March 21 Flashcards
Irreversible neuronal injury
neuronal shrinkage and intense cytoplasmic eosinophilia
–> Gliosis!
astrocyte proliferation and formation of a glial scar from astrocyte foot processes
Amyotrophic LateraL Sclerosis
ALS
atrophic precentral gyrus
thin anterior roots of spinal cord
loss of neurons at anterior horn - LMN lesion
loss of neurons in the hypoglossal and ambiguous cranial nerve nuclei
demyelination of lateral corticospinal tracts - UMN lesion
Relative Polycythemia aka Relative Erythrocytosis
normal RBC mass - Hct>52 in men or Hct>48 in women due to dehydration
as opposed to true erythrocytosis - increased RBC mass due to polycythemia vera or hypoxia
Cori Disease
defect in Debranching Enzyme
hepatomegaly
ketotic hypoglycemia
hypotonia and weakness
abnormal glycogen with short outer chains
McArdle Disease
defect in Muscle Glycogen Phosphorylase
weakness and fatigue with exercise
no rise in blood lactate after exercise
myoglobinuria
VonGierke Disease
defect in Glucose-6-phosphatase
Severe fasting hypoglycemia
increased: lactate, TGs, uric acid, liver glycogen (hepatomegaly)
hepatic steatosis
Typhoid Fever
Salmonella Typhi
Week 1: Fever, bradycardia, watery diarrhea
Week 2: abd pain +
salmon-colored rose spots on chest/abdomen = faint, erythematous maculopapular lesions
Week 3: HSM and GI bleeds
Salmonella is phagocytized by M-cells –> survive and proliferate in macrophages
complications: bowel perforation
Metabolism in the Mitochondria
beta-oxidation of fatty acids
TCA cycle
pyruvate carboxylation of gluconeogenesis
Metabolism in the Cytoplasm
glycolysis, fatty acid synthesis, pentose phosphate
elevated HbA2
Beta-thalassemia
can give falsely low HbA1c levels in diabetics with beta-thal
Paget’s Disease of the Bone
Bone deformity
Hearing loss - due to boney changes in skull
1st: increased osteoclast turnover of bone
2nd: disorganized bone reformation
- -> mixed bone sclerosis and lucency
Osteoclasts
multinucleated from mononuclear phagocytic cells that fuse (macrophage variant)
this requires:
M-CSF: macrophage colony-stimulating factor
RANK: NFkB
Osteoblasts have RANK-L aka NFkB-L and osteoclasts have the receptor RANK aka NFkB Receptor
normal osteoclasts have 2-5 nuclei
in pagets dz they have ~100 nuclei
Locations for Thoracentesis
Midclavicular @ 6-8th rib
–> lower can injure Right Hepatic Lobe
Midaxillary @ 8-10th rib
Paravertebral @ 10-12th rib
always go above rib!
below –> injury of subcostal neurovascular bundle
Anterior Humerus Dislocation
axillary nerve damage
deltoid and teres minor muscles and sensation over lateral shoulder
–> flattening of the deltoid
Pharyngeal Arch 1
Makes
Maxilla, Mandible, Muscles of mastication (masseter, temporalis, medial and lateral pterygoids)
Pharyngeal Arch 2
Some
Stapes
Styloid
Muscles of facial expression
Pharyngeal Arch 3
Interesting
Stylopharyngeus
Greater horn of hyoid
Pharyngeal Arch 4/6
Shit
pharyngeal and laryngeal muscles
cricoid and thyroid cartilage
Blinding in experiments prevents
Observer Bias
VSD
holosytolic murmur @ left sternal border
smaller = louder
Released on mast cell degranulation
histamine
MMPs - tryptase (measured)
heparin
eosinophilic chemotactic factors
Thymidine Kinase Independent antiviral
Cidofovir
Tenofovir
Foscarnet
for HSV, CMV, HIV
Source of NADPH
Pentose Phosphate Pathway
G-6-P –> –> Ribulose-5-phosphate
via G-6-P D (glucose-6-phosphate dehydrogenase)
NADPH restores glutathione for antioxidant activity
NADPH is required for cholesterol, steroids and fatty acid synthesis
Narcolepsy
caused by decreased hypocretin (=orexin) from lateral hypothalamus
tx: modafinil > amphetamines
hypnaGOgic -hallucinations while GOing to sleep
hypnopompic - hallucinations upon waking
cataplexy - loss of muscle tone following strong emotions (laughing and crying)
Paroxysmal Nocturnal Hemoglobinuria
mutation in PIGA gene –> GPI (glycosylphosphatidylinositol) deficiency –> CD55 and CD59 deficiency
GPI anchors CD55 and CD59 on RBC membranes - these CDs prevent complement-mediated hemolysis
Triad: hemolytic anemia, hypercoag, pancytopenia –> PNH
Biceps Reflex
C5-C6
Triceps Reflex
C7-C8
Pick’s Disease
Frontotemporal dementia
disinhibition, apathy, social inappropriateness, compulsive behavior, irritability/aggression, decreased speech
atrophy of frontal and temporal lobes
Pick Bodies = cytoplasmic inclusions of tau
Alzheimer Disease
neuronal loss in temporal and parietal lobes
intracellular neurofibullary tau tangles - hyperphosphorylated tau protein
beta-amyloid plaques - extracellular at gray matter
decreased ACh (synth at Basal nucleus of Meynert)
tx: AChE agonists: donepezil, rivastigmine
Neurofibrillary tangles
intracellular hyper-phosphorylated tau protein
Alzheimer disease
Pick bodies
Senile Plaques
extracellular amyloid deposition in gray matter
Cytokine associated with Cachexia
TNF-alpha
suppress appetite and increase basal metabolic rate
Leukocyte Adhesion Deficiency
Autosomal Recessive absence of CD18
CD18 necessary for integrins which are necessary for leukocyte adhesion
recurrent skin and mucosal infections with poor wound healing and no pus (no neutrophils at infection site)
delayed umbilical cord separation >3weeks
