7/31 Flashcards by lehe0943

lowers LDL

inhibits HMG CoA reductase in liver, so more LDL is cleared from circulation with increased LDL receptors

statin

myopathy, hepatotoxicity

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lowers LDL
bile acid binding resins
liver must use cholesterol to make more

Cholestyramine

GI upset

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lowers LDL

blocks intestinal absorption of cholesterol at brush border

Ezetimibe

diarrhea

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lowers Triglycerides
upregulates LPL to increase triglyceride clearance
activates PPAR-alpha to induce HDL synthesis

Fibrates

myopathy, esp with statins
cholesterol gallstones

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lowers LDL, increases HDL
inhibits lipolysis via inibiting HPL
reduces hepatic VLDL synthesis

Niacin/B3

red/flushed face
hyperglycemia
hyperuricemia

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GLP-1 agonist

decrease gastric emptying

Exentide

pancreatitis
requires some functional beta cells

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DPP-4 inhibitor

decrease gastric emptying by preventing breakdown of GLP-1

-gliptans

nasopharyngitis

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inhibits TPO and 5’deiodinase

inhibits TPO only

PTU

methimazole

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bind hydroxyappetite to inhibit osteoclasts

bisphosphonate

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inspiration ____ venous return

increases

it drops intrathoracic pressure

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valsalva ____ intrathoracic pressure

increases

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standing up ____ preload

decreases

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rapid squatting or leg raise ____
venous return
preload
afterload

increase
increase
increase

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serum tumor markers:

Alk phos

bone or liver

seminoma

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serum tumor markers:

AFP

HCC
yolk sac tumor
mixed germ cell tumor

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serum tumor markers:

beta-hCG

Hydatidiform moles
Choriocarcinomas
Gestational Trophoblastic disease
(HCG)
testicular cancer
mixed germ cell tumor

produced by syncytiotrophoblasts of placenta

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CA 15-3/CA 27-29

breast cancer

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CA 19-9

pancreatic adenocarcinoma

“9 = P”

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CA 125

ovarian cancer

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calcitonin

medullary thyroid cancer

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thyroid:
most absence of capsular vascular invasion
“colloid-containing micro follicles”
usually nonfunctional, painless

thyroid adenoma

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thyroid:
most common, excellent prognosis
Orphan Annie Eyes
psammoma bodies
nuclear grooves
RET and BRAF mutations
ionizing radiation

Papillary carcinoma

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thyroid:
invades thyroid capsule and vasculature
UNIFORM follicles
RAS mutation

follicular carcinoma

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thyroid:
from parafollicular C cells
produces calcitonin
sheets of cells in amyloid stroma (Congo Red)
MEN2A/B (RET) mutation

Medullary carcinoma

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thyroid: older pts invading local structures pleomorphic giant cells

undifferentiated/anaplastic carcinoma

ovarian: Call-Exner bodies collections of eosinophilic fluid appress yellow

granulosa cell tumor

``` ovarian: aggressive ovaries and testicles yellow, friable, sold mass Schiller-Duval bodies (~glomeruli) AFP tumor marker ```

Yolk sac (endodermal sinus) tumor

ovarian: GI malignancy that metastasizes to ovaries mucin secreting signet cell adenocarcinoma

Krukenberg tumor

uniformly enlarged, soft, globular uterus | extension of endometrial tissue into myometrium

adenomyosis

estrogen sensitive endometrial tumor irregular uterine enlargement consipation, urinary problems

leiomyoma/fibroid

postmenopausal vaginal bleeding, anovulatory cycles, hormone replacement therapy, PCOS, etc excess unopposed estrogen

endometrial hyperplasia

older F, vaginal bleeding estrogen without progesterones Histology: atypical endometrial cells that form glands

endometrial carcinoma

uterine tenderness, fever, tachy | retained products of conception or foreign body

endometritis decidua infection

endometrial tissue outside endometrial cavity | chocolate cyst

endometriosis

``` CNS: "butterfly" "pseudopalisading" pleomorphic tumor cells border central areas of necrosis GFAP positive found in cerebral hemispheres ```

glioblastoma (astrocytoma)

``` CNS: arachnoid cell origin dural attachment "tail" asymptomatic,, or seizures spindle cells in whorled pattern psammoma bodies ```

meningioma spider in the bathtub

VHL CNS tumor | most often cerebellar

hemangioblastoma

