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Rachel Salas, M.D.


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Demonstrate detailed knowledge of the basic pathology and pathophysiology of diseases of the brain infection you get in hospital purchase floxin 400mg overnight delivery, spine antibiotics lyme disease buy floxin 200mg without a prescription, and head and neck infection pus buy cheapest floxin and floxin. Learn the pathophysiology of rapidly evolving processes quotation antibiotic resistance 400mg floxin overnight delivery, in particular cerebral infarction and inflammation antibiotic resistance ks3 discount floxin 200 mg otc. Learn how to combine pulse sequences to produce effective and efficient imaging protocols for common disease processes infection elbow best buy floxin. Demonstrate detailed knowledge of the signal intensity behaviors of hemorrhage, fat and calcium. Demonstrate ability to identify and characterize focal lesions and diffuse processes and be able to provide a short differential diagnosis for the potential causes of these processes. Demonstrate detailed knowledge of the neoplastic masses arising in the orbit, skull base, petrous bone and soft tissues of the neck. Be able to use anatomic classification schemes to accurately describe the location of mass lesions. Become familiar with findings on all three modalities that allow for accurate spatial localization of spinal lesions (extra-dural, intra-dural, extra-medullary, and intra-medullary). Demonstrate ability to identify and differentiate discogenic and arthritic degenerative diseases. Demonstrate detailed knowledge of the indications, limitations, risks and benefits for each technique used for visualization of vascular anatomy and pathology. Demonstrate detailed knowledge of the imaging appearance of aneurysms, vascular malformations, occlusive diseases and vascular tumors. At the end of the rotation, the resident should be able:to obtain informed consent for invasive procedures including angiography, spinal punctures/ myelography and image-guided biopsies, and be able to explain the risks, benefits and complications of these procedures to patients and their families. Residents are responsible for appropriate follow-up of patients after performing procedures, including assessing for complications, appropriateness of discharge, handling of specimens, and tracking the results of fluid /tissue samples/biopsies. At the end of the rotation, the resident should be able to perform basic spine interventions, under close supervision by neuroradiology attending and/or fellow. Decision making/Value judgment skills, Second Rotation At the end of the rotation, the resident should be able to: 24. Demonstrate lesion recognition and appropriate differential diagnosis based on specific anatomic locations: skull base, sella, cortical, subcortical, parenchymal, sub ependymal and ventricular lesion locations. Demonstrate proficiency in lesion localization by neck spaces, applying appropriate classification schemes for location and differential diagnosis of neck congenital, inflammatory and neoplastic mass lesions. Demonstrate ability to recognize and localize spinal lesions in correct spinal compartments: extra-dural, intra-dural, extra-medullary, and intra-medullary. Be able to identify and differentiate discogenic and arthritic degenerative diseases. Demonstrate knowledge and correct application of the indications, limitations, risks and benefits for each technique used for visualization of vascular anatomy and pathology. Demonstrate knowledge and correct application of the angiographic appearance of aneurysms, vascular malformations, occlusive diseases and neoplasms. Technical and Non-interpretive Objectives, Third Rotation: At the end of the rotation, the resident should be able to: 12. Demonstrate ability to obtain informed consent for invasive procedures including angiography, spinal punctures/myelography and image-guided biopsies. Be able to explain the risks, benefits and complications of these procedures to patients and their families. Participate in the performance of diagnostic angiograms of the cervical and cranial vessels. Assist senior residents, fellows, and attending neuroraadiologists in the performance of angiograms. Demonstrate knowledge of the technical aspects and perform fluoroscopically guided punctures of the lumbar spinal canal for the purpose of spinal fluid collection, myelography and intrathecal injection of medications. Decision making/Value judgment Skills At the end of the rotation, the resident should be able to: 16. Demonstrate a detailed knowledge of anatomy, able to identify subdivisions and fine anatomic details of the brain, the ventricles, subarachnoid space, vascular structures, sella turcica, and cranial nerves; be able to identify all important extraand intra-cranial arteries (secondary and tertiary branches of the carotid and basilar arteries) and veins (cortical and deep cerebral veins) on all imaging modalities. Demonstrate appropriate image interpretation skills to differentiate different types of focal intracranial lesions (neoplastic, inflammatory, vascular) based on anatomic location. Demonstrate appropriate image interpretation skills to differentiate diffuse intracranial abnormalities. Demonstrate appropriate image interpretation skills to identify patterns of disease spread within and between areas of the head and neck. Demonstrate appropriate image interpretation skills to differentiate spinal inflammatory and neoplastic lesions. Demonstrate knowledge of the imaging features of intraspinal processes, including syringomyelia, arachnoiditis and spinal dysraphism, post-surgical and other treatment-related findings. Demonstrate appropriate knowledge to identify and differentiate acquired lesions (traumatic, ischemic, inflammatory and neoplastic) of the newborn, infant, child, and adolescent. Technical and Non-interpretive Objectives, Fourth Rotation: At the end of the rotation, the resident should be able to: 10. Evaluate the clinical status of patients prior to , during and after neuroradiology procedures; learn to recognize complications of these procedures and to initiate appropriate treatment. Be able to perform image-guided biopsies of the spine and skull base under the supervision of an attending radiologist. Residents are responsible for appropriate follow-up of patients after performing procedures, including assessing for complications, appropriateness of discharge, handling of specimens, and tracking the results of fluid/tissue samples/biopsies. Decision making/Value judgment skills, Fourth Rotation: At the end of the rotation, the resident should be able to: 12. Learn to identify those cases that require the additional expertise in assessment of imaging studies. Assume a leadership role and be able to apply your full diagnostic skills to the daily neuroradiologic case load work up. Attempt to perform at the level of an independent practitioner, with attending the neuroradiologist acting as your consultant. After a completion of intermediate rotation the resident should be familiar with all procedures performed in nuclear medicine. Pucar, Williams, Sostre and McCue Rotation 1: Nuclear Medicine Knowledge Based Objectives: At the end of the rotation, the resident should be able to: 1. Comprehend basic concepts of nuclear tracers and imaging and nuclear medicine physics. Participate in outpatient and inpatient therapies: obtain history and physicals, informed consent, assisting/supervising therapy. Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be able to: 11. Rotation 2: Nuclear Medicine Knowledge Based Objectives: At the end of the rotation, the resident should be able to: 13. Confidently conduct out patient and inpatient therapies: obtain history and physicals, informed consent, and conduct therapy under supervision. Participate/supervise daily clinical work with a degree of independence as determined by faculty. Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be able to: 24. Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be able to: 38. Rotation 4: Nuclear Medicine Knowledge Based Objectives: At the end of the rotation, the resident should be able to: 40. Attend lectures/conferences, expand concepts, applications, and comparisons with other diagnostic methods. The chief of the section or assignee will review the evaluation with the resident near the last day of the rotation. Repetition of simple facts and characteristics contained in standard references is not the best use of lecture time. Rather lectures expand on concepts, applications, and comparisons with other diagnostic methods. A generous use of examples that demonstrate strengths and limitations of the procedures is encouraged, as well as a review of specific radiopharmaceuticals in each area. These are defined in the Resident Manual and further clarified in the assigned readings and other learning assignments for each specific rotation. Technique and bedside manner are especially important since there may be two or more patients during the examinations as well as family of the patient(s). Do in-depth reading and studying order to become knowledgeable about the normal anatomy and physiology of the pregnant and non-pregnant female pelvis and the normal and abnormal developing intrauterine pregnancy as well as the presence of ectopic pregnancy, in order to gain a general understanding of the sonographic appearance of congenital or other disease entities, their clinical presentations, and current modes of treatment as well as accurate differential diagnosis. The resident should obtain a copy of the daily work schedule at each work location and explicitly note whether he/she observed the examination/procedure, performed the examination/procedure or was not present. In the unusual case of a substandard performance, this will be brought to the attention of the Radiology Residency Program Director and the resident for further counseling. Devoe, review of articles and PowerPoint presentations and other relevant educational opportunities. He/she must read the basic required literature and PowerPoint presentations beginning on st the 1 day of the rotation, and actively review and select applicable material from the books and other related st resources. It is especially critical to read the 1 two chapters of Nyberg as early as possible (available on. Issues and procedures pertaining to fertility, loss of fertility or restoration of fertility in the female patient. Understand the normal and abnormal sonographic appearance of intrauterine pregnancy during all stages of gestation as well as the genesis and detection of ectopic pregnancy. Fetal anatomy and physiology will be broadly divided into one-week segments concentrating on the head, chest, abdomen/pelvis and the extremities. The existing educational goals and resources may be utilized, with additional texts or online materials as needed. The resident will increase his/her expertise in selected areas of knowledge pertaining to the sonographic appearance of the normal and abnormal female pelvis, in the gravid and non-gravid states, and the sonographic appearance of intrauterine pregnancy during all stages of gestation as well as the genesis and detection of ectopic pregnancy. Helfgott (Tuesday) 69 7/30/2013 Pediatric Radiology Rotation Goals and Objectives Submitted by: Dr. The specific goals include objectives required for every level of training with graded supervision by the attending faculty. All aspects of Pediatric radiology will be incorporated into the rotation, except pediatric neuroimaging, nuclear medicine, and interventional procedures which will be incorporated in other sections. At the start of every working day, the resident should be familiar with the patient schedule and anticipate needs for any procedures. The resident will check requisitions to evaluate for appropriateness of the requested procedure or if additional exams/protocol needs to be performed. Requests lacking clinical indication or seemingly inappropriate requests will be clarified and discussed with referring physician. The resident assigned to Pediatric Radiology is expected to be available for consultation by pediatric imaging technologists, clinicians and other health care professionals during regular work hours except during conference times, when attending faculty will cover. Examinations should be checked by the resident before the patient leaves the department if requested to do so by the supervising faculty. Questions should be referred to the supervising faculty to which the resident is assigned. Preliminary reports may be written for emergency room studies and patients who are going to clinic appointments on the same day of the examination when appropriate. These reports should be communicated to attending radiologist and documented in the final report with name, date and time of such a communication. Review of cases with the supervising faculty will be conducted as many times in the day as necessary to keep an efficient work flow. The resident will check his/her reports prior to final verification by supervising faculty.

