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48 Cards in this Set
- Front
- Back
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TORCH
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toxo
other (syphillis) rubella CMV Herpies Simplex |
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Toxoplasmosis
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toxoplasma gondii
cat is host infection usually asymptomatic 1/3 risk of infection with primary maternal infection see higher rate of infection in 3rd trimester more deadly with infection of 1st trimester triad of symtpoms: corioretinitis hydrocephalus intracranial calcification |
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syphillis
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treponema pallidum
more likely to transmit with primary or secondary most asymptomatic RPR test fetal effects: still birth, neonatal death, hydropsy fetalis early effects: cutaneous lesions on palms and soles, snuffles, periostitis, funisitis, hematosplenomegaliy late effects: hutchinson teeth |
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how do you treat syphilis
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penicillin regardless of stage
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rubella
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single stranded RNA virus
self limiting infection earlier in preg has higher probability of affecting fetus symptoms: sensorineural hearing loss, cateracts, glaucoma, cardiac, neurologic blue berry muffin lesions |
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diagnosis and treatment of rubella
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maternal IgG is useless
isolate virus from nasal secretion, use IgM immunize! |
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most common congenital viral infection
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CMV
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cytomegalovirus
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90% asymptomatic at birth
symptoms long term: sensorineural hearing loss, vision loss, dev delay other symptoms: periventricular calcification, jaundice, petechiae, neuro problems |
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treatment for CMV
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ganciclovir
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herpes simplex virus
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HSV1 or HSV2
usually infection through genital tract rational for C-section - delivery prior to membrane rupture symptoms: skin, eyes, mouth, CNS, disseminated |
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treatment for HSV
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acyclovir
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buzzword: snuffles
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syphilis
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buzzwords: chorioretinitis, hydrocephalus, intracranial calcification
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toxoplasmosis
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buzzword: blueberry muffin lesion
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rubella
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buzzword periventricular calcification
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CMV
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which TORCH infections are usually asymptomatic
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ALL
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most preventable TORCH infection
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rubella
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post partum infection
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ascending from vagina
most common organism: strep, bacteroides, ecoli symtpoms: fever, increased WBC, foulsmelling lochia, pain uterine tenderness |
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what form does calcium take in the intracellular and extracellular space
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bound to albumin
bound to citrate, sulfate, or phosphate free ionized calcium |
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which form of calcium is controlled tightly by hormones
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free ionized calcium
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how does albumin affect calcium
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albumin carries calcium
low albumin will reflect low total serum calcium, but they can have normal ionized free calcium |
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how does acidosis affect calcium binding to albumin
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decreases
alkalosis will increase binding |
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equation for corrected calcium
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.8(expected albumin - actual albumin) + measured serum calcium
4 is the expected serum albumin |
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T/F normal serum calcium indicates bones are not osteoporotic
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false - body heavily regulates free calcium, at the expense of bone
will often be normal levels in osteoporosis |
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symptom of acute hypocalcemia
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primary symptoms: tetany - neuromuscular irritability
other: numbness paresthesia muscle cramp carpopedal spasm laryngospasm seizure |
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trousseau's sign
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hand spasm when blood pressure cuff is aboive systolic blood pressure for three minutes
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chvostek sign
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contraction of facial muscle after tapping facila nerve anterior to ear
see contraction of corner of mouth, nose, and eye |
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T/F a patient with normal thyroid should have decreased PTH when calcium is high
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true
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effects of PTH
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pulls calcium out of bones
increase absorption of calcium in kidney increased phosphate excretion increase vit D production -> increased intestinal absorption of calcium |
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calcitrol
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aka 1,25 vit D
liver adds the 25 kidney adds the 1 -> 1,25 dihydroxy vit D increases Ca++ absorption in intestine more Ca++ release from bone (with PTH) |
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where is calcitrol synthesized
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kindey
activated macrophages thymic lymphocytes |
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T/F low magnesium prevents PTH from working
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true
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general causes of ACUTE hypocalcemia
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shifting of calcium out of blood - soponification
hyperphosphatemia osteoblastic mets (build bone - suck up calcium) acute repiratory alk |
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general causes of CHRONIC hypocalcemia
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inability to mobilize bony stores due to absent/low PTH or vit D (or reduced action)
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causes of low PTH (low measured PTH) in setting of hypocalcemia
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surgical removal or damage of parathyroid (often due to thyroid surgery) - most common
autoimmune radiation congenital |
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causes of high PTH in levels of hypocalcemia
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pseudohypoparathyroid - PTH is ineffective (PTH resistance)
low magnesium - induces PTH resistance |
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vitamin D deficiency - causes
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reduced absorption
liver damage - not able to add 25 hydroxy group kidney damage - not able to add the 1 hydroxy group target organ defective response |
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general process for determining cause of hypocalcemia
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is ionized calcium decreased
are there symptoms are there any causes of acute shift of calcium history of PTH or Vit D abnormal? |
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symptoms of hypercalcemia
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CNS problems
muscle weakness constipation dehydration kidney stones shortened QT corneal calcium deposit |
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most common cause of hypercalcemia
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outpatient: hyperparathyroidism
inpatient: cancer other causes: milk alkali, chronic renal failure |
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milk-alkali syndrome
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too much calcium and vit D intake and alkali
causes hypercalcemia and metabolic alkalosis metabolic alk will cause calcium reabsorption in distal tubule |
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mechanisms for hypercalcemia
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from bone:
hyperparathyroidism hyperthyroidism malignancy pagets from diet increased Ca or VitD intake decreased renal: thiazide familial hypocalciuric hypercalcemia |
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hyperparathyroidism
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see bone disease, kidney stones
hypophosphatemia proximal renal tubular acidosis measure PTH for diagnosis |
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malginant causes of hypercalcemia
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often lung and breast cancer and multiple myeloma
mechanism: 1. osteolytic mets - release cytokines and activate osteoclast 2. tumor secretion of PTH related protein 3. tumor secretion of cacitrol = hodgkin |
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cancers that release vit D
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hodgkin often
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causes of excess vitamine D not malignancy
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excess supplementation
granulomatous disease (sarcoid) |
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thiazide causes of hypercalcemia
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lower urinary calcium excretion
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familal hypocalciuric hypercalcemia
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autosomal dominant
hypercalcemia + hypocalciruia PTH doesn't supress normal - slight increased serum (body can't sense Ca++ appropriately) no symptoms confused with hyperparathyroidism |
