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.
NOTE: Not all meetings have a Special Focus or Special Topic.
Special Focus Meetings (gay and lesbian, women’s, 100-pounders, maintainers, anorexic/bulimic, etc.) are composed of individuals who feel they can more readily identify with fellow OAers with similar attributes.
high risk lymphoma & leukemia MC skin malignancy, little mets risk, palisading histo, no precursor lesion, skin CA on upper lip and hairline, men, INC w/ age, sun exposure, translucent/pearly papule w/ telangiectasia, rolled-up edges "rodent ulcer"gouty arthritis Cause - deposit of urate crystals in joint fr excess uric acid in blood (tumor lysis syndrome fr radiation tx)Uric acid - final breakdown product of dietary & endogenous purines.
Purines broken down by hypoxanthine/xanthine Prophylaxis - allopurinol or rasburicase1) underexcretion of uric acid fr kidney: chronic kidney dz, diuretics (INC urate reabsorp), aspirin & niacin (complete w/ uric acid for excretion)2) INC dietery intake of purines - meat/Et OH (occurs at night couple hrs after meal)3) deficiency HGPRT - Lesch-Nyhan syndrome: x linked reces, necessary for recycling of purines, presents at infancy, mental retard, aggression, choreoathetosis (dance-like, twisting), self-mutilation, seizures, urate nephropathyfibroadenoma - MC breast tumor in women 15-35 yo; benign, firm, round, smooth, rubbery, MOBILE, most freq in upper outer quadrant breast Dx - US: disting cystic or solid, confimred w/ fine needle or core needle bxmultiple myeloma - malig plasma cells Dx - monoclonal light chain casts in urinelytic bone dz = bone pain, hypercalcemia MC renal dz in MM = myeloma cast nephropathy, excessive delivery of light chains (tamm-horsfall protein = uromodulin) that overwhelms ability of renal tubules for reabsorp Tubular casts block distal nephron & asc loop of Henle --boys 10-14, affects long bones of LE, scapula, ribs, pelvis, localized persistant pain & swelling, noticed after minor trauma Xray - destructive lesion w/ poorly defined margins "moth-eaten" and "onion peel" look (layers of reactive bone prod by periosteal rxn)osteoma Osteomata - skull, mandible, sinuses, auditory canal, long bones Xray - radiolucent nidus surrounded by cortical thickening Histo - nidus of osteoid & woven bone interconnected w/ trabeculae & surrounded by fibrous CT & sclerotic bone rxnplantar fasciitis - inflamm where plantar fascia inserts onto calcaneal tuberosity Tenderness at calcaneal tubercle and passive dorsiflex Xray - bony heel spur Tx - ice, rest, stretch, NSAIDs, orthoses, night splints Morton neuroma - fibrosis/degen of common digital nn that travels bet web spaces of toes (esp 3rd & 4th metatarsals) fr repetitive toe flex/extension RUNNERSTx - NSAIDs, heat/ice, low-heeled cushioned shoes w/ wide box cardiac arrhythmias (bradycardia, sinus arrest, v tach, v fib, asystole)Note: KCl used in death penalty to stop heart Tx - calcium gluconate - temp cardioprotective vs arrhythmias Albuterol (B agonist), insulin - drive K intracellularly (acute tx)**Hydration, Na polystyrene - definitive tx Dialysis if above failsmonoclonal Ab that binds to HER-2-R - overexpressed on aggressive breast CA cellsproto-oncogene on chrom 17 that encodes HER-2 (tyrosine kinase) amplifies ability of CA cells to respond to CA promoting signaling; trastuzumab blocks this process SERM - also Raloxifene MOA - stim estrogen in uterus (lead to endometrial hyperplasia), but blocks estrogen in breast Use - estrogen-R breast CA, osteoporosis Raloxifene - does not have endometrial agonist effect hyperestrogenism:young - precocious pubertyadults - irreg menses or postmenopausal bleeding d/t endometrial hyperplasia Hallmark - Call-Exner body** (follicles filled w/ eosinophilic fluid) or "coffee been" nuclei or rosette of cellsserous cystadenocarcinoma - type of malig OVCA of surface epithelial origin, includes:mucinous, endometrioid, transitional cell, clear