Block 5 Flashcards
Lung mass, dyspnea, hiccups and referred pain to the shoulder
Phrenic nerve compression C3-C5
Epidermal growth factor receptor mutation
ERBB1 –> lung cancer
ERBB2 (known as HER2)–> breast
Also ovarian and gastric cancer
N.gonnorrhea and N. meningitidis grow in
-choclate agar based medium called thayer martin agar -contains vancomycin, colistin, nysatin and trimethoprim
Problems in cross-linking in collagen synthesis
Ehlers danolos syndrome and menkes disease
Central herniation can lead to
Abducens nerve palsy
Dyskeratosis is found in
SCC of the skin
Vitamin C deficiency clinical
- most oftenly seen in malnourished people
- decreased connective tissue strength
- capillary walls are fragile –> easy bruising,mucosal bleeding and petechial hemorrhage.
- periodontal disease (gum swelling, loosening of teeth and infection)
- poor wound healing
- hyperkeratotic follicles with corecscrew hair
Ketoconazole effect on males
It a weak anti-androgen that decrease the synthesis of testosterone in leydig cells of testes, also inhibit steroid hormone synthesis by adrenals
Eosinophillic vs basophillic neurons
Eosinophillic neurons –> red neurons –> dead –> 12-24 hrs after stroke
Basohpillic neurons–> blue –> normal neurons
Left main coronary artery occlusion (ECG localization)
V1-V4 and V5-V6, I and aVL
LAD and LCX arteries
PCOS increase the risk for what cancer
Endometrial hyperplasia and adenocarcinoma
C.diphteriae leads to
-pseudomembrenous exudate
-absorption into blood stream leads to systemic symptoms such as :
Myocarditis, neurological symptoms such as coma and paralysis.
Problems in making triple helix in collagen
Osteogenesis imperfecta
Translocation in 15:17 chromosome
Acute protomyoletic leukemia- abnormal retinoic acid receptors
- translocation of retinoic acid receptor alpha (RARA) from chromosome 17 and the prolyelocytic leukemia gene (PML) on chromosome 15 leads to PML/RARA. A fusion gene which inhibit the differentiation of mylolblast and triggers APML
Bladder carcinomas:
arise from,,
presentation
Prognostic marker
- They arise from transitional epithelium lining the bladder
- in most cases the neoplastic cells resemble those of normal bladder epithelium
- tumors are called urothelial carcinoma (transitional cell)
- squamous cell carcinoma and adenocarcinoma of bladder are rare
- presentation: painless gross hematuria.
- prognostic factors: tumor stage is the most important and depends on degree of invasion.
- muscular layer involvment is an important prognostic factor.
Auer rods is seen in
Acute myelogenous leukemia (especially APML)
APML is treated using
all trans retinoic acid
PCOS diagnostic criteria
2 of 3 at least
- hyperandrogenism
- Irregular periods
- Polycystic ovaries on ultrasound
Urticaria is
Common H.S reaction, charactrized by intense pruritus.
Most often cause by IGE mediated degranulation of Mast cells.(sometimes not)
Its due to increased permeability of microcvasculature, leading to edema of superficial dermis.
Scant inflammatory cells and interstitial fibrosis after transplant
Chronic rejection
Togaviruses are responsible for
Rubella (german measles) and eastern and western equine encephalitis.
Anti Anticoagulants methods
- Warfarin overdoes :
- VIT K is effective but take a few days
- fresh frozen plasma( FFP).
- Protamine - ineffective
- prothrombin complex concentrates –> contain vitamin K dependent factors (II,VII,IX,X) can be used - Heparin overdose:
- VIT K is ineffective
- FFP is ineffective (it contains antithrombin III which enhances heparin effect)
- Protamine is heparin specific antidote
Creutzfeldt jakob disease and prions features
Its rare disease, most of transmitted cases are iatrogenic seen in patients recieving contaminated corneal transplants, implantable electrodes or preperation of growth hormone.
- prion diseases have common features:
1. long incubation periods however rapid progressive after onset
2. Associated with abnormal prion protein
3. No treatment
4. Characterstic morphologic changes are described as spongiform encephalopathy. Vacuoles form in the cytoplasm of the neutrophils and neurons. As the disease progresses, the vacuolated areas transform into cyst and no inflammatory changes present.(important)
Pancoast tumor
Tumor in the lung apex , can lead to horner syndrome or brachial plexus compression (C5-T1 ) and lead to shoulder pain.
