RNA +

[image]

naked

[image]

Transmitted Fecal-Orally

(except Rhinovirus)

[image]

• Viral RNA is already like mRNA so it uses host RNA polymrase to get translated
• 
  

• Creates a large polyprotein product that is cleaved into active smaller subunits[image]

• Replicate outside the nucleus in the cytoplasm[image]

Enteroviruses (Polio & Coxsackie A,B & Echovirus)

Rhinovirus

Hep A

[image]

Enterovirus

children especially

(Entero aviary)

normal glucose

no bacteria

elevated protein

Rhinovirus transmitted through respiratory droplets

common cause of URI

[image]

Where does Polio replicate?

How long does it take?

tonsils and peyers' patches (Submucosa of the ileum)

2-3 weeks

[image]

Whered does the poliovirus cause the most damage?

What are the symptoms?

the anterior horn of the Lower Motor Neuron Cell bodies

causing assymetric paralysis 2-3 wks after infection

myalgias

decreased deep tendon reflexes

can lead to repsiratory insufficiency (cause of death)

also can cause aseptic (viral) meningitis

[image]

There is no treatment, only prevention

Salk & Sabin vaccine

Salk: killed vaccine

only creates IgG response

[image]

Sabin: live attenuated vaccine

stimulates IgG and IgA disease

can be shed in feces and cause disease in another person

[image]

think "A" in Alive

Picornavirus

RNA +

Coxsackie A

red, vesicular rash

[image]

Summer time

[image]

Dilated cardiomyopathy

(floppy big heart)

[image][image]

 and Pleurodynia(aka Devil's grip)

[image]

Rhinovirus

transmitted through inhalation and fomites by attaching to ICAM1

[image]

also the only picornavirus that is acid labile

[image]

Where do Rhinoviruses like to grow?

Why isn't there a vaccine?

Cool temperatures like the upper respiratory tract

many different serotypes so it's difficult to develop a vaccine

no treatment for the common cold

[image]

naked RNA + virus

[image]

What is the most common Calicivirus seen clinically?

How is it usually transmitted?

Norovirus

responsible for 90% of diarrheal outbreaks on cruises

also common in daycare centers and schools

can be acquired through consumption of shellfish

causes explosive diarrhea:

[image]

[image]

[image]

[image]

RNA+

enveloped

nonsegmented

[image]

• Hep C
• Dengue Fever (Aedes Egypti mosquito)
• Yellow Fever (Aedes mosquito)
• West Nile Virus (birds are reservoir)

Type 2: "break bone fever"

invades bone marrow-->thrombocytopenia

increased risk of bleeding (hemorrhagic fever)

renal failure

Tx:supportive care

jaundice

[image]

backache

[image]

bloody stool

[image]

No treatment but prevent with live attenuated vaccine

[image]

encephelitis

myolitis-->flaccid paralysis

seizures

coma

Tx: Supportive care

Ribavirin

IFN-alpha

also..protease inhibitors

Alpha agonists

Beta blockers

diuretics (acetazolamide and mannitol)

chlinomimetics (Carbachol Pilocarpine)

Prostaglandins

Glaucoma: cupping

Hydrocephalus: Papilledema

Which of the following is not a pharamcological property of risperidone?

e. anticholinergic

Risperidone is an antipsychotic drug which is mainly used to treat schizophrenia (including adolescent schizophrenia), schizoaffective disorder, the mixed and manic states associated with bipolar disorder, and irritability in people with autism.

Which antidepressant is associated with a high risk of sudden death?

D.Desipramine

. Desipramine (also known as desmethylimipramine) is a tricyclic antidepressant (TCA). It inhibits the reuptake of norepinephrine and to a lesser extent serotonin.

Weight loss is associated with which antipsychotic agent?

D. molindone

The major mechanism of class 3 anti arrhythmic agents is inhibition of:

The beta-blocker that is classified as a class 3 anti-arrhythmic agent is:

Remember

"SAD"

Sotalol is SAD because of Amiodarones side effects

Dofetillide

Bretyllium

Ibutilide

[image]

Digoxin induced arrhythmias can be decreased by:

Magnesium

SSRIs

fluoxetine (inhibits CYP450)

paroxetine

sertaline

fluvoxamine

escitalopram

citalopram

they prevent the reuptake of serotonin , potentiating the effects of serotonin on the postsynaptic receptors

MAJOR DEPRESSION

ANXIETY

OCD

Eating disorders

premenstrual mysmorphic disorder

SE: Sexual dysfunction

DO NOT TAKE WITH MAOIs--> Serotonin syndrome

Epoietin, Darbepoietin

Mainly:

