7/17 Flashcards
1
Q
what’s a possible side effect of a pt taking dapsone
A
possible hemolytic anemia if pt is G6PD deficient
2
Q
what type of test do you want to rule out a life-threatening disease
A
highly sensitive,
because it’s able to correctly identify those with the disease.
the identification of every person with the disease is important here.
3
Q
what provides local defense against candida
A
T cells
localized Candida is common in HIV pts
4
Q
what provides systemic defense against candida
A
neutrophils,
prevent hematogenous spread
neutropenic pts are likely to have systemic candidiasis
5
Q
distinguish between conductive, sensorineural, and noise-induced hearing loss
A
conductive:
mechanical damage
(Weber localizes to affected ear; abnormal Rinne)
Sensorineural:
loss of hair cells/nerve
(Weber test localized to unaffected ear; nl Rinne)
noise-induced:
damaged to stereo ciliated cells in ORGAN OF CORTI
loss of high-frequency hearing first
suddenly extreme loud noises: tympanic membrane rupture
causes unilateral conductive hearing loss
6
Q
what does LH do in a male
A
stimulates release of testosterone from Leydig cells,
which produces negative feedback on LH
7
Q
what does FSH do in a male
A
stimulates release of inhibin B from Sertoli cells, which produces negative feedback on FSH
FSH also stimulates sertoli cells to produce androgen-binding protein locally (ABP)
8
Q
what does ABP do
A
ABP from the sertoli cells is responsible for keeping high levels of local testosterone, necessary for spermatogenesis
9
Q
which male cells are and are not temp sensitive
A
Sertoli cells support sperm synthesis and are sensitive to temperature!
Leydig cells secrete testosterone and are unaffected by temperature
10
Q
what does the pathogenicity of H influenzae depend on
A
the presence of an antiphagocytic polysaccharide capsule.
type B strain is most invasive
11
Q
what is leukocytoclastic vasculitis
A
a cutaneous small vessel vasculitis, often associated with medication for a recent infection (penicillins, cephalosporins)
typically presents w/ palpable purpora in lower extremities
characteristic histology:
marked perivascular inflammation of small blood vessels
fibrinoid necrosis
predominance of neutrophils and fragmented neutrophilic nuclei
12
Q
what is erythema nodosum
A
form of panniculitis (inflamm of subcutaneous fat)
typically presents as painful erythematous nodules in the lower extremities
histology:
widening of CT septa due to neutrophilic infiltration and fibrin exudation
histiocyte and giant cell infiltration with septal fibrosis
13
Q
what histology do you see in giant cell vasculitis
A
focal granulomatous inflammation of the media and internal elastic lamina fragmentation
14
Q
what is polyarteritis nodosa
A
transmural medium-vessel vasculitis
pts typically present with systemic symptoms, renal failure, and abdominal pain
from ischemia of involved organs
lungs/pulmonary arteries are spared
15
Q
what does urticaria histology look like
A
superficial dermal edema with a mild perivascular infiltrate (rare neutrophils) and dilated lymphatic channels
16
Q
what happens in a type 1 hypersensitivity
A
mediated by the interaction of the allergen with preexisting IgE bound to basophils and mast cells
this facilitates cross-linking of the surface IgE molecules that signals the cell to degranulate, releasing chemical mediators (histamine, heparin)
described as “cell surface-bound antibody bridging by antigen”
17
Q
how would you describe type 2 hypersensitivity
A
antibody-dependent cell-mediated cytotoxicity
IgM or IgG binds to antigens expressed on the cell surface. these antibodies are then recognized by Fc receptors on immune cells, triggering the release of perforin and granzymes that ultimately leads to cell lysis/death
18
Q
how would you describe type 4 hypersensitivity
A
CD8 T cell-mediated hypersensitivity
no antibodies
19
Q
what antibody is the most efficient in initiating complement
A
IgM in types 2 and 3 hypersensitivities
20
Q
where can enhancer sequences be located
A
upstream, downstream, or within a transcribed gene
it functions to increase (or decrease, if it’s a silencer) transcription
21
Q
what are promoter sequences
A
typically 25-75 bases upstream of their associated genes function to initiate transcription
22
Q
distinguish between HUS and TTP
A
both are thrombotic microangiopathies,
characterized by microvascular lesions with platelet aggregation
both have abnormal BLEEDING TIMES because of LOW PLATELETS
normal PT/PTT because it’s a platelet problem, not a coagulation problem
HUS:
more common in children
prominent renal involvement
TTP:
more common in adults
associated with pregnancy, HIV, cancer, bacterial infections, vasculitis, bone marrow transplant, drugs
