of plantaqr aponeursis leads to caclium deposit called heel spur, sparins are common to the anlkle Type III is all 3, type II is just ATF and calcaneofibular
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Spring ligament
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maintians medial longitudanal arch
plantar apeornerosis- strong connective tissue connection from calcaneus to phalanges |
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displacement
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angry about someone else, take it out on a different person
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Sleep stages 3,4 problems
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nigh terrors, sleep walking, sleep talking
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Sleep stage wave patterns
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stage 1- theta waves, stage 2 sleep spindles, stage 3,4, delta waves, REM beta and alpha waves like awake state
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Risk factors for suicide
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married < single < divorced
more common in elderly specific plan, no social support, recovery phase of depression, physicians, dentists |
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Alteration in NTs in:
Schizophenia, depression, Alzheimer;s, anxiety |
schizophrenia- elevated dopamine
depression- decreased serotonin, dopamine and NE Alzheimer's- decreased ACh anxiety- decreasd GABA, benzos act on GABA receptors |
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Dementia vs. delirium
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delirium- impaired consciousness, develps quickly, reversible
dementia- uimpaired consciousness, irreversible, slow progression |
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PSTD
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traumatic event, may occur any time after event, persists for > 1 month
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Somatization vs. conversion disorder vs. hypochondriasis
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somatization- sickly for most of life, diagnosis requires 12 symptoms in multiple organ systems
conversion- pseudo-neurological, symptoms begin and end suddenly |
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major depression
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dperessed mood, feeling of worhtlessness, weigh loss, early morning insomnia, not d/t recent loss of < 2 months
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Epilepsy EEG findings
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grand mal- tonic clonic- high voltage spikes
petit mal- 3/sec spikes and domes psychomotor- spikes in temporal lobes Jacksonian- pspreading muscle group from antral sulcus on EEG |
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Withdrawal symptoms for opiods
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NV, sweating, fever, muscle ache, awful but never fatal
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Relative risk vs. atibutale risk
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RR- incidenc ewith factor/incidence without risk factor
AR- incidene w/ - incidence without risk factor |
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Sensitivity
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A/(A+C)
AB on top /CD on bottom used for screening |
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specificity
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used to confirm diagnosis
D/(B+D) |
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PPV
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probability that a patient with a positive test is sick
A/(A+B) true positives divided by total positives goes up with higher prevalence of condition |
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NPV
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D/C+D
true negatives divided by total negatives, higher in pops with lower prevalence |
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P-value
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the probability of a type I error, proving there is a correlation when there is not, type II is not proving correlaiton when there is, lower p is better
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prospective cohort
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resaearcher observes natural events over time without intervention
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case control and cross sectional stufies
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case control- identify risk factors, retrospective
cross sectional- determine correlations between variables, presence of varibales recorded, data obtained from point of interest in time |
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Confidentiaility may be breached if...
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risk to others exists, HIV positve prostitute patient threatens to kill, child abuse
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Withdrawal symptoms for opiods
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NV, sweating, fever, muscle ache, awful but never fatal
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Relative risk vs. atibutale risk
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RR- incidenc ewith factor/incidence without risk factor
AR- incidene w/ - incidence without risk factor |
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Sensitivity
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A/(A+C)
AB on top /CD on bottom used for screening |
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specificity
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used to confirm diagnosis
D/(B+D) |
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PPV
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probability that a patient with a positive test is sick
A/(A+B) true positives divided by total positives goes up with higher prevalence of condition |
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NPV
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D/C+D
true negatives divided by total negatives, higher in pops with lower prevalence |
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P-value
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the probability of a type I error, proving there is a correlation when there is not, type II is not proving correlaiton when there is, lower p is better
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prospective cohort
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resaearcher observes natural events over time without intervention
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case control and cross sectional stufies
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case control- identify risk factors, retrospective
cross sectional- determine correlations between variables, presence of varibales recorded, data obtained from point of interest in time |
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Confidentiaility may be breached if...
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risk to others exists, HIV positve prostitute patient threatens to kill, child abuse
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clonidine
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alpha2 agonist decreases sympathetci outflow from CNS
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beta blockers can be used for...
