Block 13 Flashcards
Nipple discharge
Physiologic
Pathologic
- Physiologic ( billateral, nobloody, milky without masses or skins changes)
- pathologic (bloody or serosanguineous and unilateral with/without palpable masses and skin changes)
Intraductal papillomma
- MCC of alarming bloody seosanguineous nipple discharge.
- affected patients have no associated breast mass or skin changes.
- intraductal papilloma is caused by proliferation of papillary cells in a duct or cyst wall with fibrovascular core
- it may contain foci of atypia or DCIS.
alpha 1 antytrypsin
- inhibits several proteolytic enzymes (neutrophil elastase)
-AATD–> panacinar emphysyma
-AATD –> neonatal hepatitis is common ,
In adults –> hepatomegaly, cholestasis, elevated transaminases , and milf thrombocytopenia.
HS purpura(HSP) Complications
-disease usually preceeded by viral or STREP, URI.
- Ag from infection –> simulate IgA production –>IgA immune complex deposition on vessel wall –> inflammation.
Complications:
1. GI: intermmitent sever abdominal pain, hematemesis and bloody diarrhea, bowel wall edema and increased risk for intussusception
2. Kidney: renal involvment in HSP is identical to that seen in berger disease. Both cause mesangial proliferation and and crescent formation.
3. HSP classically causes palpable purpura on the buttocks and lower extremities. These lesions may begin as urticatrial papules or plaques and subsequently evolve into purpura.
4. Joints: migratory arthlagias and arthritis are most commonly seen in large joints of the lower extremities possible because of their dependent nature.
Kawasaki disease
- swollen lymph nodes
- high fevers, strawberry tongue
- perioral erythema and fissuring
- periungual desquamation.
Second branchial cleft persistance
- normally obliterated in utero
- persistance leads to branchial cleft Cyst between the angle of the mandible and sternocleidomastoid muscke.
What vascular beds are most susceptible for athersclerosis
Lower abdominal aorta and coronary arteries
Persistant fever, sore throat, anterior and posterior cervical lymphadenopathy , and splenomegaly
EBV
EBV infections, immune response
- after infection the virus gains access to the blood stream where it perferentially infects B- lymphocytes by binding to the CD21 cell surface receptor.
- CD8+ clonally exoand in response to EBV infected B cells in an effort to destroy virally infected cells.
Folate deficiency leads to anemia –> ?
Due to diminshed thymidine synthesis.
- folic acid is a single carbon donor required for synthesis of purine and pyramidine (eg.thymidine) bases incorporated in DNA.
- RNA and protein synthesis may continue relatively unaltered, leading to a state of unbalanced cytoplasmic growth with impaired cell division.
Fibrates mechanism of action (fenofibrate, gemfibrozil)
- upregulation of LPL
- increased oxidation of FA
- inhibit cholesterol 7a- hydroxylase, which catalyzes the rate limiting step in the synthesis of bile acids.
- the reduced bile acid production results in decreased cholesterol solubility in bile and favors the formation of cholesterol stones.
Aromatase effect on Gallbladder
- estrogens increase biosynthesis of cholesterol by up-regulating hepatic HMG-CoA.
- HRT, OC increases the amount of cholesterol secreted in bile and contribute to formation of gallstones.
- its inhibition will lead to decrease in gallstone formation.
African americana, female , pulmonary infiltrates , and hilar adenopathy.
- immune response
Sarcoidosis
- the immune response is Th1 –> IL-2 –> IFN-¥
CO effect on blood parameters
- CO bind to hemoglobin with an affinity of approximately 250 times of that of O2
- reducing the number of heme binding sites for O2 –> levels of CO- bound hemoglobin (carboxyhemoglobin) increases.
- when hemoglobin available in plasma decrease –> CO decreases the oxygen carrying capacity –> and oxygen content of blood
- however not the amount of oxygen dissolved in the plasma (PaO2)
- it causes left shift in hemoglobin dissociation curve reflecting a decreased tendency of O2 to unload to tissues.
Mutations in the env gene in HIV leads to
-evasion of humoral immune response
Mutation in pol gene in HIV
- drug resistance is associated with prolonged use of HAART, a regimen that includes inhibitors of HIV RT and protease.
- pol gene mutation are responsible for the mergence of HIV protease variant that are resistant to standard protease inhibitors.
- its also responsible for structural changes in HIV RT that render the enzyme resistant to standard nucleoside and non-nucleoside RT inhibitors.
High altitude changes
- the partial pressure of inspired air falls at high altitudes. The result in hypoxemia with marked reduction in arterial O2.
- tissue hypoxia triggers chemoreceptors in the carotid bodies to stimulate ventilation.,
- hyperventilation leads to fall in PaCO2 –> respiratory alkalosis and PH rises acutely.
- renal compensation leads to —> decreased HCO3-
- result after 24-48 hours of hypoxia is hypoxemia –> with complete or partial compensated respiratory alkalosis.
Compensatory physiological changes that contribute to long term high altitude acclimatization include
- increase 2,3 DPG
- increased hemoglobin production
- increased pulmonary diffusion capacity
- vascular endothelial growth factor induced angiogenesis
- increase in cellular mitochondria count
- hemoconcentration due to HCO3 diuresis and fluid shift.
Anovulatory cycles
In most women menustral cycles are consistent and last 24-35 days with menustual flow ranging from 4-6 days
- however adolescents typically have immature HPO axis for several years following menarche.
- during this time they may have longer menustrual cycles and irregular bleeding patterns due to the presence of anovulatory cycles.
- in the absence of ovulation, the ovarian follicule doesnt degenerate and become a corpus luteum.
- no progesterone is produced as a result and E2 levels remains high.
- causing endometrium to remain in proliferative phase.
- proliferative endometrium becomes disorganized and fragile with unstable cenous capillaries resulting in stromal breakdown with variable, but often heavy bleeding.
Musculocutaneous nerve injury
- most commonly in the setting of a trauma (shoulder dislocation) and stenous upper extremity activity (basebul pitching) .
- the nerve is derived from C5-C7, arises from the lateral cord of brachial plexus.
- innervates major forearm flexors (biceps brachii, brachialis and coracobrachialis
- the remaining fivers become the lateral cutaneous nerve of the forearm and provide sensory innervation to the skin of the lateral forearm.
