erg review

8/17/2019 ERG Review

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Carcinoma: mets through lymphatics Sarcoma: mets hematogenously

PITUITARYPANHYPOPITUITARISM

• pituitary failure (infarct such as Sheehan’s)

• sequence f !ecre"ent# first $H% last is A&TH (in re'erse r!er f i"prtance)

• !pa"ine inhiits prlactin

• s"atstatin (SS) inhiits $H

&RANIOPHARYN$IOMA

• cystic% ith squa"us cells * cystic spaces• Rath+e’s puch ri,in (in'a,inatin f superir prtin f naspharyn-)

• can recur if nt c"pletely re"'e!

PITUITARY ADENOMA

• most common hormone-producing adenoma: prolactinoma

increased prolactin = amenorrhea & galactorrheao Amenorrhea due to PR suppression o! "nR# $decreases # & %#'

(h) nursing mothers are usuall) amenorrheic*o Drug+induced h)perprolactinemia, Dopamine -loc.adeo T/, Dopamine agonist $-romocriptine & ca-ergoline*

•

all trophic hormones come from basophilic cells (stain blue)

ACTH, TSH, LH, FSH• prolactin, H from acidophilic cells (red)

• greater than !cm " macroadenoma (can put pressure on optic chiasm # cause

homon$mous (bitemporal) hemanopsia or erode sella turcica)

• second most common s$mptomatic adenoma: H (gro%th hormone)

• acromegal$&before epiph$ses close, gigantism

&.NTRA/ 0IA1.T.S INSIPI0US• 'aspressin2A0H stre! in psterir pituitary

• hypthala"ic r p3pituitary failure

• present ith lar,e a"unts f !ilute urine% thirst

•T-# !es"pressin (nasal a!"inistratin)

YNDROME O% INAPPROPRIATE AD# E0RETION $IAD#*

• o'ersecretion of AH

• most often paraneoplastic s$ndrome %ith small cell (oat cell) carcinoma of the lung

o rug-induced SAH: carbama*epine, SS+s, high-dose c$clophosphamide,

others

• presents %ith letharg$ # confusion due to h$ponatremia

T/, (ith 12aptans3 $tol2aptan etc45 AD#+R antagonists* or demecloc)cline

%luid restriction and 2aptans (ill correct all -ut se2ere h)ponatremiao %or se2ere5 use I6 saline5 -ut correct slo(l) $central pontine

m)elinol)sis*• h$per'olemic in 'ascular compartment onl$, dilute a e'en if normal amount

• neuronal s%elling, poss. sei*ures

• shuts o/ renin, so 0 ascites or edema, 0 H123+T3S0

THYROIDPRIMARY HYPOTHYROI0ISM

• start ith TSH4 if ele'ate! usually 5ary hypthyr

• sy"pt"s f facial2perirital "y-e!e"a% hair an! s+in chan,es

#A#IMOTO T#YROIDITI

• most common cause of h$poth$roidism in the 4S


2/29

• autoimmune destruction: anti+TPO5 anti+th)roglo-ulin anti-odies

• also ma$ be inacti'ating TSH-+ Abs

• highest in F, 56-76$

MU/TINO0U/AR $OIT.R • enlar,e! thyri!% "any n!ules

• less cncern fr un!erlyin, tu"r r cancer

• usually i!ine !eficiency (nt seen as ften n)% r en6y"e !eficiency

• lac+ f T72T8 causes TSH 'ersti"ulatin

• ,lan! ec"es hyperplastic4 rupture! 'essels% scar tissue

$RA9.S 0IS.AS.• :% ;


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malignant tumor o! th)roid

• calcitonin is the tumor mar.er; riseis not s$mptomatic

• am$loid depositionstaining on histo

• small dar8 cells are neuroendocrine

cells

• neurosecretor$ granules on 3=

• ma$ accompan$ the =3 s$ndromes

MEN YNDROME $7.no( these cold8*

• all =3 are A

• MEN 9 $:ermer*, >2s&pituitar$, 2Th, pancreas (adenomas)o problem %=3 suppressor gene

• MEN ;a, ipple s)ndrome: 2Th h$perplasia, pheochromoc$toma, medullar$carcinomath$r (more malignant in ?a)0 adenoma

o

RET oncogene acti'ation• MEN ;-


4/29

=PTH hi,h% &a l r nr"al=nt asrin,% r lsin,% calciu"

="re c""nly seen in chrnic r .SR0

=5%; !ihy!r-y chlecaciferl (9it 0) nt "a!e y !isease! +i!ney

=phsphate is hi,h (R: "eans it cannt e e-crete!)=in!s t &a in seru"% re,isterin, as hypcalce"ia t PTH ,lan!

