User:TransShanley State

Tonic-Clonic Seizure: generalized seizure affecting entire brain-->most commonly associated with epilepsy

Postictal: time period referring to POST-seizure

Micturition: urination

ecthyma gangrenosum: infection of skin by pseudomonas aeuruginosa; usually occurs in px whois ill or immunocompromised; see round/oval redness of skin with necrotic center (DO NOT GOOGLE IMAGE! VERY DISTURBING... Chris: Of course since you said not to google image, I HAD to. I confirm that it's pretty disturbing. )

Ganciclovir: antiviral medication used to treat cytomegalovirus (herpes family) infxns. Works as a competitive inhibitor, preventing addition of dGTP by viral dna pol.

Clostridium difficile colitis: gram positive bacteria; antibiotic-associated diarrhea and can lead to infection of the colon by pseudomembranosus colitis. This is normally found in gut, but becomes a problem when it overgrows→release toxins that cause bloating, constipation, diarrhea, with ab pain

tenofovir: antiretroviral drug-->nucleotide analogue reverse transcriptase inhibitors blocking reverse transcriptase; can cause acute renal failure, proteinuria, tubular necrosis due to accumulation of drug in proximal tubule.

emtricitabine: nucleoside reverse transcriptase inhibitor (usu. taken w/ tenofovir); like tenofovir can cause diarrhea, headache, nausea, rash

ritonavir: protease inhibitor; frequently prescribed with HAART

tipranavir: nonpeptidic protease inhibitor; administered w/ ritonavir; can inhibit replication of viruses already resistant to other protease inhibitors

enfuvirtide: HIV fusion inhibitor; disrupts HIV molecular machinery at final stage of fusion w/ target cell thus preventing uninfected cells from being infected

cytomegalovirus retinitis: related to herpes virus and is present in almost everyone. Normally immune system can fight virus, but immunocompromised individuals unable to fight virus. Most common type of virus infecting HIV px and can cause damage to retina (as well as rest of body)

polyradiculopathy: diffuse root involvement (ahh, remember limbs exam in POM?) inflammatory disorder that affects peripheral nerves and spinal nerve roots.

Kaposi's sarcoma: tumor caused by human herpesvirus 8 (HHV8)

squamous cell carcinoma: malignant tumor of squamous epithelium, can occur in different organs including skin, lips, mouth, esophagus, urinary bladder, prostate, lungs, vagina, cervix (any organ w/ squamous epithelium)

orthostatic hypotension: aka postural hypotension b/c this hypotension occurs when a person stands up, usually after a prolonged period of rest.

Dapsone: an antimicrobial agent used to treat leprosy and dermatitis herpetiformis. Commonly used in combination with rifampicin and clofazimine as multidrug therapy (MDT) for the treatment of Mycobacterium leprae infections (leprosy).

Fluconazole: an antifungal drug used in the treatment and prevention of superficial and systemic fungal infections

Gabapentin: an anticonvulsant dru. GABA analogue. It has been originally developed for the treatment of epilepsy, and currently, gabapentin is widely used to relieve pain, especially neuropathic pain (Neuropathic pain=Neuralgia is an acute paroxysmal pain radiating along the course of one or more nerves usually without demonstrable changes in the nerve structure).

Clonazepam: a benzodiazepine, It is a highly potent anticonvulsant (Because of its strong anxiolytic and anticonvulsant properties), muscle relaxant and anxiolytic. used especially as an anticonvulsant in the treatment of epilepsy. Clonazepam's primary mechanism of action is via modulating GABA function in the brain

Trazodone: psychoactive compound with sedative, anxiolytic(antianxiety agen), and antidepressant properties. Trazodone has less prominent anticholinergic (dry mouth, constipation, tachycardia) and adrenolytic (hypotension, male sexual problems) side effects than most tricyclic antidepressants. trazodone is chemically and pharmacologically distinct from tricyclic antidepressants and tetracyclic antidepressants. Trazodone is not a selective serotonin reuptake inhibitor (SSRI) and its antidepressant effects may be due to its antagonistic effects at 5-HT2 receptors.

