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98 Cards in this Set
- Front
- Back
Indomethacin
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Gout treatment
Works FAST Side-effects: GI & CNS |
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NSAIDS for Gout
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Indomethacin
Ibuprofen |
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Colchicine
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Gout
Prevents tubulin polymerization -> prevents leukocyte migration & phagocytosis Side effects: **GI (diarrhea)**, hair loss, bone marrow depression 2nd line to NSAIDS |
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Allopurinol
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Inhibits formation of uric acid by inhibiting xanthine oxidase (XO)
Its metabolite also inhibits XO |
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Allopurinol Pharmacokinetics
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Cleared by kidneys (know GFR!)
Long 1/2-life Converted to an active metabolite |
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Allopurinol Side Effects
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Mainly allergic (especially with ampicillin)
Exacerbation of disease with initial treatment (give colchicine or NSAIDS before starting) |
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Febuxostat
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Similar to allopurinol
Better for patients with renal insufficiency |
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Uricosurics
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Work in renal tubules to a decrease in uric acid re absorption
Use high doses |
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Probenecid
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Blocks Uric Acid reabsorption
Don't use if urine flow is low Don't use if patients excrete large amounts of uric acid already |
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Sulfinpyrazone
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Blocks uric acid reabsorption
Side effects: GI |
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Choices for control of gout and prevent joint changes
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1st: Allopurinol
2nd: Probenecid 3rd: Sulfinpyrazone |
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NSAIDS Properties
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Analgesia
Antipyresis Anti-inflammatory Anti-platelet |
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NSAIDS MOA
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Inhibits COX enzymes -> inhibition of prostaglandin synthesis
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COX 1
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Present all of the time
Protective/Maintenance Location: Stomach, Intestine, Kidney, Platelet |
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COX 2
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Inducible
Pro-inflammatory function Bring prostaglanins to inflammatory sites -> macrophages |
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Aspirin
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Non-selective COX inhibitor (irreversible)
Relieves mild pain Interferes with hypothalamus -> reduce fever |
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Diflunisal
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Flourinated derivative or salicylate
Non-selective COX inhibitor No anti-pyretic affect |
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Median Nerve Motor
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Flexors of forearm
Thenar emminence 1st two lumbricals |
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Median Never Sensory
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Anterior palm digits 1, 2, 3, & 1/2 of 4
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Thoracic Outlet compression (3 ways)
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Elevated 1st rib
Compression by clavicle Pec minor pulling coracoid process inferiorly |
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Ulnar Nerve Motor
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2 muscles of anterior forearm compartment -> Flexor carpi ulnaris & Flexor digitorum profundus (ulnar head)
Intrinsic muscles of hand |
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Ulnar Nerve Sensory
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Anterior and posterior 1/2 of 4 and 5 digits
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Musculocutaneous Nerve Motor
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Flexors of elbow (anterior arm compartment)
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Musculocutaneous Nerve Sensory
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Lateral forearm
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Axillary Nerve Motor
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Deltoid
Teres Minor Flexes, extends, & aBducts shoulder |
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Radial Nerve Motor
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Posterior arm compartment
Posterior forearm compartment Anconius & supinator |
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Erb Duchenne Palsy
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Superior trunk damage
Proximal arm problems Waiter's Tip Sign Fall on head |
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Klumpke Paralysis
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Inferior trunk damage
Stretch arm from above Distal (hand) problems |
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Superior Gluteal Never Motor & function
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Gluteus medius & minimus
Tensor Fascia Lata ABducts lower limb Resists pelvic tilt during normal gait |
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Trendelenberg Sign
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Stand on 1 foot and hip drops on that side
=Superior Gluteal Nerve Palsy |