Chrons disease composition of inflammatory infiltrates
Lymphocytes and monocytes
Proteasome inhibitors - used for
Mechanism of action
- in multiple myeloma, neoplastic B cells mature into plasma cells –> synthesize large amounts of monoclonal Ig or Ig fragment (light chain) –> as a result of increased protein production –> plasma cells are susceptible to the effect of proteasome inhibitors.
Bortezomib, boronic acid containing dipeptide
AML presentation
- anemia(fatigue, pallor)
- thrombocytopenia(petechiae, hemorrhage)
- neutropenia(fever, infection)
- DIC
Functional Hypothalamic amenorrhea
Excessive weight loss/sternous exercise/chronic illness/eatin disorder —> decrease adipose tissue/fat reserves and decreased leptin production –> hypothalamus decreases GnRH secretion –> pituitary decrease of LH and FSH –> ovaries doesnt produce Estrogen –> amenorrhea and bone loss
Subacute sclerosing panencephalitis
Causes progressive demantia, spasticity and seziures. Its linked to abnormal ,easles virus that persits in the CNS of these patients after years of recovery from measles.
C.diphtheriea pathogenesis
- colonization of respiratory tract and secretion of diphtheria toxin (the primarily virulence factor).
- diphtheria toxin is an AB exotoxin that inhibits protein synthesis by ADP ribosylation of EF-2
- toxin act locally causing respiratory cell necrosis with formation of fibrinous, exudate
Acantholysis is seen in
Pemphigus disorders, its loss of cohesion between keratinocytes in the epidermis
12 -24 hrs after stroke microscopic changes
- Red neurons-> eosinophilic staining of the cytoplasm
- Nissl substance disappears
- Nuclei becomes pyknotic (shrunkens and becomes basophillic) and undergoes fragmentation (karyorrhexis).
Absolute Vs relative erythrocytosis
- direct RBC mass is necessary. An increased in total RBC mass indicates absolute while normal RBC mass indicates relative.
- this is measured through 51Cr-tagged RBC infusion
Warfarin induced skin necrosis
Transient hyper-coagulable state that occur during the first days of warfarin therapy.
- the overall anticoagulant effect of warfarin is due to the inhibition of Vitamin K dependent Gamma-carboxylation of clotting factors II, VII, IX, and X. However it also decreases carboxylation of protein C and S. Rather earlier than the others –> hyper-coagulable state
Cushing triad
Hypertension, bradycardia, and bradypnea
= increased intracranial pressure
Primary amenorrhea is defined
Failure of menarche prior to age of 15
Angioedema causes
1.Due to mast cell activation : Type I HS reaction --> IGE mediated Direct mast cell activation Both associated with urticaria and pruritus 2. Excess bradykinin ACE inhibitors C1 esterase deficiency (usually occurs in childhood or young adults) No pruritus or urticaria
Flutamide
Its used to treat metastatic prostate cancer(not BPH due to excessive anti androgenic effect).
- it inhibits the interaction of DHT and testosterone with their receptors.
Inhibit fibrinolysis by inhibiting plasminogen activation = 2 drugs
Aminocaporic acid and tranexamic acid
Vaginal adenosis
Persistance of glandular coulmnar epithelium in vagina is a precursor of clear cell adenocarcinoma. Female offspring exposed to diethylstilbestrol in utero are at increased risk and may present with vaginal discharge or vaginal cysts/fleshy colored lesions.
Platlet derived growth factor receptor mutation leads to
Cancer , especially ovarian
Red neurons shows in microscopy as
Eosinophilic cytoplasm
Calicivruses
Norwalk virus responsible for gastroenteritis
What is St john worts
OTC medicinal herb that have both anti inflammatory and anti depressant proporties. It induces hepatic CYP450 resulting in increased substrate metabolism (warfarin, OCPS, antiepileptic, theophyline), –> decreases drug levels.
Dilated pupils =
Oculomotor nerve palsy
Acanthosis
Diffuse increase in thickness of stratum spinosum, seen in psoriasis, seborrheic dermatitis, and acanthosis nigricans.
Spongiosis is
Intracellular epidermal edema that histologically appears as an increase in the width of spaces between cells.
Seen in spongiotic dermatitis
Down syndrome cardiac congenital anomalies
- ASD
- VSD
ECG localization of MI : lead I and aVL
Lateral –> LCX
Hydrocele
Failure of obliteration of the processus vaginalis leads to persistant connection between the scrotum and the peritoneal cavity through the inguinal canal. If opening is small –> fluid leakage –> hydrocele . If communication is large –> indirect hernia.
Indirect inguinal hernia is common in children.