folate/ folic acid: vitamine B complex that is required for normal production of red blood cells, that is used especially in the treatment of nutritional anemias, and that occurs especially in green leafy vegetables, liver, kidneys, dried beans, and mushrooms. This occur naturally in the food and can also can be taken as supplements

Citalopram: is an antidepressant drug used to treat major depression associated with mood disorders. It is also used on occasion in the treatment of body dysmorphic disorder and anxiety. It belongs to the SSRI class of drugs

Fludrocortisone: is a synthetic corticosteroid with moderate glucocorticoid potency and much greater mineralocorticoid potency. Used in the treatment of cerebral salt wasting, used to replace the missing hormone aldosterone in various forms of adrenal insufficiency such as Addison's disease and the classic salt wasting (21-hydroxylase deficiency) form of congenital adrenal hyperplasia, and first line of treatment for orthostatic intolerance.

Orthostatic intolerance: a disorder of the autonomic nervous system occurring when an individual stands up. Orthostatic intolerance occurs in humans because standing upright is a fundamental stressor and requires rapid and effective circulatory and neurologic compensations to maintain blood pressure, cerebral blood flow, and consciousness.

Nelfinavir : is an antiretroviral drug used in the treatment of the human immunodeficiency virus (HIV). Nelfinavir belongs to the class of drugs known as protease inhibitors (PIs) and like other PIs is generally used in combination with other antiretroviral drugs. It can induce symptomatic junctional bradycardia.

Juctional bradychardia syndrome: ??

Sinus arrest: A pause or cessation of cardiac sinus pacemaker activity. It may in healty individuals or may occur with increased vagal tone, myocarditis, MI, and digitalis toxicity. If the pause is prolonged, escape beats may occur. Normal QRS, normal rate, normal P if present, normal conduction. Rhythem is regular and the length of the pause is not a multiple of the sinus interval.

Cachectic: Having cachexia, physical wasting with loss of weight and muscle mass due to disease. Patients with advanced cancer, AIDS, and some other major chronic progressive diseases may appear cachectic. Cachexia is a wasting syndrome that causes weakness and a loss of weight, fat, and muscle. Anorexia (lack of apppetite) and cachexia often occur together. Cachexia can occur in people who are eating enough, but who cannot absorb the nutrients. Cachexia is not the same as starvation. A healthy person's body can adjust to starvation by slowing down its use of nutrients, but in cachectic patients, the body does not make this adjustment.

Pronator drift: refers to a pathologic sign seen during a neurological examination and indicates spasticity (muscular hypertonicity), which is due to an upper motor neuron lesion. The person is asked to extend their arms 90 degrees, supinate their forearms, close their eyes and hold the position. If a forearm pronates the person is said to have pronator drift on that side.

Troponin 1: Troponin tests are primarily ordered for people who have chest pain to see if they have had a heart attack or other damage to their heart. Either a troponin I or a troponin T test can be performed; usually a laboratory will offer one test or the other. Troponins are sometimes ordered along with other cardiac biomarkers, such as CK–MB or myoglobin. However, troponins are the preferred tests for a suspected heart attack because they are more specific for heart injury than other tests Normally, cardiac troponin levels are so low that they cannot be measured. Even slight elevations may indicate some degree of damage to the heart. When a patient has significantly elevated troponin concentrations, then it is likely that the patient has had a heart attack or some other form of damage to the heart. When a patient with chest pain and/or known stable angina has normal troponin values, then it is likely that their heart has not been injured.

T-wave (flattening): The T wave represents the repolarization (or recovery) of the ventricles. Inverted (or negative) T waves can be a sign of coronary ischemia, Wellens' syndrome, left ventricular hypertrophy, or CNS disorder. Tall or "tented" symmetrical T waves may indicate hyperkalemia. Flat T waves may indicate coronary ischemia or hypokalemia

D-dimer: fibrinogen degradation factor; positive test considered a nonspecific finding because may indicate significant clot formation and breakdown, or infection, heart disease, liver disease, cancer, recent surger, and other conditions

PR Interval: the time (seconds) from the beginning of the P wave (onset of atrial depolarization) to the beginning of the QRS complex (onset of ventricular depolarization). The normal PR interval duration range is from 0.12 sec - 0.20 sec, measured from the initial deflection of the P-wave to the initial deflection of the QRS complex. The PR interval is longer with high vagal tone. A prolonged PR interval can correspond to impaired AV node conduction.

