7 Flashcards
Itching (severe), erythematous papules and excorations on extremities, axillia, nipples, or scrotum, type 4 hypersensitivity, often worse at night, scraping show mites ova and feces under LM
Scabies (sarcoptes scabiei mite)
Person-person spread
Candida Intertrigo
Fat people (or diabetics, steroid users) w/ plaques and erosions with satellite papules or pustles in axillia, genitals, finger/toe webs, other skin folds
Herpes (shignles) histo
multinucleated giant cells
SJS due to infection (post 1-3 weeks)
CMV! (or mycoplasma)
necrotic keratinocytes in the epidermis
Thyroid gland is formed from?
Outpouching (evagination) of the pharyngeal epithelium
Inappropriate apoptosis
DM1 (beta cells undergo pathologic apoptosis)
parafollicular C cells origin
ultimobranchial bodies (join thyroid via fusion)
True negatives (quick calculation)
specificity * (number of patients actually without disease)
False positives (quick)
(1-specificity)* (number of patients actually without the disease)
Net filtration pressure
(Pc-Pi) - (O(c) - O(i))
B-cell growth and isotype switching. Stimulates secretion of IgE (isotype switching). Stimulates TH0 (naive) T-helper cells into TH2 thus increasing TH2 subpopulation and the stimulus for humoral response
IL-4
Responsible for B-cell differentiation; stimulates IgA production and eosinophil activity. Important against parasitic infections
IL-5
Produced by macrophages. Activates TH0 (naive) into TH1 and TH2.
IL-1
First interleukin produced by T-cells after contact with antigen. Secreted by TH1 and stimulates CD4+, CD8+ and B-cells
IL-2
Produced by T-helper cells: stimulates growth and differentiation BM stem cells
IL-3
Produced by TH2. Inhibits synthesis of INF-gamma to decrease TH1.
IL-10
Released from Macs. Stimulates growth and development of TH1
IL-12
Enterocutaneous fistula
Crohn disease: Btw bowel and skin
Enteroenteric can also form btw bowel and another organ (bladder, vagina)
Children ages 5-14, ass. w/ Yersenia enterocolitica infection. Fever, RLQ pain, nausea and vomiting
Mesenteric Adenitis
Drug severe toxicity: Pulmonary edema, caused by rapid rise in volume that can also increase the overall hydrostatic pressure in the vasculature. Metabolic acidosis. and others.
Mannitol (avoid in CHF) or preexisting pulmonary edema
Bumetanide
Loop diuretic
Susceptibility to malignant hyperthermia is inherited as …
AD
Excess free Ca in cytoplasm–>stimulates ATP-dependent uptake by SR–>HEAT
Promotor sequences
- TATA (Hogness)- 25 bp upstream
- CAAT- 70-80 bp upstream of gene
directly bind general transcription factors and RNA pol II upstream of gene locus. Necessary for the initiation of transcription.
Bind activator proteins that facilitate bending of DNA to allow activator proteins to interact with general transcription factors and RNA pol II at the promotor
Enhancer sequences = INCREASE RATE of TRANSCRIPTION
Can be located upstream or downstream from the gene being transcribed. Or within introns of the gene being transcribed as well on separate chromosomes.
