9 Flashcards
Pernicious Anemia over time leads to
Chronic Atrophic Gastritis (autoimmune gastritis)
Histology of chronic atrophic gastritis?
Lymphocytic and plasma cell infiltrate (chronic)
Oxyntic (pale pink) found predominantly in upper grandular layer and secrete gastric acid and IF
Parietal cells
Deep aspect of gastric glands (lower grandular) what types of stomach cells are found and what do they synthesize/secrete?
chief cells- pepsinogen
Inhibits cellular oxidative phosphorylation by inhibiting Fe3+ in cytochrome c oxidase, lowering peripheral tissue oxygen consumption.
Cyanide poisoning
(PaO2, SaO2, and Capillary O2 remain at normal levels…however venous oxygen content sky rockets and the arterial venous oxygen gradient falls)
Reduced chest wall compliance–> hypoventilation of avleolar–>VQ mismatch–> Hypoxemia (low PaO2, low SaO2 and hypercapnia)
Obesity (FAT PEOPLE)
Partial pressure of oxygen dissolved in blood
PaO2
Oxygen saturation of Hb
SaO2
Oxygen content
Hb concentration
A form of bias: At least part of the exposure-disease relationship can be explained by another variable
Confounder/ Confounding
A form of bias: When subjects are selected for a study or from selective losses during follow up
selection bias
Travel (Africa and Haiti)
HIV rampant
Malaria (Africa)
Southwest USA
Coccidioides
Mississippi river valley
Blastomycosis
Ohio River Valley
Histoplasmosis
Contents of bee venum
Hyaluronidase and phospholipase–> Initiate IgE-mediated response
Rapidly progressive fever, severe sore throat, drooling and progressive airway obstruction
H.Flu
Histology of primary effusion lymphoma
large cells, big nuclei, prominent nucleoli
Classic Burkitt lymphoma histology
diffuse medium sized lymphocytes and a high proliferation index represented by high Ki-67 fraction (approaching 100%
Almost all CNS lymphomas and 1/2 of systemic B-cell lymphomas occurring in setting of HIV due to …
EBV
Formaldehyde and glutaraldehyde
Function by cross-linking and alkylating DNA and proteins
Used for hospital instruments that cannot withstand autoclave temps
Shortened ANAGEN (hair follicle growth) phase, with resulting follicular miniaturization
Androgenetic alopecia (male-pattern hair loss) Polygenic Inheritance
Oral isotretinoin used to treat severe acne MOA
Inhibits follicular epidermal keratinization in a manner similar to retinoids
Tx for androgenetic alopecia
5-alpha reductase inhibitors like finasteride
Autoimmune disorder that causes rapid onset patchy or diffuse hairloss
Alopecia areata (TX: intralesional glucocorticoids)
Pregnant woman (high levels of estrogen and progesterone) = what to hair?
Increased hair growth
Activation of specific CD4+ lymphocytes by APCs–> INF-gamma and IL-2 activation of macrophages and cytotoxic T lymphocytes.
TH1 response (ex: mycoplasma TB due to fact it is INTRACELLULAR)
Consist of epithelioid cells, T-lymphocytes, Langhans, multinucleated giant cells, fibroblasts and collagen
Caseating granulomas of TB
What activates CD8+ cells
Release of IFN-gamma and IL-2 from TH1 cells
Drug that causes side effect of anorgasmia in women?