=further sti"ulates PTH% increase! clastic acti'ity

=renal osteodystrohy

=Osteitis :irsa &ystica=e-tre"e fr" f ste!ystrphy

=ne is cystic% fills ith l!

T.RTIARY HYP.RPARATHYROI0ISM

=ccurs after ;ary hyperPTH=s PTh a!en"a

=pt ith renal failure rec’s transplant% ut PTh has ec"e autn"us an! cntinues t 'ersecrete

=!e'’s pri"ary hyperparathyri!is" (ut ecause ccurs after ;ary% calle! tertiary)

RI&E.TS S.&ON0ARY TO INA0.FUAT. PRO0U&TION O: 9ITAMIN 0 R.SU/TIN$ :ROM /A&E

O: SUNSHIN.=9it3 0 !ef’y=cartila,e prliferates ut cannt ssify (?sft nes@)

=PR.S# rachitic rsary% pi,en reast

=ric+ets can als cause ;ary hyperPTH

ADR!"A# $#A"DADDION DIEAE $Primar) adrenocortical insu>cienc)'cortisol ANDaldosterone de?cit*

• most common cause, autoimm destruction $used to -e T@)

• more common in F

• 'er$ thin bod$ habitus

h)perpigmentation


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• idiopathic h$perplasia of adrenal glands: ACTH lo%

o ACTH le'els %ill be high, glands %ill be h$pertrophic

0ONN YNDROME $Aldosterone+producing adenoma*

• one or both adrenals o'erproduce mineralocorticoids

• ma$ also be a unilateral adenoma

PRE, h)pertension & h)po.alemia5 2er) lo( renin

• most common cause of h$peraldosteronism is bilateral h$perplasia of adrenal

cortices&0T C0s@

OAT &.// &AR&INOMA O: /UN$ GITH M.TASTAT.S TO 1OTH A0R.NA/ $/AN0S

• lun, tu"rs ten! t "et t a!renal ,lan!s

C o! adrenal tissue must -e destro)ed to de2elop h)poadrenalism

P#EO0#ROMO0YTOMA

urinar) metanephrine


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7/29

Note vacuolated cytoplasm (normal, to right)

at surface of mucous membrane.

• $splastic tissue is slo% to mature and thic8ened (to the left)&can 'ar$ from mild

to se'ere based on thic8ness of abnormal cell 's. normal cell la$ers.

• Far left is carcinoma in situ (entire thic8ness is basal la$er homolog$).

• Last stage is in'asi'e carcinoma of cer'i9: penetrates through basement

membraneo f reaches l$mphatic channels, mets to distal sites

•

First 2ap smear at age ?!

.N0OM.TRIOSIS

• en!"etrial e-plants (thru,h fallpian tue) r "etaplasia in a!"inal alls

• ?"enstruatin@2lee!in, f such e-plants can cause peritnitis

• can cause irritatin2scar tissue in peritneu""ay scar fallpian tues

• ,i'en estr,en t re!uce $nRH pr!uctin% !n’t cycle

• if ta+en ff estr,ens fr fertility% feare! c"plicatin > ectpic pre,nancy (!ue t tual scarrin,2+in+in,)

SIMP/. (&YSTI&) HYP.RP/ASIA O: TH. .N0OM.TRIUM

• increase! estr,en sti"ulatin f en!"etriu" > hyperplasia

Simple: cystic hyperplasia, presents as postmenopausal bleeding


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Complex: glandular (adenomatous) hyperplasia; precanceroushistologically, need to !no" the di#erence bet"een cystic andcomplex$adenomatous hyperplasia%

&ndometrial 'denocarcinoma

/.IOMYOMATA• tu"r f s"th "uscle4 ften ccurs in uterus

• respn!s t hr"nal cyclin,4 tends to shrink a,ter menoause

• "ay cause lee!in,

i! ne/t to endometrial ca2it)5 spiral arteries ma) not -e a-le to contract,ma) cause menorrhagia

increased -leeding outside o! menstruation, metrorrhagia

• ?nee! t +n these t r!s t@

A&UT.% SU1A&UT. AN0 &HRONI& IN:/AMMATION O: TH. :A//OPIAN TU1.