TTP will have schistocytes on a blood smear
23
Q
distinguish between TTP and ITP
A
TTP will have neuro findings
24
Q
distinguish between TTP/HUS and hemophilias and VWF
A
TTP/HUS will have abnormal bleeding times
(problem with platelets)
Hemophilias will have prolonged PTT/PT
(abnormal coagulation factors)
VWF:
has both abnormal PTT and prolonged bleeding times
25
how will a hemophilia vs VWF pt present
Hemophilia:
deep tissue bleeding (hemarthrosis)
VWF:
menorrhagia
mucosal bleeding (GI, hematuria, epistaxis, gingival bleeds)
26
what are the phases of Pagets disease of the bone
Lytic: osteoclasts
Mixed: clasts + blasts
Sclerotic: blasts
Quiescent: minimal of either
27
how does Pagets bone disease present
abnormal bone remodeling forming poor-quality bone
elevated Alk Phos,
all other labs normal
Mosaic pattern of woven and lamellar bone
long bone chalk-stick fractures
Hat size may be increased (skull thickening)
hearing loss (narrow auditory foramen)
28
what are the segmented viruses, and what's their significance
```
BOAR:
Bunyavirus
Orthomyxovirus
Arenavirus
Rotavirus
```
can undergo reassortment (genetic shift) and exchange entire segments, causing a dramatic mutation and an epidemic or pandemic.
29
what characteristics cause a drug to remain inside of a plasma compartment
high molecular weight
high plasma protein binding
high charge
hydrophilic
these all give the drug a lower Vd
30
what heart rhythm is commonly seen after excessive alcohol consumption
a fib
| absent P waves, irregularly irregular rhythm, and varying R-R intervals
31
what would cause a high QRS voltage
ventricular hypertrophy, commonly 2/2 prolonged HTN
32
what can cause widened QRS complex
delay in intraventricular conduction due to fascicular or bundle branch block
the heart rhythm remains regular in this abnormality
33
what is prolonged QT interval associated with
risk of torsades de pointes (polymorphic V tach)
sudden cardiac death
34
how does chlamydia trachomatis present
L1-L3 cause lymphogranuloma venerum,
initially a painless ulcer
progresses to painful inguinal lymphadenopathy (buboes) and ulceration
see chlamydial cytoplasmic inclusion bodies
35
what are Councilman bodies
AKA acidophilic bodies, and apoptotic bodies
seen in pts with acute Hepatitis, which causes hepatocyte apoptosis and necrosis.
Apoptotic hepatocytes shrink, undergo nuclear fragmentation, and become intensely eosinophilic.
36
what does an elevated creatinine kinase suggest
underlying myopathy
37
what should be excluded in all pts with unexplained CK elevation
hypothyroidism,
via checking of TSH levels
myopathy can often be the first manifestation of hypothyroidism, so you should rule this out
38
what are common causes of myopathies
hypothyroidism
muscular dystrophies
inflammatory muscle diseases
mendications (statins)
39
describe the anatomy/pathway of the ureters
ureters pass posterior to ovarian/gonadal vessels in the retroperitoneum off the aorta and SVC
then anterior to the common/external iliac arteries
then reach the true pelvis:
anterior to internal iliac artery
medial to ovarian vessels
crosses under the uterine artery (water under the bridge)
40
how does estrogen affect bone and other tissues
estrogen decreases bone resorption
so low estrogen causes osteoporosis risk
unopposed estrogen exposure (estradiol therapy) can cause excessive endometrial proliferation, resulting in endometrial hyperplasia/cancer
41
what are Raloxifene and tamoxifen
SERMs
selective estrogen receptor modulators
they bind to estrogen receptors and exhibit estrogen antagonist or agonist properties in a tissue-specific manner
42
what is Raloxifene's specific use
estrogen agonist at bone (to decrease resorption)
improves bone mineral density
estrogen antagonist at breast
prevents breast cancer
estrogen antagonist at uterus
does not increase risk for endometrial cancer
43
what is Tamoxifen's specific use
strong estrogen antagonist in breast
used in treating ER-positive breast cancer
estrogen agonist at bone (protective)
however, also agonist activity at uterus, increasing risk for endometrial hyperplasia/cancer
44
alendronate's use
bisphosphonate that inhibits bone resorption
45
leuprolide's use
GnRH analog with estrogen agonist properties when administer pulsatile
estrogen antagonist properties when administer continuously
46
medroxyprogesterone's use
reduces incidence of endometrial hyperplasia and risk of cancer in postmenopausal women on estrogen replacement therapy
prolonged use of this as a contraceptive is associated with decreased bone mineral density
47
what parameter is increased in CHF
arteriolar resistance
via angiotensin 2 causing vasoconstriction.
