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51 Cards in this Set

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Idiopathic thrombocytopenia Purpura
purpura, mucosal bleeding, decreased platelets, self limited and ost-viral in kids, adults anti-platelet antibodies, chjronic tx is steroids
Patient with severe thrombocytopenia, shistiocytes and helmet cells, low Hb, high retic count, fever, high LDH. Dx and Tx
TTP, Tx is plamapheresis otherwise fatal

high LDH d/t lactate activity elevated by ischemic organ damage
what precipitates probs in G6PD?
things that cause increased ROS, fava beans, sulfa drugs, quininess

XLR, RBC lysis lack enzyme for NADPH synthesis
Inheritance pattern and substitution in sickle cell anemia
AR, valine for glutamate at 6th aa on beta globin chain
Direct vs. indirect Coombs test
Direct looks for antibodies bound to RBCs in blood in immune mediated hemolysis

Indirect looks for free floating antibodies in blood (Rh- females in pregnancy)
B-thalasemmia presentation
Minor- microcytic anemia, jaundice, leg ulcers, splenomegaly

Major- severe microcytic anemia, two mutated B alleles

not A-thalasemmia 4 total allels 2/parent
Patient ate some bad fish, now megaloblastic anemia. causative organism?
Diphyllobothrum latum - causes B12 deficiency

leukopenia, hyersegmented neutrophils, thrombocytopenia
Plummer-Vinson syndrome caused by...
low grade long-term iron deificency, causes esophageal web (structural defect)
Fanconi anemia
unable to remove oxygen radicals from bone marrow, AR, HIGH RISK FOR LEUKEMIA, recurrent aplastic anemia, absent radius bones, small thumbs, microcephally
Significance of Heinz odies, Howell-Jolly bodies, basophillic stippling
Heinz- G6PD, denatured Hb in RBCs

Howell-Jolly- nuclear fragments, immature RBCs

basophilic stippling- lead poison
Causes of neutropenia
Decreased production- BMD, chemo, HIV infection, B12/folate

increased destruction- Felty syndrome (autoimmune destruction)
Which baterial infection causes elevated lymphocytes?
Pertussis, kills cells in resp tract
Leukemias

1. Most common in children
2. Auer rods
3. Philadelphia Chromosome 9:22 bcr-abl fusion
1. ALL- immature lymphocytes
2. AML (immature other cell types)
3. CML- mature cells, low leukocyte alk phos
Hodgkin's vs. Non-Hodgkins lymphoma
Hodgkins- lymphocyte rich, nodular sclerosing, mixed, lymphocyte depleted, RS cells, nodal involvment contiguous spread

Non-H- widespread adenopathy, associated with viral, bcl-2, spreads to multiple nodes

both have neutrocytosis d/t inflammaiton
MOA and major side effect of the azole drugs
interact with fungal p450, block demethylationof ergosterol can't make cell membrane

hepatotoxicity
DOC for most fungal infections:
Flucanozole, vaginal candiasis - miconazole

Itraconozole is more broad sectrum and more potent but more toxic
DOC for aspergillosis
voricanozole, can have visual changes in addition to liver tox
Amphotericin B
binds ergosterol, leading to pore formation allowing electrolyte imbalances, nephrotoxic

nystatin- similar mech, used for thrush
Griseosulvin MOA, use and tox
intreacts with miucrtubules revents eukaryotic cell division, accumulates in skin and nailes ued for skin infections,

heatotixc, teratogenic, disulfarim rxn, induces 450
DOC for fungal nail infections/MOA
terbinafine- inhibits squalene epoxidase needed for synthesis of ergosterol, can cause hepatitis (used topically)
what two species of plasmodium require primaquine tx in addition to standard tx and why?
ovale and vivax- hypnozoite forms remain latent in liver and not killed by standard tx
DOC for chlorquine-sensitive species of plasmodium and pregos
chloroquine- kills drugs bt inhibiting their DNA synthesis, transmformation of heme into a toxin, forms comlexes that lyse it and RBCs contianing it
DOC for P. falciparum
quinine plus doxy, tetracycine or clindamycin
Metronidazole
DOC for tichomnasis and amoebiasis, acts as an electron acceptor, causes binidn gof protiens to DNA causing death,