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CHF, HTN, angina, laucoma (block ciliary bodh secretion), migraines
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Cholinesterase inhibitors
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physstigmine and neostigmine used for myasthenia gravis and increase GI and blader mobility
neotigmine can cause spastic paralysis edrophnium short duration can be used for diagnosis of myasthenia gravis |
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Direct cholinergic agonists
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cause parasympathetic activation t the reecetpro, casue diaphoresis, flushing, increased urinary urgency, ND
bethanecol- used for atonic bladder, especialy when the patient is postpartum pilocarpin eand carachol used for glaucoma, causes miosis to allow better aqueos humor drainagle through canals of schelm |
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Antimuscarinic drugs
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atropine and scopolamine, prevent ACH from binding receptors, but do not block nicotinic receptors
scopolamine has longer duration and more CNS effects |
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Pancuronium vs. succinylcholine
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antinicotnic agents, succincocholine (fasciculations occur early) is a depolarizing blocker and pancuronium is a nnondepolarizing
succs can cause malignant hyperthermia treateed by dantroline |
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Muscarnic receptor types
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M1,3 and 5 stimulate PLC to produce IP3 and DAG, increase calcium, found in ANS, glands and bronchial smooth muscle
M2 and M4 inhibit adenylate cyclase decrease cAMP causing K efflux and sodium influx, occurs in heart and CNS |
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Adrenergic receptors
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Beta- stimulate adenylate cyclase, yielding high cAMP
Alpha 1- stimulate PLC, high DAG, IP3, results in actiavte protein kinase C Alpha 2- inhibits adenylate cyclase, yielding low cAMP |
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sex hormones in birth control
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estrogens- side effects include nausea and vomiting, increases s risk of endometrial hperplasia
progesterones, they work together to supress follicular development and ovulation, progestin makes cervical mucus inhospitable to sperm |
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Erythema infectiosum
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parvovirus B19, slapped cheeck bilaterally in child, can cause aplastic anema with sick cell and leukemia
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Leukencephalopathy
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caused by JC virus, demleination b infecting and killing oligodendrocytes, frequently infects humans but only causes probs in immunocompromised
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Pathogenesis of HPV
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expresses E6 and E7 which inactiavte proteins encded by tumor suppressors like p53 and RB, subtypes 16 and 18 do this more than others
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small pox rash
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all lesions at same stage of evolution at same time
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+HBsAg 6 months after infection?
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chronic Hep B
presents initially as asympyomatic or RUQ pain, fever, jaundice and malaise interferon alpha is DOC |
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Shingles
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reactiation of latent VAV follows dermatomal pattern, severe infections treated with acyclovir, gabpentin can treat neuropathic pain
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EBV
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produces heterophile antibodies and atypical lymphocytes, latent in B ells, causes mono, acyclovir if severe, IgM or IgG VCA antibody detects infection
associated with Burkitt;s lymphoma |
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CMV
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transmitted nbvia body fluids, no heterohphile Absm ganciclovir is the DOC, can cause mono, retintis, interstitial pneumonitis, hepatiits and inclusion disease enchephalitis
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Roseola
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HHV 6, 6th disease, abrupt high fever for a few days then rash after fever ends
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RNA viruses
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flu viruses, MMR, rabies, Hep C, HIV, HTLV, arboviruses, rhinovirus, norwalk virus
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Polio infection
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most of the type asymptomatic may progress to mild fever, ehardache etc, or too fever ehadche and stiff neck
may also cause flaccid paralysis d/t replication of anterior horn cells in spinal cord |
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Coxsackie B causes..
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dilated cardiomyopathy, can also cause fever and pleuritic chest pain
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N antigen in flu
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neuraminidase, cleaves the cells neuraminic acid and allows release of new virus from the cell, percieived natigen by immune system
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Rubeola
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measeles, rash from face works inferiorly, see koplik spots on mouth and high fever, treatmnet is vitamin A and ribbririn in adults,
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mumps cause
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parotistis, orchitis and aseptic meningitis, benign and self limited
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Rubella
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2-3 week intubation followed by maculopapular rash that spreads downworad, mild and shorter than meases, associated with TORCH problems, causing congenital defects
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equine encephalitis viruses
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encephalitis, high feer, potentialy fatal, both east and west mosquito viruses
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St. louis encephalitis
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mosuiot from bird rservori, encephalitis, can be fatal
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Dengue and yellow ffever
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Dengue- igh fever, rash, bone/joint pain, symptm free for several days, high fever with new rash, fever headahce then symtpom free for several days, then fever + jaundice
Dengue can cause hemorrhagic fever with rexposure get high fever, shock d/t hemorrhgae |
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Fever, confusion and ascending muscle weakness,
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west Nile virus, mosquito used to be afria now includes US
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flu like symptoms then acute resp failure, exposed to mice in western US
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hantvirus
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Rabies virus
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seizure, paralysis and coma nearly all die, 2-16 weeks after bite, depends confusion, lethargym increased salivation can give vaccine and rabies Ig, + negri bodies on autopsy
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Ebola virus
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causes hemorrhagic fever, fever, headache, diarhea, vomitng folowed by thrombocytopenia, hemorrhage and shock, DIC nearly 100% mrotality rate
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Progressive multifocal leukencephalopathy
