final exam from before wk 10 Flashcards
1
Q
what type of response and ILs to get atopic dermatitis, asthma, allergic rhinitis
A
Alarmins: IL25, IL33, TSLP Th2 response secrete IL4, IL5, IL9, IL13 atopic dermatitis, asthma, allergic rhinitis
2
Q
mast cell degranulation in allergic rhinitis, atopic derm
A
Mast cell degranulation to allergen and cause histamine, serotonin, proteases etc. from the B cell becoming IgE type 2 repsonse
3
Q
Th_ and IL_ in psoriasis
A
Th17; IL23
4
Q
allergic contact dermatitis
needs which steps
what Th_ response
A
Allergic contact dermatitis: sensitization, elicitation (subsequent exposure), resolution
- Hapten mediated IL1
- Th1 response
5
Q
toxigenic factors in staph aureus
A
- Pore forming toxins, phenol soluble modulins, exfoliative toxins, superantigens (i.e. enterotoxin, toxic shock syndrome toxin)
- Neutrophil invasion : protein A, staphylococcal nucleause, chemotaxin inhibitory protein etc
- Exfoliative toxins cause blistering skin disorders
o Bind CAM desmoglein-1
6
Q
group A strep toxigenic factors
A
- M protein
- Streptolysin O and streptolysin S
- Exotoxins, nuclease A, Dase Sda1
- Type 1 response
- Superantigens cytokine storm ; TNFa, IL1, IL6
7
Q
pseudomonas aeruginossa toxins and what does it cause
A
- Grape, greenblue
- Alkaline protease, elastase, exotoxin A, procyanin, LPS, biolfilm
- Green nail syndrome, toe web infection, hot foot, follicultiis
8
Q
dermatophytes (fungal)
which type of response
dermatophytic rxn?
A
- Mannan activates TLR
- Th1 and Th17 response
- Dermatophytid reaction: dermatitis at distance site from primary infection
9
Q
onychomycosis
A
- Nail fungal infection
- Trichophyton rubrum and T.interdigitale, Candida spp
10
Q
tinea barbae
A
- Beard fungal infection
- T. interdigitale and t verrucosum
11
Q
tinea corporis
A
- Dermatophytosis of glaborous skin
- T. rubrum
12
Q
ținea cruris
A
- Groin
- T rubric and epidermophyton floccosum
13
Q
tinea pedis and mannum
A
- T rubric, t interdigitale, Epidermophyton floccosum
14
Q
measles
rubella
causes
A
Measle
- ssRNA , paramyxoviridae
rubella
- ssRNA togaviridae family
15
Q
erythema infectiosum- parvovirus B19
A
- 5th disease/ slapped cheeks
16
Q
Human herpes virus 6 HHV6
A
- Febrile seizures without rash in kids
- Chronic infection with latent stage
17
Q
herpes simplex virus HSV
A
- HSV1 oral, HSV2 genital
- Most primary infection asymptomatic; latent in ganglia
18
Q
herpes zoster virus HZV
A
- Chicken pox initially and shingles when reactivate
- Shingles is dermatomal pain and rash; postherpetic neuralgia
19
Q
HPV
which strains are high risk
A
- Low risk; warts
- High risk malignancy ; E6 and E7 proteins
- Infect keratinocytes
- Common warts,
- Butchers warts; HPV7
20
Q
skin cancer mutations
A
- UVA; C >T in tumor suppressor TP53
21
Q
basal cell carcinoma
from what?
mutation in?
pathway?
