4 Flashcards
Light microscopy PSGN
Hypercellular glomeruli (leukocytes), mesangial and endothelial proliferation
IF PSGN (starry sky)
Granular deposits of IgG, IgM, and C3*(alternative pathway-no C1 or C4)
EM PSGN
Sub-epithelial humps (Ab-Ag(exotoxinB) deposits)
Subendothelial C1q deposits
Type 1 Membranoproliferative GN
Lupis nephritis: IgE deposits in capillary wall
Poorer prognosis
Cannulation of the femoral vein should occur where?
1cm below inguinal ligament and just medial to the femoral artery pulsation
Variability in mitochondria disease expression is due to
herteroplasmy
Name 3 mitochondria disease
1) LHON-bilateral vision loss
2) Myoclonic epilepsy with ragged-red fibers: myoclonic seizures and myopathy w/ exercise. Red ragged fibers on muscle biopsy
3) MELAS- mitochondrial encephalomyopathy with lactic acidosis and stroke like episodes
Variable expressivity is seen in
AD disorders
M3R in endothelial surface (muscarinic toxicity)
vasodilation/relaxtion (via NO–>hypotension). In other sights causes smooth muscle contraction
M2 receptors (mostly in cardiac muscle)
G-protein decrease intracellular cAMP–>opens potassium channels to slow depolarization. Descreased inotropy (contractility) and chronotropy (HR)
Endocardial cushion defects that result in ostium primum atrial septal defects and regurgitation atrioventricular valves
Down syndorme
aortic valve incompetence, MVP, cystic medial necrosis of aorta
Marfan (AD)
Pericarditis often follows what? Pain is worse when?
Upper respiratory viral syndrome.
Lying flat
Blood pressure disparity btw arms (greater than 10mmHg) and tearing pain to back
aortic dissection
occurs w/ repetitive activity; reproducible pain w/ palpation and worse with movement
costosternal syndrome (costochondritis)
siezures in patient from rural or central south america
neurocysticercosis (Taenia solium - pork tape worm)
Screening test for T.Pallidum
Rapid plasma reagin (RPR) test and VDRL
Confirmatory test for T.Pallidum
FTA-ABS
TTP (FAT-RN)…Differs from DIC because TTP has
NORMAL PT and aPTT
Most common cause of coronary sinus dilation (know your anatomy fool)
elevated right-sided heart pressure secondary to PHTN (pulmonary hypertension)
Low frequency sound commonly associated with increased left ventricular end-systolic volume (left ventricular systolic failure)
S3
When is S3 best heard
Place bell over apex (midclavicular 5th intercostal space) with patient lateral decubitus position
When do you hear an S3
Heart failure, dilated cardiomyopathy, mitral regurg.
Cough reflex (afferent limb): can be damaged when sharpe shit (like fish bone) gets lodged in piriform recess
Internal laryngeal nerve (sensory and autonomic fibers)
Gag reflex
Afferent: CN IX
Efferent: CN X
KIT receptor tyrosine mutation (CD117)
systemic mastocytosis (expression of mast cell tryptase)
Histamine mediated via degranulation of mast cells: syncope, flushing, hypotension, pruritis, urticaria, gastric acid secretion (phys.pic), diarrhea
Systemic mastocytosis (abnormal proliferation of mast cells and increased histamine release)
Chronic lithium toxicity (confusion, ataxia, neuromuscular excitability) can be precipitated by volume depletion and drug interactions
thiazides, ACE inhibitors, NSAIDS
How do human cell resist chemo therapy
MDR1 gene–> P-glycoprotein (prototype gene product)
What is p-glycoprotein (product of MDR1 gene)
Transmembrane pump that functions at an ATP-dependent efflux pump. Normally expressed in intestinal and renal cells for elimination.
What drugs have been shown to fuck w/ this lil shit head p-glycoprotein?
verapamil, diltiazam, and ketoconazole (all reduce the action of this multi-drug resistance protein
Musculocutaneous nerve injury causes
trauma (shoulder dislocation) and strenuous upper extremity activity (baseball pitching)
Where is the musculocutaneous nerve derived from? Innervations? Sensory?
C5-C7 of the lateral cord of brachial plexus…it innervates forearm flexors (biceps, brachialis) and coracobrachialis (flexes and adducts the arm). Sensory of skin of lateral forearm
First dose hypotension (esp. in patients with volume depletion from diuretic, HF, etc)
ACE inhibitors (titrate up dose to prevent)
*note also no beuno in BILATERAL renal artery stenosis
Uni is “okay”
Mucocutaneous canidiasis (and other infections), persistent diarrhea, failure to thrive, thymic hypoplasia or aplasia, low or absent CD3+ T-cells and hypogammaglobulinemia
SCID
Brutons is a T or B issue?
B ONLY
Most common disorder of heme synthesis?
Porphyria cutanea tarda (PCT) due to deficient Uroporphyrinogen decarboxylase
