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nbme 2 block 4 q 1------- q50 - drona99
#51
25B---Gained weight , anhedonia, increased sleep, fatigue, difficulty concentratin ---5 symptoms required for diagnosis of Major depressive disorder
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#52
SIG E CAPS
s- sleep disturbances - more or low
i -- loss of interest
g- guilt feeling of worthlessness
e-loss of energy
A- apetite loss or increase
p-pschychomotor retardation
s -suicidal ideas
d-depressed mood
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#53
i meant all above for depression
Major depression disorder- 2 or more above symotoms with symptom free interval for abt 2 month


* Dysthymia- milder form of depression lasting at least 2 years

* seasonal affective disorder - associated with winter season -can be rx with full spectrum light exposure
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#54
26- I
presenceof S3 gap.; coarse creps with h/o HTN s/o cardiac failure
Rx diuerectics and ask pt to restrict salt and water
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#55
27-cc -inactivated vaccine/ salk is killed vaccine given IM

The Salk vaccine, or inactivated poliovirus vaccine (IPV), is based on three wild, virulent reference strains, Mahoney (type 1 poliovirus), MEF-1 (type 2 poliovirus), and Saukett (type 3 poliovirus), grown in a type of monkey kidney tissue culture (Vero cell line), which are then inactivated with formalin





The injected Salk vaccine confers IgG-mediated immunity in the bloodstream, which prevents polio infection from progressing to viremia and protects the motor neurons, thus eliminating the risk of bulbar polio and post-polio syndrome.



The OPV - sabin vaccine- live atttenuated vaccine

The live virus used in the vaccine is shed in the stool and can be spread to others within a community, resulting in protection against poliomyelitis even in individuals who have not been directly vaccinated. IPV produces less gastrointestinal immunity than does OPV, and primarily acts by preventing the virus from entering the nervous system. In regions without wild poliovirus, inactivated polio vaccine is the vaccine of choice
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#56
28= the last step of glycolysis
phosphoenolpyruvate ---------to---------pyruvate is catslysed by pyruvate kinase and we produce 1 ATP through substrate level phosphorelation.

Pyruvate kinse deficiency leads to decrease in ATP formation.-
The def of ATP causes the erythrocytes to loose its characteristic biconcave shape and signal its destruction in spleen.
The Na/K ATP ase result in loss of ion balance and causes osmotic fragility leading to swelling and lysis
PK def -present with--
hemolytic anaemia
increase in 2;3 BPG
absence in heinz bodies
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#57
29--A
progesteron in pregnancy cause relaxation of lower esophageal spinctor leading to heart burn and reflux.



During the pregnancy, the progesterone is needed in the following ways, (mostly in conjunction with estrogen):

Makes the endometrium develop and secrete fluids after being primed by estrogen

Maintains the functions of the placenta and fights off unwanted cells near the womb that could cause damage to the placenta or foetus.

Keeps the endometrium in a thickened condition

Stops the uterus making spontaneous movements

Stimulates the growth of breast tissue

Prevents lactation until after the birth (with estrogen)

Strengthens the mucus plug covering the cervix to prevent infection.

Strengthens the pelvic walls in preparation for labour.

Stops the uterus from contracting (thus keeping the baby where it is)



At the end of the pregnancy, the levels of progesterone secreted by the placenta drop off. It is this action that stimulates the beginning of the contractions that will lead to birth.





The effects on a woman due to raised levels of progesterone can include any or all of the following:

Constipation

Heartburn

Runny and irritable nose

Eyesight problems (blurring or headaches)

Increased kidney infection risk.



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#58
30-dd

Cyclosporine is a polypeptide of 11 amino acids of fungal origin and is active against helper T cells, preventing the production of IL-2 via calcineurin inhibition (binds to cyclophilin protein). This agent is used for induction and maintenance immunosuppression.

Adverse effects include nephrotoxicity with 3 stages:
(1) immediate, secondary to renal ischemia;
(2) 2-3 weeks after transplantation, secondary to renal vasoconstriction; and
(3) chronic, secondary to interstitial nephritis.

Other adverse effects include hyperkalemia, hypomagnesemia, nausea, vomiting, diarrhea, hypertrichosis, hirsutism, gingival hyperplasia, hyperlipidemia, glucose intolerance, infection, malignancy, and hyperuricemia. Hypertrichosis and hirsutism can be alleviated by switching from cyclosporine to tacrolimus, provided the patient is carefully monitored. Multiple drug interactions are possible, primarily with agents affecting the cytochrome P-450 system



read all drugs here


http://emedicine.medscape.com/article/432316-overview
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#59
31--ee
serotonine syndrome with cheese and MAO inhibitors,

Serotonin syndrome most often occurs when two drugs that affect the body's level of serotonin are taken together at the same time. The drugs cause too much serotonin to be released or to remain in the brain area.

few eg-[other than stem]
you can develop this syndrome if you take migraine medicines called triptans together with antidepressants called selective serotonin reuptake inhibitors (SSRIs) and selective serotonin/norepinephrine reuptake inhibitors (SSNRIs)
).
Older antidepressants called monoamine oxidase inhibitors (MAOIs) can also cause serotonin syndrome , as well as meperidine (Demerol, a painkiller) or dextromethorphan (cough medicine)

Drugs of abuse, such as ecstasy and LSD have also been associated with serotonin syndrome
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#60
32--ff chronic iron loss anemia
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