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Inferior Gluteal Nerve Motor & function
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Gluteus maximus
Extend hip (climbing stairs and getting up from a chair) |
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Femoral Nerve Motor & Function
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Anterior thigh
Psoas Iliacus Flex hip and extend knee |
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Femoral Nerve Sensory
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Medial thigh, leg, and heel (via saphenous nerve)
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Obturator Nerve Motor
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ADductors in medial compartment of thigh
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Obturator Nerve Sensory
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Medial thigh
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Sciatic Nerve Branches
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Tibial
Common Fibular |
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Tibial Nerve Motor in the thigh
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Hamstrings
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Common Fibular Nerve Motor in the thigh
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Short head biceps femoris
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Tibial Nerve Motor (lower leg) & Function
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Deep and superficial posterior compartments of leg
Plantar flexion Inversion Toe flexion |
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Common Fibular Branches
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Superficial Fibular
Deep Fibular |
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Superficial Fibular Nerve Motor & Function
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Lateral lower leg
Eversion |
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Deep Fibular Nerve Motor & Function
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Dorsiflexion
Toe extension |
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Muscle Spindle Fibers
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Provide info on tension
Adjust tone to prevent injury Relaxes antagonist muscle |
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Golgi Tendon Organs
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Cause stretched muscle to relax
Contract antagonist Prevents a muscle tear |
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UMN Lesion
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Weakness
Increased tone Increased reflex |
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LMN Lesion
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Weakness
Atrophy Fasiculations Decreased reflex Decreased tone |
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Most common manifestation of SLE
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Polyarthralagia or arthritis
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Rheumatoid Factor
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Produced by B-cells of synovium
IgG or IgM Ab against Fc region of IgG |
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Citrullinated Peptides
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Key in the diagnosis of rheumatoid arthritis
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Where does Rheumatoid Arthritis typically begin?
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Small joints of hands, wrists, ankles, knees, elbows, and shoulders
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Joints in fingers affected by Rheumatoid Arthritis
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PIP
MCP NOT DIP |
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Subcutaneous Nodules on extensors surface of forearm?
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Rheumatoid Arthritis
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Diagnostic Criteria of Rheumatoid Arthritis
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Morning stiffness
Arthritis in 3 or more joints Arthritis of hand joints Symmetric Rheumatoid nodules Serum Rheumatoid Factor (RF) Radiologic changes |
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Felty's syndrome
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Association of rheumatoid arthritis, splenomegaly, & neutropenia
Develops in patients with high titer rheumatoid factor, nodules, and HLA-DR4 |
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TNF Alpha (in Rheumatoid Arthritis)
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Activates inflammatory mechanisms
Stimulates endothelial cells Cells breakdown surrounding matrix |
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Juvenille Rheumatoid (Idiopathic) Arthritis
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<16 years old
1 or more joint Both cellular and humoral immune abnormalities |
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Ankylosing Spondylitis
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Chronic inflammation of sacroiliac joints, vertebrae, entheses
HLA-B27+ No RF X-Linked (usually younger men) Always stiff in morning **Inflammation in eye** |
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Reactive Arthritis (Reiter's)
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Arthritis, urethritis, & conjunctivitis
Usually affects males Asymmetric Usually lower extremity joints Thought to be an immune response to an infection somewhere else in the body HLA-B27 + (80%) |
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Myasthenia Gravis
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Ab's against post-synaptic acetylcholine receptors at NMJ
Muscle Weakness |
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Myastenia Gravis is often associated with?
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Thymomas
Thymic hyperplasia |
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What do all types of polymyositis & dermatomyositis have in common?