Enhancers
Similar to enhancers but decrease transcription rates by binding to repressors
Silencers
Intrapleural pressure at FRC
-5cm H20
Airway pressure is zero
Diuretic, natriuretic and vasodilation effects that antagonize RAAS
BNP
Metalloprotease that cleaves and inactivates endogenous peptides including BNP, glucagon, oxytocin, and bradykinnin
Neprilysin
can use neprilysin inhibitors to improve outcomes in patients with chronic systolic heart failure
Maturity-onset diabetes of the young
Heterozygous mutations of the glucokinase gene causing a decrease in beta cell metabolism of glucose, less ATP formation, diminished insulin secretion. Will see in pregnancy. Homozygous mutation = severe hyperglycemia and fetal growth retardation
Decreased exercise tolerance and muscle stiffness
LDH deficiencies
Lactic acidosis and fasting hypoglycemia
Infant with failure to thrive
Elevated pyruvate and alanine (possible)
pyruvate decarboxylase deficiencies
Carcinoid tumor (malignant transformations of neuroendocrine cells) possible locations:
GI (small intestine, rectum, appendix–>cause appendicitis if at base; if appendectomy will be found at tip)
Also Bronchopulmonary system
Light microscope: Uniformity in shape and size of cells that comprimse the islands. Eosinophilic cytoplasm and oval to round stippled nuclei
Carcinoid syndrome
EM carcinoid syndrome
Multiple dense-core granules seen in cytoplasm; contain vasoactive molecules (serotonin, bradykinin, histamine) or hormones (gastrin)
Location of meningiomas
dural reflections (falx cerebri, tentorium cerebelli)
Cheyne-Stroke breathing
Advanced congestive HF, stroke, brain tumors, TBI–> poor prognostic sign
Cyclic breathing pattern in which apnea is followed by gradual increase then decrease in tidal volumes until next apneic event
Cheyne-Stroke breathing
Deep and labored breathing pattern often associated with severe metabolic acidosis, especially diabetic ketoacidosis
Kussmaul breathing
Hypothyroidism can cause hypoventilation from respiratory muscle weakness (low tidal volume) and can develop obstructive sleep apnea due to development of
macroglossia (big tongue)
Treatment for PCOS
Weight loss
For those who do not want to be prego: Oral contraceptive pills
For those who want a baby: Clomiphene and letrozole
Selective estrogen receptor modulator that prevents negative feedback inhibition on hypothalamus and pituitary by circulating estrogen, resulting in increased FSH and LH and ovulation. Tx: for PCOS who want a baby
Clomiphene and letrozole
11-beta-hydroxylase inhibitor, blocks synthesis of cortisol
Metyrapone
Tissues that do not depend on insulin for glucose transport (diabetes related)
lens, peripheral nerves, blood vessels and kindeys (Aldose reductase converts glucose to sorbitol. sorbitol then converted to fructose. Sortbitol and fructose accumulation increases osmotic pressure. Water influxes. Lens= cataracts and Schwann cells= peripheral neuropathy
Aldose reductase converts galactose into galactitol. If level of galactose is increased such as in galactasemia…more galactitol is produced. This could lead to what?
cataracts in patients with galactosemia
Regenerative source of ciliated cells in bronchioles
Club (clara) cells are nonciliated, secretory cells found predominately in the terminal portion of the bronchioles
Transmembranous efflux pumps confer resistance to antibiotics that require entry into the cell to function
Tetracyclines and macrolides
A salvage metabolic pathway can restore metabolic function that would otherwise inhibited by
Sulfamethoxazole or trimethoprim
Gly is necessary at every third position to ensure
compact coiling of collagen triple helix
Ehlers Danlos due to procollagen peptidase deficiency (impaired cleavage of terminal propeptides in EXTRACELLULAR space. Symptoms?
Joint laxity, hyperextensible skin and fragile tissue due to the formation of soluble collagen that does not properly crosslink
Acute allergic contact dermatitis (a form of eczematous dermatitis) Type 4 hypersensitivity. Characterized by?