this exacerbates HF because the heart is now pumping against against a higher arterial resistance (after load)
48
what do pts with deficient C5b-C9 have problems with
unable to form membrane attack couplex MAC
often experience recurrent infections with Neisseria
49
which anti fungal targets mitosis
griseofulvin
50
which anti fungal targets DNA and RNA synthesis
flucytosine
51
which anti fungal targets cell wall polysaccharide synthesis
capsofungin
note, it's the WALL not plasma membrane
52
which anti fungal inhibits ergosterol synthesis
azoles
53
which anti fungal damages cell membrane
amphotericin B and nystatin
they bind ergosterol and "tear holes" in it
54
what is congenital long-QT syndrome
mutated K channel,
causing a delayed re-polarizing rectifier current (Ik) of the cardiac AP
Jervell and Lange-Nielsen syndrome is the recessive form that also has sensorineural hearing loss
increased risk of sudden cardiac death 2/2 Torsades de pointes
55
what is the pathology of achondroplasia
exaggerated inhibition of chondrocyte proliferation
56
how does superior vena cava syndrome present
impaired venous return from the upper body:
dyspnea
facial swelling
dilated collateral veins in the upper trunk
possible headache, dizziness, confusion
most commonly caused by lung cancer as a mediastinal mass compressing SVC
57
what is a superior sulcus tumor
pan coast tumor
arises at lung apex and frequently causes shoulder pain 2/2 compression of brachial plexus
commonly involves cervical sympathetic ganglia, leading to Horner's syndrome
may cause SVC syndrome, but the shoulder pain and Horner's are most common manifestation
58
what is seen on NF-1:
cafe-au-lait spots
Neurofibromas (short, sessile, or pedunculate lesions varying in size)
optic gliomas
Lisch nodules (asymptomatic hamartomas of the iris)
mutations in NF1 on chromosome 17 (Von Recklinghausen)
auto dominant
59
what is seen on NF-2
bilateral acoustic schwannomas
juvenile cataracts
meningiomas
ependymomas
NF2 gene on chromosome 22
auto dominant
60
what does spherocytosis come from
mutation in spectrin or ankyrin, two plasma-membrane scaffolding proteins
61
what are 2 complications of spherocytosis
pigmented gallstones
aplastic crisis from parvovirus B19 infection
62
what are fava bean reactions a buzzword for
G6PD deficiency
gives you bite cells, Heinz bodies, all from eating some fava beans :)
63
what does ubiquitin ligase do
ubiquitin ligase recognizes specific protein substances and attach a ubiquitin tag
the proteins are degraded to an appropriate size,
then coupled with MHC 1 protein complex in the ER
then they're presented on cell surface for recognition by CD8 lymphocytes
all part of the ubiquitin proteasome pathway
64
what is a suggestive asthma presentation
intermittent resp symptoms
normal CXR
sputum eosinophils
reduced FEV1
65
what can you use to treat recurrent C diff
fidamoxicin
| macrocyclic (related to macrolide)
66
how do you remember 30s vs 50s inhibitors
"buy AT 30; CCEL at 50"
30:
Aminoglycosides
Tetracyclines
```
50:
Chloramphenicol
Clindamycin
Erythromycin (macrolides)
Linezolid
```
67
what would give you a winged scapula
damage to long thoracic nerve,
possibly during axillary lymph node dissection
unable to abduct shoulder past horizontal because the serrates anterior muscle is paralyzed and cannot rotate scapula upward
68
what do you see 0-4 hours post MI
gross:
none
micro:
none
complications: decreased organ perfusion:
cariogenic shock
CHF
arrhythmia
69
what do you see up to 1 day post MI
gross:
dark discoloration
(pyknosis, karyorrhexis, karyolysis)
micro:
coagulative necrosis
(anuclear cells)
complications:
arrhythmia
(damaged conducting system will show up early, or not at all)
70
what do you see up to 1 week post MI
gross:
yellow pallor
(WBCs within myocardium
```
micro:
neutrophils
(acute inflamm always follows necrosis)
then macrophages
(eat dead/necrotic debris; the wall is weakest here)
```
complications:
fibrinous pericarditis- presenting as chest pain with friction rub (neutrophils infiltrate past the entire wall into pericardium)
RUPTURE:
of ventricular free wall (leads to tamponade)
interventricular septum (leads to shunt)