Cardiovascular events and thrombotic complications if used in pts with renal failure to increase Hgb levels over 13 g/dL

Teratogen

HTN (increase volume)

alpha-glucosidase inhibitors

inhibit this enzyme at the brush border of the small intestine that is responsible for breaking down oligosaccharides and disaccharides into monosaccharides.

this inhibits postprandial carbohydrates and thus glucose levels are lowerd

SE: GI upset (flatulence and diarrhea)

Name the Nephrotic Syndromes and their general characteristics

O=prOteinuria and azotemia >3.5

hypoalbuminemia→edema

hypogammaglobulinemia→infection (not MCD)

hypercoagualble state (loss of antithrombin III)

hyperlipidemia and hypercholesterolemia

_______________________________________

Effacement of foot processes

MCD (most common in children)

Glomerulus looks normal on H&E

effacement of foot processses on EM due to massive overproduction of cytokines (associated with non-hodgkins lymphoma and Reed Sternberg cells)

[image]

Loss of albumin only, excellent response to steroids but if doesn't respond to steroids it will progress to FSG↓

FSG (heroine, AIDS, sickle cell, blacks, latinos)

focal and segmental sclerosis on H&E

effacement of the foot processes on EM

poor response to steroids

__________________________________________

Immune complexes

Membranous Nephropathy(Hep B, Hep C, SLE, solid tumors, drugs(NSAIDs and penicillamine, white adults)

thick glomerular basement membrane on H&E

Subepthelial Immune complex deposition→granular IF

spike and dome appearance on EM

[image][image][image]

Membranoproliferative Glomerulonephritis

Thick capillary membranes on H&E, mesangial cell seperation creating a with tram-track appearance

types:

subendothelial: TYPE 1(HBV,HCV)

or

intramembranous (within the basement membrane)

(Type 2: C3 NEPHRITIC FACTOR which stabalizes C3 convertase-->decrease serum C3 and overactivation of complement)

both immune complex deposition→granular IF

[image][image]

_________________________________________

systemic

Diabetes Mellitus
1)high serum glucose leads to non-enzymatic glycosylation of vascular basement membrane→2)hylaine arteriosclerosis

efferent arteriole more affected than afferent leading to 3)higher GFR (hyperfiltration injury)→4)microalbuminuria

Sclerosis of mesangium and Kimmelstiel-Wilson Nodules

[image]

ACEinhibitors will block angiotensin and decrease futher narrowingof the efferent arteriole which is causing the hyperfiltration injury

Systemic Amyloidosis

amyloid deposits in mesangium

characterized by Congo stain, apple-geen birefringence under polarized light

I =Inflammation and glomerular bleeding

hypercellular inflammed glomerulus

[image]

limitied proteinuria <3.5

oliguria azotemia

salt retention and periorbital edema w/hypertension

RBC casts and dysmorhic RBCs in urine

__PSGN__

[image]

2-3 wks after infection (usually strep and usually in children)

immune complex deposition mediated inflammation

sub-epithelial hump

will clear out and dissipate

Tx: supportive care, rarely progresses to renal failire (RPGN)

↓

___RPGN__

[image]

nephritic syndrome that progresses to renal failure in weeks to months

crescents in bowman's space

crescent is made up of macrophages and fibrin

 etiology determined by serum antibodies, clinical presentation and IF:

 Goodpasture Syndrome: linear IF, hemoptysis from lug involvmen common in young males

Diffuse proliferative glomerulonephritis: caused by SLE (most common cause of death in Lupus pts) or PSGN: granular IF

Wegener's (c-ANCA) : negative IF (pauci immune) history of sinusitis, mouth ulcers

Microscopic polyangitis(p-ANCA): negative IF (pauci immune)

Churg Strauss (p-ANCA): negative IF (pauci-immune)

asthma, eosinophilia, granulomatous inflammation

_____________________________________________

IgA Nephropathy

most common cause of nepropathy worldwide

presents during childhood, episodic microscopic hematuria with RBC casts usually following mucosal infections due to overproduction of IgA

may slowly progress to renal failure

IgA deposits in mesangium on IF

[image]

_______________________________________

Alports syndrome

Inherited defect in Type IV collagen

X-linked mostly

thinning and splitting of glomerular basement membrane

isolated hematuria

sensory hearing loss and ocular disturbances as well

look for family history

urethritis

commonly due to chlamydia trachomatis  or gonorrhea

Pyelonephritis:

Fever, flank pain WBC casts in addition to cystitis symptoms

common causes: E.Coli, Klebsiella and Enterococcus

characteristic of vesicouretal reflux causing chronic pyelonephritis

atrophic tubules with eosinophilc material reminiscent of thyroid follicles

waxy casts in the urin

Thyroidization of the kidney

[image]

Ammonium magnesium phosohate stone

 caused by:

Proteus

Klebsiella

bc they are urease positive and create alkaline urine favoring formation of these stones

[image]

What type of kidney stone is radiolucent?

