5/26 Mixed Flashcards
ALL
The most common malignancy of childhood
B-cell ALL is responsible for 70-80% of all cases of ALL
T-cell ALL accounts for 15-17% of all ALL
T-cell ALL often presents as a mediastinal mass that can cause respiratory symptoms, dysphagia, or superior vena cava syndome (young male)
Graft vs. host disease
can occur following transplantation of organs rich in lymphocytes (e.g. liver)
T lymphocytes found in the donor organ become sensitized against MHC antigens of the recipient and subsequently attack the host’s tissues
The skin, liver and GI tract are most frequently affected (diffuse maculopapular rash, diarrhea, intestinal bleeding, abdominal pain)
Lesions of the femoral nerve
Can occur due to trauma, nerve compression, stretch injury, or ischemia
Patients develop weakness of the quadriceps muscle, loss of the patellar reflex, and loss of sensation over the anterior and medial thigh and medial leg
Specific features of hyperthyroidism
Pretibial myxedema and exopthalmous are specific features of hyperthyroidism due to Graves disease
They are caused by an autoimmune response directed against the TSH receptor that results in accumulation of glycosaminoglycans within the affected tissue
“Red ragged” Muscle fibers
Mitochondrial disease
“Blotchy red muscle fibers on Gomori trichrome stain”
Muscle fibers have this appearance because abnormal mitochondria accumulate under the sarcolemma.
Mitochondrial dx show maternal inheritance
Ex. Myoclonic epilepsy, Leper optic neuropathy, Mitochondrial encephalopathy with stroke-like episodes and lactic acidosis
Osteogenesis Imperfecta
Results from defective synthesis of type 1 collagen
Clinical findings include a history of fractures after only minimal trauma, abnormal (blue) sclerae, and small malformed teeth
Problem with bone matrix formation
Kawasaki disease
Vasculitis of medium sized arteries
Presents with persistent fever for > 5 days, bilateral conjunctivitis, cervical lymphadenopathy, mucocutaneous involvement
Coronary artery aneurysms are a serious complication
Most common cause of calcium kidney stone disease
Idiopathic hypercalciuria
Normal serum calcium levels with hypercalciuria
Polyhydramnios (excessive accumulation of amniotic fluid)
Presents with increase abdominal circumference out of proportion to gestational age
Etiology is decreased fetal swallowing or increased fetal urination
Fetal anomalies associated with impaired swallowing include gastrointestinal obstruction (eg, duodenal, esophageal, intestinal atresia) and anencephaly
Alzheimer’s Disease
Beta-AMYLOID deposits in the brain parenchyma (neuritic plaques) and walls of cerebral vessels (amyloid angiopathy)
Individual subunits of hemoglobin
Structurally analogous to myoglobin
Monomeric subunits will demonstrate a hyperbolic oxygen- dissociation curve similar to that of myoglobin
COX-2
An inducible enzyme that is upregulated to increase synthesis of pro-inflammatory arachidonic acid metabolites
Selective COX-2 inhibitors (Celecoxib) decrease inflammation by inhibiting COX-2 but have no effect on COX-1 (minimizing gastroduodenal toxicity)
Non-pharmacologic treatments for insomnia
Sleep hygiene Stimulus control Relaxation Sleep Restriction Cognitive behavioral therapy
Stimulus control focuses on eliminating stimulating bedroom activities and getting into bed only when sleepy
Rheumatoid arthritis
Progressive joint destruction involving the hands, wrists, elbows, knees. Cervical spine involvement can lead to spinal instability and cord compression
Acetazolamide in the treatment of open-angle and angle-closure glaucoma
Carbonic anhydrase in proximal tubule
Acetazolamide inhibits CA, blocks NAHCO3 and water reabsoprtion in PT, resulting in urinary bicarbonate wasting
Relieve intraocular pressure in open-angle and angle-closure glaucoma
B12 deficiency myelopathy
Subacute combined degeneration
Degeneration of both the dorsal columns and corticospinal tract
Loss of position and vibration sensation, ataxia, and spastic paresis are common manifestations
Auer rods
Deformed azurophilic granules found in the cytoplasm of myeloblasts that stain positively for myeloperoxidase (PEROXIDASE)
Auer rods are found in abundance in AML M3 (APL)
Meningococcal lipooligosaccharide (LOS)
Responsible for many of the toxic effects observed in meningitis and meningococcemia
Blood levels of LOS correlate closely with morbidity and mortality
Ischemic-hypoxic encephalopathy
Profound cerebral hypoperfusion may lead to global cerebral ischemia (also called ischemic-hypoxic encephalopathy)
Watershed infarcts occurs between the zones of perfusion of the anterior, middle, and posterior cerebral arteries
These infarcts typically appear as bilateral wedge-shaped strips of necrosis over the cerebral convexity, parallel and adjacent to the longitudinal cerebral fissue
Transference
The unconscious shifting of emotions associated with a significant person from one’s past to a person in the present
Poor long-term prognostic factor for PSGN?
