March 25 Flashcards
Acute Respiratory Distress Syndrome (ARDS)
injury and inflammation of alveolar pneumocytes and pulmonary endothelium
increased pulmonary capillary permeability –> hyaline membrane formation
Diabetic Nephropathy
mesangial expansion
glomerular basement membrane thickening
glomerular sclerosis
Kimmelstiel-Wilson lesion if the sclerosis if nodular
Cardiac Conduction Velocites
His-Purkinje 2.2m/s
Atria 1.1m/s
ventricle 0.3 m/s
AV node 0.05m/s
Osteosarcoma
bone tumor associated with Paget’s disease of the bone
“mixed lysis and sclerosis with focal periosteal elevation and reactive new bone formation”
mixed radiodense and radiolucent areas
periostal ew born formation
lifting of the cortex
adjacent soft tissue shows “sunburst” pattern of ossification
Dicoumarol
vitamin K depletor
MOA Rifampin
inhibits mRNA synthesis
via DNA-dependent RNA polymerase
Globus sensation
aka Globus hystericus
aka Globus pharyngeus
sensation of “something stuck in the throat: when there isn’t
Endometriosis
endometrial glands and stroma out of uterus
Adenomyosis
endometrial glands and stroma into myometrium
painful, heavy periods
What vitamin should not be supplemented in pregnancy
Vitamin A
can be real teratogenic: abortion, microcephaly, cardiac anomaly
Micturition
Stretch of detrusor - pelvic
detrusor contraction - hypogastric
sphincter relaxation - pudendal
Auer Rods
t(15:17) APML
tx - all-trans retinoic acid
Chromosomal Translocations
APML Burkitt Lymphoma CML ALL Follicular
APML - 15:17 #auerrods Burkitt - 8:14 CML - 9:22 #imatinib ALL - 12:21 Follicular - 14:18
cytokine exclusive to T-cells
IL-2 - only released by T-cells
stimulates growth and differentiation of T, B, NK cels and macrophages
Molluscum contagiosum
poxvirus (enveloped linear dsDNA)
flesh colored papules (pruritic) with umbilicated centers contained white, curd-like material
microscopy: large eosiniphilic cytoplasmic inclusions aka cytoplasmic inclusion bodies
Vessel at greatest risk of injury @ Knee Dislocation
Popliteal artery is high risk for Anterior and Posterior knee dislocations
Postpartum endometritis
occurs after C-section and amniocentesis
Chronic cocaine abuse
chronic nasal discharge
atrophic nasal mucosa
perforation of the nasal septum
ulceration/perforation of the palate
oropharyngeal ulcers
Heminephrectomy
50% GFR immediately after removal of 1 kidney
65-70% GFR within the first week
80% by 4-6 weeks
Serratus Anterior
stabilizes and rotates the scapula upwards
injury causes winging of medial border of the scapula
innervated by the long thoracic nerve
Exocrine pancreatic secretions
fixed: High Na, Low K
at low flow: Cl- > HCO3-
at high flow HCO3- > Cl-
stimulate pancreas, shoot out bicarb because we have a big acidic chyme ball incoming
Exocrine salivary secretions
fixed: HCO3 > Cl
at low flow: K > Na
at high flow: Na > K
Acute Stress Disorderq
PTSD but shorter
Wound Healing 1-3days
Inflammatory
cells: platelets, nuetrophils, macs
clot formation, increased vessel permeability, and neutrophil migration
@ day 2 macrophages clear debris
Wound Healing 3days - weeks
Proliferative Phase
cells: fibroblasts, myofibroblasts, endothelial cells, keratinocytes, macrophages
deposition of granulation tissue, type III collagen, angiogenesis, dissolution of clot,
Wound Healing weeks - months
Remodeling Phase
cells: fibroblasts
replace type II collagen with type I collagen (increases tensile strength of tissue)
via metalloproteinases
overexpressed in a keloid scar
PDGF platelet derived growth factor
Erythema multiforme
infections and drugs (sulfa and beta-lactam)
macules, papules, vesicles, target lesions
Herpes encepahlitis
tends to affect temporal lobe
hallucinations, personality change, delirium
Acute Intermittent Porphyria
Autosomal Dominant defect in Porphobilinogen deaminase
abd pain, port-wine colored urine, PBG and ALA in urine, neuro changes (restless, irritable, aggressive)
precipitated by CYP450 inducers: EtOH, smoking
sterile urine cultures and pyuria (puss in the urine)
Chlamydia or neisseria g.
