Day 5 June 25 Flashcards
Treatment of cornybacterium diptheria
Diptheria antitoxin - IMPORTANT -preformed neutralizing antibodies that inactivate the circulating toxin
Antibiotics (penicillin, erythromycin)
MOA of diptheria toxin
Inhibits host protein synthesis (ADP-ribosylation of EF-2)-> local and systemic effects
what are potential systemic effects of the diptheria toxin?
life threatening cardiac (myocarditis) and neurological complication
Melanocyte origin
neural crest
Lung findings of asbestosis
Fibrosis and honeycombing, asbestos bodies (brown, beaded rods) and ferruginous bodies, pleural plaques are common
lung findings of chronic hypersensitivity pneumonitis
noncaseating granulomas, peribronchalar fibrosis and patchy lymphocytic infiltrates
cryptogenic organizing pneumonia lung findings
patchy fibrosis, fibroplastic plugs in the alveolar sacs and ducts, and a characteristic butterfly pattern
lung findings of idiopathic pulmonary fibrosis
patchy interstitial fibrosis
honeycomb pattern
Fibrosis prominently in the subpleural and perilobular regions
increasing collagen over time
Signs of chronic inflammation (lymphocytes?)
what is the gram stain of bortedella pertusis?
Gram negative coccobacillus
Retinitis pigmentosa pathophys
- genetic disease characterized by retinil dystrophy
- progressive dystrophy of the pigmented epithelium and photoreceptors
- early disease primarily effects rods, but advanced disease will result in degeneration of cones as well
Presentation of retinitis pigmentosa
Early disease results in loss of rods leading to night blindness and peripheral vision loss. Later disease will progress to loss of cones resulting in decreased central vision acuity
Fundoscopic findings of retinitis pigmentosa?
- retinal vessel attenuation
- optic disc pallor
- pigment accumulation (in a bone spicule pattern around vessels)
how does retinoblastoma present?
Leukocoria (white pupillary reflex), strabismus and a creamy white mass on fundoscopy
what causes acute rejection of organ transplant?
Mediated by T cells which react to the graft MHC antigens
in what time frame does acute rejection of organ transplant occur?
1-4 weeks
what will be different about a person with lactose intolerances stool?
It will have a lower pH -acidified stool
what will be different about a person with lactose intolerances breath?
it will have increased hydrogen content
which hormone is produced by duodenal cells in response to increased H concentrations?
Secretin - which stimulates Bicarb from the pancreas
what type of diuretic is spironalactone?
K sparing
how does estrogen effect osteoblasts?
increases their production of OPG, a decoy receptor that binds RANK-L which thus decreases its binding with RANK on osteoclasts decreasing bone resorption
Denosumab clinical use?
osteoporosis
Denosumab MOA?
monoclonal antibody that acts similarly to OPG
It binds the RANKL as a decoy and prevents binding with RANK on osteoclasts, thus decreasing osteoclast activity
what is the most common cause of bloody or serousanguineous (blood tinged) nipple discharge?
intraductal papilloma
A temporal lobe abscess from a prior bacterial infection may have gotten to the brain through what?
mastoid air cells
A frontal lobe abscess from a prior bacterial infection may have gotten to the brain through what?
ethmoid or frontal sinus
what is keratoderma blennorrhagicum?
vesicles on the palms and soles associated with reactive arthritis
what is circinate balanitis?
erpiginous ring-shaped dermatitis of the glans penis associated with reactive arthritis
what mediates DIC in pregnancy?
tissue factor release which activates factor VII
-released from sites of placental injury
is the rectum involved in crohsn disease?
no the rectum is SPARED in crohns disease
what type of granumolas are found on biopsy of crohns disease?
NON-caseating
which cytokine is important in the pathogenesis of crohns disease?
TNF- alpha
which cytokine do macrophages secrete to induce immature t cells to differentiate into the Th1 subtype?
IL12
A macrophage secretes IL12 to induce t cell differentiation into Th1. What happens next?
The Th1 cell secretes IFN gamma, which is important for macrophages nad CD8 cytotoxic t cells to get rid of intracellular pathogens
what can you give a patient who is IL-12 deficient to improve response to mycobacteria?
IFN - gamma
what is restricted in the diet of someone with a urea cycle disorder?
proteins - prevent excess ammonia
ornithine is part of which cycle?
urea cycle where it combines with carbamoyl phosphate to produce citrulline
what is cyclophosphamide metabolized into?
acrolein
what is acrolein?
metabolite of cyclophosphamide that is excreted in urine but toxic to the uroepithelial cells
complication of chemotherapy with cyclophosphamide or other nitrogen mustard agents?
hemorrhage cystitis due to acrolein
how can you prevent hemorrhage cystitis in someone taking cyclophosphamide?
Agressive hydration and MESNA -inactivates toxic metabolites
Leucovirin is the rescue drug for what?
methotrexate overdose
Phenelzyine use?
monoamine oxidase inhibitor, thus increases presynaptic availabilty of monoamines
why must you wait two weeks between taking a MOAi and SSRI?
risk of serotonin syndrome, so you need to wait for MAO to regenerate
pathophys of neimann-pick disease?
sphingomyelins accumulate in lysosomes resulting in lipin-laden foam cells in the spleen and liver. Eventually accumulates in the nervous system as well
list the steps in the adenoma to carcinoma sequence
- APC inactivation= normal colon -> hyperproliferative epithelium
- Kras mutation = hyperproliferative -> adenoma
- p53 inactivation = adenoma -> carcinoma
What changes are seen 4-12 hours after an MI?
wavy fibers with narrow, elongated myocytes
what changes are seen 12-24 hours after an MI ?
myocyte hypereosinophilia with pyknotic shrunken nuclei
what changes are seen 1-3 days after an MI ?
coagulative necrosis and neutrophil infiltrate
what changes are seen 3-7 days after an MI ?
dead neutrophils and myofibers
Macrophage infiltrates
what changes are seen 7-10 days after an MI ?
granulation tissue
name two highly conserved sequences used for initiation of transcription in humans?
CAAT and TATA
what is the best measure of risk for a case control study?
odds ratio
is the measure of relative risk commonly used for case controls?
NO this is used for cohort studies
Inheritence of Crigler-Najjar syndrome type I?
AR
What is deficient in Crigler-Najjar syndrome type I?
lack of UGT- enzyme needed to catalyze bilirubin with glucoronic acid
pathophys of Crigler-Najjar syndrome type I?
The inability for the liver to conjugate glucoronic acid with bilirubin leads to a build up of UNconjugated bilrubin, which is not easily excreted as it binds tightly to albumin. It deposits in different tissues, including the brain, leading to kernicterus.
What is deficient in Dubin Johnson?
absent biliary transport protein (MRP2) which excretes bile glucuronides into bile cannaliculi
Inheritence of Dubin Johnson?
AR
Findings in Dubin Johnson syndrome?
USually asymptomatic with black liver
What is Rotor syndrome?
AR disroder with asymptomatic conjugated hyperbilirubinemia. Patients are jaundiced but live normal life
Inheritence of Rotor syndrome?
AR
Life expentancy in rotor syndrome?
Normal
How is tetanus usually diagnosed?
Based on clinical presentation (bacteria only replicate at wound site and results would take days to come back, toxin assays are not widely available)
MOA of donepezil?
Acetylcholinesterase inhibitor (used for alzheimers)
Memantine MOA?
NMDA receptor antagonist (used for alzheimers)