• :allpian tue fille! ith pus > pysalpin-

• &ause! y N. gonorrhea, C. trachomatis• Acute PI0# chan!elier si,n

%eared complication, ectopic pregnanc)o Most common cause o! ectopic pregnanc), PID $most common

etiolog) = antecedent in!ection -) 04 trachomatis*• septic arthritis als pssile ith N. gonorrheae

• typical h-# he"rrha,e =B+ after /MP

• rea+!n f hite cells in pysalpin- causes s"tic sellin, f fallpian tue# hy!rsalpin-

H.MORRHA$. 0URIN$ PR.$NAN&Y


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• causes f 5st=tri"ester he"rrha,e# ectpic pre,nancy% "iscarria,e% i"plantatin

• causes f ;n!=tri"ester he"rrha,e# inc"petent cer'i- (t- ith cercla,e)

o "ay e cause! y pre'3 resecte! cer'ical carcin"a in situ

• causes f 7r!=tri"ester he"rrha,e ('ery serius% lar,e l! lss)# placenta pre'ia (placenta 'er

cer'i-)% a-ruptio placentae $separation o! the placenta !rom the uterine(all*J placenta increta2accreta2percreta

o ?phar"acl,ists are ,nna anna +n hy this ccurs@

o 5


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o mets: mucinous c$stadenocarcinoma in o'ar$ cause pseudom$9oma

peritonii: abdomen is 9 higher than FSH (de


11/29

• most common malignanc$ of breast: in?ltrating ductal carcinomao can present (ith -lood) nipple dischargeo if it’s utsi!e the !uct (lular)% it can , utsi!e the reast

• if estr,en= r pr,esterne=receptr psiti'e% etter pr,nsis

#ER;


12/29

• Nodular hyperplasia of prostate

•

MAE REPRO EM@RYOan* become the male repro ducts %hen stimulated

%testosteronea4 e)dig cells5 # sensiti2e

?. Anti+mullerian !actor (ertoli cells5 %# sensiti2e) -loc.s aromatase (nomore con'ersion to estrogens)

a4 -loc.s the de2elopment o! the paramesonephric ly"ph"a f the testes

• CD arise fr" ,er" cells

o /ey!i, cell tu"r

o 0r)stals o! Rein.e, +ectangular, cr$stal-li8einclusions, composed ofprotein, %ith pointed or

rounded ends in theinterstitial cells of the testis(Le$dig cells)

o


13/29

• Sertli cell# "a+es teststerne

o tu"rs in th Sertli an! /ey!i, cells can elarate an!r,ens% estr,ens% r crticsteri!s

• In chil!ren "ay e assciate! ith preccius puerty

• In a!ults "ay e assciate! ith ,ynec"astia

o SEMINOMA OF !E ESES

o

NOT assoc4 (ith increased A%Por h0",

o eminoma

• "etastasi6e t periartic ly"ph n!es

• T-# Re"'in, testis% irra!iatin, periartic

ly"ph n!es

o

o T.RATOMA

• in "ales% all "ali,nant

• ten! t e cystic

• cystic testicular tu"rs > terat"a

o

o $I TRACTo SA/I9ARY $/AN0 TUMORS

• tu"rs further frar! (s"aller ,lan!s) ten! t e "ali,nant

o Pleomorhic Adenoma2 us9 arotid gland

•


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o 'allory(:eiss syndrome

• PR.S# '"itin, l!

• ln,itu!inal tears at unctin f espha,us an! st"ach

• cause! y se'ere '"itin,

• usually self=healin,

o %oerhaave syndrome

• Mallry=Geiss perfratin, ruptureentire all tears

• PR.S# Thracic pain% su5cutaneous emhysema (air ules% epi,astriu"2ler chest)

• sur,ical e"er,ency% usually fatal re,ar!lesso o

o

o Esophageal 6arices

• portal h$pertension or li'er cirrhosis

• can rupture, e9cessi'e bleeding

• 2+3S: hematemesis

• surgeons can band endoscopicall$; used

to be fatal

o @arrett Esophagus

"landular $columnar* metaplasia o! lo(er 9


15/29

o o Helicobacter pylori in,ection

• &""n cause f chrnic ,astritis

• &""n cause f peptic ulcer !isease

o Infla""atin in antru" causes release f

,astrinaci! releaseaci!ificatin f

!u!enu" PU0

• $ra" ne,ati'e r!