AGE. Most children recover completely but adult patients have a relatively poor prognosis and higher risk of chronic HTN and renal insufficiency
Synaptophysin
Protein found in the presynaptic vesicles of neurons, neuroendocrine and neuroectodermal cells
CNS tumors of neuronal origin frequently stain positively for synaptophysin on immunohistology
Neoplasms of glial origin (astrocytomas, ependymomas, and oligodendrogliomas) strain for GFAP
Sheehan Syndrome
High estrogen levels during pregnancy cause enlargement of the pituitary gland without a proportional increase in blood supply
Peripartum hypotension can cause ischemic necrosis of the pituitary leading to panhypopituitarism (Sheehan syndrome)
Patients commonly develop failure of lactation due to deficiency of prolactin
Factor V Leiden
One to nine percent of Caucasians worldwide are heterozygote carriers of factor V Leiden, which is modified to resist activated protein C
The resulting hypercoagulable state predisposes to deep vein thromboses, which are the source of most pulmonary emboli
SGLT2 Inhibitors (Canagliflozin, dapagliflozin)
Oral anti-diabetic agents
Decrease proximal tubular reabsorption of glucose, promoting urinary glucose loss
*Recommended to monitor serum creatinine before and after initiating therapy with SGLT2 inhibitors
Maternal serum quadruple screen
Performed to assess risk of congenital defects in fetuses
Accurate dating is important for determining whether levels of alpha-fetoprotein and other analytes are abnormal for gestational age
Patients with a history of irregular menses are at risk for inaccurate pregnancy dating
A yellowish eyelid papule or plaque containing lipi-laden macrophages= xanthelasma
Xanthelasma may occur in association with primary or secondary hyperlipidemia; cholestatic conditions such a primary biliary cirrhosis are a potential cause of hypercholesterolemia leading to xanthelasma
Atherosclerotic plaque formation
Vascular smooth muscle cells are the only cells within the atherosclerotic plaque capable of synthesizing structurally important collagen isoforms and extracellular matrix
Progressive enlargement of the plaque results in remodeling of the extracellular matric and VSMC death, promoting development of vulnerable plaques with an increased propensity for rupture
First generation H1-histamine receptor antagonists (Diphenhydramine and chlorpheniramine)
Can cause significant sedation, especially when used with other medications that cause CNS depression (such as benzodiazepines)
Parotid gland tumors
The facil nerve exists the stylomastoid foramen and courses through the substance of the parotid gland, where it divides into its 5 terminal branches that innervate the muscles of facial expression. Malignant tumors of the parotid gland often compress and disrupt the facial nerve causing ipsilateral facial droop
Ethylene glycol ingestion
Leads to toxic, acute tubular necrosis with vacuolar degeneration and ballooning of the proximal tubular cells
Typical clinical findings include high anion gap metabolic acidosis, increased osmolar gap, and calcium oxalate crystals in the urine
Acute renal allograft rejection
Can be an antibody or cell mediated process
Acute cellular rejection is associated with diffuse lymphocytic infiltration of the renal vasculature (endotheliitis), tubules, and interstitium
Expanding space occupying lesions within the temporal lobe can cause elevated intracranial pressure with transtentorial herniation of the uncus
Uncal herniation often compresses the ipsilateral third cranial nerve as it exits the midbrain, resulting in oculomotor nerve palsy with a fixed dilated pupil (eg due to preganglionic parasympathetic fiber damage)
These fibers run on the outer portion of the third cranial canal
Fick principle = used to calculate cardiac output using the rate of oxygen consumption and the AV oxygen content difference
Cardiac output= rate of O2 consumtion/ AV O2 content difference