Syndromes

Structural ciliary abnormalities (most common are absent dynein arms) result in abnormal ciliary beat frequency and decreased clearance of respiratory secretions bacteria que se come la piel buy on line floxin, thereby predisposing the patient to infection antibiotics pink eye generic floxin 400mg with amex. In addition bacteria horizontal gene transfer order floxin 200 mg online, because spermatozoa have tails with the same ultrastructural abnormalities as respiratory cilia antibiotic 127 generic 200 mg floxin overnight delivery, they move less well antibiotics for acne and eczema order online floxin, causing infertility antibiotic infusion order floxin without a prescription. Between 5% and 10% of preadolescent children are reported by their parents to snore at night. During the day, there may be excessive daytime sleepiness, learning problems, morning headaches, or personality changes. Less commonly required are videofluoroscopy of the upper airway, computed tomography, or magnetic resonance imaging. It is strongly implicated in the development of hypertension, ischemic heart disease, arrhythmias, and sudden death (in individuals with coexisting ischemic heart disease); it also contributes to the risk for stroke. Congenital laryngomalacia occurs as a result of prolapse of the poorly supported supraglottic structures: the arytenoids, the aryepiglottic folds, and the epiglottis. Stridor is loudest after crying or exertion, but it typically does not interfere with feeding, sleep, or growth. How can you clinically distinguish bilateral from unilateral vocal cord paralysis in an infant Normally, the vocal cords are tonically abducted, with voluntary adduction resulting in speech. With unilateral paralysis, one cord is ineffective for speech, and hoarseness results. With bilateral paralysis, hoarseness is less apparent, and the cry remains weak, but stridor (both inspiratory and expiratory) is usually quite prominent; in addition, the infant is more likely to have frank symptoms of pulmonary aspiration. These are vocal cord nodules caused by vocal abuse, such as repetitive screaming, yelling, and coughing. They are the cause of a hoarse voice in more than 50% of children when hoarseness persists for more than 2 weeks. Symptoms and history n Child less than 4 years old n Boys twice as common as girls n Coughing n Hemoptysis n Respiratory infection not resolving with treatment n History of choking n Difficulty breathing Signs n Fixed, localized wheeze n Wheezing in a child who has no history of asthma n Reduced breath sounds over one lung, one lobe, or one segment n Mediastinal shift n One nipple higher than the other as a result of unilateral hyperinflation n Stridor 68. Features suggesting a foreign-body aspiration are as follows: n Expiratory chest radiograph showing asymmetry in lung aeration as a result of obstructive emphysema (the foreign body often acts as a ball-valve mechanism, allowing air in but not out) n Right and left lateral decubitus films that show the same asymmetry (these views are often used in uncooperative children who cannot or will not exhale on command) n Obstructive atelectasis 69. What are the possible mechanisms for the development of lung abscesses in children Bronchiectasis is the progressive dilation of bronchi, most likely from acute and/or recurrent obstruction and infection. Clinical findings can be variable but usually include persistent cough, chronic production of purulent sputum, recurrent fevers, and digital clubbing. A novice teenage mountain-climber develops headache, marked cough, and orthopnea at the end of a rapid 2-day climb. This condition results from insufficient time to adapt to altitude changes above 2500 to 3000 meters, with alveolar and tissue hypoxia as a result of pulmonary hypertension and pulmonary edema. Treatment consists of returning the patient to a lower altitude and administering oxygen. If descent and supplemental oxygen are not available, portable hyperbaric chambers and nifedipine should be used until descent is possible. What is the likely diagnosis of a child with diffuse lung disease, microcytic anemia, and sputum that contains hemosiderin-laden macrophages This condition, the presenting symptoms of which can include chronic respiratory problems or acute hemoptysis, is characterized by alveolar hemorrhage and microcytic hypochromic anemia with a low serum iron level. Hemosiderin ingested by alveolar macrophages can often be detected in sputum or gastric aspirates after staining with Prussian blue. If the pneumothorax is small and the child is asymptomatic, observation alone is appropriate. Administration of 100% oxygen may speed resorption of the free air, but this technique is less effective in children in older age groups. If the pneumothorax is larger than 20% (as measured by the [diameter of pneumothorax]3/[diameter of hemithorax]3) and/or the patient has evolving respiratory symptoms, insertion of a thoracostomy tube and application of negative pressure should be considered. Adolescents with spontaneous pneumothoraces have a high recurrence rate because of the common association with subpleural blebs. As a follow-up measure, many authorities recommend chest computed tomography with contrast because significant blebs can be treated by surgical pleurodesis. In children with pleural effusions, how are exudates distinguished from transudates Philadelphia, with exudative and transudative pleural Hanley & Belfus, 1998, p 61. Exudates result from conditions of increased capillary permeability, whereas transudates occur with increased capillary hydrostatic pressure. Although uncomplicated pleural effusions can usually be managed conservatively without the need for surgery, about 5% of patients with pleural effusions progress to empyema (. In general, a simple diagnostic and therapeutic thoracentesis is done with insertion of a chest tube in the early exudative phase of an empyema when fluid is accumulating. What is the value of chest physiotherapy in patients with pediatric pulmonary disease The main function of chest physiotherapy is to assist with the removal of tracheobronchial secretions to lessen obstruction, reduce airway resistance, enhance gas exchange, and reduce the work of breathing. She put a curse on him with the stipulation that, should he ever betray her, he would suffocate by not breathing when he fell asleep. Unfortunately, Hans fell for the charms of Bertha, and he eventually succumbed to the curse while dozing. This rare condition is often associated with other abnormalities of brainstem function. This is a key ion channel that regulates chloride and sodium transfer across the apical membrane of epithelial cells and other cells. These hyperviscous secretions obstruct pancreatic ducts, resulting in steatorrhea from exocrine pancreatic insufficiency, and