pulsus paradoxus: an exaggeration of the normal variation in the pulse during the inspiratory phase of respiration, in which the pulse becomes weaker as one inhales and stronger as one exhales. It is a sign that is indicative of several conditions including cardiac tamponade, pericarditis, chronic sleep apnea, croup, and obstructive lung disease

(infective) endocarditis: an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves (native or prosthetic valves). Endocarditis is characterized by a prototypic lesion, the vegetation, which is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells.

cardiac tamponade: also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium (the sac in which the heart is enclosed), significantly elevating pressure on the heart, preventing the heart's ventricles from filling properly. Leads to a low stroke volume and ineffective pumping of blood, shock, and often death.

constrictive pericarditis: occurs when a thickened fibrotic pericardium, of whatever cause, impedes normal diastolic filling.

pericardial knock: a loud 3rd heart sound (relatively high pitch, often ↑ in intensity with inspiration)occurring when the ventricular filling abruptly stops at the end of the early diastolic pressure dip– ie, at the end of the rapidly filling phase of the ventricles; classically associated with severe constrictive pericarditis, or with penetrating trauma to the pericardium

heparin: a highly-sulfated glycosaminoglycan, an injectable anticoagulant; produced naturally by basophils and mast cells. Prevents formation of clots and extension of existing clots within the blood. Does not break down clots that have already formed (unlike tissue plasminogen activator).

enoxaparin: is a low molecular weight heparin in subcutaneous injection form. Anticoagulant effect of enoxaparin can be directly correlated to its ability to inhibit factor Xa. Factor Xa catalyzes the conversion of prothrombin to thrombin, so enoxaparin’s inhibition of this process results in decreased thrombin and ultimately the prevention of fibrin clot formation.

protein S: is a vitamin K-dependent plasma glycoprotein synthesized in the liver… Role in the anti coagulation pathway: functions as a cofactor to Protein C in the inactivation of Factors Va and VIIIa. Protein S deficiency is a rare blood disorder which can lead to an increased risk of thrombosis.

factor V: a protein cofactor involved in clot formation. Allows factor X to activate an enzyme called thrombin. Thrombin in turn cleaves fibrinogen to fibrin, which polymerizes to form the dense meshwork that makes up the majority of a clot. Activated protein C is a natural anticoagulant that acts to limit the extent of clotting by cleaving and degrading factor V.

factor V Leiden: is the name given to a variant of human factor V that causes a hypercoagulability disorder. The Leiden variant of factor V cannot be inactivated by activated protein C.

cardiolipin: an important component of the inner mitochondrial membrane, It serves as an insulator and stabilizes the activity of protein complexes important to the electron transport chain.

anticardiolipin antibodies: Anti-cardiolipin antibodies (ACA) are antibodies often directed against cardiolipin and found in several diseases. Patients with anti-cardiolipin antibodies (Antiphospholipid syndrome) can have recurrent thrombotic events even early in their mid-late teen years. These events can occur in vessels where thrombosis may be relatively uncommon, such as the hepatic or renal veins. It has recently been proposed that antibodies to HIV cannot be easily made by humans because certain HIV antigens too closely resemble cardiolipin. Thus, anti-HIV antibodies would not be made by the immune system because they can induce autoimmune disease.

idiopathic: is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause.

warfarin: is an anticoagulant (vitamin K antagonist) that prevents thrombosis and embolism

saddle embolism: A straddling embolism at any vascular bifurcation, e.g., of the aorta which occludes both common iliac arteries.

McConnell's sign: In Echocardiography - finding of akinesia of the right ventricle mid-free wall but normal motion of the apex. This phenomenon has a 77% sensitivity and a 94% specificity for the diagnosis of acute pulmonary embolism. (also explained in article)

alteplase: a tissue plasminogen activator (tPA). Helps to break down unwanted blood clots.