SSRI
SSRI side effects
#1 sexual dysfunction (make sure you ask patient about this) Others: transient nausea (at start), risk of seizures (rare) and weight gain
Orthostatic Hypotension and urinary hesitancy ADR due to antagonism of cholinergic and alpha-adrenergic receptors
Urinary hesitancy
1) Regulator of Urea cycle
2) Rate limiting enzyme of urea cycle
N-acetylglutamate (the regulator) regulates the action of the rate limiting enzyme Carbamoyl phosphate synthetase (Bicarb + ammonia/NH3 +2ATP–> Carbamoyl phosphate)
Note: occurs in mitochondria
Chemokine responsible for:
- Phagolysosome formation
- Inducible nitric oxide synthase release
- Development of granulomas and caseous necrosis
INF-gamma
Air-fluid level (CT) in lower lobe of right lung
Pulm. abscess due tissue damage and resultant abscess formation caused by lysosomal content released by macs and neutrophils
Stimulates natural kill cells to destroy
Responsible for T-helper cell secretion of IFN-gamma
IL-12
Blood flow equation
Flow (Q) = [(P1-P2)*r^4]/nL
Genetic code is degenerate
more than 1 codon can code for a pair of amino acids
also called wobble
Genetic Transition
purine–> purine
Genetic transversion
purine–> pyrimidine
Brachial plexus controls all motor activity in the upper extremity except for …
Trapezius muscle (innervated by CN XI) Actions? fucking cant copy and paste
Interscalene nerve block
regional anesthesia technique for procedures involving shoulder and upper arm. Administer in scalene triangle: affects brachial plexus roots and trunks
ipsilateral diaphragmatic paralysis (roots of phrenic- C3 to C5) pass through interscalene sheath
Interscalene nerve block
Avoid in patients with chronic lung disease or phrenic nerve dysfunction
Omohyoid muscle Origin Insertion Action Innervation
Origin: upper scapular border and travels along the front of the neck
Inserts: hyoid bone
Action: ?
Innervation: C1-C3 ansa cervicalis (cervical plexus branches)
Superficial neck muscle covering the clavicle and sternocleidomastoid before inserting around mandible. Innervation ?
Cervical branch of facial nerve
Superficial neck muscle controlling neck flexion and head rotation that is innervated by the accessory nerve (XI)
STERNOCLEIDOMASTOID
Howell-Jolly Bodies (splenectomy)
DNA
Pappenheimer bodies (sideroblastic anemia)
Iron
Abnormal Eosin-5-maleimide Test
Hereditary Spherocytosis
Increased osmotic fragility on acidified glycerol lysis test
Hereditary spherocytosis
When do you use colchicine for ACUTE gout ?
Mild to moderate renal failure, peptic ulcers, or other
Where are uric acid crystal located in the nephron?
Distal tubules and collecting ducts due to low pH (acid environment)
Thus to prevent tumor lysis syndrome: Urine alkalinization and hydration (throw some allopurinol in there too)
Overflow incontinence is due to? (involuntary and continuous leakage when bladder is full and have incomplete emptying)
Impaired detrusor contractility (DM1 autonomic neuropathy) or bladder outlet obstruction (tumor obstructing urethra)
Watch out for them UTIs too!
Test to confirm inadequate bladder emptying?
PVR (post-void residual testing with ultrasound or cath)
Urge incontinence (sudden desire to urinate)
NPH or spinal cord lesion–>inhibition of of detrusor contraction (urge incontinence)
Aedes mosquito transmit both Dengue Fever and Chikungunya fever
simultaneous outbreaks in subtropical regions (south asia, pacific islands, caribbean, americas)
Prevent w/ bed nets, window screens, and insect spray
Febrile, flu-like, prominent polyarthralgia/arthritis (hands wrists and ankles), with diffuse macular rash
Chikungunya fever
How is typhoid fever (salmonella) acquired?
Contaminated food or water (areas with poor sanitation)
Duodenal ulcers on anterior wall
perforation
Duodenal ulcers on posterior wall
Hemorrhage (gastroduodenal artery)
Carbolfuchshin acid-fast stain results:
Red vs Blue
Red: mycobacteria (norcardia-ish)
Blue: non-acid fast
Mycobacterium cell membrane and wall most similar to
gram positive (weakly positive on gram stain)
N-actylmuramic acid and N-actylglucosamine
saccharides that combine with an amino acid chain to form the peptidoglycan layer in both gram positive and gram negative cell wall
Serves as antigenic determinant for organism identification in lab and an antigenic target for human immune system. Linked to peptidoglycan cell wall of Gram positive but not gram negative
Teichoic acid
Component of outer cell envelope of gram-neg bacteria
LPS
Inheritance pattern in which one parent must also affected in order for child to have disorder
AD
Only _______ is able to bind to both antithrombin III and thrombin to allow antithrombin to inactivate thrombin
LMWH
A dihyropyridine calcium channal blocker commonly used as monotherapy or in combo to treat HTN. ADRs = HA, flushing, dizziness, and PERIPHERAL EDEMA
Amlodipine
Decreased forced expiratory volume in 1 sec (FEV1) and decreased peak expiratory flow rate
Asthma…If normal us methacholine challenge to diagnose
Cardiogenic shock and evidence of watershed necorsis
hypoxic-ischemic encephalopathy
most vulnerable to ischemic injury and affected first
Pyramidal cells (hippocampus) Purkinje cells (cerebellum)
Profound ischemia (cerebral)
necrosis of areas supplied by distal-most branches of cerebral arteries (watershed infarction)
Cortical watershed infarcts typically appear how?