Tx?

third most common kidney stone: uric acid

hydration and

alkalinization of urine

allopurinol for pts with gout

commonly seen with gout and in leukemia or myeloproliferative disorders

Cysteine

common in children

associated with cystinuria-a genetic defect of the tubule that results in decreased reabsorption of cystein

Tx: hydration and alkalinization of urine

can also produce staghorn caliculus but think CHILDREN

Diabetes

HTN

Glomerular disease

uremia,

hyperkalemia and anion-gap metabolic acidosis,

anemia (eryhtropoietin is produced by the renal peritubular interstitial cells),

hypocalcemia (high phosphate which binds calcium and low vitamin D),

renal osteodystrophy (osteitis fibrosa cystica(Hypocalcemia-->increase PTH-->resorption of calcium-->destroy bone and get fibrosis and cysts), osteomalacia (do to loss of mineralization from low vitamin D), and osteoperosis (due to the metabolic acidosis)

Tx: dialysis and/or transplant

often pts on dialysis develop shrunken cystic kidneys

increased risk of renal cell carcinoma on dialysis in this shrunken kidney

Renal cell (clear cell) carcinoma

loss of VHL(3p) increases IGF-1 and HIF transcription factoR which increases VEGF and PDGF

Von Hippel Lindau Disease

hereditary

-Renal cell carcinoma

-Hemangioblastoma of the cerebellum

Lung

Bone

Retroperitoneal lymph nodes

Wilms tumor (WT1 mutations especiallyin WAGR Syndrome)

malignant tumor of blastema, primitive glomeruli and tubules and stromal cells

average age is 3 yo

presentation: hematuria and HTN (renin secretion)

What cancer is associated with the rare condition this child has

[image]

Beckwith-Weidman Syndrome

Wilms tumor

Neonatal hypoglycemia

Muscular hemihypertrophy

Organomegaly (ex.tongue)

Urothelial carcinoma of the bladder

RF: smoking

napthylamine

azo dyes

long term cyclophasphamide or phenacetin

Urothelial carcinoma

Painless hematuria

Can be papillary (starts low grade and progresses to high grade and invasion)

or flat(starts high grade and progrsses to invasion)

tumors are often multifocal and recur(field defect)

__________________________________

2nd most common bladder cancer

SCC metaplasia-->SCC

risk factor: nephrolithiasis (chronic)

chronic cystitis

schistosoma hematobium (middle eastern man)

_______________________________________

3rd kind

Adenocarcinoma

-arises from urachal remnant

present at the DOME OF THE BLADDER

-cytitis glandularis

-exstrophy

infections Mono

Bartonella Henselae

Otitis Media

How do you treat ADHD?

Stimulants Used in ADHD

• Methylphenidate (Ritalin) and Dextroamphetamine (Adderall)
- Amphetamine, increases pre-synaptic norepinephrine vesicle release
• Atomoxetine (Strattera)
- Norepinephrine reuptake inhibitor
• Other clinical uses of stimulants
- Narcolepsy (modafinil), obstructive sleep apnea an excessive daytime sleepiness, major depressive
disorder

Fluphenazine

Pimozide

Tetrabenazine

Rett Disorder

females only

males usually die in utero

hypochloremic metabolic alkalosis

hypokalemia

bcl2 overexpression

follicular (B cell) lymphoma

Uridine

by inhibiting CPS II

ASD

secretory proteins

membrane bound proteins

lysosomal proteins

Inhibin B inhibits FSH

Testosterone primarily inhibits LH

common in uncontrolled maternal diabetes where the baby is born with abnormal development of the lower spine

infant presents with flaccid lower extremities and absent reflexes

syntheticderivative of vitamin D (calcitrol) used in the treatment of psoriasis

delerium

acute changes in consciousness

commonly caused by UTIs

drungs like anticholinergics

AA

Disulfuram

Topiramate

Naltrexone

Acamprosate

Alcohol withdrawal

shakes, tactile hallucinations, seizures, autonomic instability

Tx: Benzodiazepines and/or alcohol

alcoholic cirrhosis (30% heavy drinkers)

hepatitis

pancreatitis

esophageal varices

peripheral neuropathy

testicular atrophy

Radial nerve palsy

aspiration pneumonia

Klebsiella pneumonia

hypomagnesia

Wernicke-Korsakoff(Thiamine/B1 deficiency)

wet beri beri

Mallory Weiss Syndrome

Opioid use

overdoses: seizures, respiratory depression

Reversal: naloxone, naltrexone

Opioids

Cholinergic Agonists

uncomfortable, but not life threatening

dilated pupils, runny nose, sweating, diarrhea

Methadone

Suboxone

What receptor do Barbituates and

Benzodiazepines work on? How do you treat intoxication?

