2015.04.12 Flashcards
Indirect Inguinal Hernia
Male infants
Enters internal inguinal ring lateral to inferior epigastric vessels.
Caused by persistent processus vaginalis & failure of internal inguinal ring to close.
Covered by all 3 spermatic fascial layers
Direct Inguinal hernia
Occurs in older men.
Bulges through Hesselbach’s triangle, medial to inferior epigastric vessels, to reach external inguinal ring.
Caused by weakness of the transversalis fascia.
Covered only by external spermatic fascia.
Femoral Hernia
Occurs in women
Protrudes through the femoral ring, medial to the femoral vessels & inferior to the inguinal ligament.
Endothelial Nitric Oxide Synthase (eNOS)
Stimulated by increase in cytosolic calcium levels (due to acetylcholine, bradykinin, serotonin, substance P or shear froces which activate specific membrane receptors).
Synthesizes nitric oxide from argininge, NADPH, O2.
NO activates guanylyl cyclase and increases cGMP. Activate protein kinase G, reduces cytosolic calcium levels and relaxation of vascular smooth muscle.
Follicular Lymphona
Non-hodgkin lymphoma of follicular B-lymphocytes.
t(14;18) causing Bcl-2 overexpression (protooncogene because of its anti-apoptotic effefcts)
“Water-hammer” pulses and head-bobbing with each heart beat (de Musset sign)
Aortic regurgitation
Large left ventricular stroke volume (LVSV), large regurgitant SV, large pulse pressure.
Left ventricular end diastolic volume also increased.
Bounding femoral and carotid pulses marked by abrupt distention and quick collapse (“water-hammer” are the result of large pulse pressure.
LVSV causes the head-bobbing with carotid pulsations due to transfer of momentum.
Gallbladder hypomotility
Risk factors: pregnancy, rapid weight loss, prolonged use of total parenteral nutrition or octreotide, and high spinal cord injuries.
Formation of biliary sludge due to bile precipitation - contains cholesterol monohydrate crystals, calcium bilirubinate, and mucus.
Glucocorticoid acute effects on CBC
Increased neutrophil count due to “demargination” (neutrophils previously attached to the vessel wall)
Decreased lymphocyte, monocyte, basophil and eosinophil counts.
Viridans Streptococci
normal inhabitants of oral cavity.
capable of producing extracellular polysaccharides (dextrans) using sucrose as a substrate.
Dextrans facilitate streptococcal adherence to fibrin.
Fibrin and platelets are deposited at sites of endothelial trauma (pre-existing valve damage), providing a site for bacterial adherence and colonization, leading to formation of valvular vegetation.
S. aureus is more aggressive and can adhere to intact endothelium without prexisiting lesion.
P bodies
distinct foci within eukaryotic cells involved in mRNA regulation and turnover.
role in translation repression and mRNA decay
contain RNA exonucleases, mRNA capping enzymes, and consitituents involved in mRNA quality control and microRNA-induced mRNA silencing.
Storage of mRNA
CD14
surface marker of monocyte-macrophage cell lineage
Filtration Fraction
GFR/RPF
Characteristics of a drug that traps drug in plasma compartment, resulting in low volume of distribution
High molecular weight
High plasma protein binding
High charge
Hydrophilicity (charged)
Blunt Aortic Injury (Traumatic Aortic rupture)
Most commonly caused by motor vehicle collisions
Injury most often at aortic isthmus (tethered by the ligamentum arteriosum - relatively fixed and immobile compared to descending aorta)
Due to sudden deceleration
Widened mediastinum may be seen on x-ray
Where do atherosclerotic plaques predominantly develop?
Large elastic arteries and large/medium sized muscular arteries.
- Abdominal aorta
- coronary arteries
- popliteal arteries
- internal carotids
- circle of willis
Cardiovascular toxicity due to TCA (anti-depressant)
QRS and QT prolongation and cardiac dysrhythmias
Due to inhibition of fast sodium channels.
Treatment: hypertonic sodium bicarbonate to correct QRS prolongation, reverse hypotension and treat ventricular dysrhythmias
Multiple Myeloma
Plasma cells (characteristic with basophilic cytoplasm, eccentric nuclei, “wagon wheel”/”clock face”) infiltrate the bone marrow.
Normocytic, normochromic anemia - due to bone marrow infiltration
Bone resorption - due to osteoclast activation by IL-1 and IL-6 by neoplastic cells.
Hypercalcemia - due to bone destruction
Increased susceptibility to infection - monoclonal immunoglobulin production (M protein and Bence-Jones protein)
AL amyloid - due to accumulation of monoclonal Ig light chains.
Renal failure - infiltration of kidney
What does pulmonary capillary wedge pressure (PCWP) measure?
Left atrial EDP, which under normal conditions is nearly equal Left ventricle EDP.
Mitral stenosis elevates LAEDP and PCWP relative to LVEDP.
Primaquine
eradicate the intrahepatic stages (latent hypnozoites) of P. vivax and P. ovale.
Chloroquine is used for treatment of susceptible erythrocytic forms (trophozoites, merozoites) of all Plasmodia species.
Nitroprusside
agent of choice in treating hypertensive emergency.
metabolized to cyanide, with subsequent conversion to thiocyanate by liver rhodanase.
risk of cyanide toxicity. treated with Sodium thiosulfate which donates sulfur to liver rhodanase to enhance conversion of cyanide to thiocyanate
Common disease-causing intracellular organisms
Chlamydia, Legionella, Listeria monocytogenes, Mycobacterium, Neisseria meningitidis, Nocardia, Rickettsia, Salmonella typhi
Cryptococcus neoformans, Histoplasma capsulatum, Pneumocystis jirovecii
Plasmodium, Toxoplasma gondii
Listeria Monocytogenes
Facultative intracellular, Gram + rod, B-hemolysis (like Streptococcus agalactiae)
Immotile at 37C but demonstrates tumbiling motility at 22C. Also can multiply at temps as low as 4C.
Listeriolysin O - pore forming toxin that allows Listeria to lyse the vacoular membrane and stay intracellular.
Listeria stimulates production of cytokines that induce a cell-mediated immune response leading to killing of intracellular Listeria. In patients with compromised cell-mediated immunity, the organism survives.
Lymphatic drainage of the scrotum
Superficial inguinal lymph nodes. (drain all cutaneous lymph from the umbilicus to the feet, including external genitalia and anus)
Lymphatic drainage of testes
Para-aortic (retroperitoneal) lymph nodes