Ebstein anomaly
Lithium exposure in utero
-charactrized by apical displacment of tricuspid valve leaflets decreased volume of the right ventricle and artializtion of right ventricle.
Amniotic fluid embolism
Its rare catastrophic complication.
Amniotic fluid containing arachidonic acid metabolites is thought to enter maternal circulation through sites of uterine trauma of cervial laceration.
-this result in anaphylactoid reaction- >caused by metabolites.
-It causes occlusion and vasospasm of the maternal pulmonary circulation –> left ventricular failure –> decreased CO, –> severe V/Q mismatch –> hypoxia and hypotensive shock –> cardiopulmonary arrest.
- tissue factors thromboplastin is also released from amniotic fluid and triggers DIC
-histology shows fetal squamous cells and mucin in maternal pulmonary arteries
-
Cp450 inducers
- Alcohol use
- St. John wort
- Phenoytoin
- Phenobarbital
- Carbamazepine
- Rifampin
- Griesofluvin.
Acute rejection in biopsy
Dense infiltrates of mononuclear cells usually composed primarily of T lymphocytes
Low serum sodium, diarrhea , high fever, pneumonia , headache
Legionella
Exposure to : recent travel(cruise) , hospital/nursing home stay
General paresis
Form of neurosyphillis
Alcohol abuse and chronic mental ilness
Korsakoff psychosis wernicke encephalopathy
Thiamine deficiency
ECG localization of MI :
V3-V4
V5-V6
V3-V4 (distal LAD) anteroapical
V5-V6 (LAD or LCX) anterolateral
Contrast ct angiography should be avoided in
Renal insufficiency (elevated creatinine) due to the increased risk of contrast induced nephropathy
Promoter region contains?
Consensus sequence that are typically AT rich (TATA, or CAAT boxes) or GC rich (GC box)
Typical chrons disease presentation
-20-30 y.o , weight loss , fatigue , low grade fever, and aphtous ulcers of oral mucosa
What are proteasome
They act as recycling centers for proteins, breaking down misfolded, damaged and cytotoxic proteins into their component, building blocks for reuse in new proteins.
- its inhibition results accumulation of toxic intracellular proteins.
- they regulate the balance between pro and anti-apoptotic proteins–> their inhibition leads to excess in pro-apoptotic proteins
Reye syndrome is charactrized by
- Hepatic dysfunction : vomiting, hepatomegaly, liver biopsy shows microvesicular steatosis, the presence of small fat vacuoles in the cytoplasm of hepatocytes.
- Encephalopathy:toxic effect of hyperammonemia on the CNS leading to cerberal edema.
Progressive multifocal leukieencephalopathy (PML)
- Jc virus
- HIV patients
- demyelination of oligodendrocytes is the primary pathologic effect. (Inflammatory)
Squamous cell carcinoma of bladder is associated with
Schistosoma haematobium
Several months to years after stroke
Appears after brain infarction the necrotic area appears as a cystic cavity surrounded by a wall of dense fibers formed astrocytic processes (glial scar)
Uncal herniation may result in
Psilateral oculomotor nerve palsy with a fixed dilated pupil due to damage to preganglionic parasympathetic fibers.
Polycystic ovary syndrome
Clinical features :
-androgen excess: hirsutism, acne, androgenic alopecia
-ovarian dysfunction: menustral irregularity, polycystic ovaries
-insulin resistance : acanthosis nigricans, glucose intolerance/DM
-obesity
Treatmet :
-weight loss
-combination hormonal contraceptives
-metoformin
Calcineurin
Its a protein phosphate that is activated upon stimulation of the appropriate cell receptor.
Once activated, calcineurin dephophorylates nuclear factor of activated T cell (NFAT), which allows NFAT to enter the nucleus and bind to IL-2 promoter.
-IL-2 –> stimulate and proliferate T cell
-its the action site for TACROLIMUS and CYCLOSPORINE
ECG localization of MI : V1-V2
Anteroseptal - LAD- (proximal also associated with V3-V4 elevation however distal spares V1-V2)
Pathogenesis of atheromas
- its thought to begin with endothelial injury –> increased endothelial permeability –> enhanced leukocytes adhesions –> altred gene expression. Endothelial dysfunction also promtes platelet adhesion, aggregation and release of growth factors and cytokines.
- – PDGF –> promotes migration of smooth muscle cells from the media to the intima and increase smooth muscle cells proliferation.
- platlets also release transforming growth factor beta (TGF-ß) which is chemotactic for Smooth muscle cells and induce interstitial collagen production.