they interfere with pulmonary mucociliary clearance, thereby causing chronic respiratory disease. More than 1500 mutations of the gene that codes for this protein have been identified. A level of sweat chloride of more than 60 mEq/L is abnormal; 40 to 60 mEq/L is borderline; and less than 40 mEq/L is normal. Gastrointestinal manifestations can include pancreatic insufficiency, bowel obstruction, rectal prolapse, intussusception, gastroesophageal reflux, and cholelithiasis. Pulmonary colonization with Pseudomonas aeruginosa or Burkholderia cepacia is a poor prognostic sign. The prognosis has been improving now that pneumothoraces are being managed aggressively. The pandemic of influenza H1N1 places it in the differential diagnosis of community-acquired pneumonia in all age groups. Both organisms become more prevalent in school-aged children and are the most common etiology for pneumonia in older children. As a rule, the correlation between throat and nasopharyngeal bacterial cultures and lower respiratory tract pathogens is poor and of limited value. Healthy children may be colonized with a wide variety of potentially pathologic bacteria. How often are blood cultures positive in children with suspected bacterial pneumonia The incidence of bacteremia is unclear because the true denominator in the equation (the number of true bacterial pneumonias) is difficult to ascertain due to imprecision with making a definitive diagnosis. The low rate of positive blood cultures does suggest that most bacterial pneumonias are not acquired by hematogenous spread. How often are pleural fluid cultures positive in children with suspected bacterial pneumonia This high yield emphasizes the importance of recognizing a pleural effusion in patients with pneumonia and the value of early thoracentesis before starting antibiotic therapy. Before the introduction of the pneumococcal conjugate vaccine, children younger than 5 years without clinical evidence of pneumoniabutwithatemperatureof39 Corhigherandatotalwhite bloodcellcountof20, 000or morehadapositivechestradiographforpneumonia in19%ofcases. Sincetheintroductionofthe vaccine, the likelihood of occult pneumonia has fallen but is still significant at 9%. Can a chest radiograph reliably distinguish between viral and bacterial pneumonia Viral infections more commonly have interstitial, perihilar, or peribronchial infiltrates; hyperinflation; segmental atelectasis; and hilar adenopathy. However, there can be considerable overlap in features with bacterial (and chlamydophilal and mycoplasmal) pneumonia. Bacterial pneumonia more commonly results in lobar and alveolar infiltrates, but the sensitivity and specificity of this finding are not very high. Atypical pneumonia refers to one caused by certain bacteria, including Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila. These infections tend to start gradually, have minimal or a nonproductive cough, and have frequent constitutional signs. Chest radiographs tend to show patchy, peribronchial infiltrates with only occasional lobar consolidation. The syndrome is usually the result of Chlamydia trachomatis, cytomegalovirus, Ureaplasma urealyticum, orMycoplasma hominis. Affected infants develop progressive respiratory distress over several days to a few weeks, along with poor weight gain. There may be eosinophilia and elevated quantitative immunoglobulins (IgG, IgA, IgM). The etiologic causes overlap in clinical picture, although a history of conjunctivitis suggests chlamydia. Cold agglutinins are IgM autoantibodies that are directed against the I antigen of erythrocytes, which agglutinate red blood cells at 4 C. Up to 75% of patients with mycoplasma infections will developthem, usuallytoward the end of the first week of illness, witha peak at 4 weeks. A single cold agglutinin titer of 1:64 is therefore suggestive but not conclusive evidence of infection with M. Culture and serologic studies are time-consuming, so rapid diagnosis using a specific polymerase chain reaction test for M. If significant radiologic abnormalities persist for more than 6 weeks, there should be a high index of suspicion for a possible underlying problem. Exceptions would include children with pleural effusions, those with persistent or recurrent signs and symptoms, and those with significant comorbid conditions. Radiographic findings in patients with mycoplasmal infections are highly variable. In a febrile infant with a white blood cell count higher than 20, 000/mm3, consider a chest radiograph to look for occult pneumonia. How does the pH of a substance affect the severity of disease in aspiration pneumonia A low pH is more harmful than a slightly alkaline or neutral pH, and it is more likely to be associated with bronchospasm and pneumonia. The most severe form of pneumonia is seen when gastric contents are aspirated; symptoms may develop in a matter of seconds. Acute aspiration can often be treated supportively without antibiotics because the initial process is a chemical pneumonitis. If secondary signs of infection occur, antibiotics should be started after appropriate cultures; either penicillin or clindamycin is a reasonable choice to cover the oropharyngeal anaerobes that predominate. If the aspiration is nosocomial, antibiotic coverage should be extended to include gram-negative organisms. In addition to underlying immunologic immaturity, why are infants more susceptible to an increased severity of respiratory disease Although extra-acinar airway development is complete by 16 weeks of gestation, alveolar multiplication continues after birth. Early studies suggested that postnatal alveolar multiplication ends at 8 years of age. However, more recent studies have shown that it is terminated by 2 years of age and possibly between 1 and 2 years of age. After the end of alveolar multiplication, the alveoli continue to increase in size until thoracic growth is completed. Rates in children who are awake can be widely variable, depending on the psychological state and activity. Rates while sleeping are much more reliable and are a good indicator of pulmonary health. As a general rule in an afebrile, otherwise healthy and calm, resting infant or child, the expected maximal respiratory rate declines with increasing age. In the absence of other signs and symptoms, term newborns breathe up to a mean of 50 breaths/minute, decreasing to 40 breaths per minute by 6 months and to 30 breaths per minute at 1 year. Beyond 1 year of age, the rate declines gradually, reaching the typical adult rate of 14 to 20 breaths/minute by the middle teenage years. Counting respiratory rates over 1 minute gives a more accurate measurement than extrapolating rates over shorter periods to 1 minute. Grunting respirations are moaning, crying-like noises heard during expiration and thought to be a physiologic attempt to maintain alveolar patency. What is normal oxygen saturation in healthy infants who are younger than 6 months

