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Which gene do T regulatory cells express?
Which genes are susceptible to autoimmunity?
HLA-B27 (Class I MHC)
Which type of hypersensitivity is myasthenia gravis?
Type II, non-cytotoxic (Ab alters function)
inflammatory disease of white matter in the CNS - presentation is variable and depends on location of lesion (plaque)
Inflammatory cell infiltration and demyelination are hallmarks of disease
Which type of hypersensitivity is MS?
Type IV (TH1 and CTLs participate)
What are CSF findings for MS?
Normal WBCs, Protein
IgG is present and has oligoclonal look
inflammatory cytokines and cells leads to proliferative granulation in joints - erodes bone and cartilage
What type of hypersensitivity is RA?
Type IV (T, B Cells, and TNFa)
What are signs of RA?
rheumatoid factor and anti-cyclic citrullinated proteins, joint space increases (opposite of OA)
arthritis of spine - inflammatory back pain (worse in morning, worsens w/ rest, improves w activity) - vertebrae fuse together
What gene is AS associated with?
HLA-B27 (Class I MHC)
autoantibodies to widespread Ag (almost every cell in body) - binding causes inflammation and damage
What type of hypersensitivity is SLE?
What are signs of SLE?
Anti-nuclear Ab or ANA is high (not specific to SLE) as well as Anti-dsDNA Ab
Complement factors decrease (b/c being used) during flares & disease (can do serum tests for complement levels)
hallmark: periductal mononuclear/lymphocyte (mostly CD4) infiltrate in salivary and lacrimal glands
What are signs of Sjorgen?
Anti-Ro/SSA and anti-La/SSB
activation of fibroblasts - vasculopathy, immune dysregulation & fibrosis of multiple organs
What are the chemicals of scleroderma?
Auto-Ab include topoisomerase and anti-centromere - profibrotic mediators present (TGFb)
skeletal muscle inflammation - unknown type - many have anti-Jo-1 and anti-SRP Abs
Damaged fibers and infiltration of WBCs on biopsy
What are the AChE inhibitors?
Physostigmine, Neostigmine, Pyridostigmine, Edrophonium
central and peripheral effect (can cross BBB) so not specific (AChE inhibitor)
no CNS (effect greater than physostigmine) (AChE inhibitor)
more selective on MEP (less muscarinic activity) (AChE inhibitor)
very selective for MEP but very short duration - used as diagnostic - Tensilon Test
What is used for MG when AChE is not enough?
What are the non-glucocorticoid and AChE inhibitor options of MG?
Cyclosporine, Tacrolimus, Azathioprine, Mycophenolate Mofetil
binds to cytoplasmic protein cyclophilin which forms a complex that inhibits calcineurin which inhibits T-Cell early activation by blocking NF-AT an IL-2 release from T-cell
cyclosporine (treat MG)
binds to FK binding protein which forms a complex that inhibits calcineurin
tacrolimus (treat MG)
prodrug that is converted to 6-MP then TIMP (purine analog) - disrupts PRPP
azathioprine (treat MG)
Inhibits IMPDH (important enzyme in de novo pathway of guanine nucleotide synthesis) and also interferes w/ leukocyte adhesion thru inhibition of e- and p-selectin
binds to C5 and inhibits activation of terminal complement (Contraindicated for people w/ Neisseria meningitidis infection or if unvaccinated for it)
Patient's w/ MuSK MG often do not respond or worsen w/ oral anti-AChE drugs and should use
Treatment w/ aminopyridines (amifampridine) which act by blocking K channels → prolonged depolarization (enhanced ACh release)
Lambert-Eaton Myasthenic Syndrome
What is used to treat lambert-eaton myasthenia syndrome?
infection of epidermis - streptococci and staphylococci
o infection of upper dermis and superficial lymphatics - streptococci (GAS) - marked border
white-headed lesions around one or more hair follicles - staph and pseudomonas
suppuration and extension into subcutaneous tissue - staphylococci
lesions coalesce to form larger masses - staphylococci
subcutaneous fat - streptococci, staphylococci, H. Influenzae (unimmunized)
Diffuse rapidly spreading, systemic manifestations possible
painful tender collections of pus within dermis
HSV may manifest as inflammation as inflammation to finger - dentists
deep infection of subcutaneous tissue; destruction of fascia and fat
Can occur on own or w/ gas gangrene (C. Perfringens)
risk w/ DM or peripheral vascular disease; infection begins at site of surgical incision, at mucosal tear or sites of skin breakdown - by mixed aerobic and anaerobic bacteria
type i necrotizing fasciitis
anyone can get it - penetration injury - by GAS/streptococcal gangrene
type II necrotizing fasciitis
hemorrhagic bullae, gas felt in tissues (crepitus), discoloration, foul smell
What can cause necrotizing fasciitis?
C. Perfringens or or by GAS/streptococcal gangrene/streptococcal pyogenes
this myositis is caused by S. Aureus and results in pus-filled abscesses
Pyomyositis/Tropical Pyomyositis/Myositis Tropican
this myositis is caused by influenza virus a and b
What are the exogenous sources of osteomyelitis?
G-/P. Aeruginosa (dirt and water)
Staph Aureus/Coagulase Positive (postoperative)
Coagulase Negative Staph (prosthesis)
What are the endogenous sources of osteomyelitis?
