4/14/19 Flashcards
Luteal phase (proliferative) of the menstrual cycle looks like?
Decidualized endometrium only
dilated, coiled endometrial glands
vascularized edematous stroma
under the influence of progesterone
What does the uterus look like in a molar pregnancy to spontaneous abortion?
Enlarged chorionic villi
avascular edematous stroma
Early proliferative phase of the menstrual cycle looks like?
straight, short endometrial glands
compact stroma
4-7 days after onset of menses
chronic alcoholic pancreatitis results in
pancreatic exocrine insufficiency
malabsorption
Tx for methanol and ethylene glycol poisoning
Fomipazole - competitive inhibitor of alcohol dehydrogenase
Ethanol - sometimes used as competitive inhibitor
Both decrease the conversion rate of poison into toxic metabolite
Toxic metabolites of methanol poisoning
Formic acid
causes retinal injury/blindness
Toxic metabolites of ethylene glycol poisoning
oxalic acid
glycolic acid
glyoxylic acid
causes AKI d/t cytotoxicity and crystalline obstruction
What do chelators (deferoxamine) do?
Bind to heavy metals and form inert complex that is cleared renally
How does activated charcoal work?
Absorbs toxins in stomach
prevents absorption into the body
use in phenobarbital and acetaminophen poisoning
doesn’t absorb alcohol
Boy w/Hx of bone cancer + lung tumor with sheets of uniform, smalll, round cells
Ewing sarcoma
Histology of Ewing sarcoma
uniform, small, round cells w/clear scan’t cytoplasm
separated by fibrous septae
patches of necrosis/hemorrhage
Ewing sarcoma involves translocations of?
EWSR1 and FLI1
Ewing sarcoma believed to arise from?
mesenchymal stem cells
Histology of osteosarcoma
Pleomorphic
spindle-shaped cells
produce new osteoid and bone
Histology of MM
Eccentric nuclei with “clock-face” chromatin
perinuclear clearing
abundant basophilic cytoplasm
Histology of chondrosarcoma
neoplastic chondrocytes in hyaline cartilage matrix
usually w/small calcifications
Histology of adenocarcinoma of the lung
neoplastic glands lined by mucin-producing cells
Hepatitis D virus does not encode for ?
viral envelope proteins
cannot generate viral progeny on its own
“replication-defective”
Hepatitis D is what kind of virus
small
enveloped RNA
does not contain replicase or RNA polymerase
needs co-infection with HBV or superinfection in chronic HBV carrier
Aortic regurgitation is characterized by
rapid loss of aortic pressure during diastole
d/t back flow of blood in L ventricle
Hemodynamic changes in aortic regurgitation
reduced aortic diastolic pressure
elevated LV diastolic pressure
aortic and LV systolic pressure are increased
Aortic pressure = 160/60
LV pressure = 160/20
Changes in the heart from AR
LV becomes dilated
increased EDV
eccentric hypertrophy
compensatory for increase in SV and CO
Cardiac changes in a normal aging heart
decreased LV cavity size
sigmoid shape of ventricular septum
increased collagen within ventricular wall
myocardial cells w/brownish (lipofuscin pigment) perinuclear cytoplasmic inclusions - d/y indigestible byproducts of sub cellular membrane lipid ox)
Skeletal muscle is not affected by Verapamil bc?
little dependence on extracellular calcium influx
Calcium moves in what direction in skeletal muscle?
Release calcium out of the cell from sarcoplasmic reticulum
Calcium moves in what direction in SM and cardiac muscle?
influx of extracellular calcium
activates sarcoplasmic RyR channels
induces release of additional calcium from sarcoplasmic reticulum (calcium-induced calcium release)
Infraspinatus does what?
external rotation
supra scapular nerve
subscapularis does what?
adduction
internal rotation
upper & lower sub scapular nerve
teres minor does what?
adduction
external rotation
axillary nerve
supraspinatus does what?
abduction (first third, followed by deltoid, then trap)
supra scapular nerve
G6PD deficiency is what type of inheritance?