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However antibiotic drops for ear infection purchase floxin with visa, it is fre creases the risk of mesothelioma and lung can quently preceded by actinic keratosis bacteria gif cheap floxin 200 mg on line, can oc cer antimicrobial bath mat discount 400mg floxin visa. Keratin pearls appear as Barr virus increases the risk of nasopharyngeal pink antibiotics safe during pregnancy cheap floxin 400 mg on line, extracellular concretions on hematoxylin carcinoma antibiotic expiration order floxin 400mg with amex. Actinic keratosis antibiotics for sinus infection allergic to penicillin order floxin toronto, Although gastrin-secreting tumors (called gas which can progress to squamous cell carci trinomas) are just as likely to arise in the duo noma, is the most common precancerous der denum and peripancreatic soft tissue as in the matosis. In contrast to basal cell carcinoma, in Ellison syndrome arises from hypergastrin tercellular bridges are also present. Acanthosis nigricans the G cells of the stomach antrum and duo involves thickened hyperpigmented zones. Excess gastrin typically malignant conditions elsewhere in the body, leads to excess acid production. Laboratory val such as endocrine disorders or adenocarci ues commonly seen in this condition include nomas. Histologically, there is hyperkeratosis increased basal and maximal acid output and with prominent rete ridges and basal hyperpig serum gastrin levels >1000 pg/mL. A tumor in the right disease, and to ulceration and gastric bleeding, apex would not result in left-sided symptoms. Although squamous vated serum gastrin level would be diagnostic cell carcinoma of the lung usually appears of gastrinoma. The lighter epithe der contraction and pancreatic enzyme secre lium well above the gastroesophageal junction tion. Intrinsic factor is re as velvety Barrett esophagus, which is a precur leased by the parietal cells of the stomach. Its sor lesion to esophageal adenocarcinoma in principle function is to bind vitamin B12 to which intestinal epithelium replaces normal promote its absorption. Secretin is produced If not already taking a proton-pump inhibitor, normally by the S cells of the duodenum and the patient should be started on one to prevent promotes pancreatic bicarbonate secretion. The vignette de scribes a superior sulcus tumor, otherwise Answer D is incorrect. Although Pancoast H2-blocker that can be used to treat mild re tumors may be lung neoplasms of any type, fux. This patient has a precancerous lesion primary squamous cell carcinomas are the (Barrett esophagus) as a result of his long most commonly seen. Located in the apex of standing gastroesophageal refux disease; thus, the affected lung, the tumor compresses the treatment with an H2-blocker alone is inappro cervical sympathetic plexus as it grows, result priate. Sucralfate works by silateral ptosis, miosis, and anhidrosis), and coating the gastric mucosa. Pancoast tumor is a It works by catalyzing the activation of anti squamous cell carcinoma. This description is con let function or one that affects platelet func sistent with a diagnosis of oligodendroglioma, tion, such as von Willebrand disease, would a relatively rare, slow-growing, benign tumor result in an increase in bleeding time. The reverse in the case of supratherapeutic antico clinical presentation typically involves severe agulation. The initial therapy of choice for in headaches, visual changes, and growth failure patient anticoagulation (absent specifc contra secondary to pituitary dysfunction. This is a description of be monitored when warfarin is used as an anti a meningioma, a benign primary intracranial coagulant. Symptoms of in or a neurologic defcit that gradually wors creased intracranial pressure (nausea and vom ens over time secondary to mass effect. Focal iting), in conjunction with cerebellar signs of symptoms can vary by location; however, a nystagmus and truncal ataxia in a young child meningeally-derived neoplasm is unlikely to are highly suspicious for a diagnosis of medul result in radiologic fndings localized to the loblastoma, which arises in the cerebellum. This description is toms of abdominal pain (more than 90% of characteristic of glioblastoma multiforme, the cases), neuropathy, high sympathetic tone, most common primary adult brain tumor. It is and neuropsychiatric disturbances, including generally localized to the cerebral cortex, and anxiety, depression, seizures, and paranoia. There are high and low-risk strains porphyria are not associated with chest pain. Polyphagia, or greatly cogenes E6 and E7 coupled to the viral pro increased hunger, is one of the cardinal symp moter and enhancer sequences, allowing their toms associated with diabetes mellitus, not continued expression after integration. Ultimately, there problems, but it is not found in acute intermit may be progression to malignancy. By light penetrating through the basement membrane microscopy, Burkitt lymphoma has a classic and pushing into the underlying stroma. Human herpesvirus ribbean, and is transmitted through blood 8 genome segments have been identifed in products, breast milk, and sexual secretions. In adult caused by a proliferation of spindle cells from T-lymphocyte leukemia, the neoplastic cells a single clone of endothelial cell origin. Histo have multilobated nuclei (in a clover leaf pat logic fndings include proliferation of spindle tern), and will often invade the dermis and cells, prominent slit-like vascular spaces, and subcutaneous tissue layers. This dis occlusion of the pulmonary capillaries causes order is a result of functional problems with acute chest syndrome. This factor serves as the ligand for plications include aseptic necrosis of the femo platelet adhesion to a damaged vessel wall. The the spleen, autosplenectomy, and increased disease may be acquired (via malignancy, auto susceptibility to infection by encapsulated immunity, or drug therapy) through antibodies bacteria. Chronic intravascular hemolysis pre directed against the factor, or it may be inher disposes these patients to calcium bilirubinate ited (typically in an autosomal dominant pat gallstones, which are radiopaque more often tern). Heinz bodies are pre cipitated hemoglobin, often associated with Answer B is incorrect. Ringed sideroblasts re sult from iron accumulation in the mitochon Answer D is incorrect. These are the most common sites of metastasis (after patients may present with splenomegaly and lymph nodes) because of the high blood fow aplastic crisis but not vasoocclusive symptoms. Breast metastases are found of the coagulation cascade leads to the devel more often in brain and bone. Lung tumors often me