A
- UVB
- Head and neck; local, rarely metastatic
- Most common
- P53 and PTCH1 mutations
- Malfunction in sonic hedgehod signalling pathway
o SMO not inhibited by PTCH1
22
Q
squamous cell carcinoma
A
- Keratinocytes
- Dark skin, immunosuppressed (i.e. HIV)
23
Q
viral carcinogens causing skin cancer
A
- HPV (type 16 and 18) impact TP53
24
Q
malignant melanoma
which genes
A
- In melanocytes
- Genes: CDKN2A, CDK4, POT1, TERT
- Start as benign nevi (mole)
25
what is the hair cycle ACTE
- Anagen – grow (years)
- Catagen- involution
- Telogen- rest (3 months)
- Exogen -shed
26
androgenic alopecia
- Genetics, hormones
- Shorten anagen phase
- Male pattern: frontal hairline and vertex thinning
- Female: centroparietal thinning or Christmas tree
27
telogen effluvium
- Diffuse hair loss
- Early termination of anagen, increase shedding
- Club hairs shed
- Psychophysiologic stressors
28
alopecia areata
which type of T cells
- Autoimmune hair loss, usually kids, in patches
- Cytotoxic CD8 T cells
29
nails onchomycosis vs psoriasis
- Onchomycosis: fungal infection, dermatophyte usually distal toes
o Hyperkeratosis; separate nail from bed and thicken
- Psoriasis on skin with nails too; pitting and shedding, leukonychia, oil or salmon spots
30
atopic dermatitis
Th_
Ig_
- IgE
- Th2
31
atopic dermatitis
- IgE
- Th2
o IL33, TSLP
- Filaggrin mutation
- Chemokines: CTACK, CCR4, CCL17
- Th1 reponse in chronic AD
32
allergic contact dermatiis
type ___ hypersentizitvity
- Type IV delayed hypersensitivity
- Need prior sensitization (sensitization elicitation phase)
- Haptens bind skin protein and form complexes (complete antigens)
33
irritant dermatitis
- Immediate rxn, doesn’t need sensitization phase like ACD
- Climate, occlusion, detergents, wet/dry
34
seborrheic dermatitis
Th_
which bacteria
which glands
- Greasy scaly patches
- Malassezia globosa and restricta , sebcaeuous glands
- Th17
35
normal vagina bacteria
lactobacilli
36
bacteria in bacterial vaginosis
- Dysbiosis; more Gardnerella, mycoplasma
37
chlamydia
different types
saying
- Serotypes D-K = chylamdia
- Serotypes L1-L3= lymphogranuloma venereum
- Reactive arthritis; cant see cant pee cant dance with me
38
neisseria gonorrhea
proteins that make toxic
- Lipooligosaccahrdie (LOS)
- Opa and pilin proteins
39
treponema pallidum causes which UTI?
stages
syphilis
- Primary stage: painless single chancre
- Secondary: ulcer disappears and get rash
- Latent stage
- Tertiary: granuloma, neurological, cardiac
40
haemophilus ducreyi causes
- Painful chancroid/ ulcer
41
trichomonas vaginalis main sx
strawberry cervix
42
complication of gonorrhea and chlyamidya
pelvic inflammatory disease PID
43
candida albican
two forms
- Dimorphic; yeast (ph <6) or hyphae (ph >7)
- Phenotypic switching; quorum sensing
44
HSV2
- Herpes genital
- Latent in sacral sensory ganglia
45
HIV
which ligand to attach to host
what does it need to have to turn into AIDS
- Protease, reverse transcriptase and integrase to get into host DNA
- Use XR4 ligand to attach to CXCR4 on CD4+ T cell to spread in lymph or R5 ligand to attach to CCR5 on macrophage
- Not replicated until active
- 4 stages when worse is <200 of CD4+ at stage 4 it turns into AIDS
46
hyperprolactineamia inhibits ___
GnRHp
47
primary dysmenorrhea
no structural abnormalities but prostaglandins cause muscle contractions and hypoxia
48
esophageal atresia
tracheoesophageal fistula
Esophageal atreaisa:proximal and distal esophagus dont connect; blind ending tube
Tracheoesophaeal fistula: abnormal connection between trachea and esophagus
49
type I vs II alveolar cells
Type II alveolar cells= rich in surfactant to reduce surface tension in air-alveolar interface
Type I= blood air barrier
50
visceral vs parietal plura
Visceral pleura= inner
Parietal= outer
51
right vs left lung
Right lung: 3 lobes, 2 fissures; shorter and wider than left lung
Left lung: 2 lobes, 1 fissure
52
terminal bronchioles - which type of cells and what do they secrete
club cells that secrete granules like surfactant lipoproteins and mucin
53
muscles of inspiration
- Diaphragm flattens down/ contracts, increase volume of thoracic cavity
- Contract external intercostal muscles (and scalene and SCM) to lift ribs up and sternum anterior
- Negative pressure for air to move into lungs
54
muscles of expiration
passive; elastic recoil
- Forced: ab muscles, internal intercostals
55
tidal volume
inspiratory reserve volume
expiratory reserve volume
residual volume
Tidal volume= amount inspired or expired with breath
Inspiratory reserve volume= extra air that can be inspired over tidal volume
Expiratory reserve volume=
Residual volume= remain in lungs after forceful expiration
56
inspiratory capacity
functional residual capacity
vital capacity
total lung capacity
Inspiratory capacity= tidal volume + inspiratory reserve volume
Functional residual capacity= expiratory reserve volume + residual volume
Vital capacity
Total lung capacity
57
dead space volume
Dead space volume= air that never reaches gas exchange area
ventilation occurs but no respiration (o2 and co2 exchange in alveoli)
58
minute respiratory rate
= tidal volume * RR
59
what promotes oxygen to decrease affinity to hemoglobin and promote unloading of it
- Increased CO₂, acidity, temperature, and 2,3-BPG shift the curve to the right.