``` CNS: cerebellopontine angle, CN8 hearing loss S-100 + ```

schwannoma

``` CNS: frontal lobe chicken wire capillaries fried egg oligodendrocytes often calcified ```

oligodendroglioma

CNS: posterior fossa/cerebelum GFAP + Rosenthal fibers- eosinophilic corkscrew fibers

pilocytic astrocytoma

CNS: compress 4th ventricle, causing noncommunicating hydrocephalus Homer-Wright Rosettes small blue cells

medulloblastoma Water Boy

CNS: 4th ventricle perivascular rosettes rod-shaped blepharoplasty (basal ciliary bodies)

ependymoma

CNS confused w/ pituitary adenoma for bitemporal hemianopia remnant sof Rathke pouch calcifications cholesterol crystals found in "motor oil or wet keratin"

craniopharyngioma

CNS: Parinaud syndrome (compression of tectum, vertical gaze palsy) obstructive hydrocephalus precocious puberty in M (beta-HCG) histologically similar to germ cell tumors

pinealoma

hypercellular glomeruli starry sky- granular IF IgG, IgM, C4 deposition in GBM sub epithelial immune complex humps on EM most frequently seen in children 2/2 strep infection Type 3 HSN

PSGN

crescent moon shape on | crescents made of Fibrin (crescent rolls have fiber) and plasma proteins and macrophages

RPGN includes Goodpasture, Wegener Microscopic polyangitis

Pauli-Immune RPGN no BM deposits c-ANCA

Wegener | Granulomatous with polyangiitis

type 2 HSN antibodies to GBM and alveolar BM linear IF

Goodpasture syndrome

SLE renal problem "wire looping" capillaries immune complex deposition

diffuse proliferative glomerulonephritis membranoproliferative GN

IgA deposits in mesangium | renal path of Henoch-Schonlein Purpura

IgA nephropathy | Berger disease

episodic gross hematuria that occurs w/ resp or GI infection (IgA is secreted by mucosal linings)

IgA nephropathy

mutated type 4 collagen- splitting GBM | old, can't see, can't pee, can't hear a bee, basket-weave"

Alport

renal "tram track" on PAS stain 2/2 GBM splitting

membranoproliferative GN

effacement of foot processes recurrent infections, immunization hypoalbinemia

MCD

segmental sclerosis | focal deposits of IgM, C3

FSGN

diffuse GBM thickening spike and dome appearance SLE antibodies to PLA2 receptor

membranous GN

Kimmelstiel-Wilson lesions

diabetic GN

telangiectasis, epistaxis, AV malformations, GI bleeds, hematuria

Hereditary hemorrhagic telangiectasia | AKA Osler Weber Rendu syndrome

``` TP53 "SBLA" cancer syndrome sarcoma breast leukemia adrenal gland ```

Li Fraumeni

``` cafe au last spots cutaneous neurofibromas optic gliomas pheochromocytoma, Lisch nodules ```

NF1 | Von Recklinghausen

unilateral cafe au last spots precos=cious puberty polyostotic fibros dysplasia/osteolytic leiosns endocrine abnormalities

McCune Albright Syndrome

renal cysts RCC hemangioblastomas of cerebellum

VHL

neurocutaneous disorder w/ multi-organs | benign hamartomas

tuberous sclerosis

``` port wine stain leptomeningeal angioma- seizures intellectual disability scleral hemangioma tram track calcifications GNAQ gene neural crest derivatives ```

Sturge Weber

ischemia/infarcts in most tissues cell outlines preserved anucleated cells

Coagulative necrosis

``` bacterial abscesses brain infarcts neutrophils release Lysosomal enzymes pus CSF-filled spaces viscous, liquid mass ```

liquefactive necrosis

TB, systemic fungi necrosis granular debris cheesy appearance

Caseous necrosis

damaged cells release Lipase saponification- chalky white pancreatitis!!! trauma

fat necrosis

immune rxns in vessels immune complexes combine with fibrin to cause vessel wall damage walls are thick and pink

fibrinoid necrosis

the artery that gives you the "pie" vision loss

MCA

the artery that gives you hemianopia with macular sparing

PCA

down and out gaze

CN3 palsy

compensatory head tilt for vision

CN4 palsy

headache: periorbital pain unilateral lacrimation

cluster

headache: bilateral- band like pattern around forehead steady pain no other problems

tension