papillary muscle (leads to mitral insufficiency)
71
what vessel supplies papillary muscle
RCA
72
what do you see up to 1 month post MI
gross:
red border emerges as granulation tissue enters from edge of infarct
micro:
granulation tissue with plump fibroblasts, collagen, and blood vessels (neovascularization)
all healing and forming a scar
73
what do you see >1 month post MI
gross:
white scar
micro:
fibrosis
complications:
aneurysm
mural thrombus
Dressler syndrome
74
what is Dressler syndrome
pericardium inflammation
expose antigens to immune system
Ab's against own pericardium develop
results in pericarditis 6-8 weeks post MI
75
what does neutrophil elastase do
it's the major protease of extracellular elastin degradation
released by neutrophils and macrophages
76
what inhibits elastase
alpha-1 antitrypsin
smokers can permanently inactivate AAT through oxidation of crucial methionine residue
77
what is projection
the misattribution of one's unacceptable feelings or thoughts to another person who does not actually have them
boy is mad at parents for divorcing, but avoids them because he thinks they're mad at him
(vs reaction formation, where boy would be overly nice to his parents)
78
what labs do you see in parotitis
elevated amylase without pancreatitis
| normal lipase
79
what is the defect in Kartageners
dynein arm,
| causing primary ciliary dyskinesia
80
how does Kartageners present
situs inversus
chronic sinusitis
bronchiectasis
81
what causes SCID
defects in T cell IL-2 recepotrs
82
what does deficiency in C1 complement component
increased susceptibility to encapsulated bacteria
and predisposes pts to SLE
83
what is immunoglobulin gene rearrangement impaired in
hyper-IgM syndrome
B cells produce high IgM but are unable to class switch
84
what is tryptase
an inflammatory mediator, similar to histamine
relatively specific for mast cells (marker for mast cell activation)
released from degranulation of mast cells and basophils in anaphylaxis
85
when do you see elevated myeloperoxidase
following inflammation and infection, because it's found in neutrophils
(not seen in anaphylaxis)
86
how does an allergic reaction trigger substance release
"receptor aggregation"
the high affinity IgE receptor is found on the surface of mast cells and basophils.
It normally binds to the Fc portion of circulating IgE antibodies.
Cross-linking of multiple membrane-bound IgE antibodies by a multivalent antigen results in aggregation of the high-affinity IgE receptors,
causing degranulation and release of preformed mediators that initiate the allergic response
87
what does the ureteric bud turn into
collecting system, including collecting tubules, ducts, major/minor calyces, renal pelvis, and ureters
88
what does the metanephric mesoderm turn into
structures from the glomerulus through to the DCT
| AKA metanephric blastema
89
what does the mesonephros turn into
interim kidney and male genitals
90
which murmur goes with the buzzword head bobbing/ bounding pulses
aortic regurg
91
which murmur radiates to cartotids
aortic stenosis
92
which murmur radiates forward axilla
mitral/tricuspid regurg
93
which murmur causes mid systolic click
mitral valve prolapse
the click is sudden tensing of chord tenidnae
94
what is a holosystolic, harsh murmur
VSD
95
which murmur has an opening snap
mitral stenosis
due to abrupt halt in leaflet motion in diastole, after rapid opening due to fusion at leaflet tips
delayed rumbling late diastolic murmur
96
what murmur has continuous machine-like murmur
PDA
97
what is Edwards syndrome
Trisomy 18
"election age"
CLENCHED HANDS with overlapping fingers
micrognathia
low-set Ears
rocker-bottom feet
98
what do Edwards Syndrome labs show
```
low PAPP-A (same as 13,21)
low beta-hCG
low alpha-fetoprotein
low estriol
low/nl Inhibin A
```
99
what is Patau syndrome
Trisomy 13
"Puberty"
```
MIDLINE DEFECTS
CLEFT LIP/PALATE
POLYDACTYLY
omphalocele
microphthalmia
microcephaly/holoprosencephaly
cutis aplasia
cardiac defects
rocker bottom feet
```
100
what do Patau syndrome labs show
low PAPP-A (same as 13,21)
| low free beta-hCG
101
what do Down Syndrome labs show
high nuchal translucency
hypoplastic nasal bone
```
low PAPP-A (same as 13,18)
HIGH BETA-HCG!!!
