6/5 Mixed Flashcards
Giant Cell (Temporal) Arteritis
Elderly woman with jaw claudication, and episode of amaurosis fugax, polymyalgia rheumatica (pain in shoulder and hip girdles), headache, diplopia, blurred vision, ischemic optic neuropathy
Dx: C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR)- highly sensitive, always very elevated, temporal artery biopsy
Microsomal monooxygenase overreactivity causing cancer
Most chemical carcinogens enter the body in an inactive state (pro-carcinogens)
These are converted into active metabolites by the cytochrome p450 oxidase system
Individual susceptibility to chemical carcinogens depends on the activity of these enzymes, which is genetically determined
Sebaceous glands
Are a type of HOLOCRINE exocrine gland
Can cause inflammatory acne
Gastric varices only in the fundus
The short gastric veins drain blood from the gastric fundus into the splenic vein Pancreatic inflammation (pancreatitis, pancreatic cancer) can cause a blood clot within the splenic vein, which can increase pressure in the short gastric veins and lead to gastric varices ONLY in the FUNDUS
Loss of cardiomyocyte contractility occurs within 60 seconds after the onset of total ischemia
When ishcemia lasts less that 30 minutes, restoration of blood flow leads to reversible contractile dysfunction (myocardial stunning), with contractility gradually returning to normal over the next several hours to days
However, after about 30 minutes of total ischemia, ischemic injury becomes irreversible
Prior disease
PrP (prion protein) is a normal cellular protein found in neurons that has an a-helical secondary structure. if this protein undergoes a conformational change to a B-pleated sheet, it is highly resistant to proteases, causing intracellular accumulation
Accumulation of an abnormal prior protein is considered a cause of prion diseases
Characteristic microscopic findings are vacuoles in the gray matter (spongiform encephalopathy) with no inflammatory changes)
Ex.Creutzfeldt-Jakob disease
Macrocytic Megaloblastic anemia
Underlying feature is a defect in DNA synthesis
In chronic alcoholics, this can result from a nutritional deficiency of vitamin B12 or folate, which impairs synthesis of purine and pyrimidine bases (ex. diminished thymidine synthesis)
Body dysmorphic disorder
Preoccupation with a perceived defect in appearance and repetitive behaviors in response to the preoccupation
It can present with absent insight/delusional beliefs and result in significant psychosocial dysfunction
Aromatase Inhibitors (anastrozole, letrozole, exemestane)
Decrease the synthesis of estrogen from androgens, suppressing estrogen levels and slowing progression of Er-positive tumors
Estrogen is the main hormone responsible for the growth and development of ER+ breast tumors
Good in postmenopausal women
Combination oral contraceptive pills to treat hirsutism
Suppress pituitary LH secretion and subsequently decrease ovarian androgen production
Complications of invasive vascular procedures
Atheroembolic renal disease
May involve the kidneys (MC), GI tract, CNS, and the skin
Light microscopy shows a partially or completely obstructed arterial lumen with needle-shaped cholesterol clefts within the atheromatous thrombus
Signs of embolism = blue toe, livedo reticularis, normal peripheral pulses)
Capitation
An arrangement in which a payer pays a fixed, predetermined free to provide all the services required by a patient
Payers may negotiate a capitated contract with an insurance company that then pays the providers or a large medical group may negotiate directly with the payer
Child language development: age 2
Children should have a vocabulary of 50-200 words and be using 2-word phrases
Gallbladder hypomotolity
Causes bile concentration, while promotes bile precipitation and accumulation of viscous biliary sludge that predisposes to gallstone formation and bile duct obstruction
Pulmonary actinomycosis
Develops most commonly following aspiration and can be confused with lung abscesses, malignancy, or tuberculosis
Microscopic findings include filamentous, branching, gram-positive bacteria or sulfur granules
Found in dental caries, margins of gums in patients with poor dendition
Lymph node malignancy
Monoclonal lymphocytic proliferation is strong evidence of malignancy
“monoclonal T-cell receptor gene rearrangements”
ACE inhibitor first-dose hypotension
ACEi can cause first-dose hypotension in patients with volume depletion (from diuretic use) or heart failure)
To reduce the risk of first-dose hypotension, ACEi therapy should be initiated at low dosages
Meconium ileus
Distal small bowel obstruction due to abnormally dehydrated meconium in a patient with cystic fibrosis (CF)