• &lni6atin f st"ach increases ith a,e

o &""a shape! acteria ithin superficial

"ucus layer

• Is "ile (has "ultiple fla,ella)

• Pr!uces urease (ith pr!uctin f a""nia)

o enales sur'i'al in 'ery l=pH en'irn"ent

• Pr!uces en!t-in# causes infla""atin in st"ach

an!2r !u!enu"

• Superficial ly"phplas"acytic infiltrate Q2= ly"phi!

fllicles

o Neutrphilic infiltratin f ,lan!s

o

o Chronic Petic Ulcer o, the &tomach

• =ru,al fl!s , ri,ht t e!,e f ulcer (s"th "ar,ins)

• =can perfrate

• =free air un!er !iaphra," n i"a,in,

• =paralytic ileus n auscultatin (!ue t peritnitis)

o STOMA&H N.OP/ASMS

o Poly2 "odule or mass that ro;ects a5ove the level o, the surrounding mucosa9

o "on(neolastic Polys

• Hyperplastic plyps

• :un!ic ,lan! plyps

• u'enile plyps# efre y2a,e% in rectu"% ha"at"atus

• Peut6=e,hers plyps# ccur thru,hut $I tract% ha"art"atus plyp

o assciate! ith increase! cancers NOT in $I tract% ut in ther areas f the !y

o 'alignant Tumors

• ,astric a!encarcin"a# si,net=rin, cells

• /initis plastica# st"ach has ?leather a,@ appearance

• prly !ifferentiate! a!encarcin"a

• !eeply infiltratin,# sprea!s thru,h entire st"ach all

• 'ery "ali,nant% 'ery pr pr,nsis

o

o @ cell+l)mphoma

• Associated %ith H. pylori infection

• B of all gastric malignancies

o "astrointestinal stromal tumor $"IT*

• essentiall$ a smooth-muscle tumor

Positi2e !or c+IT $0D99*'t)rosine .inase mar.er

• +esponsi'e to imatinib (lee'ec&receptor t$rosine 8inase inhibitor) therap$


16/29

o

o PA"CR!A&o PAN&R.ATITIS

o =if a"pulla f 9ater is lc+e!% pancreatic !uct un!er increase! pressure

o Hemorrhagic Pancreatitis

• Alchlis"

o 1in,e !rin+ers# alchl ,ets t !u!enu" in un!ilute! state% urns a"pulla f 9ater

•

1iliary tract !iseaseo S"all ,allstnes can lc+ ile !uct

• Metalic !isr!ers

o Hypertri,lyceri!e"ia# fat "icelles ,et cau,ht in s"all l! 'essels f pancreas

o Hyperparathyri!is"

o Other causes f hypercalce"ia

• 9ascular ische"ia

o Shc+

o Thr"sis

o 9asculitis

• Trau"a

• Infectius# Mu"ps in a!ults

• I!ipathic (5


17/29

• :i'e year sur'i'al rate is nly D

• Pri"arily !isease f the el!erly

• &hrnic pancreatitis "ay e assciate! ith the !e'elp"ent f pancreatic carcin"a

o

o #I1!R o Can tell liver mets 5y multile lesions =unusual ,or rimary to 5e multile0 * central

necrosis

• &entral necrsis > tu"r ut,rin, l! supply

Most sensiti2e indicator o! space+occup)ing lesions in the li2er, increasedal.aline phosphatase

o f al8phos ele'ated, measure gamma glutam$l transferase (T)

o

o If direct>con;ugated 5ili is ele'ate! (type present in urine)# surgical ro5lem

o If uncon;ugated ,raction ele'ate! (as in sic+le=cell crisis)# medical ro5lem

o

o #EREDITARY #YPER@IIRU@INEMIA

• 0rigler+NaQQar $t)pe 9*, FATAL FAC1&A+

• total de


18/29

o #EPATITI @

Onl) hepatitis DNA 2irus

Ris. !or hepatocellular carcinoma, #ep @ & 0

• Can cause inGammation, some can become carriers

• about !, usu $oung F, undergo fulminant li'er necrosis

#epatitis E in a pregnant (oman (ill result in death unless she has a li2ertransplant

o

• H1Sa, ,es up% then !n4 H1Sa ,es up later I,$

• Mar+er present hen neither f the a'e are# I,M H1&a, (cre anti,en)