HIGH INHIBIN A!!!
low alpha-fetoprotein
low estriol
```
102
what can paraneoplastic cerebellar degeneration come from
small cell lung cancer
Female cancers
an immune response against tumor cells cross-reacts with Purkinje neuron antigens
antibodies involved:
Anti-Yo
Anti-P/Q
Anti-Hu
103
what is P-glycoprotein
AKA multidrug resistance protein 1 (MDR1)
used to pump out toxins, including chemotherapeutic agents
an "ATP-dependent transporter"
classically seen in adrenal cell carcinoma
104
what does Inulin estimate
GFR
105
what does PAH estimate
RPF
106
what's a general explanation for heavy proteinuria or edema
decrease in serum albumin and total protein concentrations
this lowers the plasma oncotic pressure, and increases net plasma filtration in capillary beds
107
what causes Zenker diverticulum
abnormal spasm or diminished relaxation of cricopharyngeal muscles during swallowing, causing increased intraluminal pressure in the oropharynx.
the mucosa will herniate through the zone of muscle weakness, forming a Zenker diverticulum (FALSE diverticulum)
108
how does Zenker diverticulum present
"Elder MIKE has bad breath"
```
Elderly
Male
Inferior pharyngeal constrictor
Killian triangle
Esophageal dysmotility
Halitosis!!!
```
109
what is VHL
deletion or mutation of the VHL tumor suppressor gene on chromosome 3p
110
how does VHL present
cerebellar hemangioblastoma
clear cell renal carcinoma!!
pheochromocytomas
111
distinguish between Wilms tumor and neuroblastoma
Wilms:
nephroblastoma (renal)
large, palpable, smooth, UNILATERAL flank mass and/or hematuria
WT1/2 on chromosome 11
Neuroblastoma:
adrenal medulla
from neural crest cells
firm, irregular mass that CAN cross the midline
can present with "opsoclonus-myoclonus syndrome
N-myc over expression
112
what are Homer-Wright rosettes characteristic for
Neuroblastoma (adrenal)
| and Medulloblastoma
113
what does LMWH bind to
Antithrombin 3
Antithrombin3 binds to Factor 10a, and stops 10a from converting prothrombin to thrombin
114
how do beta blockers treat open-angle glaucoma
open-angle glaucoma is from elevated IOP.
| BBs diminish the SECRETION of aqueous humor by the ciliary epithelium
Acetazolamide also does the
115
how do prostaglandin F2alpha and cholinomimetics treat glaucoma
PF2alpha:
latanoprost, travoprost
Cholinomimetics:
pilocarpine, carbachol
both decrease IOP by increasing OUTFLOW of aqueous humor
116
what does vaccination conjugation cause
protein conjugation causes a T cell-mediated immune response,
leading to long-term immunity through production of memory B cells
117
what is the most common cause of native valve infective endocarditis in developed nations
mitral valve prolapse with regurgitation
| rheumatic heart disease causes IE in developing nations
118
what is secretin
secreted from duodenal S cells in response to H+ concentrations
it increases pancreatic HCO3 secretion
119
what are pulsion diverticula
false diverticula that develop 2/2 increased intraluminal pressure created during straining bowel movements (chronic constipation)
out pouching of mucosa and submucosa through the muscularis
120
what is a traction diverticula
created by inflammation and subsequent scarring of the gut wall,
which typically results in pulling and out pouching of all gut wall waters (true)
may occur in the mid esophagus due to mediastinal lymphadenitis caused by TB or fungal infection
121
what stone is crohn disease associated with
oxalate
2/2 impaired bile acid absorption in terminal ileum and loss of bile acids in feces
lipids bind Ca ions, and the resulting soap complex is excreted
free oxalate (normally bound to Ca) is absorbed and forms urinary stones
122
how does pancreatitis cause ARDS
pancreas releases lots of inflammatory cytokines which activates neutrophils in alveolar tissues
interstitial and intraalveolar edema, inflammation, and fibrin deposition cause the alveoli to become lined w/ waxy HYALINE MEMBRANES
123
what is pseudotumor cerebri
AKA idiopathic intracranial hypertension
increased ICP with no apparent cause
headache, diplopia without change in mental status
papilledema
increased opening pressure
in an obese female of childbearing age; possible Vita A excess
the ICP compresses the optic neves, causing an impaired axoplasmic flow and optic disc edema
124
what is optic neuritis
associated with MS
monocular vision loss over several weeks w/ painful eye movement
afferent pupillary defect w/ hyperemia and swelling of the optic disc
125
what's a common finding in gallstone ileus
pneumobilia
| air in biliary tract
126
how can Crohn disease cause a bleeding problem
an ileal resection/involvement cause cause bile acid malabsorption,
which may lead to impaired absorption of fat soluble vitamins,
including Vitamin K.