This promotes oxygen unloading, ensuring tissues receive more O₂ during exercise, fever, or hypoxia.
60
bohr and Haldane effect
Bohr effect: CO2 promotes release of O2 in the tissues —> help Hb release O2 and give to tissues
haldane effect: O2 promotes CO2 release in the lungs —> helps Hb unload CO2 for gas exchange
61
pulmonary circualtion
: high flow, low pressure, low resistance
62
where does most blood flow to in lungs
most blood flow to base (bottom of lungs)
gravity effect
63
zone 1 vs 2 vs 3 in lungs
zone 1: PA (alveolar pressure) > Pa (pulmonary arterial pressure) > Pv (pulmonary venous pressure)
- Alveolar pressure is higher so no blood flow; alveolar dead space; ventilated but not perfused
Zone 3 (base): Pa>Pv> PA
64
central pattern generator for respiratory control
pons and medulla
65
medulla has which two things for inspiration and expiration
o DRG = inspiration
Nucleus of tractus solitarius
o VRG= active expiration
Pre botzinger complex
66
pontine has what for breathing
o Apneustic centers: deep breathe
o Pneumotaxic center: relax after inspire
67
voluntary control/ emotional or breathing
hypothalamic and limbic
68
shunt in the lungs
Blood reaches the alveoli without gas exchange due to absent or impaired ventilation.
69
deadspace in lungs
Air reaches alveoli, but no blood flow is available for gas exchange.
70
apnea dx
: lose >90% respiration for >10 secs
71
obstructive vs central sleep apnea
Obstructive sleep apnea; FAT
Central sleep apnea from neurological disorders ; central respiratory center not working
72
pulmonary edema ; intestinal vs alveolar
1. Interstitial:
2. Alveolar; fluid crosses and gets into alveoli ; prevents ventilation
73
cor pulmonale
RV fails from high pulmonary artery pressures
74
allergic rhinitis Th_ and Ig_
th2, Ige
75
allergic rhinitis
- Sensitization then reexposure
- IgE
- Early phase: leukotriene and histamine
- Late: Th2: IL4, Il5, IL13
- Gut microbiome: increase bactriodetes
76
non allergic rhinitis
- Viral
- Occupational
- Vasomotor: cold air, strong odor, alcohol, spicy
77
HHV 6 causes
apthous ulcer
78
obstructive vs restrictive lung disease
FEV1/FVC
total lung capacity
residual volumes
obstructuive:
TLC is normal
FEV1/FVC reduced
residual increased
restrictive:
TLC is reduced
FEV1/FVC normal/ physiologic
residual reduced
79
obstructive lung disease
(hard to exhale; air trapped )
- Total lung capacity: normal
- FEV1/FVC: reduced
o Expiratory volumes…
- Residual volume and functional residual capacity: increased
- i.e. asthma, COPD, bronchiectasis
80
restrictive lung disease
(hard to inhale)
- Total lung capacity: reduced
- FEV1/FVC: normal
o Because all volumes are reduced
- Residual volume and functional residual capacity: reduced
- i.e. ARDS, fibrosis, sarcoidosis
o extrapulmonary: obesity, chest deformity
81
asthma 3 symptoms and key findings
inflamed, obstructive, hyperresponsive, reversible
- Hyperinflated lungs, mucus plugs
- Charcot leyden crystals
- Curshcmann spirals
82
COPD
chronic bronchitis vs emphysema
- Chronic bronchitis: larger airways, mucus
- Emphysema: terminal ariways, loss of alveoli, air trapping
83
centriacinar vs panacinar emphysema
o Centriacrinar emphysema= smoking; upper lobes
o Panacinar= a1 antitrypsin gene, lower lobes
84
bronchiectasis
- Airway dilation; lots of mucus, usually lower lobe, right side
- Infectious or non infectious
85
ARDS
stages
cause
- Increased vascular permeability; protein get into alveoli; necrosis; reduce diffusion capacity
- Exudative stage, proliferative stage, fibrosis (honey comb)
- From: aspiration, infection, sepsis
86
what is released from inhibitory control to go pee
what muscles contract and relax
pontine micturition center released from inhibitory control to go pee
- Periaqueductal grey PAG too?