XR
Vitamin D resistant rickets has what type of inheritance?
XD
Most blood cell structural abnormalities have what kind of inheritance?
AD
hereditary spherocytosis
Most enzyme deficiencies are what kind of inheritance?
AR
G6PD deficiency
Internuclear ophthalmoplegia a disorder of?
conjugate horizontal gaze
damage to heavily myelinated fibers of medial longitudinal fasciculus
Medial longitudinal fasciculus is?
paired neural tract that medicates communication between CN III and VI
coordinated horizontal eye movements
Unilateral MLF lesions can occur with?
Lacunar stroke in the pontine artery distribution
dorsal pons
What is usually preserved in MLF lesions?
Convergence
pupillary light reflex
Bilateral MLF lesions are seen in?
MS
MLF lesions present with?
affected eye (ipsilateral to lesion) unable to adduct contralateral eye abducts w/nystagmus
Insulin independent receptors
GLUT-1, 2, 3, 5 Brain Kidney Liver Intestine RBCs
Insulin mediated receptors
GLUT-4
muscle cells
adipocytes
Tetanus toxoid vaccine acts by
stimulates a humoral antibody response
prevents neurological damage
Stress incontinence etiology
decreased urethral sphincter tone
urethral hyper mobility
Stress incontinence symptoms
leakage with coughing, lifting, sneezing
Urge incontinence etiology
Detrusor hyperactivity
Urge incontinence symptoms
sudden overwhelming urge to urinate
overflow incontinence etiology
impaired detrusor contractility
bladder outlet obstruction
overflow incontinence symptoms
incomplete emptying
persistent involuntary dribbling
In a male, non-fusion of the urethral folds causes
hypospadias
more common than epispadias
In a female, non-fusion of the urethral folds causes
vestibule of the vagina (labia minora)
Epispadias happens because
faulty positioning of genital tubercle in 5th week gestation
Bifid scrotum happens because
malunion of labioscrotal folds
In a female, the labioscrotal folds forms the
labia majora
Strep that can cause cavities
Viridans strep (mutans and sanguinis) make dextran (insoluble extracellular polysaccharides) using sucrose as substrate
can cause infective endocarditis too
P. aeruginosa toxin and mech
Exotoxin A
Inactivates EF-2 via ribosylation
inhibits host cell protein synthesis
Clostridium perfringins toxin and mech
Most important is Lecithinase (aka phospholipase C or alpha toxin)
lethal and necrotic effects
catalyzes splitting of phospholipid molecules
causes cell lyses
also uses carbs for energy which produces gas (gas gangrene)
Severity of tetralogy of fallot based on
degree of pulmonary stenosis
right ventricular outflow tract obstruction
Tetrology of fallot includes
VSD
overriding aorta
right ventricular outflow obstruction (stenosis)
RV hypertrophy
Phenylephrine binds to
alpha-1 rec on vascular smooth muscle
Gq
Gq receptors
active phospholipase C –> IP3 + DAG
DAG stim protein kinase C –> SM contraction
IP3 increase intracellular calcium –> stim protein kinase C
Extramedullary hematopoiesis is associated with
chronic hemolytic anemias (b-thalessemia)
Neisseria meningitides reaches the brain how
pharynx –> blood –> chord plexus –> meninges
Cotton-wool spots and micro aneurysms
nonproliferation phase of diabetic retinopathy (early)
neovascularization in eye of DM
proliferative phase of diabetic retinopathy (late)
Epithelia of the ovary
simple cuboidal
epithelia of fallopian tube
simple columnar
ciliated cells transport egg
damage can cause infertility, hydrosalpinx, ectopic prego
epithelia of uterus
simple columnar
epithelia of cervic
ectocervix = stratified squamous non-keratinized endocervic = simple columnar
epithelia of the vagina