Tinidazole- same mech, less side effects, DOC for giardia
Drug for treatment of trypansoma cruzi
nifurtimox, creastes ROS destroys enzymes killing organism

abd pain, NV
tetanus toxin vs. botulinum toxin
tetanus- blocks glycine release leads to disinhibition and spasm

botulinum- inhibts release of ACh leads to parlysis
Diphtheria toxin
inhibits protein synthesis
Obligate aerobes vs. obligate anaerobes
aerobes- TB, pseudomonas, nocardia, require O2

anaerobes- clostridium, actinomyces, ferment and killed by O2

most of the rest are facultative anearobes
Most common cause of pneumonia in infants, young adults and elderly
infants- RSV
young adults- mycoplasma
elderly- strep pneumonia
Most common causes of diarrhea in kids, adults, travelers
kids- rotavirus
adults- campylobacter
traveler's- E coli, Shigella, salmonella
Most common causes of bacterial menigitis in neonates, adults, elderly
neonates- E coli, strep agalctia, listeria
Adults- neiuserria
Elderly strep pneumo
gram + cocci in clusters, catalase and coagulase (huge for this one) positive, what exotoxins?
staph
enterotxins - darrhea
toxic shock syndrome toxin- anaphylaxis
exfolaitin- scalded skin
alhpa toxin - tissue necrosis
Patient with acute sore throat, malaise, fever of 39-40 C, yellow exudates... bacterial =
strep pyogenes
B-hemolysis vs, alpha vs. gamma
B- complete hemolysis, clear, pyogenes, most others

a- incomplete- green halo, pneumocccu, viridans

gamma- no hemolysis, enterococci
bean shaed gram - diplococci, fements maltose has capsule on CSF gram stain
Neiserria Menigitidis

Waterhouse-Fiderichsen syndrome- adrenal failure d/t hemorrhage of glands in septic patients, causes much badness

Tx is pcn
Male has dysuria and urulent discharge, gram stain is gram neg diplococci bean shaped =
neiserria gonorrhea treat with ceftriaxone, can cause purulent arthritis
corynebacterium diphteheria
pseudomembranes, Chinese characters
Bacillus anthracus
gram + bacillus, anthrax, woolsorter's dz
Clostridium erfingens
spore forming rod, anearobe

a-toxin causes gas gangrene

entertoxin causes food poisoning
Patient has nausea vomiting and abd cramps then develos dry mouth, diplopa, loss of pupil reflex, does home canning. Thoughts?
C. botulinum, will rogress to descending parlysis adn resp failure
Facultative anearobe, gram neg rod, most common cause of UTI
E coli
Shigella
non-motile gram neg lactose negative, causeswatery diarrhea followed by fever, bloody stools and cramping

attacks and invades GI epithelium
E coli vs. salmonella vs. shigella
e coli- motile and lactose +

salmonella - motile, lactose -

Shigella- non-motile lactose neg
Patient has UTI develops ammonium calculus
proteus, motile produces urease leading to ammonium calculi
treatment for H. pylori
metronidazole, tetracylcine and bismuth

associated with MALT lymphoma
Comma shaped gram neg, rice-watery diarrhea. Toxin and tx
vibrio cholera

hydration, tetracyline

toxin ribislyates Gs protein causing permanent activation of adenylate cyclase causing secretory diarrhea
Exposure to rodents, large tender lymph nodes...
yersinea pestis, bubonic plaque from fleas tx is streptomycin and tetracycline
Patient has lesion expanding macule with central clearing then gets fluctuating mengiitis, facial palsy peripheral neuropathy
lyme disease from tick, tx is docycycline
Tx for all chlamydias from pneumonia to trachomatois (coitus) to psitcci (bird poop)
tetracycline
Life cycle of chlamydia
elemnary bodies are infected then transforms into reticulocyte body for cell division (initial body) then back to elementary body and rupturing of cell
Patient has fever, headahce, conjunctival redness, trash on wrist and later trunk, went hiking...
R. ricjetsiea from ticks