tastasize to brain and bone, and less often to Answer A is incorrect. Inhibition cells can be seen in hemolytic-uremic syn of both of these steps results in ineffective drome, pyruvate kinase defciency, uremia, heme synthesis and subsequent microcytic and other disorders. Patients with sickle cell disease are anemic tients exhibit epistaxis, thrombosis, bruising, and functionally asplenic; this patient has nei bleeding, and mild splenomegaly. In addition, platelet levels are complain of erythromelalgia, which is burning normal in sickle cell disease. Hydroxyurea is and redness of the hands and feet caused by approved for use in sickle cell disease, because platelets obstructing blood fow in capillaries it increases expression of fetal globin chains, and arterioles. Older patients also may experi thereby providing a pool of functional hemo ence transient ischemic attacks. When these microthrombi phagocytosis by macrophages, causing plate form, they circulate. This patient has none of these signs matic, but once the platelet level falls below or symptoms; in fact, the patient has increased 20, 000/mm3, they may have bleeding, mani platelet levels. In these cases, laboratory testing for elevated methylmalonic acid can be used to Answer C is incorrect. Normocytic anemia can be caused by acute hemorrhage, enzyme defects (eg, Answer D is incorrect. Furthermore, vitamin, antibodies against intrinsic factor can iron defciency anemia is associated with a result in cobalamin defciency and pernicious high, not low, iron-binding capacity. Patients sus indicates a macrocytic anemia, which can be pected of cobalamin defciency are adminis caused by a folate or vitamin B12 defciency. Iron defciency ane tracts, after which radioactivity in the urine is mia is accompanied by a low, not high, ferritin measured. In premenopausal receptor on cancer cells, preventing receptor women, pregnancy is a common cause of iron stimulation and inhibiting cell growth. Imatinib mesylate is characterized by a low ferritin level, high iron used to treat chronic myeloid leukemia. Methotrexate is an microscopic examination one observes the antimetabolite that acts as a folic acid analog. Rituximab is a mono eral nervous systems, the joints, the eyes, and clonal antibody that interacts with the surface the heart. Lyme disease is diagnosed by exam protein found on non-Hodgkin lymphoma fndings and exposure history, with corrobo cells. This patient is in presents with a high fever, fatigue, and myal fected with Leishmania donovani, which is gias, and can cause leukopenia, thryombocy transmitted by the sandfy. Diagnosis is with hepatosplenomegaly, malaise, anemia, again by exam and exposure history, with cor leukopenia, and weight loss. The Aedes mosquito Chronic infection with T cruzi causes Chagas spreads the faviviruses responsible for dengue disease, a condition characterized by cardio fever and yellow fever. Dengue fever is charac megaly and, often, dilation of the intestinal terized by headache, myalgais, arthralgias, and tract. Microscopic examination reveals fagel a petechial rash; laboratory tests show throm lated trypomastigotes in the blood and nonmo bocytompenia and a relative leukopenia. An geographic area of infection and the Plasmo important simplifying fact to help remember dium species involved; agents include chloro the different chromosomal translocations is quine, hydroxychloroquine, and atovaquone that those involving the immunoglobulin loci proguanil. The t(8;14) rearrange term survival rates of 70%-80%, unique among ment is found most commonly in Burkitt the acute leukemias. Translocation predisposing them to excess bleeding, a major of the c-myc gene next to the immunoglobulin source of mortality. The P450 and causes increased concentrations of translocation results in a Bcr-Abl fusion protein drugs processed via the system. Other inhibi that functions as a constitutively active tyrosine tors include isoniazid, sulfonamides, cimeti kinase to promote leukemia growth. Cyclosporine is notori ment of imatinib mesylate (Gleevec) for the ous for causing nephrotoxicity. However, inhibitor of Bcr-Abl, platelet-derived growth by increasing the serum levels of cyclosporine, factor, and c-kit tyrosine receptor kinases. The t(11;22) chromo somal translocation is associated with Ewing Answer B is incorrect. Because erythromycin ric transcription factor that activates the c-myc increases cyclosporine, cyclophilin levels fall. Ewing sarcoma is other macrolide antibiotics are known to cause a small, round cell tumor of the bone usually C diffcile colitis. X-ray will opportunistic but is instead caused by over show a lytic tumor with reactive bone deposited growth of C diffcile in the colon when normal around it in an onion-skin fashion. The charac centration of cyclosporine, it has no effect on teristic fusion of the pro-myelocytic leukemia the concentration of erythromycin. Although the combination of eryth retinoic acid receptors, restores differentiation, romycin and cyclosporine therapy increases and can induce temporary remission. Combi the serum concentration of cyclosporine, it nation differentiation treatment together with has no effect on the concentration of erythro conventional chemotherapy can result in long mycin. Adverse effects include hepatotoxicity, mycin [doxorubicin], Bleomycin, Vinblastine, neuropathy, and potentially psychiatric symp and Dacarbazine) used to treat Hodgkin lym toms. It inhibits microtubular formation of the mitotic spindle, so affected cells cannot 23. Vinblastine is used to likely has immune thrombocytopenic purpura, treat both Hodgkin and non-Hodgkin lympho an autoimmune disease characterized by a mas as well as many solid tumors. Adverse ef low platelet count and easy bruising or bleed fects include alopecia, constipation, myelosup ing through skin or mucous membranes. Cyclosporine is an im because of increased platelet production; there munosuppressant used in transplant patients also tend to be more megakaryocytes in the and patients with autoimmune disorders. Its major adverse ies are siderosomes, or iron bodies, seen on effect is myelosuppression. Clear cell carcinoma a positive direct antiglobulin test (also known of the kidney is a malignancy derived from the as the Coombs test), low haptoglobin level, renal tubular cells. Iron defciency anemia is a common cause of anemia that is often due Answer D is incorrect. Blood smear should show a nary tract, and can occur in the renal calyx, re microcytic, hypochromic anemia, instead of nal pelvis, ureters, and bladder. Megaloblastic anemia tumor does not arise in the kidney; instead, it is usually due to lack of either vitamin B12 or forms from the adrenal medulla and paraspi folate. Therefore it does not anemia, gastrectomy, disease of the terminal il distort the kidney architecture.