Persistent, treatment resistant infectious pneumonias, bronchiectasis, and cor pulmonale account for most deaths due to CF
Raltegravir
Integrase inhibitor
Disrupts HIV genome integration into the host cell’s chromosomes, preventing host cell machinery from being used to synthesize HIV mRNA
SLE
Loss of immune self-tolerance with production of autoantibodies against nuclear antigens
Binding of autoantibodies to self antigens leads to deposition of immune complexes in tissue and consumption of complement
Butterfly rash, inflammatory arthritis, ulcer on hard palate
Acute arsenic poisoning
Impairs cellular respiration and presents with abdominal pain, vomiting, diarrhea, hypotension and a garlic odor on the breath
Insecticides and contaminated water and common sources of arsenic
Rx: Dimercaprol is the chelating agent of choice
Zollinger-Ellison syndrome
Caused by gastrinomas located in the small intestine/pancreas and presents with peptic ulcers (especially DISTAL duodenal ulcers), heartburn, and diarrhea
Patients typically have elevated gastrin levels that rise in response to exogenous secretin administration
(vs. secretin inhibits release of gastrin from normal gastric G cells)
Antithyroid drug SE
Agranulocytosis is a rare but very serious complication of antithyroid drugs (methimazole, propylthiouracil) that commonly presents with sudden onset of fever and sore throat
If agranulocytosis is suspected, the eliciting drug should be discontinued immediately and a white blood cell count with differential obtained to confirm the diagnosis
Rx of essential tremow
First line treatment is the nonspecific B-adrenergic antagonist propranolol
White/yellow membrane-like plaques on colonoscopy
C. difficile
Abdominal aortic aneurysm
Transmural aortic wall inflammation, abnormal collagen remodeling and cross linking and loss of elastin and smooth muscle cells
Leads to weakening and progressive expansion of the aortic wall, resulting in aneurysm formation
Osteoarthritis of the hands
Osteophyte formation leading to hard bony enlargement of the distal interphalangeal joints (Herberden nodes) and proximal interphalangeal joints (Bouchard nodes)
Brief morning stiffness may be present
Ion pump failure due to ATP deficiency during cardiac ischemia
Causes intracellular accumulation of Na and Ca
The increased intracellular solute concentration draws free water into the cell, causing the cellular and mitochondrial swelling that is observed histologically
Multiple endocrine neoplasia type 1
Hyperparathyroidism, endocrine pancreatic tumors (gastrinoma), pituitary tumors)
Genetic defect involves the MEN1 gene
Confounding bias
Occurs when the exposure disease relationship is muddied by the effect of an extraneous factor that has correlations with both the exposure and the disease
Confounding bias can result in the false association of an exposure with a disease
Vasopressin and desmopressin
Causes a V2 receptor-mediated increased in water and urea permeability at the inner medullary collecting duct
The resulting rise in urea reabsorption (decreased urea clearance) enhances the medullary osmotic gradient, allowing the production of maximally concentrated urine
Diastolic heart failure (DHF)
Caused by decreased ventricular compliance and is characterized by normal left ventricular (LV) ejection fraction, normal LV end-diastolic volume, and elevated LV filling pressures
Hypertension, obesity and infiltrative disorders (e.g. transthyretin-related amyloidosis, sarcoidosis) are important causes of DHF
Traumatic aortic rupture
Most often caused by the rapid deceleration that occurs in motor vehicle collisions
The most common site of injury is the aortic isthmus, which is tethered by the ligamentum arteriosum and is relatively fixed and immobile compared to the adjacent descending aorta
Post streptococcal glomerulonephritis
Elevated anti-streptolysin O (ASO) titers, elevated anti-DNase B titers, decreased C3 and total complement levels and the presence of cryoglobulins.
C4 IS USUALLY NORMAL!
Hepatic angiosarcoma
Associated with exposure to carcinogens such as arsenic, thorotrast, and polyvinyl chloride
Tumor cells express CD31, an endothelial cell marker
Rare vascular tumor
Erosions
Mucosal defects that do not fully extend through the muscularis MUCOSA.
Ulcers penetrate through the mucosal layer and extend into the submucosal layer
Trigeminal nerve and stroke symptoms
CN V arises at the level of the middle cerebellar peduncle at the lateral aspect of the midpons
Infarcts involving the anterior portion of the medial pons can produce dysarthria and contralateral ataxic hemiparesis
Chronic rejection in lung transplant
Affects small airways, causing bronchiolitis obliterans
It is characterized by lymphocytic inflammation, fibrosis, and ultimately, destruction of the bronchioles