Spongiosis (accumulation of edema fluid in intracellular spaces of the epidermis)
Thickening of stratum spinosum
acanthosis
Thickening of stratum corneum
hyperkeratosis
Premature keratinization of individual keratinocytes below strartum granulosom
Dyskeratosis congenita (AD) or squamous cell carcinoma sometimes
Hypergranulosis- increased thickness of stratum granulosum
Lichen planus
Mold with broad ribbonlike hyphae with rare sepations
Rhizopus
Attack rate (used in outbreak investigations)
Ratio of number of individuals who become ill divided by the number of individuals who are at risk of contraction that illness
Phenylketonuria (2 possible enzymes messed up) *seizures, retarded, abnormal pallor of catecholaminergic brain (lack of neuromelanin), hypopigmentation of skin hair eyes, body odor
Dihydropteridine reductase or phenylalanine hydroxylase
Burnt sugar smell in urine (diapers)
Maple syrup urine disease
Rare dysautonomia characterized by ptosis, orthostatic hypotension, hypoglycemia and hypothermia
Dopamine hydroxylase def. (dopa–>NE)
Hyperpigmentation and degenerative joint disease due to accumulation of homogentisic acid
Alkaptonuria (AR)
Disorder of tyrosine degradation caused by deficiency in homogentisic acid oxidase
Albinism inheritance
AR (depressed or absent tyrosinase)
“Blowing diastolic decrescendo murmur best heard at the left sternal boarder in the 3rd and fourth intercostal space. The precordial impulse is hyperdynamic and displaced laterally and downward
Aortic Regurgitation
Bounding femoral and carotid pulses (abrupt distention and quick collapse)–>wide pulse pressure
Aortic regurg (water-hammer pulses)
Head bobbing with cartotid pulsations (de Musset sign) due to transfer of momentum from the large LV strove volume to head and neck. Systolic pulsations also heard in other organs (liver, spleen, retina) and finger tips
Aortic regurgitation
Small pulse amplitude (pulsus parvus) with a delayed peak and slower upstroke of the arterial pulse (pulsus tardus) due to diminished stroke volume and prolonged ejection time
Aortic stenosis
Arterial pulse, pulse pressure, and forward stroke volume changes in patients with chronic (compensated) mitral regurg
no change. normal.
Rubella spreads faster and does not darken or coalesce as compared to rash of
rubeola
Rare AR disorder of de novo pyrimidine synthesis: Physical and mental retardation, megaloblastic anemia, elevated urinary orotic acid levels
Hereditary orotic aciduria due to defect in uridine 5’monophosphate (UMP) synthase (polypeptide with two enzymatic domains)
Treatment of UMP synthase deficiency (orotic aciduria)
Uridine to bypass. Uridine converted to UMP via nucleoside kinases
TCA- Clomipramine
Role in TX of OCD
Fist anterior branch of aorta and its branches
Celiac trunk
- Left gastric
- Common hepatic
- Splenic arteries
Runs with the portal vein and common bile duct to form portal triad in the liver. Forms the arterial blood supply to the liver and perfuses right hepatic lobe mass
Proper hepatic artery
IMA branches off abdominal aorta at the level of
L3
Supplies blood to pancreas and the intestine from the lower part of duodenum to the first 2/3 of transverse colon
SMA
Charcot-Leyden crystals contain
eosinophil membrane protein
Chronic eosinophilic bronchitis in asthmatics involves bronchial wall infiltration by numerous activated eosinophils, largely in response to IL-5 released by allergen activated
TH2 cells
Activates macrophages to promote adaptive immunity against intracellular pathogens
INF-gamma
CT is negative (10%) but you still suspect SAH…what do you do?
spinal tap—> xanthochromia (blood in CSF)
Recurrent brief attacks of sudden, severe, unilateral periorbital pain associated with ipsilateral rhinorrhea and watering of the eyes
Cluster headaches
Thunderclap headache
SAH
Adipose tissues composed of cells that contain one intracytoplasmic fat droplet
White adipose tissue
Posses several small intracytoplasmic fat vacuoles and considerably more mito (tan color)
brown adipose tissue (requires more capillaries than white adipose tissues)
ETC transport and phosphorylation are uncoupled. Protons pumped out are returned to matrix via _________ (uncoupling protein). No ATP is made. Energy released as heat
Mitochondrial membrane protein THERMOGENIN (seen in brown fat)
Progressive cough, dyspnea, orthopnea, and lower extremity edema. Tachycardia, tachypnea, accessory muscle use, bilateral crackles or wheezing (cardiac asthma)
ADHF
Always preceded by events such as sepsis, aspiration, pneumonia or trauma–> endothelial injury and fluid leakage from the capillaries
ARDS
Bilateral airspace opacification
ARDS
Diffuse reticular opacities typically associated with decreased lung volumes. Slowly progressive dyspnea and a non-productive cough
Idiopathic interstitial fibrosis
Atherosclerosis vessel involvment
Abdominal aorta>coronary>popliteal>ICAs>circle of willis
C8-T1 medial cord branch–>courses posteriomedially in the upper arm–>passes posterior to the medial epicondyle of the the humerus to enter anterior compartment of arm
Ulnar nerve
Innervates flexor carpi ulnaris and medial portion of the flexor digitorum profundus
Ulnar nerver
- Passes between the hook of the hamate and the pisiform bone with Guyon’s canal.