---

Needle in the Haystack-----------------------

Hemoptysis: coughing up of blood or of blood-stained sputum from the bronchi, larynx, trachea or lungs; may be due to bronchitis or pneumonia, lung neoplasm, can be due to over anticoagulation from treatment by drugs such as warfarin

Lorazepam: benzodiazepine drug w/ short to medium duration of action; anxiolytic, amnesic, sedative/hypnotic, anticonvulsant, muscle relaxant. Used primarily for anxiety; hi addictive potential.

Mirtazapine: antidepressant for treatment of moderate to severe depression. Side effects of drowsiness and weight gain

S4 heart sound: . If the ventricle is stiff and non-compliant, as in ventricular hypertrophy due to long-standing hypertension, the pressure wave generated as the atria contract produces an S4

Pericardial effusion: fluid around heart, accumulation of fluid in pericardial cavity→increased intrapericardial pressure can lead to cardiac tamponade. CAUSES: pericarditis, viral infection, cancer, inflammatory disorders, kidney failure w/ excessive BUN levels.

Cardiac tamponade: emergency condition in which fluid accumulates in pericardium; it can prevent ventricles from filling properly→low SV→shock→death DIAGNOSIS: beck’s triad: hypotension, JVP, muffled heart sounds. Also see: pulsus paradoxus, ST segment changes, signs of shock. Radiography will show enlarged pericardium or collapsed ventricles, chest x-ray→large globular heart. DDX include tension pneumothorax and acute heart failure.

Perihilar: pertaining to the thorax

Furosemide: loop diuretic to treat CHF and edema, hypertension; inhibits the Na-K-2Cl transporter in thick ascending limb of loop of henle.

Metroprolol: slective B1 receptor blocker to treat diseases of cardiovascular system, esp. HPN.

Vasculitis: refers to heterogeneous group of disorders characterized by inflammatory destruction of bv→arteries(arteritis) and veins (phlebitis); due to leukocyte migration; causes unknown, usually w/ an immune component, so usually the antibody found is used for classification, ie: ANCA-associated vasculitides.

Glomerulonephritis: (GN) inflammation of glomeruli or small bv in kidneys; may present w/ isolated hematuria and/or proteinuria; or as actual renal failure or chronic renal failure. Primary causes are intrinsic to kidneys, secondary causes are association w/ infections, drugs, systemic disorders or cancer.

Hematuria: presence of RBC in urine; sign of tumor, kidney stone; if WBC present→urinary tract infection.

Papilledema: optic disc swelling caused by incr. intracranial pressure; usually bilateral and can occur over a period of hours to weeks.

Myeloma: cancer of plasma cells; symptoms may be: elevated calcium, renal failure, anemia, bone lesions

COX-2 inhibitor: form of nonsteroidal anti-inflammatory drugs (NSAIDs); COX-2 is an ez responsible for inflammation and pain.

Hydronephrosis: distension and dilation of renal pelvis and calyces, usu. Caused by obstruction of the free flow of urine from the kidney→progressive atrophy of kidney. SYMPTOMS: acute obstruction causes intense pain, raised creatinine and electrolye imbalance, elevated urine pH due to destruction of nephrons; enlarged kidney may be palpable

Oliguria: decreased production of urine (anuria is absence of urine prodxn); may be a sign of dehydration, renal failure, or urinary obstruction/urinary retention.

Arthralgia: joint pain; symptom of injury, infection, illness or allergy to medication

Antinuclear antibodies (ANA): ab against cell nucleus, usually occurs in autoimmune condition. Hi titer may indicate SLE, viral infections, liver disease,

Focal segmental glomerulosclerosis (FSGS): disease that affects kidney fxn by attacking glomeruli; glomerulosclerosis refers to the scarring of the tiny bv w/in kidney. Symptoms: proteinuria, hematuria, hypoproteinemia (low blood protein), edema, inefficient filtering of wastes from blood.

Azotemia: aNL levels of nitrogen containing compounds such as urea, creatinine in the blood due to insufficient filtering of blood by kidneys. Prerenal azotemia is due to decr. CO.