• H1.a, in!icates presence f 0NA ply"erase2acti'e replicatin

• Hep& test# fr H&a4 7


19/29

o th psiti'e > path,n"nic fr auti"" hepatitis

• Type ;# /i'er2+i!ney "icrs"es (/EM5)# Usually yun, chil!ren

• &hrnic auti""une !isease

• Pre!"inantly affects yun, t "i!!le a,e! "an (K


20/29

0holangiograph) sho(s acharacteristic 7-eaded8appearance due to segmentalstrictures

Progresses to a 7pruned8appearance (ith loss o! ducts

Picture sho(s 7onion s.inthic.ening


21/29

Par.insonian traits $rigidit)5 ata/ia5 tremors5 d)sarthria5 drooling*

• decr. biliar$ copper e9cretion

• incr. urinar$ copper e9cretion

o

o o #EPATO0EUAR0AR0INOMA

mar.er, alpha !etoprotein

• ris8 factors: Hep # C, cirrhosis

• d9 'ia li'er biops$

• 2+3S: cterus of sclera and mucus

membranes, ascites,hepatosplenomegal$

o

o &HO/.&YSTITIS

• "ay ha'e chlelithiasis

• ?:at% fe"ale% frty * fertile@

• stnes "ay e calciu" carnate r iliruin

• ili stnes 'ery s"all% seen in pts ith he"lytic ane"ia (sic+le cell% etc3)

o Acalculous Cholecystitis =?@0• Ten!s t ccur ith !ecrease! l!fl t ,allla!!er

• Mre ften "en (;#5)4 < years

• Usually se'erely ill patients# se'ere trau"a% urns% sepsis% shc+

• Usually acute secn!ary t !irect ische"ic c"pr"ise

o

o I"T!&TI"!o Adhesions formed &y previous a&dominal surgery can form o&structive &ands 'hyperactive &o(el

sounds)

o M.&E./’S 0I9.RTI&U/UM

• presents ith pain in R/F4 ften "ista+en fr appen!icitis

• persistence f "phal"esenteric !uct ('itelline !uct)

• "ay ha'e ectpic ,astric (parietal) cells4 ill praly cause peptic ulcer

o

o 0EIA0 DIEAE

• Allerg$ to proteins in gluten

• 2resence of anti+gliadin and anti+transglutaminase (anti-endom$sial)antibodies

o IgA A-s to transglutaminase portion o! gliadin 'er$ speci


22/29

o INTUU0EPTION

• telescoped small bo%el, %hich can cause infarctionperitonitisdeath

can cause necrosis i! not resected immedicatel)

• most common location: ileum telescopes into cecum

• must be resected

o

o 0I9.RTI&U/ITIS

• acute an! chrnic

• cause# increase! pressure

• "ucsa e'a,inates thru,h the "uscularis here it’s ea+esthere l! 'essels enter

• secretins pl% fr" fci fr pss acterial infectin

• s"eti"es calle! ?left=si!e! appen!icitis@# //F se'ere pain

o

o o A&UT. APP.N0I&ITIS

• Appen!i- ith fecalith ("st c""n cause in

a!ults)

• pe!s "st c""n cause# infectin

o

o IN:/AMMATORY 1OG./ 0IS.AS.

• Ulcerati'e clitis "re c""n than &rhn !isease

• Three a,e=relate! pea+s# early ;


23/29

o o &ROHN 0IS.AS.

• &an in'l'e entire $I tract

'ost common location is in the ileum

• &lestne appearance

• &reepin, fat (?serpi,inus@)# ecause f

scarrin, aln, all f intestine

• ?/ea! pipe@ appearance# trans"ural !isease

(actually in U&MISTAE.)