stratified squamous non-keratinized
Posterior part of the external auditory canal is innervated by
small auricular branch of the vagus nerve
stimulation can cause vasovagal syncope d/t PNS outflow via vagus = decreased HR and BP
Majority of the external ear receives cutaneous innervations from
great auricular nerve
lesser occipital nerve
auriculotemporal nerve
External auditory canal innervated by
mandibular branch of trigeminal V3
auriculotemporal branch
Diuretic used for acute angle-closure glaucoma
Acetazolamide
inhibits carbonic anhydrase in the proximal tubule
block HCO3- reabsorption
enhanced HCO3- and water excretion
increased urinary pH
potential metabolic acidosis
Nitrates predominately affect
large veins
ventilation and increased venous capacitance
decreased preload
reduced LV EDV and pressure
decreased myocardial oxygen demand (relieves angina symptoms)
Tardive dyskinesia looks like
involuntary movements
associated with long term DA antagonists (antipsychotic, metoclopramide)
Akanthisia looks like
subjective restlessness with inability to sit still
extrapyramidal SE of antipsychotics
symptoms of neuroleptic malignant syndrome
fever
rigidity
mental status changes
autonomic instability
TCA affects on the heart
inhibit fast sodium channel conduction
slows down myocardial depolarization
cardiac arrhythmia in overdose
also refractory hypotension
decreased cardiac contractility
direct peripheral vasodilation (peripheral alpha 1 antag)
Little kid with increased blood ammonia levels and orotic acid in urine
ornithine transcarbamylase (OTC) deficiency
MC urea cycle disorder
Ornithine transcarbamylase deficiency results in
excess carbamoyl phosphate
stimulates pyrimidine synthesis
decreased citrulline and urea
Filtration fraction is
GFR/RPF
GFR can be estimated with
inulin or creatinine clearance
RPF can be determined by
PAH clearance
Clearance of any substance
C = ([Urine conc. of X] x [urine flow rate]) / (plasma conc of X)
pleural plaques with lower lung fibrosis in elderly
pleuropulmonary asbestosis
interstitial fibrosis association with ferruginous bodies
asbestos fibers can be differentiated from other ferruginous bodes (carbon, talc) by
translucent fiber core
Secondary hyperparathyroidism is seen in
chronic kidney disease
phosphate retention
decreased production of 1, 25 - dihydroxyvitamin D
Primary hyperparathyroidism cause
parathyroid hyperplasia or adenoma
large, red, lingual mass causing difficulty creating, hoarseness, dysphagia
lingual thyroid that failed to migrate
DM type 1 is caused by
pathologic apoptosis of pancreatic beta cells
Charcot-Bouchard aneurysms are
small
in patients with long standing HTN
found in arterioles that supply basal ganglia, internal capsule, deep white matter
cause intracerebral bleeds not SAH
Gestational diabetes affects the baby how
excessive trans placental glucose transfer to fetus
stimulates insulin production in fetus and beta cell hyperplasia/hyperinsulinism
becomes hypoglycemic at birth bc insulin is still hyper functioning even though no glucose is transferred
Polycythemia is caused by
abnormal transduction of erythropoietin growth signals JAKSTAT pathway (cytoplasmic tyrosine kinase)
Burkitt lymphoma is caused by
translocation of c-myc oncogene on Christmas 8 to Ig heavy chain on Christmas 14
c-myc is a
growth-stimulating transcription factor
flank pain, hematuria, and wedge-shaped kidney lesion on CT
renal infarction
MCC of renal infarction
systemic thromboembolism from left atrium or ventricle
common with afib
why are the brain and kidney more likely to suffer embolic infarctions?