persistent leukocytosis - neutrophils trapped in vessels
Always give Thiamine with Glucose
glucose without thiamine can precipitate encephalopathy
thiamine is required for glucose metabolism, if you only give glucose you will make thiamine deficiency WORSE
Phenotypic mixing
host cell is infected with 2 viruses
genomes are unchanged
progeny are packaged in the others capsid/envelop
can infect target animal of other virus
but progeny revert back to OG because thats the genome they have
Pancreatic islet amyloid deposition
Type II DM
Diabetic Opthamoplegia
down and out with reactive pupil and ptosis
due to nerve ischemia @ CN III
Graft-vs-Host
Weeks after transplant
Triad: Hepatitis, Dermatitis, Gastroenteritits
Acute Transplant Rejection
Weeks to Months
CD8+ against donor MHC I
vasculitis of graft vessels with lymphocytic infiltrate
Type IV
Chronic Transplant Rejection
CD4+
Type II (antibody mediated) and Type IV (delayed)
arteriosclerosis
Sensory below dentate=pectinate
Pudendal Nerve and its branches (external hemorrhoids @ inferior rectal nerve)
Achondroplasia
Autosomal Dominant
2 copies = fatal
mutation at FGFR3 (fibroblast growth factor receptor)
inhibition of chondrocyte proliferation
Statistical Power
1-beta
ability to detect a difference when one exists
probability of rightfully rejecting a null hypothesis when it is truly false
increase sample size : increase power
Null Hypothesis = H0
hypothesis that there is no difference/no relationship
Alternative Hypothesis = H1
there is a difference
Type I error = alpha
false positive, accepting H1 when you should accept H0
saying there is a difference when there is not
alpha = probability of making a type I error = p-value
if p/alpha is very low we can be confident that we made a true positive.
Type II error = beta
false negative = accepting H0 when you should accept H1
saying there is no difference when there is!
increase power by decreasing beta
increase sample size
increase precision of measurement
Hyperammonemia and Astrocytes
astrocytes take up excess ammonia in the blood –> increase glutamine production –> increased intracellular osmolarity –> astrocyte swelling –> less glutamine released to neurons –> less glutamine to glutamate conversion in neurons –> disruption of excitatory transmission
Measles
paramyxovirus
Koplik spots, cough, conjunctivitis, fever
rash on face –> trunk –> arms and legs
acute infection depletes vitamin A stores
giving Vitamin A can speed recovery and decrease morbidity
Dermatomyositis
Anti-Jo, CD4+
heliotrope rash = rash @ eyelids
and/or SLE-like malar rash
plus worsening proximal muscle weakness
increased aldolase
increased creatinine kinase
IFN-beta
MS
Where does mRNA processing occur?
in the nucleus 5'-cap poly AAA tail intron splicing (in the trash) methylation of 5'Guanine cap
Alternate to aspirin for stroke prevention?
Clopidogrel
blocks the P2Y12 component of ADP receptors at platelet and prevent aggregation
increased 14-3-3 protein
Creutzfeldt-Jakob Dz
Jet lag
suprachiasmatic nucleus
elevated urinary 5-hydroxyindoleacetic acid
carcinoid syndrome
elevated 5-HIAA in the urine due to 5-HT breakdown
Secondary bacterial pneumonia after influenza infection in pts >65
step pneumo > staph aureus > haemophilus influenzae
Clostridium perfringens
anaerobic gram positive bacillus
gas gangrene
food poisoning –> transient watery diarrhea
Cardiac tamponade
Becks Triad
- JVD
- hypotension
- diminished heart sounds
+ pulsus paradoxus - inspiration causes drop is systolic BP >10mmHg
Adrenal Crisis
Seen in pts with adrenal insufficiency
severe hypotension abd pain vomiting weakness fever
give fluids + glucocorticoids
Cheyne-Stokes breathing
advanced congestive heart failure
dying patients
Thoracic outlet syndrome
compression of the brachial plexus lower trunk @ the scalene triangle
scalene triangle: anterior and middle scalene and 1st rib
symp: upper extremity numbness, tingling weakness, pain
Methotrexate causes an accumulation of
dihydrofolate polyglutamate
inhibits DHFR = dihydrofolate reductase
Drug-Induced Lupus
Hydralazine Procainamide Isoniazid Minocycline Quinidine
+ANA
+anti-histone
no anti-dsDNA
Osteoporosis drug similar to pyrophosphate
bisphosphonates
alendronate
riseronate
bind to hydroxyapatite preferentially in areas of increase osteoclast activity –> taken up by osteoclasts –> osteoclast dysfunction :)
decrease osteoclast activity
(also increase osteoclast apoptosis)
Decreased choline acetyltransferase activity at nucleus basalis
Alzheimers Dz
decreased ACh in basal nucleus of Meynert
Vitamin E deficiency
Vitamin E is an antioxidant
hemolytic anemia - RBCs receive more oxidative damage
degeneration of spinocerebellar and dorsal column - ataxia, impaired proprioception
Periodic Acid-Schiff (PAS) Stain
highlights glycogen and glycoproteins
polysacchrides of fungal cell walls
mucosubstances from epithelia
basement membranes
alpha-1-antitrypsin deficiency @ liver
spindle cells with surrounding blood vessel proliferation
Kaposi carcoma
Metabolism of 6-MP (6-mercaptopurine)
inactivation by xanthine oxidase
activated by HGPRT
Silicosis
eggshell calcification of hilar lymph nodes
birefringent silica particles surrounded by dense collagen fibers