'ay inter,ere /ith %?8 a5sortion2

megalo5lastic anemia

• Mucsal chan,es

• 1ra! ase! ulcers

• Se,"ental !isease ith s+ip lesins

o MI&ROS&OPI& :.ATUR.S

• Trans"ural infla""atin

• Dee ,issuring ulcers>,istulas# intestine

attaches t a!"inal ca'ity4 penin, t

utsi!e ccurs

$ranulomatous in,lammation =B@ ts0

o

o

o

o

o MEENTERI0 IN%AR0T

• decreased bloodGo% through ? out of

> of intestinal arties: celiac arter$,S=A, =A

• problem is aortic atherosclerosis at

arteries origin

• intestinal angina: eat a meal, then

e9perience intense abd pain• de'elop peritonitis, or distall$ bo%el

necrosis

Man (


24/29

o

o NEOPATI0 POYP, ADENOMA

The onl) potentiall) malignant pol)ps are adenomatouso The rest are non+neoplastic

• ALL are precancerous

• 2ol$ps are masses that proDect abo'e the normal mucosal surface le'el

• 2edunculated: Tubular or 'illous (if papillar$ proDections)

• Sessile

• disco'ered 'ia colonoscop$

• !st colonoscop$ if no FH of colon cancerB6$

• 2re'alence: K 56 $rs (?B); 76 $rs (B6)

o APC =Adenomatous Polyosis Coli0 'UTATIO" IN SPORA0I& &AS.S

.@ o, colorectal carcinomas

• /ss f this ,ene is thu,ht t e the earliest e'ent in a!en"a fr"atin

• 5 c" plyp ith AP& "utatin carries a 5D ris+ f carcin"a in 5< yrs

o A0.NO&AR&INOMA O: TH. &O/ON

• ccurs in si,"i! cln (//F)

• ,rs int all# en!phytic

o presents ith cnstipatin• R/FR=si!e! carcin"as ,r e-phytically (int lu"en)

o present ith irn=!eficiency (hypchr"ic) ane"ia

• pe!unculate! a!encarcin"a presents as apple=cre lesin

o

o 0AR0INOEM@RYONI0 ANTI"EN $0EA*

erum tumor mar.er positi2e in +C o! colorectal carcinomas

• ncreased in pts %ith mucin-secreting tumors

• 3le'ated in cirrhosis, hepatitis, inGammator$ bo%el disease, smo8ers

• 2reoperati'e le'els related to tumor burden

•

2ersistent ele'ation post-op ma$ indicate residual tumor• +ising le'els post-op ma$ indicate recurrencemetastasis

o

o INH.RIT.0 :ORMS O: &O/OR.&TA/ &AR&INOMA

o 6amilial Adenomatous Polyosis =6AP0

• AP& (a!en"atus plypsis cli) ,ene

• Ras * TP7 are als assciate!

• Auts"al !"inant cn!itin

• Ris+ f !e'elpin, cln cancer is 5


25/29

o hM#; ? 76

o hM#9 > >B

o hPM9 ? B

o hPM; J B

• Tend to occur on + side of colon

• B-F4 is not e/ecti'e in these patients

• etter prognosis than tumors that arise 'ia the A2C path%a$

• H2CC: ?-B of all colorectal cancer

• Assoc. %L$nch s$ndrome

• =icrosatellites: fragments of repeat seuences in the human genome

• =utations in the mismatch repair genes result in the perse'erance of microsatellites

• Some of this occurs in the areas of suppressor genes or oncogenes

o

o L1CH S1+0=3 (H2CC)

Autosomal dominant

Earl) onset colon cancer

Association (ith e/tra+colonic cancers, Endometrium5 o2ar)• +ight-sided lesion

• 4reter• Small intestine, stomach, hepatobiliar$ tract

• Turcot s)ndrome, L$nch s$ndrome plus glioblastoma multiforme (=)

o

o

o 'ICRO%IO#O$Yo . ducreyi , pain!ul ulcers


26/29

• Ha'e a uniue de'elopmental c$cle (reticulate bod$ " intracellular; elementar$

bod$ " infectious).o :hat 0hlam)dia trachomatis loo.s li.e under microscope,

• 0bligate intracellular bacterium

0ften does not gram stain o #o( it gro(s in the -od) 2s4 ho( it is cultured,

• =ust culture %ithin a cell line; %ont gro% on their o%n in agar

o

o #P6 t)pe responsi-le !or MOT cer2ical cancers, #P69

o

o :hich -ug causes septic arthritis that can -e cultured !rom the Qoint "onorrhea

"ram stain, man) "ram+negati2e diplococci inside o! se2eralpol)morphonuclear leu.oc)tes4

Pili are the most important 2irulence !actor necessar) !or thisorganism to initiate in!ection4

• eisseria gonorrhoeae gro% on Tha$er-=artin agar, are o9idase positi'e and utili*e

glucose.

o

o Intestinal parasites,

• Trichinella spiralis from undercoo8ed por8 (%orms in gut, c$sts in muscles)

• Tremotodes


27/29

• ouble-stranded, linear A genome

• +eplicates in nucleus

• Malac$clo'ir is most e/ecti'e for the treatment of herpes simple9 'irus infections.

o Ac$clo'ir 0+ Famciclo'ir 0+ Malac$clo'ir

o ucleoside analogs, inhibit 'iral A pol$merase

o +esistance to ac$clo'ir in'ol'es mutation of th$midine 8inase or A

pol$merase

• +eacti'ation of herpes 'iruses infections ma$ be caused b$ 4M, fe'er and stress.