S. Aureus for G+ and E. Coli for G-
[answer 1] plays role in children, hematogenous osteomyelitis, while [answer 2] plays role in adults, hematogenous, prosthetic osteomyelitis
facultative or strict anaerobe - opportunistic - chronic suppurative abscess (cervicofacial abscess is most common w/ poor dental hygiene/tooth extraction) - macroscopic sulfur granules visible
strict aerobic, branches filamentous and colony w/ aerial hyphae forms, weakly acid fast - G- appearance w/ G+ beads (microscopic examination)
in soil everywhere (exogenous), opportunistic (inhalation, trauma, NOT person-person)
can cause systemic (necrosis and abscess in lungs or brain) or cutaneous infection
G-, aerobe, oxidase negative, plump coccobacilli - moist and dry surfaces - its everywhere
Pulmonary Infections (opportunistic) - in patients receiving respiratory therapy
Wound Infections - traumatic and nosocomial wounds (Iraq)
Have extracellular (infective) form called trypomastigote (flagellated) that is what is passed in feces of kissing bugs to humans and seen in human blood but they also have an intracellular (replicate form) called amastigotes (w/o flagellum) that is seen in tissuesof humans right after transmission
Infection can cause chagoma (erythematous and indurated area at primary entry site) or Romaña's Sign (rash and edema around eyes and face)
What causes Chagas disease and where can Chagas disease spread to?
CNS, heart, gut, spleen
tapeworm muscle infection and can cause calcified cysts - from undercooked pork
nematode - can complete life cycle in host - from raw, infected prk
Eat meat → larvae digest out of SI and develop into adult worms → female worms release larvae directly into intestinal tissues → larvae are carried in blood or lymph and then penetrate striated muscles and eventually even into brain/meninges
trichinosis of trichinella spiralis
medication for gas gangrene (C. Perfringens) and syphilis (T. palladium)
once every 3-4 weeks, IM - for streptococcal pharyngitis (prophylactic) and syphilis during pregnancy
Benzathine Penicillin G
B-lactamase resistant medication
medication for variety G+ cocci and G- bacteria - HHELPSS kill enterococci
this drug is used for pseudomonas infections and can target anaerobic bacteria
Which organisms are not covered by 1-4 generations of cephalosporins?
listeria, atypical (chlamydia, mycloplasma), MRSA, enterococci
Which generation is cefazolin and what can it treat?
G+ cocci, S. Epidermidis, and for G- it treats it PEcK
Treats G+ (except MRSA) primarily
Which generation is cefoxitin and cefuroxime and what can it treat?
H. Influenzae, Enterobacter, Neisseeria,, serratia, marcescens, bacteroides fragilis, and PEcK
Treats anaerobic infections (primarily), then G+ (except MRSA), some G- (except pseudomonas)
Which generation is ceftriaxone, cefotaxime, ceftazidime and what do they treat?
3rd - can reach CSF
G- bacilli, tri and tax for meningitis, taz for pseudomonas
G- (taz treats pseudomonas)-primarily, G+ (except MRSA)
What generation is cefepime and what does it treat?
haemophilus, neisseria, pseudomonas, enterobacteriaceae and serious infections in hospitalized patients
Pseudomonas (primarily) and then G+ (except MRSA) and other G-
What generation is ceftaroline and what does it treat?
MRSA, enterococcus faecalis and CA-PNA
MRSA (primarily), then G+ and G-
This drug treats G- (including enterobacteriaceae and P. aeruginosa) only (no G+ or anaerobes), is given as injection or inhalation, and penicillin-allergic patients can tolerate
Monobactams - Aztreonam
This enzyme targets B-lactamase producing G- bacteria and is given in 10/10 life threatening infections
Carbapenems - Imipenem/Cilastatin, Meropenem
polymer synthesis inhibitor (binds to D-Ala-D-Ala) - slow IV infusion - excreted passively
Treat G+ only for serious resistant organisms like MRSA, MRSE, C. Diff., Enterococcus
The oral version of this drug is the first line treatment for colitis from C. Diff
Adverse reactions include nephrotoxicity, ototoxicity, thrombophlebitis, red man syndrome (rapid IV infusion)
inhibits first step (NAG à NAM) for G+ and G- -- uncomplicated lower UTI in women
targets carrier of peptidoglycan and is active against G+ (surface lesion os skin, wounds, and mucous membranes and can also be used for irrigation of joints, wounds, or pleural cavity) - highly nephrotoxic so only used topically
fracture that extends into joint (damages articulated cartilage) — degenerative arthritis can occur down the line
another word for medial angulation
another word for lateral angulation
most common elbow fracture in adult - usually from fall on outstretched hand
radial head fracture
most common elbow fracture in children - contains posterior fat pad sign (indicating elbow effusion)
2nd most common large joint dislocation (complete loss of contact between articulate surfaces)
fracture of ulnar shaft and dislocation of radial head
very common - often in osteoporotic adults - fall on outstretched hand
distal radius fracture
distal radial fracture w/ dorsal angulation of distal fracture fragment
common fracture of children and young adults - occurs most commonly in mid shaft
fracture of anteroinferior glenoid - predisposes to recurrent dislocation
Bony Bankart Lesion
impaction fracture of posterolateral humeral head - predisposes to recurrent dislocation
common fracture of 5th metacarpal neck - usually radial and palmar angulation of distal fracture fragment
bone fragment is pulled from its parent bone by tendon or ligament
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