Block 18 Flashcards
Exetrtional dyspnea with medical history significant for pneumonia and hypertension. Decreased breath sounds and bilateral wheezing
- indicative for centriacinar emphysyma seen in COPD.
- dilated airspaces seen on CT
Lingual thyroid
Thyroid gland is formed from outpouching of the pharyngeal epithelium and subsequently descends to lower neck.
- failure of migration, the thyroid can reside anywhere along the thryroglossal duct usual path, including the tongue (hence lingual).
- it can lead to obstructive symptoms such as dysphaia, dysphonia and dyspnea, especially at timse of highetend thyroid stimulation.
IgG binding site for the complement
Its not the same as attachment to phagocytic cells (not lower FC portion)Rather its the part superior to it (closer to the hinge region)
What are the main factors that influence cerebral circulation
Systemic BP and arterial blood gas levels.
-when systemic BP is decreased it has no effect on brain due to autoregulation(60-140). (However under 50 -> risk for ischemia, and above 150 risk for increased ICP due to increase cerebral volume)
Arterial PaCO2 role on brain circulation
- its the most important regulator.
- a drop in PaCO2 due to hypoventilation —> vasoconstriction, —> reduction in cerebral blood volume —> decrease ICP.
- lowering of PaCO2 is one of the measures employed to reduce ICP in mechanically ventilated patients with cerebral edema
Renal gluconeogenesis is stimulated by
Epinephrine is better than glucagon in stimulating “renal” gluconeogenesis, this is done when hypoglycemia is sustained.
ubiquitin proteaosome pathway
Its essential for breakdown of ntracellular proteins, both native and foreign and helps recycle them.
- this process is perforemed by ubiquitin ligases enzymes.
- this process is essential for MHC class I presentation of infected cells.
Antioxidant enzymes
Superoxide dismutase, glutathione peroxidase and catalase.
Converts ROS to O2 and H2O
Posterior urethral valves
Occurs only in males, males and males
- can present with bilateral hydronephrosis, and clyceal dilation due to obstruction of urine flow in the urethra.
- they occur from a malformation in woliffian duct therefore occurs only in males
Vesicouretral reflux (reflux nephropathy)
-normally, after bladder fills, there is a flip valve mechanism that prevents retrograde flow of urine, however of this mechanism doesnt work —> vesicoureteral reflux occur —> can lead to multiple pyelonephritis —> renal scarring commonly in upper and lower poles of kidney —> secondary hypertension and nephron damage may occur
Compound papillae vs simple papillae
Compound papillae are always open thus more susceptible to kidney injury.
Clinical manifestation of asbestos exposure
- Pleural plaques: affects parietal pleura near the diaphragm, dense collagen that beomes calcified.
- Asbestosis: progressive diffuse pulmonary fibrosis, asbestos bodies (green-brown beaded rods)
- Bronchogenic carcinoma
- Mesothelioma
Alkylating agents and benzene exposure associated with
Acute leukemias
Hydrocephalus types
- Communicating hydrocephalus: globular ventricualr dilation and increased ICP without significant CSF flow blockage. Usually due to impaired arachinoid villi due to inflammation or fibrosis.
- Normal pressure hydrocephalus: enlarged ventricles in the seeting of normal ICP, it have impaired CSF absorption compensated by decreased formation of CSF.more common in adults
- Hydrocephalus ex vacuo : present with normal ICP and increased dilation of ventricles secondary to cortical atrophy(usually occurs with alzehaiemr)
- Pseudotumor cereberi presents with elevated ICP and classicaly occurs in young women who are overweight.
The etiology of the condition isnt well known but its thought to be related to cerberal venous outflow abnormalities due to elevated ICP
Cholesterol gall stones treatment
- decreased amounts of bile acids and phospholipids can cause bile to become supersaturated with cholesterol allowing it to crystalize and form cholesterol gallstones.
- risk for stone formation including increasing age,obesity, excessive bile salt loss, and female sex.
- cholecystectomy is the best management
- medical management : hydrophilic bile acids ( Ursodexycholic acid) reduces cholesterol secretion and increases billiary bile acid concentration —> promotes gallstones dissolution.
Pagets disease of bones clinical presentation
Hearing loss(bony deformity of the skull)(due to auditory foramen narrowing)
Increased Hat size
Increased ALP
Long bones chalk stick fractures
High output heart failure (due to increased blood flow from increased AV shunts)
Pagets disease pathogenesis
- initially, excessive osteclastic bone resorption—> increased bone formation by osteoblasts —> this result in high bone turnover (new bone disorganized. Easily fracture)
- osteclasts originates from mononuclear phagocytic cell lineage and are ultimately formed when sever precursor cells fuse to create multinucleated mature cells.
- e 2 most importamt factor for osteoclasting differentiation is M-CSF and receptors for activated RANK-L.