• 2regnant %oman %acti'e infection must ha'e C-section (ris8s of neonatal herpes

encephalitis and death)o

o Enterohemorrhagic &scherichia coli $9K,#*

• Foodborne illness that presents %ith hemol$tic uremic s$ndrome is most li8el$associated %ith this

o

o line,elters +E FFY# :SH ele'ate!% teststerne l

o Prader+:illi, ghrelin5 cr$ptorchidism, h$pogonadism

o Turners 7 +B F@ (usually)#

o

o

o

o POPU#ATIO" H!A#TH

5 Relative Risk =AA Risk Ratio02 Ris+ f a !isease in ne ,rup ith a certain factr (i3e3 s"+ers an!

lun, cancer)% c"pare! t the ris+ in a ,rup ithut that factr (i3e3 nn=s"+ers)3a If the RR is ;3K% then the praility that s"+ers ill !e'elp lun, cancer is ;3K ti"es ,reater

than the praility that nn=s"+ers ill !e'elp lun, cancer3

A hi,h RR ?su,,ests@ a causal relatinship eteen the factr an! the !isease3c RR is use! ith chrt stu!ies% ut NOT case=cntrl stu!ies (case=cntrl stu!ies ! nt !eal

ith inci!ence)3

! A 'alue > 5 su,,ests n relatinship eteen the e-psure an! the !isease4 'alue 5 su,,ests acausati'e effect4 'alue 5 su,,ests a prtecti'e effect3

e RR 7 incidence rate among eincidence rate among non(e=aG50 > c>=cGd0 7 @9@?> @9@?B 7 ?98-E

o

8 Relative Risk Reduction2 Anther ay t e-press treat"ent effects3 Change in the risk o, those in thetreatment grou4 relative to those in the control grou =lace5o09

a Usually e-presse! as a percent3

5 $reater the RRR4 the more e,,icacious the theray9

c If nu"er is ne,ati'e% there is a ?relati'e ris+ increase3@

d %e a5le to interret /hat the RRR means in /ords =look at PHP slide0

e RRR 7 ?(RR < ?@@

f or RRR > (c2cQ!) J (a2aQ)V 2 (c2cQ!) - 5


28/29

7 A5solute Risk2 Inci!ence f a !isease in a certain ppulatin f e-pse! in!i'i!uals3 In!icates the"a,nitu!e f ris+ in a ,rup f peple ith a certain e-psure3 0es nt ta+e int cnsi!eratin the ris+

f !isease in nn=e-pse! in!i'i!uals3 0es nt in!icate hether the e-psure is assciate! ith an

increase! ris+ f the !isease3 AR 7 J o, ne/ cases in the etotal J o, e


29/29

o

$r

o De,inition o &uggestions ,or ractice

utei,h the enefits

o

I

o The USPSTF concludes that the current

evidence is insuicient to assess the balance o

beneits and harms o the service! evidence is

lac"ing# o poor $uality# or conlicting# and the

balance o beneits and harms cannot be

determined

o I oered# patients

should understand the

uncertainty about the

balance o beneits and

harms

o

o

o

o

o

o 'ICROCYTIC A"!'IA

o Iron De,iciencyAnemia =most common0hyochromic

o Ane"ia f &hrnic 0isease

o Si!erlastic Ane"ia

o /ea! Pisnin,

o 'ACROCYTIC A"!'IA

o 'egalo5lastic 'acrocytic Anemia =inhi5ition o, D"A synthesis in red 5lood cell

roduction0

o

1itamin %?8 De,iciency =Pernicious Anemia0o :late 0eficiency (ften Alchl relate!)

o "on(megalo5lastic 'acrocytic Anemia

o Alchl Ause

o Hypthyri!is"

o He"lytic2Pst=he"rrha,ic Ane"ia

o Ostructi'e aun!ice

o

erg review

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