- PNS contracts detrusor, relax external and internal sphincters
87
umbrella cells
line bladder and protect from urine; stretch when bladder fills
88
ureterovesical junction
between bladder and ureter so no reflux; muscle contracts during filling
89
UTI - which 3 bacterias cause it
75% e coli, then klebsiella and proteus
90
e coli, klebseilla and proteus virulence factors in causing UTI
- E coli: adhesin, p fimbriae, type 1 pilus
- Proteus: urease to increase pH, IgA protease, hemolysin, operons
- Klebsiella: biolfilms, LPS, polysaccharides
91
interstitial
cystitis finding
: hunner lesions
- GAG layer barrier disrupted
92
bladder cancer risks
- 90% urothelial malignant neoplasms
- Smoking, industrial dyes and solvents
93
atelectasis
collapse of lungs or airspaces i.e. alveoli
94
resorption atelactasis
compression atelactasis
contraction atelectasis
- Resorption atelectasis: obstruct airway; alveoli collapse bc air cant reach them (i.e. tumor, mucus plug)
- Compression atelectasis: something in pleural space compresses (i.e. pneumothorax, pleural effusion, empyema- pus in pleura)
- Contraction atelectasis: fibrosis of lung or pleura reduces compliance
95
transudative vs exudative pleural effusion
o Transudative pleural effusion: due to starling forces (i.e. congestive heart failure, cirrhosis)
o Exudative PE: rich in protein (i.e. malignancy, infection, pulmonary emboli)
96
parapneumonic pleural effusion
from pneumonia (exudative stage full of protein, fibrinopurulent stage full of pus, organization stage when fibroblasts prevent inflation)
97
key proteins in influenza
- PB portein
o RNA dependent polymerase
o Make viral mRNA
- Hemagglutinin spike (BIND)
o Bind and invade host
- Neuramidase spike (BUD)
o Disengage from cell and spread; cleave where hemagglutinin binds
98
hemagluttin vs neuramidase in influenza
- Hemagglutinin spike (BIND)
o Bind and invade host
- Neuramidase spike (BUD)
o Disengage from cell and spread; cleave where hemagglutinin binds
99
influenza A key proteins and antigenic shift or drift?
- M2 protein
- Antigenic drift and shift
o Shift= large change in RNA sequence
o Drift= point mutation
100
influenza B key proteins and antigenic shift or drift?
- NB protein
- Antigenic drift
101
covid 19
bind via? what allows entry?
- Spike protein binds ACE2 on cell
- Cleave spike protein by TMPRSS2 allows viral entry
- Endosome forms
- Dysregulates RAAS- increase ATII and vasoconstrict
- Hypoxia without dyspnea possible
102
kidney embryology
Pronephros (induction) mesonephros (temporary filter- bowman and glomerulus ) metanephros (proper kidney)
103
kidney ascent in embryo via
Kidney ascent from L4 T12-L1 via transient lateral splanchnic arteries
104
where are macula densa cells and function
distal convoluted tubule; salt sensors
105
intercalated cells location and function
distal convoluted tubule; acid base balance
106
cells in distal convoluted tubule
macula dense (salt)
principal cells (aldosterone)
intercalated (pH)
107
principal cells location and fucntion
distal convoluted tubule
response to aldosterone (increase Na and h2o reabsorb and K secrete)
108
what happens if too much of too little Na+ to macula densa
Too much Na+ to macula densa release ATP to decrease GFR and renin decrease AT II , less dilation of afferent, less constriction of efferent arterioles and GFR drops
Too little Na+ macula densa release prostaglandins to increase renin secretion to vasodilate afferent (helps with volume depletion) and increase GFR
109
macula densa release what in response to too much or little Na+
too much: release ATP
too little: release prostalgandins
110
PCT absorbs
absorbs 60% of water and solutes
111
juxtaglomerular apparatus/ late afferent arteriole has which cells
granular cells
112
granola cells contains
renin
renin for RAAS
113
loop of henle; ascending vs descending
- Descending limb: reasbrob water
- Ascending: ions
114
collecting duct
- Reabsorb water (ADH)
- Via aquaporin channels
115