The organism de leg and foot areas of the motor and sensory cor scribed Listeria monocytogenes homeopathic antibiotics for dogs 400 mg floxin sale, causes men tices bacteria and archaea buy floxin online pills. Thus antibiotic resistance lecture buy cheap floxin 400mg on line, a lesion in the artery would lead to ingitis and sepsis in neonates and the im defcits in contralateral motor function of the munocompromised antibiotics for dogs after spaying buy cheap floxin 200 mg online. Ingestion of poorly pasteurized milk xone antibiotic buy discount floxin on line, soft cheeses antibiotics for sinus infection in toddlers purchase floxin 200mg with mastercard, coleslaw, and ready-to-eat turkey and Answer B is incorrect. The artery in question pork products are implicated in the pathogen does not supply the face; the middle cerebral esis of listeriosis in the immunocompromised artery does. While Escherichia coli, does not supply the arm and hand; the middle a common gram-negative bacterial cause of cerebral artery does so in a contralateral fash neonatal meningitis, can produce urinary tract ion. The artery in question mised adults, the organism described in the does not supply the face; the middle cerebral clinical case is the gram-positive bacilli Listeria artery does so in a contralateral fashion. Direct inoculation is a supplies the medial side of the brain respon common route of transmission of infection, in sible for contralateral motor function, not ipsi cluding gas gangrene produced by Clostridium lateral leg and foot motor functions. The layers of the munocompromised is most often from inges head from superfcial to deep are skin, perios tion of poorly pasteurized milk, soft cheeses, teum, bone, dura mater, arachnoid, pia, and coleslaw, and ready-to-eat turkey and pork brain parenchyma. Berry aneu of infected amniotic fuid, or nosocomial in rysm rupture releases blood into the subarach fection, listeriosis in the immunocompromised noid space and covers the surface of the brain is most often from ingestion of poorly pasteur with blood. However, the blood cannot be ized milk, soft cheeses, coleslaw, and ready-to scraped off since it is trapped under the arach eat turkey. The specimen in the low (this indicates the presence of bilirubin in photo is the circle of Willis. This fnd brain, the area responsible for the contralateral ing is called xanthochromia. It would likely be deeper the lateral ventricles may appear dilated be in the brain, commonly affecting the basal cause of the caudate atrophy. An intraparenchymal been shown to minimize the motor abnormali hemorrhage appears more like a bruise of the ties observed in Huntington disease. Alzheimer disease is the most common cause of dementia in the el Answer C is incorrect. It is marked by progressive memory loss thick, fbrous structure of dense connective tis and cognitive impairment. Pathophysiologi sue without space for a signifcant amount of cally, this disease is associated with deposition blood to pool. Blood collects either above or of neuritic plaques (abnormally cleaved amy below the dura but not within it. Wilson disease, an au When the calvarium (and its adherent dura) is tosomal recessive disease, is caused by failure removed, this space is exposed, and any blood of copper to enter circulation bound to ceru there should be readily scraped off. Blood loplasmin due to a problem with excretion that cannot be scraped off must be under the of copper from the liver. Subdural in copper accumulation in the liver, corneas, hemorrhages are commonly caused by blunt and basal ganglia. Symptoms include asterixis, trauma, especially in the elderly, alcoholics, parkinsonian symptoms, cirrhosis, and Kayser and children, who have atrophied or underde Fleischer rings (corneal deposits of copper). An epidural hemor though Wilson disease can cause chorea and rhage is caused by temporoparietal bone frac dementia, it is less likely in this scenario as it tures that damage the middle meningeal ar is inherited in an autosomal recessive fashion tery. If the bony calvarium and the dura are and other expected manifestations are not pres removed, an epidural (above the dura) hem ent. The sults from loss of dopaminergic neurons and blood in an epidural hemorrhage is between therefore loss of pigmentation in the substantia the dura and the cranium. These changes alter the direct pathway of the basal ganglia, resulting in loss of excita 4. Patients with Parkinson disease present is characterized by chorea, dystonia, altered with diffculty initiating movement, cogwheel behavior, and dementia. Treatments are aimed at immunosuppres exits the skull through the foramen spinosum, sion. Protrusion of the me muscle, parasympathetic innervation of the ninges and brain through a defect in the skull parotid gland, and sensory innervation of the is consistent with a diagnosis of meningoen pharynx, middle ear, and posterior third of cephalocele, which also carries a grave progno the tongue. Seventy-fve percent of these infants die or tors and baroreceptors of the carotid body. Protrusion of the me parasympathetic innervation to visceral organs, ninges and spinal cord through a vertebral de and sensory innervation to the pharynx and fect to form a sac is consistent with a diagnosis meninges. Protrusion of the me spinal accessory nerve innervates the sternomas ninges through a defect in the skull is consis toid and upper part of the trapezius muscles. More males are secretion but not synthesis, and also stimu affected than females, and the incidence rises lates uterine contractions during parturition. Unlike the neuro nal connection of the supraoptic hypophyseal Answer A is incorrect. Demyelination of ax tract, the hypothalamic-hypophyseal portal ons in the dorsal columns and spinocerebellar system is a capillary system that transports hor tracts occurs in subacute combined degenera mones synthesized in the hypothalamus that tion of the spinal cord, which is also known as act on the anterior pituitary. It is associated with in response to reduced plasma volume is acti pernicious anemia and results in loss of vibra vated by pressure receptors in the veins, atria, tion and position sense (dorsal columns) and and carotids. Milk synthesis is medi sule would cause contralateral spastic paralysis ated by prolactin, which is secreted by the an secondary to disruption of the descending f terior pituitary gland and hence would be un bers of the corticospinal tract, resulting in up affected by ablation of the transport tract from per motor neuron signs. Although oxytocin does not have a role region of the anterior horn cells and posterior in milk synthesis, it allows milk letdown in lac columns in the spinal cord occurs in Charcot tating women. Neuronal loss in the the transport tract from the hypothalamus to region of the anterior horn cells in the spinal the posterior pituitary gland. Salt retention is a pri matory viral infection that affects the lower mary action of aldosterone, acting at the renal motor neurons and results in a faccid paralysis distal tubules to increase sodium and chloride (pure lower motor neuron disease). The right internal ca stimulated by follicle-stimulating hormone, rotid artery supplies blood to both the right an which is secreted by the anterior pituitary terior cerebral artery and the middle cerebral gland and hence would be unaffected by abla artery. Decreased blood supply to both the an tion of the transport tract from the hypothala terior and middle cerebral arteries would most mus to the posterior pituitary gland. Prochlor zone would be more susceptible to infarction perazine is a typical anti-psychotic agent that is and ischemia because this area is downstream more often used for its anti-emetic properties. During occlusion of regulate motor control, control of eye move the internal carotid artery, blood supply would