perfused at a higher rate
Hand foot and mouth disease is caused by
enterovirus
coxsackie virus A or B
can also cause myocarditis leading to CHF, dysrhythmia, acute circulatory collapse
spontaneous gas gangrene caused by clostridium septicum are triggered by underlying
colonic malignancy
creates a portal of entry for the bacteria
also, IBD and immunosuppression
clostridium perfringens gas gangrene is associated with
trauma
patients with hemochromatosis are at increased risk of infection with
fulminant vibrio vulnificus (dependent of free iron)
indwelling catheters increase risk for
candidemia
MM at most risk for infections with
pneumococcus and H. flu- PNA
e. coli - UTI
Genetic instability with hepatitis C virus is due to
3’–>5’ exonuclease activity
no proofreading built into the vision encoded RNA polymerase
Guillain-Barre syndrome is associated destruction of
schwann cells
AV nodal blocking drugs for rate control
beta blockers
calcium channel blockers
prevent rapid ventricular response
Rhythm control for paroxysmal a fib
sotalol
flecainide
amiodarone
class III
Class III antiarrhythmics
sotalol
flecainide
amiodarone
block potassium channels
inhibit outward repolarizing currents during phase 3 of AP
increased AP duration, QT interval prolongation
class III antiarrhythmics are associated with
Torsades de pointes
from QT interval prolongation
less with amiodarone than sotalol
Drug induced lupus caused by
hydralazine procainamide isoniazid minocycline quinidine
IL-2’s anti tumor effects due to
increased activity of T cells and NK cells
IL-2 therapy currently used in what cancers
metastatic melanoma
RCC
Bevacizumab MOA
interferes with VEGF receptor activation
inhibits angiogenesis
Alemtuzumab MOA
anti-CD52 to treat CLL
binds to CD52, direct cytotoxic effect via complement fixation and Ab-dependent cell-mediated cytotoxicity
Chemotherapeutics MOA
etoposide
vincristine
cyclophosphamide
induce apoptosis
Interferon gamma increases
MHC I
MHC II
improving antigen presentation in all cells
Hawthorne effect
tendency of study subjects to change their behavior as a result of their awareness that they are being studied
pygmalion effect
the fact that a researcher’s beliefs in the efficacy of treatment can potentially affect the outcome
i.e. assigning higher IQ to students and telling teachers, students did better bc teachers had higher expectations
immotile at body temp but tumbling at room temp
listeria monocytogenes
elimination of intracellular pathogen relies on
cell-mediated immune response
increased urinary ______ prevent kidney stones
citrate
Duchenne’s muscular dystrophy is due to
deletions of dystrophin gene (frameshift)
links a component of the cytoskeleton to transmembrane proteins that are connected in extracellular matrix
Floppy baby large anterior fontanelle umbilical hernia macroglossia nonpitting edema (puffy face)
congenital hypothyroidism
congenital hypothyroidism is caused by
thyroid dysgenesis (genesis, hypoplasia, ectopy) iodine deficiency
Mycoplasma pneumonia infection can be diagnosed with
cold agglutinins
clumping in cold temp
from developing cross reactive IgM antibodies on erythrocytes
also see in infectious mononucleosis and certain hematologic malignancies
common cause of tracheobronchitis and walking pneumonia in adolescents
mycoplasma pneumoniae
Methylxanthines (theophylline and aminophylline) cause bronchodilation by
blocking phosphodiesterase
increasing intracellular cAMP
Ipratropium MOA
blocks acetylcholine
inhibits bronchoconstriction
What happens to the endometrium after progesterone stops
increase prostaglandin synthesis
vasoconstriction of spiral arteries
apoptosis of endometrial epithelium
degeneration of functionalists layer = mesntrual flow
Prolonged exposure to estrogen at the uterus
hyperplasia
precancerous state
suppressed by progesterone and medroxyprogesterone
The first step of gluconeogenesis is
Pyruvate to oxaloacetate with pyruvate carboxylase
needs acetyl-coa
ADH is made in the
paraventricular and supraoptic nuclei of hypothalamus
ADH is stored in the
posterior pituitary
Damage to hypothalamic nuclei causes permanent
diabetes insipidus (central)
damage to posterior pituitary/infundibular can cause