GABA receptor

calm neuronal firing can cause sedation

Toxication Tx: Flumazenil

withdrawl can be life threatening like alcohol withdrawl with hyperexcitability, tremors, chills, seizures etc..

Amphetamines

(Cocaine blocks the reuptake of NE)

(pupillary dilation)

Benzodiazepines

severe: Haloperidol

inhibits reuptake of dopamine and 5-HT(Serotonin) and NE

horizontal nystagmus, psychosis, delerium, agitation, homocidal ideation

Tx: Benzodiazepines, Haloperidol

Withdrawl is the opposite, but can have violent withdrawl too

visual hallucinations and somewhat pleasurable psychosis

pupillary dilation

Renal Cell carcinoma

Hemangioblastoma

Hepatocellular carcinoma

Pheochromocytoma

Mu: morphine

delta: enkephalin

kappa: dynorphin

Loperamide or

Diphenoxylate

Herpes Simplex Virus

eosinophilic neuronal inclusion

[image]

Parkinsons

Diffuse Lewy body dementia

Alzheimer disease with Lewy bodies

Pick bodies

[image]

Acetylcholinesterase inhibitors:

Donepazil, Galantamine, Rivastigmine

in combo with NMDA receptor antagonist:

Memantine

Syphillis screen

HIV

TSH (hypothyroidism)

Vitamin B12

Head CT or MRI (multiple infarct, normal pressure hydrocephalus, stroke)

MMS exam

Alzheimers

chromosome 21

(also ApoE4 allele is associated)

OCPs

increased risk of stroke

-triptans

Sumatriptan

cause vasoconstriction in the brain (vasodilation with bounding pulses causes the migraine)

SE: do not give to a pregnant woman or somone with coronary artery disease

cluster headache

Sumatriptan

-triptans

treat migraine headaches and cluster headaches

contraindicated in pts with CAD and prinzmetal angina

Bupropion

inhibits reuptake of NE and dopamine, and also acts as a nictonic antagonist (blocks the reward loop experienced with smoking)

SE: psychosis, seizures, dry mouth

BALSA

Bromocriptine, pramipexole, ropinorole (dopamine receptor agonists)

Amantadine

Levodopa, carbidopa(converted to dopamine in body)

Selegiline, entacapone, tolcapone (prevent Dopamine breakdown)

Antimuscarinics (benzotropine to affect tremor)

CT scan

MGM Studios

Metastasis

Glioblastoma multiforme

Meningioma

Schwannoma

Oligodendroglioma

medulloblastoma (Homer wright rosettes and psuedo rosettes) associated with Turcot syndrome APC gene mutation, colon polyps and cancer

[image]

_______________________________________

ependymoma (perivascular rosette or pseudo rosette)

[image]

Astrocytoma

Medulloblastoma

Ependymoma

SHINE

Sevoflurane

Halothane (hepatotoxicity)

Isoflurane (also used in brain surgery)

Nitric Oxide (low solubility, fast induction

Enflurane (epileptic side effects)

Methoxyflurane (Nephrotoxic-Meth is Neph)

What are the IV anesthetics?

Barbituates (decrease cerebral blood flow so good for brain surgery)

conscious sedation

Benzodiazepams (can cause amnesia, used in combo with an opioid to treat pain)

Ketamine (PCP analog, increases cerebral blood flow usually used in kids under 13)

Propofol (used for short procedures, milky color, high TG content which can cause acute pancreatitis)

dont work well in acidic/infected tissue

so deaden around the tissue

blocking small diameters, myelinated fibers before large unmylenated fibers so Pain is lost first before pressure

give local anesthia with vasoconstriction to keep the anesthetic in that region

paralytic agent

given with an anesthetic usually

Succinylcholine

Phase 1: cholinesterase inhibitor will increase the block effect

Phase 2: cholinesterase inhibitor can reverse the block

Atracurium

Mivacurium

Pancuronium

Vecuronium

Rocuronium

Tubocurarine

competitively compete with ACh receptor

can be reversed with cholinesterase inhibitors

Malignant Hyperthermia

tx: dantrolene

Propofol

(killed micheal Jackson)

prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle

stops muscle contraction

block Na channels

blocking the small myelinated and unmyelinated first (pain)

and then then large ones last (pressure)