PCT main pumps and mechanism s
- Na/K pump on basolateral side (get Na out and back into blood)
- Na/H on apical side
- Na glucose co transport (SGLT or GLUT)
- Sodium bicarb co transport (NBC)
- K+ and Cl- are paracellular
- HCO3- and H+ converted in CO2 and H2O via carbonic anhydrase
o Na/H exchange
116
distal convoluted tubule and principal cells (respond to aldosterone)
- Na reabsorb via ENaC channel
o Upregulated by aldosterone
- Water via aquaporin 2 channel
- K secrete by na/k atpase
117
urine ; what happens if dehydrated
- Blood osmolarity increase (dehydrate); hypothalamus secretes ADH to promote water absorption via increase aquaporin channels
118
RAAS pathway
Angiotensinogen angiotensin I via renin II via ACE aldosterone for na and h2o retension and vasoconstrict
119
high vs low Na diet impact on renin and RAAS
- High Na diet suppressed renin
- Low Na diet increases renin
so renin will or will not convert angiotensinogen into angiotensin I
120
buffer systems
- Carbon acid bicarbonate buffer
o H2CO3 and HCO3- and H+
- Protein buffer
o Albumin and hemoglobin
- Phosphate buffer
o HPO42
- Ammonia buffer
o NH3 to NH4+
- Bone buffer
o Calcium carbonate and calcium phosphate
121
bladder muscles for pee vs storage
and which muscle is voluntary
- Pee: PNS contract detrusor, PNS relax internal urethral sphincter
- Storage: SNS relax detrusor, SNS contract internal urtheral sphincter
- External urethral sphincter is skeletal muscle and voluntary
122
ATII impacts on arterioles and GFR
constrict afferent a little, constricts efferent arteriole way more increase GFR and reabsorption
123
NE
epinephrine
endothelin
natiruretic peptide
impact on GFR and kidneys
NE: increase renin release from granular cells
Epinephrine: constrict afferent and efferent; decrease renal blood flow and GFR
Endothelin: vasoconstrict; decrease GFR , released by vascular damage
Natriuretic peptide ANP, BNP: inhibit renin, increase GFR
124
substances that are only filtered; use to measure GFR
- inulin from artichoke
Creatinine
Cystatin C
125
non small cell lung cancer
- adenocarcinoma
-squamous cell carcinoma
-large cell carcinoma
small cell lung cancer
Nonsmall cell lung cancer (most common)
- Adenocarcinoma
o Women, non smoker,
o mucosal glands
- Squamous cell carcinoma
o Pancoast tumors: in apex of lung
o Men, smoking
o Keratin pearls
- Large cell carcinoma
o Smoking
Small cell lung cancer
- Women, smoking, central or hilum
- Neuroendocrine cells
126
adenocarcinoma key finding
mucosal glands
127
squamous cell carcinoma key finding
keratin pearls
pancoast tumor
128
tumor staging
T: tumor size
N: lymph nodes
M: metastases
Stage 1= small size, no lymph or meta
Stage 2 and 3= regional lymph
Stage 4= meta
129
pancoast tumor and Horners syndrome
- Horner syndrome: ptosis, miosis, anhidrosis
- Pancoast syndrome: horners, hand muscle atrophy, arm pain
130
paraneoplastic syndrome
Paraneoplastic syndrome (from tumors making hormones or enzymes etc)
- Hypercalcemia (PTH) hyperparathyroidism
- Syndrome of inappropriate antidiuretic hormone (SIADH) hyponatremia
- Cushing (cortisol) hypokalemia
131
genes for lung cancer
- K-ras
- EGFR
- EML4-ALK
132
mesothelioma - cause
- Pleural lining
- Asbestos exposure
133
causes of typical vs atypical pneumonia
Typical pneumonia: s. pneumoniae
Atypical pneumonia: mycoplasma, chlamydia, legionella
134
gram + vs - staining
Gram+ = stain blue from peptidoglycan wall
Gram - =red
135
key toxins in staph aureus
- Catalase
- Coagulase
- Enterotoxin (food poison)
- Toxic shock syndrome toxin
- Exfoliatin (scalded skin syndrome)
136
alpha vs beta hemolytic strep
- Alpha hemolytic (incomplete lysis) i.e. s. pneumonia
- Beta hemolytic; streptolysin O + S (complete lysis) i.e. s. pyogenes
137
s pneumonia key toxins
- Polysaccharide capsule
- CRP
- C substance
- Pneumolysin
- IgA protease
138
pneumonia criteria
- One of: fever, leukopenia/ leukocytosis, altered mental state if >70yoa
- 2 of: rales, worsen gas exchange, cough, sputum