Atheroma: accumulation and swelling in artery walls that is made up of cells (macrophage), cell debris that contain lipids, calcium, and fibrous c.t

Atheroembolism: occurs when cholesterol is released and travels in bloodstream, blocking blood vessels. Skin symptoms, gangrene, renal failure, fever, muscle ache, weight loss. Diagnosis involves biopsy; may be due to anticoagulant medication

Livedo reticularis: lace-like purplish discoloration of lower extremities , usu. Vascular disorder affecting women

Hypocomplementemia: condition of absent or suboptimatl functioning of one of the complement system proteins

Urinary casts: cylindrical aggregations of particulate matter that form in the distal nephron, dislodge and eventually pass into urine; form via precipitation of tamm-horsfall mucoprotein which is secreted by renal tubule cells, and also sometimes by albumin n condtions of proteinuria. Formation favorable in conditions of protein denaturation/precipitation: low flow, concentrated salts, low pH. GRANULAR: second most common type

Uremia: illness accompanying kidney failure, in particular the nitrogenous waste products; symptoms include anorexia, lethargy, late symptoms: decreased mental acuity and coma

---

BAck To bAsics

nephrolithiasis: big fancy worth for f-in' kidney stones

skin turgor: an abnormality in the skin's ability to change shape and return to normal (elasticity); used to assess degree of dehydration or fluid loss. Grasp skin so it is tented up: normal skin will snap back, skin with decreased turgor will slowly return to its position.

prophylaxis: is any medical or public health procedure whose purpose is to prevent, rather than treat or cure a disease. Roughly, prophylactic measures are divided between primary prophylaxis (to prevent the development of a disease) and secondary prophylaxis (whereby the disease has already developed and the patient is protected against worsening of this process).

Magnesium gluconate: is used to treat low blood magnesium. Low blood magnesium is caused by gastrointestinal disorders, prolonged vomiting or diarrhea, kidney disease, or certain other conditions. Certain drugs lower magnesium levels as well.

_________________________________________________________________________________________________________________________________________________________

Clinical Problem Solving: Island Intruder

Dilantin- (Phenytoin sodium) antiepileptic drug, acts by dampening unwanted, runaway brain activity seen in seizure by reducing electrical conductance among brain cells; it stabilized inactive stage of voltage gated sodium channels.

Hemiplegia- condition in which one half of patient's body is paralyzed; more severe than hemiparesis (weakening of one half of the body).

Anaplasia- lack of differentiation; characteristic of malignant neoplasm.

Pilocytic- made up of cells that look like fibers when viewed under micrcoscope.

Stereotactic- refers to precise positioning in 3-d space; in stereotactic needle biopsy, spot to be biopsied is located 3-dimensionally, info entered on computer which calculates ino and positions a needle to remove biopsy sample.

temozolomide- oral alkylating agent to treat grade IV astrocytoma; epigenetic silencing of MGMT gene which encodes a protein that removes alkyl groups from the O-6 position of guanine.

Procarbazine- antineoplastic chemotherapy for treatment of hodgkins lymphoma and certain brain cancers such as glioblastoma; alkylating agent; metabolized and activated in liver.

Lomustine- alkylating nitrosourea compound used in chemo; highly lipid soluble drug that can cross blood brain barrier so it is ideal for treating brain tumors (its primary use).

Vincristine- mitotic inhibitor used in cancer chemo. Binds to tubulin dimers to prevent assembly of microtubule structures (thus preventing mitotic spindle); cell is arrested in metaphase of mitosis.

Lateral decubitus- act of lying down

Remifentanil- potent ultra short-acting synthetic opioid analgeis drug; given during surgery to relieve pain and as adjunct to an anesthetic.

Mayfield frame- device used to hold head in craniotomy

Pterional-

Dexmedetomidine- sedative used by intensive care units and anesthesiologist; provides sedation without respiratory depression (unique feature).; agonist of alpha 2 receptors in certain parts of brain.

Propofol- short acting IV sedative used for induction of general anesthesia, maintenance of gen. anesthesia; provides no analgesia.

lenticulostriate perforators- end artery meaning it is the only artery supplying oxygenated blood to a portion of a tissue; the arteries originate from the middle cerebral artery, enter the underside of brain to supply basal ganglia

indolent- causing little or no pain

p53- remember that this is a tumor suppressor gene, plays role in cell cycle regulation

hyperchromasia- abundance of DNA that stains darkly, indicative of malignancy