Alveolar ducts lined with hyaline membranes is characteristic of
ARDS
Mitochondrial DNA
Nuclear chromosomes contain ,most of the DNA, however mitochondria also contain DNA called Cricular DNA (mtDNA).
- overtime most of genes coding for mitochondrial protein have migrated to nuclear DNA
- however mtDNA still codes for 14 proteins and the ribosomal and transfer RNA needed for mitochondrial protein synthesis.
Injury to radial nerve results from
Leads to
It results from repetitive pronation/supination of forearm(frequent screwdriver use) (as the radial nerve passes from supinator canal,) direct trauma, or dislocation of radius.
- it leads to weakness in the finger and thumb extension (“finger drop”).
- triceps brachii and extensor carpi radialis are preserved as the branches are superior to the lesion.
- cutaneous sensory branches are similarly preserved
Centrilobular congestion in the liver occurs in
Right sided HF patients
ECG localization of MI : V7-V9
Posterior PDA ( also ST depression in V1-V3 with tall R waves)
Methionine synthesis requires
B12 - from homocysteine to methionine
Ehlers danlos syndrome defect in ?
Defective collagen synthesis –> deficiency in procollagen peptidase –> N-terminal pro-peptide removal inability.
ECG localization of MI : lead II, III and aVF
Inferior - RCA
Lens subluxation
Downward : homocystinuria
Upward: marfan syndrome
Parvovirus
B19 virus
Erythema infectiosum, fifth disease, aplastic crisis in sickle cell and hydrops fetalis.
Angioedema is
Rare and potentially serious adverse effect of ACE inhibtor therapy . Symptoms typicaly appears within days but can also appear after weeks to years.
- it can affect anyplace in the body but usually affect the lips, tongue or eye lids. Laryngeal edema and difficulty breathing may also occur.
- ACE inhibitor angioedema is due to bradykinin accumulation.
- normally ACE is responsible for bradykinin breakdown. ACE prevents bradykinin degradation leading to increased levels.
CCK is produced by
I- cells of dudenum and jujenum when fat-protein rich cheme enter the dudenum
Bile duct proliferation is present in
Primary biliary cirrhosis
Poly A is found on
Mature RNA, poly A protects the mRNA from degradation within the cytoplasm after it exits the nucleus
along with
1. 5’ capping : 7 methyl guanosine cap is added to end of mRNA
2. Splicing : the initial mRNA transcript contains sequences from coding and non coding regions of DNA, known as exons and introns respectively. Spliceosomes remove introns containing GU at the 5’ splice site and AG at the 3’ splice site
Hypoxic Vs secondary erythrocytosis.
Meaurment of arterial oxygen saturation (SaO2) is important to exclude hypoxemia as a cause of erythrocytosis.
- SaO2 <92% can cause secondary polycythemia.
- SaO2<92% = PaO2 <65 mm Hg
Erythrocytosis is defined as
Men Ht >52%
Women Ht >48%
It may result from true increase in the RBC mass (absolute) or from decrease in plasma volume (relative)
Viral hepatitis, liver histology
- apoptosis of hepatocytes
- acinar necrosis and periportal mononuclear inflammatory infiltration
Vitamin C is necessary for
Hydroxylation of proline and lysine residues in collagen synthesis.
Hydroxyproline and hydroxylysine are essential for cross linking collagen molecules. In scruvey, collagen cross linking is compromised, theryby greatly reducing tensile strength
Anaphylaxis following blood transfusion
IgA deficiency
Brassy barking cough and breathing difficulty with a history of recent upper respiratory tract infection(URI) –?
Croup (acute layngiotracheitis )
- the dyspnea associated with croup occurs when inflamed subglottic tissue obstruct the airway.
- the characterstic stridor of croup is a sign of significant airway obstruction.
- croup is typically caused by the standard URI viruses with parainfleuenza viruses most commonly responsible. (Paramyxoviridae)
Aspiration pneumonia -> histology
Inflammation and foreign body response with giant cells. Usually in the right lower lobe
Aspirin effect on the liver in children
Mivrocesicular steatosis.
Reye syndrome
Multiple myeloma- clinical
-bone pain, Fatigue Anemia Kidney disease And hypercalcemia
Cp450 ihibitors
- Acute alcohol abuse
- Ritonavir
- Amiodarone
- Cimitidine
- Ketoconazole
- Sulfomaides
- Ketoconazole
- Isoniazid
- Grapefruit juice
- Quinidine.
- Macrolides.
Risk factors for gallbladder disease
- forty
- Fat
- Female