vit K deficiency presents as impaired coagulation with easy bruising, large hematoma formation in deep tissues/joints after minor trauma, and prolonged bleeding after surgery
127
what causes an elevated ESR
high levels of circulating fibrinogen (ACUTE PHASE REACTANTS) increase ESR
it's a nonspecific marker of inflammation
128
what 3 cytokines mediate systemic inflammatory responses and acute phase reactant release
IL-1
IL-6
TNF-alpha
129
what does AAT deficiency look like histologically
reddish-pink, PAS (+) granules of unsecreted, polymerized AAT in the periportal hepatocytes
130
what does acute tubular necrosis look like when alcohol is the culprit
generic:
vacuolar degeneration and ballooning of the proximal tubular cells
specific to alcohol:
calcium oxalate crystals
131
how does Hepatitis B cause damage
Hep B virus itself doesn't have cytotoxic effect
the presence of viral HBsAg and HBcAg on cell surface
stimulate the host's cytotoxic CD8+ T cells to destroy the infected hepatocytes
132
what are muddy brown casts pathognomonic for
acute tubular necrosis
133
how does CO poisoning affect blood
CO binds Hb with stronger affinity than O₂,
which reduces the number of Heme binding sites available for O₂.
the levels of CO-bound Hb (carboxyhemoglobin) increase
CO decreases the oxygen carrying capacity and oxygen content of blood, but
NOT the amount of oxygen dissolved in plasma, which is the partial pressure PaO2 of oxygen
134
what murmur is heard best with pt leaning forward
aortic regurg
135
distinguish between rheumatic heart disease and infectious endocarditis
Infectious endocarditis:
aortic or mitral regurgitation
Rheumatic heart disease:
most common cause of aortic stenosis in developing world
always accompanied by mitral valve disease (stenosis/regurg)
uncommon cause of aortic stenosis in developed world
136
what does GFAP indicate
astrocytomas
137
what does vimentin indicate
it's an intermediate filament found within cells of mesenchymal origin
used in diagnosing sarcomas
138
what is neural cell adhesion molecule indicate
a cell with a neuroendocrine origin, such as small cell lung carcinoma
139
what is a cavernous hemangioma
most common benign liver tumor
consist of cavernous, blood-filled vascular spaces lined by single epithelial layer
do not biopsy- expected to bleed and cause fatal hemorrhage
140
what can help the regression of hepatic adenoma
discontinue oral contraceptives
141
which cancer is associated with hemochromatosis
HCC
142
what is positive in a neuroendocrine tumor
chromogranin A
synaptophysin
143
what does HER2 do
oncogene that encodes for a transmembrane glycoprotein with intrinsic tyrosine kinase activity
member of the epidermal growth factor receptors
over expression accelerates cell proliferation
144
what is paroxysmal nocturnal hemoglobinuria
complement-mediated intravascular RBC lysis
caused by absent GPI anchor for DAF and MIRL (CD55/59) that protect RBC membranes from complement destruction
145
what does portal vein thrombosis cause
portal HTN
splenomegaly
varicosities at portocaval anastomoses
does not cause histologic changes to the hepatic parenchyma
(ascites is rare)
146
what is Budd Chiari
thrombosis or compression of hepatic veins
biopsy shows centrilobular congestion and necrosis
leads to congestive liver disease (ascites)
absence of JVD
may cause nutmeg liver
147
what do metalloproteinases do
they're zinc-containing enzymes that degrade the extracellular matrix
they participate in normal tissue remodeling and in tumor invasion through the basement membrane and connective tissue
148
what do NSAIDs do to kidneys
chronic interstitial nephritis and papillary necrosis
149
what may determine the stability of a vessel plaque
plaque stability largely depends on mechanical strength of fibrous cap.
inflammatory macrophages in the intima may reduce plaque stability by secreting metalloproteinases,
which degrade extracellular matrix proteins (collagen)