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Skeletal muscle that is damaged by lymphocytic inflammation
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polymyositis & dermatomyositis immunologic features
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ANA +
Ab against cytoplasmic antigens CD8+ T-cells and macrophage infiltration of involved muscle Pro-inflammatory and cytotoxic cytokine production |
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Proximal muscle weakness
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Think polymyositis & dermatomyositis
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Heliotrope rash
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dermatomyositis
Eyelids |
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Gottron's sign
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dermatomyositis
Knuckles |
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Diagnostic criteria of polymyositis & dermatomyositis
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Proximal muscle weakness
Biopsy evidence Elevated muscle enzymes (CCK) |
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Anaerobes Usually Lack
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Superoxide dismutase
Coverts O2- to O2 + H2O2 |
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Clinical findings suggestive of anaerobes
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Foul smell
Necrotic tissue with gas Black discoloration |
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Predominate anatomical sites for anaerobic infection
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Mouth
GI |
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Bacteroides fragilis
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Gram - rod
Growth stimulated by bile Think abdominal -> GI abscess Pelvic inflammatory disease Think below waste |
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Prevotella (Bacteriodes) melaninogenicus
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Gram - coccobacilli
Oral and brain abscesses Think above waist |
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Above waist infection think
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Prevotella (Bacteriodes) melaninogenicus
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Below waist infection think
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Bacteroides fragilis
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Tx of anaerobic infection
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Debridement and drainage
Metronidazole or clindamycin |
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Fusobacterium nucleatum
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Thin gram - rods
Fusiform shaped Head, neck, & chest infections |
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Vincent's angina aka trench mouth
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Fusobacterium nucleatum
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Gram + spore formers
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Most pathology due to toxins
Unable to infect healthy tissue Will not produce toxin at high Eh |
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Clostridium perfringens
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Normal habitat is GI and soil
Causes cellulitis & gas gangrene Alpha toxin -> degrades mammalian cell membranes |
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Alpha toxin
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Think Colstridium perfringens
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Myonecrosis
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Gas gangrene
Clostridium perfringens Follows trauma/lack of circulation |
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Gram + box car-like rods
Zonal hemolysis |
Clostridium perfingens -> gas gangrene
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Clostridium tetani
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Virulence factor -> tetanospasmin
Gram + rod Terminal spores |
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Tetanospasmin
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Clostridium tetani
Suppresses release of inhibitory NT's -> signals are unopposed and muscles are constantly stimulated |
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Clostridium botulinum
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Toxin produces release of acetylcholine from alpha-motor neuron
No signals to muscle = flaccid paralysis |
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Clostridium difficile
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Causes pseduomembraneous colitis
Enterotoxin (Toxin A) -> fluid production and mucosal damage Cytotoxin(Toxin B) -> Kills mucosal cells |
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pseduomembraneous colitis
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Clostridium difficile
Usually caused by selection via antibiotic treatment |
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Necrotizing Fasciitis Features
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Extensive tissue destruction
Thrombosis of vessels Bacteria spread through fascial planes |
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Differentiating necrotizing fasciitis vs cellulitis
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**PAIN**
High fever Toxic appearance |
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Type 1 Necrotizing Fasciitis
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Mixed infections
Diabetes, ab surgery, perineal infection Resembles gas gangrene Unpleasant odor Involved muscle still reacts to stimulation |
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Type 2 Necrotizing Fasciitis
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Group A Strept
Rapid progression |
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Type 1 Necrotizing Fasciitis Diagnostic aids
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Culture usually mixed
Anaerobic strept, group A strept, S. aureus Increased leukocytes (left shift) Increased ESR Increased CCK |
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Gangrene with/without gas
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With -> Clostridium
Without -> Strept pyogenes |
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Aeromonas hydrophilia myonecrosis
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Motile Gram - rods
Live in fresh water Oxidase positive Rapid progression following penetrating trauma in freshwater environment Tx -> Fluoroquinolone |
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Clinical Findings with Necrotizing Fasciitis
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Lots of pain
Pt appears ill with rapid pulse and falling BP Shock and renal failure may follow shortly Rapid process and often fatal |
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Spontaneous, non-traumatic gas gangrene
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Clostridium septicum
Usually associated with colon cancer, diverticulitis, or GI surgery |
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Neisseria Characteristics
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Gram -
Diplicocci (coffee bean shape) Oxidase positive |
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Clinical features of infectious arthritis
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90% are mono-articular
Knee is most common, followed by hip Swollen hot painful joint |
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Joints most susceptible to infection?
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Previously damaged -> Increase adhesion factors
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