cell, Brenner tumors Risk factors - nulliparity, early menarche/late menopause, fam Hx Suspect BRCA1/2 mut if 1 family member had breast/OVCAPsammoma bodies also seen in papillary thyroid CAyolk sac tumor (type of malig ovarian germ cell tumor), aka endodermal sinus tumoracute abd signs if there's degen/rupture F - ovary, M - testes Malig germ cell tumor: dysgerminoma (INC LDH)yolk sac tumor (INC AFP)immature teratoma Reflects extent Rx dristrib in extravasc tissue as opposed to plasma If Rx distrib in tissue = HIGHER Vd*Note Vd can exceed known vol of all body compartments combined if distrib primarily in tissue (ie chloroquine - malaria) --somatostatin analog - "off switch" for GIUse - bleeding esophageal varices *DOC, gastrinoma or glucagonoma, acromegaly MOA - inhib serotonin rel (Tx met carcinoid tumor) & almost all GI hormones (gastrinn, VIP, serotonin, insulin, glucagon, motilin), inhib GHSE - N, abd pain, constipation OR diarrhea, abnorm glucose tolerance, flatulence Spironolactone - K sparing diuretic, prevent excretion K (can lead to hyper K )SE - gynecomastia, testicular atrophy, amenorrhea Note - CHF d/t DEC CO & DEC renal perfusion which acitv RAAS sys & INC absorb Na, Cl, H2O in kidney --1. support to neurons: nutrients (lactate), homeostasis (K metab), removal NT (glutamate), physical support3.
Alternative Methods to Finding an OA Meeting Near You — If you aren’t able to find a meeting in your city, please consider attending an online, telephone, or non-real-time meeting or select the service body tab.
Service bodies are central OA offices located in most urban areas.others: t pedis (feet), cruris (groin/jock itch), capitas (scalp), manuum (hand), faciale (face), barbae (beard) - monomorphic fungal infection cased by Microsporum, Trichophyton, Epidermophyton fungi. Dx - KOH stain Tx - "-zazoles"MOA - inhib ergosterol syn Use - systemic mycoses (blastomyces, coccidiodes, histoplasma), superficial fungal infections (ringworm), Candida albicans (oral thrush)SE - gynecomastia, DEC libido, hair loss (M), amenorrhea (F)Immunocompetent w/ oral thrush - Tx: nystatin mouthwashhypocalcemia, INC phosphorous, lower limit of normal PTH, Chvostek's sign (facial nn tapping cause facial mm contraction), Trousseau's sign (BP cuff on arm causes carpopedal spasms), perioral parathesias, seizures, depression, anxiety INC concen req for Rx to prod half its maximal effect (EC50).Thus, addition of competitive antag DEC POTENCY of drug (shifts response curve to right)ex. Tx - opiate intoxication (pupil constriction, resp depression, coma)progesterone antag - Mifepristone (RU 486) - abortifacient Progesterone - responsible for stim endometrial glandular secretions, spiral aa development, DEC myometrial excitability, uterine smooth mm relaxation, prod thick cervical mucusosmotic fragility test.; 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...prone to excessive lysis in hypotonic soln Hereditary spherocytosis - RBC membrane defect (DEC spectrin)Small RBC, central pallor, macrophages destroy these cells (splenomegaly), hemolytic anemia, hyperbilirubinemia Complication - cholelithiasis90% of head/neck CA are squamomus cell CA and occur in oral cavity Mid-age men, chronically smoke, consume Et OHMC on ventral surface tongue, floor of mouth, lower lip, soft palate, gingivaearly - hard, raised, pearly plaue or verrucous areas of mucosal thickening w/ irregular bordersas they grow --Beriberi - malnourished alcoholics Thiamine - frees energy fr glucose; thus Sx include lethargy & fatigue Affects nervous & cardiac sys Dry beriberi - inflamm of nn (polyneuritis) & mm wasting Wet beriberi - high output cardiac failure (dilated cardiomyopathy) & myxedema- afferent/efferent renal arterioles constrict = DEC GFR, RBF- INC sympathetic nervous activityactiv renin-ang-ALD pathway (in response to low arterial pressure)Note: at low levels, Ang II vasoconstricts efferent arteriole (DEC blood flow & INC GFR).