``` headache: pulsating aura photophobia/phonophobia unilateral Nausea disabling ```

migraine

normal melanocytes low melanin production low enzyme activity

albinism

autoimmune destruction of melanocyte cells

vitiligo

envelope or dumbbell shaped stone | square with X

calcium oxalate

wedge shaped prism stone

calcium phosphate

coffin lid stone | AKA struvite

ammonium magnesium phosphate

rhomboid, yellow brown diamond stone

uric acid

hexagon flat stone

cystine | 6 sides

binds PBP transpeptidases to prevent cross linking

penicillin

inhibits cell wall synthesis by incorporating into the wall precursors structural wall analog

vancomycin

from T cells in response to IL-12 from macrophages stimulates macrophages to kill phagocytized pathogens inhibits differentiation of Th2

interferon gamma

mediates septic shock activates endothelium causes WBC recruitment, vascular leak causes cachexia in malignancy

TNF-alpha

anticardiolipin, anti-dsDNA anti-Smith anti-nuclear

SLE

anti-centromere

CREST

anti-desmoglein/desmosome

pemphigus vulgaris

anti0GAD65

T1DM

anti-hemidesmosome

villous pemphigoid

anti-histone

drug induced lupus

anti-Jo-1, anti-SRP, anti-Mi-2

polymyositis, dermatomyositis

anti-microsomal | anti-thyroglobulin

Hashimoto

anti-mitochondrial

PBC

anti-parietal cell

pernicious anemia

anti-PLA2

primary membranous nephropathy

anti-Scl-70 | anti-DNA topoisomerase I

Scleroderma diffuse

anti-Smooth muscle

autoimmune hepatitis

anti-SSA, | anti-SSB (anti-Ro, anti-La)

Sjogren syndrome

anti-TSH receptor

Graves

anti-tissue transglutaminase

Celiac

p-ANCA

microscopic polyangiitis | eosinophilic granulomatosis with polyangitits (Churg Strauss)

c-ANCA

Wegener

IgM against IgG Fc | anti-CCP (more specific)

Rheumatoid arthritis

cross-link IgE on presensitized mast cells pre-formed antibody allergic, anaphylaxis

type 1 HSN

``` antibody mediated IgM, IgG bind to fixed antigen on enemy cell antibody and complement lead to MAC cytotoxic Coombs tests ```

Type 2 HSN

antigen-antibody (IgG) complexes activate complement, which attracts neutrophils to release lysosomal enzymes serum sickness

Type 3 HSN

``` T cell mediated sensitized T cells encounter antigen and release cytokines to activate macrophages Transplant rejections TB skin test Touching (contact dermatitis) T cells ```

type 4 HSN

pre-existing recipient antibodies react to donor antigen (typ 2 HSN) and activate complement within minutes/hrs

hyper acute transplant rejection

"dense interstitial lymphocytic infiltrate" cellular: CD8+ T cells activated against donor MHCs (type 4 HSN) humoral: antibodies develop after the transplant to activate complement weeks/months

acute transplant rejection

CD4 T cells respond to recipient APCs presenting donor peptides, including allogenic MHC both cellular and humoral components (type 4 and 2) months/yrs of lymphocytic infiltrate, fibrosis, and tissue destruction

chronic graft rejection

grafted donor T cells proliferate and reject host cells severe organ dysfunction type 4 HSN usually in bone marrow and liver transplant- rich in lymphocytes

graft vs host disease

``` vasculitis with asthma, sinusitis skin nodules kidneys eosinophilia p-ANCA ```

Chung Strauss | Eosinophilic granulomatosis with polyangiiits

``` vasculitis with URI palpable purpura on but arthralgia GI pain IgA immune complex deposition w/ Berger disease) ```

Hence Schonlein purport

similar to Wegener, but no nasopharyngeal involvement | p-ANCA

Microscopic polyangiitis

``` vasculitis asian children conjunctival injection rash adenopathy strawberry tongue hand/foot edema and erythema fever "CRASH and burn" may develop coronary artery aneurysms ```

Kawasaki

vasculitis Hep B association typically in renal and visceral vessels that are NOT lungs transmural inflammation of arterial wall with fibrinoid necrosis

polyarteritis nodosa