- Provides sensation over medial 1/2 digits and hypothenar eminence deep motor branch
- Deep motor branch that supplies intrinsic muscles of hand
Ulnar nerve
Wrist flexion/adduction, finger abduction/adduction and flexion of the fourth and fifth digits
Ulnar nerve
Loss of sensation over the lateral forearm and paralysis of forearm flexors at elbox
musculocutaneous nerve injury
Loss of sensation over the lateral up arm and deltoid weakness
Axillary nerve injury
Palmar sensory loss involving the majority of the first through third digits
median nerve
Weakness on wrist flexion/abduction, flexion of second and third fingers, flexion and opposition of the thumb
Median nerve.
Preachers hand when try to make fist due weakness of the thenar and flexor digitorum profundus muscles of second and third digits
Loss of sensation over posterior arm and forearm, dorsolateral hand and dorsal thumb
radial nerve
Calcimimetic that allosterically activates the calcium-sensing receptor in the parathyroid gland, decreasing PTH release.
Cinacalcet is normally used for secondary hyperparathyroidism in dialysis patients
Glucocorticoids (prednisone) can worsen hypocalcemia by
decreasing the expression of vit. D receptor
Non-absorbable phosphate binding polymer that decreases absorption of phosphate in GI.
Sevelamer (used to treat hyperphosphatemia in dialysis patients)
Postoperative hypothyroidism (thyroidectomy) supplementation with _______ can be used to prevent post-op hypocalcemia
Oral calcium or Vit. D (calcitriol)
Test used to measure the amount of protein in body fluids (ex: measure insulin levels)
ELISA
Detect target mRNA in a sample to asses gene expression
Northern blot
Addition of ______ to the blood of a patient with hemophilia results in clotting
thrombin
Synthesized in liver, activated by endothelial injury, activates factor XI (intrinsic)
Factor XII (Hageman factor)
Most common pediatric malignancy
ALL (acute lymphoblastic leukemia)
Fever, fatigue, pallor, petechiae, and bleeding. LAD, HSM, and bone pain
ALL
Large anterior mediastinal mass that can compress great vessels causing SVC syndrome or esophagus (dysphagia) or trachea (dyspnea and stridor)
T-cell ALL (most commonly affects males in late childhood through young adulthood)
Both B-ALL and T-ALL are positive for
TdT (antigen of lymphocyte precursors)
Pre-B lymphoblasts (B-ALL) markers
CD10, CD19 and CD20
Pre-T lymphoblasts (T-ALL) markers
CD2, CD3, CD4, CD5, CD7, and CD8
AML M4 and M5
Arise from monocytic precursors
AML M6 arises from and typically affects
Erythroid precursors (elderly)
Which is more common: B-ALL or T-ALL
B-ALL (70-80%)
rare AML subtype arises from primitive megakaryoblasts and is associated with t(1;22) and DOWN SYNDROME in children
AML M7 subtype
Plane Xanthomas (linear lesions in skin folds)
Ass. w/ Primary biliary cirrhosis
Xanthelasma
soft eyelid or periorbital plaques with no associated abnormalities
small aggregates of dermal foam cells (benign macrophages packed with finely vaculated cytoplasm) that are present without inflammation or fibrosis
Xanthelasmas
Vs. Xanthomas do have inflammatory cells and fibrotic stroma
