By C. Renwik. Indiana University - Purdue University, Fort Wayne. 2018.
IL6) cheap vasotec 5 mg mastercard, probably through mechanisms of competition for The currently available topical anti-acne drugs and the commonly required co-activator proteins [8–10] generic vasotec 5mg visa. Reti- pathophysiological factors which are targeted by them are noid receptors are members of the steroid-thyroid hor- given in figure 1, as well as the adverse drug profile in mone superfamily and exist as ·-, ß-, and Á-subtypes with tables 1–3. Efficacy of topical acne Agent Keratolytic/ Sebo- Anti- Anti- therapeutics anti-comedogenic suppressive microbial inflammatory Tretinoin ++ – (+) (–) Isotretinoin ++ – (+) (+) Adapalene ++ – (+) ++ Tazarotene ++ – (+) + Azelaic acid ++ – ++ + Clindamycin – – ++ – Erythromycin – – ++ – Tetracycline – – ++ (+) Benzoyl peroxide (+) – +++ (+) Salicylic acid + – (+) – +++ = Very strong; ++ = strong; + = moderate; (+) = weak; – = none. The expression of the retinoid receptors is tissue- turbed follicular keratinization, but do have in addition specific, with RARÁ being the predominant type of RAR some anti-inflammatory actions, in vivo and in vitro dif- expressed in human epidermis. They should therefore also Embryotoxicity/teratogenicity is the major drawback in be used for inflammatory types of acne, i. In those types of acne with higher the fetus during the first trimester to oral retinoids is inflammatory grades (III and IV according to Plewig and known to produce characteristic malformations. Kligman), the combination of topical retinoids with oral There have also been case reports about malformations antibiotics or topical BPO or azelaic acid is indicated. They all target the major congenital abnormalities when mothers had used microcomedo and are comedosuppressive in different po- topical tretinoin during the first trimester of pregnancy tencies; however, they vary concerning anti-inflammatory versus 2. Even though the daily variation of natural retinoid plasma levels is larger than the plasma levels occurring under topical retinoid application for the treatment of skin Tretinoin disease [17, 18], an individual embryopathy risk under topical application cannot be fully excluded. Today, topi- Tretinoin which was the first topical retinoid described cal application of retinoids should be strictly avoided dur- in the first reports by Stüttgen and by Beer. It significantly ing the first trimester of pregnancy. While in Germany the reduces the number of comedones but also of inflammato- administration of topical retinoids is not permitted during ry acne lesions. It has been shown in several trials that at the entire period of pregnancy, but contraception during least during a 12-week course the reduction of lesion the topical application of retinoids is not required, in the counts ranges between 32–81% for noninflammatory le- US effective contraception during topical retinoid treat- sions and 17–71% for inflammatory lesions, i. The scientific and ethical dis- for the total lesion count. Currently tretinoin is available in tretinoin, isotretinoin and adapalene; however, they are different galenic formulations: cream (0. Adverse drug reactions of topical therapeutics Agent Erythema Scaling Burning Flare-up Bacterial Photo- Other of acne resistance sensitivity All-trans retinoic acid +++ +++ ++ ++ – ++ Isotretinoin ++ ++ + + – + Adapalene + + + + – – Azelaic acid + + ++ – – – Benzoyl peroxide ++ ++ + + – – bleaches hair and clothes, contact allergy Topical antibiotics +++ tetra- contact allergy, bacterial cyclines resistance – = None; + = mild; ++ = considerable; +++ = extensive.
These reactions usu- ally include rash and nausea and sometimes include fever cheap 5mg vasotec fast delivery. If a patient with a previous reaction to abacavir is rechallenged with the medicine generic 5mg vasotec with amex, he or she can develop a much more severe life-threatening reaction with marked hypotension. The major side effects of zidovudine are myositis and anemia. Rarely, zidovu- 102 BOARD REVIEW dine can cause severe liver disease. The sudden onset of symptoms is not typical for Mycobacterium avium complex. Indinavir can cause nephrolithiasis but does not cause cholelithiasis. Indinavir can cause an unconjugated hyperbilirubinemia (as this patient has), but it is always asymptomatic. A 27-year-old pregnant woman is found to be HIV positive on prenatal blood testing. Her CD4+ T cell count is 410 cells/µl, and she has a viral load of 35,000 copies/ml of plasma. She does not wish to take any antiretroviral medications. What should you advise her to do to best decrease the risk of transmission of HIV virus to her child? Do nothing, because she already has a very low risk, because her CD4+ T cell count is > 200 cells/µl B. Breast-feed the child until the age of 6 months C. Receive prophylaxis for HSV II Key Concept/Objective: To understand the factors that can decrease the risk of HIV transmis- sion to the fetus The best option to decrease the risk of transmission of HIV to the child would be mater- nal antiretroviral therapy.