``` associated with polymyalgia rheumatica (pain in shoulder, torso, pelvis) headache jaw claudication blindness focal granulomatous inflammation elevated ESR!!!! and CRP!!!!! ```

giant cell arteritis

``` vasculitis Asian female adults "Pulseless disease" (weak UE pulse) granulomatous thickening/narrowing of aortic arch and proximal great vessels elevated ESR ```

Takaysu arteritis

false positive VDRL/PRP and prolonged PTT (paradoxical with hyper coagulable state) history of thrombosis and recurrent abortions anti-cardiolipin antibodies

antiphospholipid syndrome

high CD4/CD8 ratio high ACE levels high Ca

Sarcoidosis

symmetric proximal muscle weakness patchy necrosis/inflammation with CD8 cells most often involves shoulder anti-Jo-1 anti-SRP anti-Mi-2 high CK + includes malaria rash, Gottron papules shawl and face rash mechanics hands

polymyositis dermatomyositis

increase bleeding time means

defects in platelet plug formation

defect in plt plus formation | low Gp1b plt/VWF adhesion

Bernard Soulier Syndrome

low Gp2b/3a plt/plt aggregation

Glanzmann thrombocytopenia

thrombocytopenia microangiopathic hemolytic anemia acute renal failure typically in children w/ diarrhea

HUS

anti-Gp2b/3a antibodies splenic macrophage consumption of pltatelet/antibody complex commonly 2/2 viral illness

ITP

``` ADAMTS 13 unable to degrade VWF multimers large platelet adhesions, platelet aggregation, thrombosis elevated LDH NEURO symptoms ```

TTP

low fibrinogen D-dimers abnormal coag cascade and bleeding time

DIC

``` increased bleeding time normal platelet count mucosal bleeding normal PT normal/high PTT ```

VWF

defect in BTK no B cell maturation (no germinal centers) X linked Recessie recurrent infections after 6 months (no maternal IgG) low Ig in all classes absent lymph nodes and tonsils

X linked Bruton agammaglobulinemia

``` mostly asymptomatic can see airway/GI infections Autoimmune disease Anaphylaxis to IgA blood products low IgA ```

selective IgA deficiency

defect in B cell differentiation can be acquired in 20s/30s increased risk of various diseases

common variable immunodeficiency

``` cleft palate abnl facies thymic aplasia/ T cell deficiency cardiac defects hypocalcemia 2/2 parathyroid hypoplasia 22q11.2 deletion failure to develop 3rd and 4th pharyngeal pouch ```

thymic aplasia | DiGeorge syndrome

disseminated mycobacterial and fungal infections may present after BCG vaccine macrophages --> IL-12 --> T cells and NK cells --> IFN gamma low IFN-gamma!!

IL-12 receptor deficiency

``` coarse facies cold staph abscesses retained teeth high IgE derm problems deficiency of Th17 cells impaired recruitment of neutrophils ```

hyper-IgE syndrome (Job syndrome)

chronic diarrhea, thrush, failure to thrive recurrent infections ADENOSINE DEAMINASE DEFICIENCY absence of thymic shadow, germinal centers, and T cells low TRECs

SCID

``` triad: cerebellar defects (ataxia) spider angiomas IgA deficiency defects in ATM gene, failure to repair DNA double strand breaks, cell cycle arrest ```

ataxia telangiectasia

``` severe pyogenic infections and opportunistic infections early in life commonly 2/2 CD40L on Th cells, class switching defect ```

hyper IgM syndrome

``` WAX TIE: X-linked Thrombocytopenia Recurrent infections Eczema mutated WAS gene high IgA, IgE ```

Wiskott Aldrich syndrome

recurrent skin/mucosal infections with absent pus formation delayed separation of umbilical cord defect in LFA-1 intern (CD18) impaired migration and chemotaxis

LAD

``` recurrent pyogenic infections by staph and strep partial albinism peripheral neuropathy progressive neurodegeneration giant granules in granulocytes and plts pancytopenia defect in LYST microtubule dysfunction in phagosome-lysome fusion!!!! ```

Chediak Higashi syndrome

susceptible to catalase + organisms defect of NADPH oxidase, low ROS, low Respiratory burst in neutrophils, impaired intracellular killing

CGD cats gain dominance

jaw jerk reflex

CN 5-3 both

pupillary reflex

CN2 | CN3

gag reflex

CN 9 | CN 10

CN 5 lesion

jaw deviates toward side of lesion

CN 10 lesion

uvula deviates away | "U and V"

CN 11 lesion

weakness turning head to contralateral side of lesion | shoulder droop on same side as lesion

CN 12 lesion

tongue deviates toward side of lesion