transient central DI
hypothalamic nuclei intact
axonal regeneration and hypertrophy can compensate
Lambert-Eaton is seen as
paraneoplastic syndrome
small cell carcinoma of lung
weakness improves with muscular repetition
Lambert-eaton is caused by
autoantibodies that react with voltage gated calcium channels on presynaptic membrane
hampers release of acetylcholine
Guillain bare syndrome thought to be due to
molecular mimicry
segmental demyelination
endometrial inflammatory infiltrate composed of T cells and macrophages
acne vulgarism caused by propionibacterium acnes pathogenesis
proliferation of lipid utilizing bacteria within pilosebaceous follicles
persistent fluctuating LAD who may have had unrelated pharyngitis (treated with Abx)
follicular lymphoma
follicular lymphoma is the mc
indolent non-hodgkin lymphoma in adults
from follicular B cells
waxing and waning course
translocation of (14:18)
follicular lymphoma presentations
middle aged
painless lymph node enlargement
abdominal discomfort from an abdominal mass
long waxing and waning course
follicular lymphoma histology
mixture of cleaved and non cleaved follicle center in a nodular pattern
follicular lymphoma genetics
t(14:18)
over expression of bel-2 oncogene
blocks programmed cell death
Diffuse large B cell lymphoma presentation
rapidly enlarging nodal (neck, abdomen, mediastinum) or extra nodal symptomatic mass
Waldeyer’s ring (oropharyngeal lymphoid tissue) and GI tract commonly involved
systemic B symptoms: fever, weight loss, drenching night sweats
Hairy cell leukemia presentation
older men
splenomegaly
lymph node enlargement not classic
leukemic cells have hairlike cytoplasmic projections
positive for tartrate resistant acid phosphatase (TRAP)
ALL presentation
children LAD hepatosplenomegaly fever bleeding bone pain
Hyper IgM syndrome is due to
defect in class switching in B lymphocytes
noncaseating granulomas of GI tract
crohn’s disease
Crohn’s disease is characterized by
transmural inflammation
strictures from bowel wall edema, fibrosis, and hypertrophy of muscular mucosae
fistulas
abscesses
skip lesions
Ulcerative colitis involves the
mucosa and submucosa
H. flu type B can cause
epiglottitis
meningitis
bacteremia
pneumonia
H. flu type B virulence factor
polyribosylribitrol phosphate (PRP capsule)
inhibits complement-mediated phagocytosis
can invade tissues and survive in bloodstream
mycoplasma pneumonia is treated with
doxycycline
lithium induced diabetes insipidus caused by
lithium reduces ability of kidneys to concentrate urine
antagonizes action of ADH in collecting tubules and ducts
Etanercept is characterized as
soluble receptor decoy protein
Etanercept MOA
TNF alpha inhibitor
added to methotrexate to treat moderate to severe RA
biological agent ending in cept
receptor molecule
biological agent ending in nib
kinase inhibitor
what is derived fro the ventral pancreatic primordium
main pancreatic duct
The dorsal pancreatic bud makes the
pancreatic tail
body
superior aspect of the head
accessory pancreatic duct
the ventral pancreatic bud makes the
uncinate process
inferior/posterior part of the head
major pancreatic duct (of Wirsung)
pancreas divisum
failure of the dorsal and ventral pancreatic buds to fuse
pancreatic ductal systems remain separate
accessory duct draining most of pancreas
Most dangerous effect of amphotericin B
nephrotoxicity
renal tubular dysfunction
decreased GFR
chronic lymphocytic (hashimoto thyroiditis) histology
intense lymphoplasmacytic infiltrate with active germinal centers
residueal follicles often surrounded by Hurthle cells (large oxyphilic cells filled with granular cytoplasm)
special test for hashimoto
elevated antithyroid peroxidase antibody
graves disease histology
tall follicular epithelium and crowded with hyperactive reabsorption causing scalloping around the edges of colloid
Reidel thyroiditis histology
extensive fibrosis extending into surrounding structures
subacute granulomatous (de Quervain) thyroiditis histology
disruption of follicles and mixed cellular infiltrate with occasional multinuclear giant cells
subacute granulomatous (de Quervain) thyroiditis presentation
viral URI with fever and painful tender thyroid nodule