Carbamazepine

Phenytoin

Valproic Acid

Lamotrifine

Topiramate

Gabapentin (postherpetic neuropathy and diabetic peripheral neuropathy)

Ethosuximide

Valproic Acid

current seizure: Benzodiazepines

Eclampsia: MgSO4

Diplopia

Sedation

Ataxia

Nystagmus

Dizziness

This seizure drug has many side effects including gingival hyperplasia, hirsutism, fetal hydantoin syndrome, drug induced lupus, stevens johnson syndromem, and induces CYP450

Phenytoin

Carbamazepine

Valproate (spina bifida)

• Seizure drugs (ethosuximide, phenytoin, lamotrigine, carbamazapine, phenobarbitol)

• Sulfonamides

• -cillins

• Allopurinol

Carbamazapine (seizure)

Clozapine (antipsychotic)

Colchicine (gout)

PTH (antithyroid)

Methimazole (antithyroid)

BCG PQRS

Barbituates

Carbamazepine

Griseofulvine

Phenytoin

Quinidine

Rifampin

St.John's Wart

Carbamazepine

Phenytoin

Lamotrigene

Topiramate

Valproate

Valproate

Phenobarbitol

Benzodiazepines

Gabapentin

Topiramate

Tiagabine

Viagabatrin

Levetiracetam

bind Gp IIb/IIIa

interpersonal awkwardness

odd thoughts

odd appearance

social withdrawal without psychosis

personality disorder

Haloperidol

Fluphenazine

Thiothixene

Chlorpromazine

Thioridazine

Molindone

Loxapine

Trifluoperazine

Molindone

Loxapine

Trifluoperazine

Olanzapine

Quetiapine

Risperidone

Cloazapine

Aripiprazole

Muscle rigidity

autonomic instability

myoglobinuria

hyperpyrexia

mental status changes

tx: Dopamine agonist (bromocriptine)

dantolene (for muscle symptoms)

trazodone

zolpidem

haloperidol

Lithium

Carbamazepine

Valproate

Lamotrigine

Olanzapine

Teratogen (Ebstein's Anomaly)

Tremor

Hypothyroidism

Nephrogenic DI w/ polyuria

to stop bleeding

treat hemophilia

MoA:inhibits plasminogen activation resulting in an inhibition of fibrinolysis

similar drug: Tranexamic acid

Mannitol

acts on the Proximal tubule and the descending limp of the LoH

DO NOT USE IN someone with CHF bc it will initially increase effective circulating volume before renal elimination occurs

Depression with:

hyperphagia

hypersomnia

mood reactivity or rejection hypersensitivity

psychomotor retardation

What is the mechanism of action of benzodiazapines?

Barbituates?

Benzos:

Increase GABA by increasing frequency of chloride channel opening

Barbituates: increase GABA by increasing the duration of chloride channel opening

Typical: block dopamine

Atypical: block both dopamine and serotonin

What do all these have in common?

Setraline, Paroxetine, Citalopram, Fluvoxamine, Fluoxetine

SSRIs

inhibit the reuptake of serotonin

What do these drugs have in common?

Imipramine, Amitriptyline, Desipramine, Nortiptyline, Clomipramine, Doxepin

What class do these drugs belong to?

Phenelzine, Tranylcypromine, Selegiline

Convulsions

Coma

Cardiotoxicity

Hyperpyrexia

Respiratory depression

Musce rigidity

Hyperthermia

Cardiovascular collapse

Hypertensive crisis

Hemorrhagic stroke

Cardiac arrhythmias

Know this image well

[image]

Do you know it?

Draw it from memory

Which artery traps the horseshoe kidney?

Inferior mesenteric artery

assoc. with Turners syndromw

[image]

ECF is 20% of pt. weight=20 L

plasma volume is 25% of ECF= 5L

bilateral agenesis due to

malformation of uretic bud

oligohydramnios

pulmonary hypoplasia

flat facies

extremity defects

creatinine is an approximation of GFR

normal 90-135 ml/min

Start spilling glucose at 200 mg/dL

max saturation at 350 mg/dL

def. of tryptophan

Niacin/B3 deficicency

(Pellagra)

What is the equation for renal clearance?

Renal Clearance= UV/P