Mutation in the matrix protein of a virus causing viral persistence Key Concept/Objective: To be familiar with theories of pathogenesis for CNS diseases caused by slow viruses and similar agents Spongiform encephalopathies are caused by prions: proteins that cheap vasotec 5 mg online, when abnormal cheap 10 mg vasotec overnight delivery, pre- cipitate as crystals, yielding plaques and spongiform degeneration. HIV dementia is thought to be caused by injury to neurons by toxins secreted from HIV-infected microglia. HTLV-I–associated myelopathy is thought to be the result of autoimmune attack by CD8+ T cells on HTLV-I–infected glial cells. Lysis of cells that produce myelin (oligodendrocytes) by reactivated JC virus, a papovavirus, is the cause of progressive multifocal leukoen- cephalopathy. Subacute sclerosing panencephalitis (SSPE) is a late CNS disease caused by the measles virus containing mutated protein, perhaps accounting for viral persistence in the presence of an appropriate host-humoral response. An HIV-seropositive 36-year-old woman presents with progressive right-sided weakness and right inferi- or quadrantanopia. MRI reveals hypointense T1-weighted lesions without gadolinium enhancement and with hyperintense T2-weighted lesions involving the left frontoparietal and occipital white matter. Biopsy shows areas of demyelination, large atypical astrocytes with bizarre nuclei, and oligodendrocytes with enlarged nuclei, some with displacement of the chromatin by an intranuclear basophilic process. What is the most appropriate therapy for this patient at this time? Radiation therapy Key Concept/Objective: To understand the findings of progressive multifocal leukoencephalopa- thy (PML) and current thought regarding its therapy 48 BOARD REVIEW This patient has a classic presentation and studies for PML. On MRI, the lack of contrast enhancement is typical for PML, as distinct from toxoplasmosis, lymphoma, or astrocy- toma. Bizarre cells are seen on biopsy but do not indicate the presence of a malignancy. The intranuclear inclusions in the oligodendrocytes are typical for PML.
She has had these symptoms for the past several days buy vasotec 10 mg overnight delivery. She also reports arthralgias and has now developed a rash purchase 10mg vasotec. On physical examination, the patient is mildly tachypneic, but her vital signs are otherwise stable. Pulmonary examination reveals dullness to percussion and decreased breath sounds over the right lower lung field, with no egophony. Cardiac and abdominal examinations are unremark- able. Lower extremities are notable for purpura and trace edema below the knees. Evaluation of her diarrhea reveals an eosinophilic gastroenteritis. You suspect that her underlying problem is Churg-Strauss syndrome (CSS). Which of the following components of this patient’s medical history would be most supportive of the diagnosis of CSS? Polymyalgia rheumatica Key Concept/Objective: To understand the importance of history in the diagnosis of Churg- Strauss syndrome CSS displays clinical similarities to Wegener granulomatosis (WG) in terms of organ involvement and pathology, especially in patients with upper or lower airway disease or glomerulonephritis. CSS differs most striking- ly from WG in that the former occurs in patients with a history of atopy, asthma, or aller- gic rhinitis, which is often ongoing. In the prevasculitic atopy phase, as well as during the systemic phase of the illness, eosinophilia is characteristic and often of striking degree (≥ 1,000 eosinophils/mm3). When eosinophilia is present in WG, it is usually more modest (~500 eosinophils/mm3). Chronic sinusitis can be seen in both CSS and WG, although it is more characteristic in the latter than the former.
In northern latitudes cheap vasotec 10 mg fast delivery, exacerbations of psoriasis commonly occur dur- ing the spring and summer D order vasotec 10 mg fast delivery. In persons with earlier age of onset, psoriasis is more likely to be severe Key Concept/Objective: To understand the epidemiology of psoriasis The estimated prevalence of psoriasis ranges from 0. The reasons for the geographic variation in prevalence are unknown, but climatic factors and genetics may play a role. On the basis of a survey mailed to 50,000 households, the prevalence in the United States is estimated to be 2. Psoriasis can occur in patients of any age, with some cases being reported at birth and others being reported in patients older than 100 years. The average age of onset is 23 years in the United States. Psoriasis occurs with equal frequency in men and women. In populations in which there is a high prevalence of pso- riasis, onset tends to occur at an earlier age. In persons with earlier age of onset, psoriasis is more likely to be severe, with involvement of a large area of skin surface. It has long been known that psoriasis improves when patients are exposed to sunny climates and to regions of lower latitude. In northern latitudes, exacerbation of psoriasis commonly occurs during 6 BOARD REVIEW the fall and winter. An 18-year-old college student presents to the student health clinic for evaluation of a rash. The patient was recently evaluated for sore throat and diagnosed with streptococcal pharyngitis. Physical examina- tion reveals small, scaling erythematous papules on the trunk and bilateral extremities. This patient’s clinical presentation is most consistent with which clinical variant of psoriasis? Pustular Key Concept/Objective: To be able to differentiate among the clinical variants of psoriasis Nearly 90% of psoriasis patients have plaque-type psoriasis, a form that is characterized by sharply demarcated, erythematous scaling plaques.