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caused by JC virus, loss of vision, intellectural impairment, snensory changes,d eath within 1-9 monthjs
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Prion diseases
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CJD, memonie deficits, rigidiity, terminal state marked by akinesia dn muteness, 3-12 months of sx onset, usually death occurs by way of complicating pneumonia, can be acquired from transplant or hereditary
also can get the mad cow form |
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HTLV-1
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human T cell lymphotropic virus causes adult T cell leukemia - lymphadenopathy, hepatospneomealy, lytic bone lesions,
also myelobathy causing gait disturbance, lower extremity weakness, low back pain,bladder/bowel incontinence |
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Major HIV gene products
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gp160- when cleaved becomes gp41 and 120
41 binds to CCR5 or CXCR4, gp120 binds CD4 receptors |
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Diangosis of HIV
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screened with ELISA, confirmed with western blot, ELISA neg in first few months
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HAART
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2 nuckes + 1 protease inhbiotr, 1 NNRTI, or 1 integrase inhibitor
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Acute HIV
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2-4 weeks after infection, resolves in 2 weeks, fever, lymphadenopathy, sore throat lethary, antibodies within 3-4 weeks
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treatment for toxoplasmosis in HIV
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pryimethamine, leucovorin and sulfadiazine, prohpylax with TMP/SMX
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Prophylaxis for MAC, crytoococcal menningitis and CMV reitinints in HIV
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MAC- azithromycin, add ehtambutol for tx, crytococcus amp B and flucytosine for tx, flucanozole erarly, CMV retitnis tx is ganciclovir
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Molds vs. yeasts
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yeasts are round or oval, mold are fungal cells that unite end-toend to form one long string of ccells called hyphae
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sporotrichosis, tinea versicolr and dematophytosis
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sporotrichosis- locla pustules at ubcutre site, cigar shaped udding yeast,
tinnea versicolar, hyppigmeted areas with prurits and scaling, hyphae form, dermatphytosis glows under wood's lamp, red ring with central clearing |
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Coccidoides
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live in soil as artrerospores, live in tissue as endospores, found in southwest US,San Joquain valley fever
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aspergillosis
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monomorphic with V shaped septate hyphae, lung cavitations created by TB or Wegener's. form fungus balls, also causes allerfic bronchopulmonary aspergillosis, asthma like symptoms
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Patients at risk for mucor or rhizops
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DKA, burns, leukemia
monoorphic mold, non-septate hyphae with right angle branches,multiply in vessels leading to infarction and necrosis |
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Life cycle of plasmodium
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sporozoites gain entry to mosquito in saliva, sporozoites enter bloodstream and then become merozoites in the liver, then can enter RBCs merozoites in all RBCs lyse at same time causing severe hemolysis every 48 hours
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Plasmodium falciparum
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infects RBCs of all ages and stages, hypnozoites only affect immature RBCs, more RBCs afected leads to RBC aggregates and hemorrhage and necrosis including brain
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multiple ring enhancing lesions in the brain, immunocompromied patient, exposure to cats
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toxoplasma
tx is prymethrimine + sulfadiazine and leucovorin |
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Leishmania
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sandfly from dog, fox and rodent reservoir, treatment is stibogluconate, causes Kala-Azar, pancytopenia, splenomegaly, weight loss, yperpigmentation
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African sleeping sickness
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typanozoma briucei from tse-tse fly, fever spiking every 2 weeks then lympadenopathy then encepalopathy and sleap problems, tz is suramin or pentamine
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crytosporidium
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causes severe diarrhe in immunosuprressed, causes sever watery diarrhea, debilitating and lifethreatening
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schistosoma
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free swimming immature forms in water enter skin, enter blood, enter arterial circulatin, mature into adult flukes then migrate into portal flow to live in mesenteric vessel
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Clonorchis
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blood fluke leads to cholangitis, chronic infection cleads to cholangiocarcinoma
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Taenia solium
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tapeworm, found in infected pork, enters intestine and mature into adult tapewrm, eggs excreted in stool, can aloso spread fecal oral, eggs hatch penetrate intestine wall and migrate to brain and eyes, leads to death
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Diphyllobothrium latum
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fish tapewom, raw or undercooked fish, settle in small intestine, consume B12 leading to deficit
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echinococcus
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dog tapeworm, human ingests dog fees, eggs devlop into cyts in lungs, liver or brain leading to hemotysis, liver disfunciton, focal neuro deficits respectively
cysts rupture leading to fatal anaphylaxis |
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Enterobius vermicularis
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pinworm, occurs only in humans, perianal pruritis, wose at night, scothc tape test, hatch in small intestine and mature to adults wihch migrate to colon, egg laying at night causes pruritis
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Necator americanus
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hookworm, pruritis at entry site, diarrhea, voming, abndominal pain, iron feficit, mature in lung, caused by bare ffet on moist soil, grass, feed on blood in GI capilarries
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Strongyloides
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asymptomatic, may cause watery diarrhea and pneumonitis, warm moist soil, larvae penetrate skin, enters blood and migrate to lung then ascends to mature in small intestine, larvae either pass into small intestin
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Massive lymph node obstruction leading to edema, in the tropics
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Wucheria
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River blindness, africa central ameriaca
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black fly, onchocerca
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Anisakis
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acquired by ingesting raw seafood, primairly in US, sushiu, gastroeneteritis, eosinophilia, occult stool blood, sx of appendicitis, ay progress to mimic GI malignancy
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