BILATERAL wedge-shaped strips of necrosis over cerebral convexity
Severe carotid artery stenosis may = UNILATERAL
Cardiac embolism
MULTIPLE infarcts within different major vascular territories (eg. middle and anterior cerebral arteries)
Charcot-bouchard aneurysm rupture usually causes hemorrhage involving
Deep brain structures (basal ganglia, cerebellar nuclei, thalamus, pons)
HA, Vomiting, confusion—>coma/death–>autopsy shows brain EDEMA and PETECHIAL HEMORRHAGES throughout gray and white matter
Hypertensive ENCEPHALOPATHY
Saccular aneurysm rupture
Subarachnoid hemmorrhage
Cerebral amyloid angiopathy (AB40)
deposition of amyloid. Results in lobar hemorrhages (occipital, parietal) esp. in elderly
Hirano bodies
elongated, eosinophilic, ACTIN-containing bodies found in pyramidal neurons of hippocampus
Chromosomal rearrangement that creates a fusion gene btw EML4 (echinoderm microtuble-associated protein like 4) and ALK (anaplastic lymphoma kinase). Results in constitutive active tyrosine kinase that causes malignancy
NSCLC
Most common cause of glomerulonephritis
IgA nephropathy (Berger Disease)
Painless hematuria within 5-7 days of URI in older child or young adult
IgA nephropathy
Renal Biopsy of IgA nephropathy
Nonspecific mesangial hypercellularity and mesangial IgA deposits
IgA nephropathy with extrarenal symptoms (ab pain, arthralgias, purpuric skin lesions)
HSP
Primary and secondary amyloidosis. Most frequent organ involved?
Kidney
Basket weave appearance (lamellated BM w/ irregular thinning and thickening)
Alport syndrome (renal failure by 40 - eyes and ears involved)
Disorder of type IV collagen that typically causes microscopic hematuria. Only abnormality is a thin basement membrane
Thin basement membrane disease
The immune reaction to M.tuberculosis is ______ cell-mediated
TH1
Name four risk factors for TB reactivation
1) HIV
2) Infliximab/ etanercept
3) calcineurin inhibitors (cyclosporine)
4) Chronic corticosteroid users
Classic extrapulmonary sites of TB?
Basal meninges (tuberculous meningitis), psoas muscle (psoas absecess), lumbar spine (Pott disease), serous membranes such as pericardium and pleura.
Idiosyncratic aplastic anemia
not dose dependent
Absorbed by upper dermis and contribute to sunburn and increased risk of malignancy
UVB wavelengths
Penetrate deeper in into the skin and cause photoaging
UVA wavelengths
How does UVA cause photoaging?
Produce reactive oxygen species, which cause upregulation inflammatory cell-surface receptors an nuclear TFs. This leads to decreased collagen fibril production and upregulation of matrix metalloproteinases
Photoaging (wrinkling)
Epidermal atrophy with flattening of rete ridges.
Decreased collagen fibril production and increased degradation of collagen and elastin in the dermis.
Also increased cross-linking
Alzheimers disease brain atrophy is most pronounced where?
Temporoparietal lobes and HIPPOCAMPUS
Hippocampal atrophy is evident even in early stages of disease and can be detected with and MRI
HA, memory loss, cerebrospinal fluid VDLR+, and pleocytosis
Neurosyphilis
Valvar lesion in late (tertiary) syphilis
gumma
Valvar lesion in primary syphilis
chancre
Secondary syphilis (bactermic stage that develops 5-10 weeks after chancre resolution)
Presents with diffuse macular rash (palms and soles included)
CONDYLOMATA LATA
Warfarin initiation ( first factors to fall)
FACTOR VII (also called?) and protein C
Warfarin skin necrosis Tx
Fresh frozen plasma to replenish protein C and get the hell off warfarin