ments, and acoustic relay. It contains several decrease to tissue supplied by the middle ce essential nuclei of auditory and visual systems. However, tissue in the watershed zone would be more susceptible to infarction Answer B is incorrect. The pituitary plays and ischemia because this area is downstream many roles in autonomic and endocrine con of the tissue that is purely in the middle cere trol. Thirst, Adenohypophysis control via releasing factors (gonadotropin hormone-releasing hor Answer C is incorrect. The internal carotid mone, thyroid hormone-releasing hormone), artery does not supply the posterior cerebral Neurohypophysis and median eminence, artery; therefore, tissue in the distribution of Hunger, Autonomic regulation, Temperature the posterior cerebral artery would not be in regulation, and Sexual urges. The internal carotid in many vital functions such as respiratory and artery supplies the middle cerebral artery, but urinary bladder control. It also conveys motor still be supplied by the posterior cerebral ar information from the cerebral hemispheres to tery. The cerebellum regu with signs of Wernicke-Korsakoff syndrome, lates movement and posture by providing con which is caused by thiamine (vitamin B1) de stant feedback in order to allow for correction fciency. Malnourished chronic alcohol abus ers are thus particularly prone to this disease. Wernicke en [thyroid], Serous [ovary], Meningioma, Meso cephalopathy presents frst, and may progress thelioma). The of any clues to suggest metastatic disease, me classic triad of Wernicke encephalopathy is ningioma is the most likely culprit. Meningio confusion, ataxia, and ophthalmoplegia (weak mas are the second most common type of pri ness of eye muscles that may result in diplopia mary brain tumor; they frequently occur in the and/or nystagmus). Whereas Wernicke en convexities of cerebral hemispheres and in the cephalopathy may be reversible if treated early, parasagittal regions. Meningiomas arise from Korsakoff psychosis is an irreversible condition arachnoid cells external to the brain. Know characterized by anterograde amnesia, confab what psammoma bodies look like and with ulation, and personality changes. Astrocytes give rise to a and confabulation is the act of flling in gaps variety of tumors, most notably gliomas. The lesion in Wernicke dystrophic calcifcations such as psammoma Korsakoff syndrome is located in the mamillary bodies. Bilateral lesions of to melanomas, which do not present with the amygdala causes Kluver-Bucy syndrome, psammoma bodies. Oligodendrocytes give ganglia are associated with movement disor rise to oligodendrogliomas, which tend to oc ders such as Parkinson disease. Broca area is located in round nuclei with a clear halo of cytoplasm the inferior frontal gyrus. Oligodendrogliomas do not here have motor/nonfuent/expressive aphasia, contain psammoma bodies. As a consequence, the right demonstrates psammoma bodies, which are eye cannot adduct. The reverse is true for gaze lamellated mineral deposits formed via calcif directed to the right. However, convergence is cation of whorled clusters of cells found inside usually intact as this maneuver does not utilize the tumor. Ablating part of the is the tract of neurons connecting Broca area internal segment of the globus pallidus (palli and Wernicke area in the left cerebral hemi dotomy) would reduce its tonic inhibition of sphere. The medial lemniscus is the tract in the brain stem that carries sen Answer C is incorrect. The internal capsule is sory information on light touch, propriocep a white-matter tract that transmits the axons of tion, and vibration in the extremities from the upper motor neurons to the brainstem and spi nucleus gracilis and cuneatus to the thalamus. It con is the tract in the brain stem that carries sen tains neurons with dopamine receptors that are sory information on light touch, propriocep responsive to projections from dopaminergic tion, and vibration in the extremities from the neurons of the substantia nigra. In this disease the internal segment allowing the two halves of the brain to com of the globus pallidus produces excessive in municate. This motor nerve palsy of the facial nerve would patient may also experience dryness in her ip cause dryness of the ipsilateral (right), not con silateral (right) eye and mouth because the fa tralateral (left), eye. Physostigmine and sublingual glands, which provides lubrication neostigmine, both of which are amines, are re to the eye and mouth, respectively. Both compounds weakness of the facial muscles prevents com act as substrates for acetylcholinesterase, plete eye closure, exacerbating the eye dry thereby preventing the esterase from break ness. Patients with facial nerve paralysis should ing down acetylcholine in the neuromuscular be given lubricating eye drops and instructed junction or synapse. Neostigmine does not cross the lesions, in most cases no cause is discovered blood-brain barrier. Decreased sensation of because of its ability to cross the blood-brain the left upper cheek could be caused by lesion barrier and treat central anticholinergic toxic of the left maxillary division of the trigeminal ity (delirium, agitation) as well as peripheral nerve (cranial nerve V); however, this patient anticholinergic toxicity. Neostigmine has a lesion of the right maxillary division of the tri greater effect on skeletal muscle than does geminal nerve (cranial nerve V2); however, physostigmine. Neither compound has much this patient shows signs of facial nerve palsy effect on the bladder. Lesion of the right va a greater effect on skeletal muscle than does gus nerve would lead to deviation of the uvula physostigmine. Neither compound has much and soft palate to the left; however, all signs effect on the bladder. Both physostigmine presents in the third to ffth decades and is not and neostigmine are reversible anticholines associated with Lewy bodies. Isofurophate and other organophos phates irreversibly bind acetylcholinesterases, Answer E is incorrect. This answer choice is permanently preventing the breakdown of ace likely referring to metastatic melanoma of the tylcholine until the protein can be replaced brain. This syndrome results in numbness symptoms are characteristic of Parkinson dis of the ipsilateral face and contralateral limbs, ease, and this answer choice describes the pro diplopia, dysarthria, and an ipsilateral Horner cess underlying this disease. The pathology de quadrant of the medulla contains the tract of scribed in this answer choice is characteris cranial nerve V (face pain), vestibular nuclei tic of Alzheimer disease, the most common (dysequilibrium), nucleus ambiguus (palate cause of dementia in the elderly. This answer problems and hoarse voice), the spinothalamic choice can be defnitively ruled out, because tract (contralateral pain and temperature loss), Alzheimer disease is not associated with Lewy and descending sympathetic fbers (Horner bodies. The pathology de are not found because corticospinal fbers are scribed in this answer choice is consistent with in the ventral medulla at this location. This vascular territory in copper transport that leads to the accumula is supplied by the anterior inferior cerebel tion of copper in tissues. Disruption in blood fow typically associated with parkinsonian symptoms, as well causes ipsilateral deafness from involvement of as chorea, psychiatric symptoms, liver disease, the labyrinthine artery, ipsilateral facial weak and the characteristic Kayser-Fleischer ring. It is the second most common Although some aspects of this answer choice brainstem stroke syndrome. The cochlea and ves more, Wilson disease is not associated with tibular apparatus are perfused via the labyrin Lewy bodies.

Discount floxin. Microbiology Chapter 20 Lecture part 1.

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