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Lepromatous - weak immunity, nodules, plaques bilat thruout body esp hands, fingers, forearms, face(leonine facies, resemble lion, loss of eyebrows, nasal collapse)Tx - long-term dapsone (PO) or w/ rifampin or clofazimine Dapsone SE - hemolysis, methemoglobinemia Dx - pheochromocytoma Clonidine - alpha-2-R agonist normally suppresses rel catecholamines fr adrenal glands but ineffective for pheochromocytoma Confirm dx - CT/MRITx - resection w/ alpha-blocking meds (phenoxybezamine - irreversible alpha blocker), BB only if adequate alpha blockade achieved bc unopposed alpha stim can lead to dangerous INC BP0-4 h normal4-12 h hypereosinophilia12-24 h neutrophilic infiltration, beginning of coag necrosis2-4 days eextensive NT infiltration, extensive coag necrosis5 days granulation, macrophages6-8 wks contracted scarsummer/fall, prodrome (fever, chills, NV, HA) followed by encephalitis (seizures, somnolence, obtundation, asymmetrical reflexes, Babinski, coma)Nonfatal encephalitis in kids, occurs usually summer/fallmacrolide (erythromycin)MOA - motilin agonist (secreted by gastric, intestinal & colonic enterochrommaffin & Mo cells; controls motility during fasting state via MMCs; acts on G-protein R, INC motility stomach/intestings SE - NVDCNS & GI neutrotransmitter - cause signif intestinal secretion electrolytes (and water), relax intestinal smooth mm & sphincters, inhib gastric acid secretion, dilate peripheral BVDz - diarrhea, hypokalemia, low gastric acid, dehydrationprod by gastric G cells in response to peptides and aa, stomach distention, vagal stim Zollinger-Ellison syndrome (gastrinoma) - excess gastric acid, arise in DUODENUM (less likely in pancreas where it's more malig)Dx - INC gastrin, give IV secretin (normal gastric cells inhib by secretin), tumor localted w/ US or radionuc octreotide scanning Tx - acid suppression w/ PPI (omeprazole), surg exploration Rifampin - hepatotoxicity* (follow LFTs), orange-red body fluids, MOA - inhib RNA poly (P450 inducer)INH - peripheral neuropathy (give B6), MOA - inhib mycolic acid syn (P450 inhibitor)Pyrazinamide - nongouty, arthralgia Ethambutol - color-blindness, optic neuritis, MOA - obstruct cell wall Streptomycin - ototoxicity & nephrotoxicity, bind 30S, inhib protein syn Type 1 - bone, tendons, skin, fascia, dentin, cornea, ex Osteogenesis imperfecta - multiple fx after min trauma, blue sclerae, hearing loss, dental imperfection Type II - cartilage, vitreous body, nuc pulposis, ex achondrogenesis - lethal neonatal disorder (large head, short neck, lung hypoplasia, short limb)Type III - skin, BV, uterus, fetal, granulation tissue, ex Ehler-Danlos syndrome (EDS) - hyperelastic skin, hypermobile jt, easy bruising, transluscent skin, scoliosis, pes planus, assoc w/ berry aneurysm, MVP, organ rupture, also - Marfan syndrome Type IV - basement membrane (kidney, lung alveoli, ears, eyes), epidermis basal lamina, ex Goodpasture's (RPGN, pulm dz), Alport's syndomre - hematuria, progressive GN, sensorineural hearing loss, cataracts Type VII - fibrils at dermoepidermal jxn, ex.
; F - irreg menses, hirsutism, M - DEC libido, ED; Lab - elev 24-h urinary free cortisol, glucose, low KCushing's syndrome Causes - excess pituitary/ectopic ACTH, primary adrenal hypercorticism, exogenous GCs (MCC; like prednisone); Cushing's dz - excess ACTH fr pituitary adenoma of basophilic cells, ACTH-secreting small cell CA of lung or carcinoid tumor NSTEMI - subendocardial infarct Cause - INC in partial occlusion of coronary aa (newly ruptured plaque w/ partially occluding thrombosis), or INC O2 demand in setting of partial coronary aa occlusion (person w/ atherosclerosis who runs a marathon)myasthenia gravis - asymmetric mm weakness in ext, dysarhtria, dysphagia, cranial mm weakness; repeated use worsens, improves w/ rest; visual disturb, ptosis Note - nicotinic-R only on skeletal mm, muscarinic-R on cardiac/smooth mm & glandsrenal cell CA - 95% kidney neoplasmcigarette smoking INC riskassoc w/ von-Hippel Lindau dz (mut chrom 3)Can invade vena cava, ascites, LE edema, hematogenous spread Dx - CT/MRI, CXR to r/o tumor into hilar LN, Histo - clear cell ca Tx - surg** prefendometrial hyperplasia (precursor to endometrial CA) -- overgrowth of endometrial sromal or glandular cellscause - unooposed estrogen (absence of proges)risk factors - chronic anovulation (PCOS), obesity, estrogen-prod tumors (granulosa-theca cell tumors), exogenous estrogens nystagmus of abducting eye Tested in multiple sclerosis Normal: look left, abducens (CN VI) stim ipsi (L) lat rectus to look left (ABduct), also sends axons & activ contralat oculomotor nn (CN III) so R eye looks left (ADduct) = both eyes gaze same direction Paralysis of medial rectus mm of ADducting eye upon lat gaze & contralat nystagmus (of ABducting eye)Wilms tumor (nephroblastoma) - MC renal malig in kids 3-4 yo, WAGR syndrome (Wilms tumor, Aniridia, GU malformation, mental Retardation)Dx - US, f/u with abd/chest CT to assess mets Tx - nephrectomy, chemo, radiation Paget's dz (osteitis deformans) - affects skull, femur, tibia, spine, pelvis Etio - preceding paramyxovirus infection, elderly Complications - hearing loss, high-output heart failure d/t INC formation AV shunts, osteosarcoma Tx - symptomatic, biphosphate, calcitonin to slow osteoclastic resorp Neuroleptic malignant syndrome - life-threatening occurs in first 10 days tx of high potency typical antipsychotic (haloperidol, fluphenazine)Tx - stop med, IV fluids, if continues -- dantrolene, bromocriptine, amantadine (optional)Yellow fever - flavivirus and arbovirus, transmitted by Aedes mosquito (arthropod)env, icosahedral, ss RNA.
reservoir: monkeys Tx - self-limiting; live attenuated vaccine avail to travelers of S america & Africa 50, RESTING tremor ("pill-rolling" goes away when performs task, worsens w/ emotional stress), "masked face," bradykinesia, cogwheel rigidity (ratchet-like jerking when testing tone in UE while pt clenches opposite fist), micrographia (small handwriting)Graves dzfemales, mid age, HLA DR3 and B8, precip by stress, infection, excess iodine, childbirth.opthalmopathy & exopthalmos (protruding eyes, eye mm weakness), pre-tibal myxedema (non-pitting edema), swelling/clubbing digits, diffuse goiter, thyroid scan - INC diffuse radioiode uptake Tx - BB (DEC adrenergic effects & peripheral conversion), anti-thyroid (methimazole or PTU) - inhib thyroid hormone syn; if unresponsive to rxs --Tinea corporis...
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