Myasthenia gravis
fatigable chewing, diplopia, weakness of the face muscles
10% get thymoma
DKA electrolyte changes
increase K
decrease Na
increase H
increase ammonia due to muscle degradation
Preoperative medical management of Pheochromocytoma
Phenoxybenzamine - alpha adrenergic blocker prevents hypertensive crisis during removal
Intraventricular hemorrhage in a premature infant
due to germinal matrix fragility
the germinal matrix @ subependymal zone
Cisplatin
ototoxic, damages hair cells in the cochlear membranous labyrinth
tx for: testicular, bladder, ovary, lung carcinoma
cross-links DNA
nephrotoxic, ototoxic, peripheral neuropathy
prevent ADRs: amifostine and hydration
aspirin-exacerbated airway disease
dysregulation of arachadonic acid pathway
towards 5-lipoxygenase pathway –> leukotrienes
LTC, LTD, LTE - bronchoconstrictive
Birbeck Granules
langerhanscellhistiocytosis
Langerhans cells
S-100+
lytic bone lesion + eczema like rash
Melanin distribution
Black - free melanin
Asian - in a melanosome above the nucleus
White - in a melanosome anywhere in the cell
Hemodynamic affects of Nitrates
vasodilate –> less preload = Decreased End-Diastolic LV Volume
decreased SV and decreased BP
reflex Tachy, increase HR to preserve CO
Histone Acetylation
Activates - relaxes DNA coiling and allows for transcription
Linker Histone
H1
Pseudohypoparathyroidism
end-organ resistance to PTH
hypocalcemia, hyperphosphatemia, increased PTH
short stature, short fingers, round face
Allelic heterogeneity
different allele mutations cause same disease presentation
ex. mutations in different exons still make beta-thalassemia
Exercise-induced asthma
exercise/cold –> shest tightness, wheezing
eosinophils and mast cells –> LTC/LTD/LTE –> bronchospasm and increase bronchial mucus secretion
tx: Montelukast -antileukotriene medication
Hereditary Hemochromatosis
“Bronze Diabetes”
hyperpigmentation, arthralgia
hepatomegaly –> cirrhosis –> hepatocellular carcinoma
DM & hypogonadism & hypothyroidism
restrictive/dilated cardiomyopathy
excessive iron uptake in the gut
Portal Hypertension
can cause increased pressure in the splenic vein –> splenomegaly
N-terminal peptide signal sequence of mRNA
targets to RER
without this you accumulate in the cytosol
MSUD
deficiency in branched chain alpha-keto acid dehydrogenase - requires Thiamine
pt presents with severe metabolic acidosis and increased amounts of branched-chain alpha-keto acids in the blood and urine
also poor feeding and vomiting
inability to decrease Leucine, Isoleucine, Valine
Glucagon
Glucagon –> Gs –> adenylate cyclase –> increase cAMP –> PKA –> glycogenolysis and gluconeogenesis
Hyperhidrosis
increased sympathetic nervous system activity
ANS cholinergic neurons innervate eccrine and apocrine glands
Surgical sympathectomy - cut the sympathetic trunk at T2
Thoracic Sympathetic Trunk!
Red Safranin
cartilage (collagen type II) = carTWOlage
mast cell granules
mucin
peptidoglycan layer (gram negatives)
Gubernaculum remnant in females
round ligament attaches uterus to labia majora via inguinal canal
round ligament is covered in broad ligament
round ligament is inferior to fallopian tube
Pheo outside of adrenals
Paraganglioma
origin: chromaffin cells at the organ of Zuckerkandl (which is a collection of chromaffin cells at the aortic bifurcation)
these secrete epi and norepi
elevated Vanillylmandelic acid (breakdown product)
ABG for PE
pH increased
CO2 decreased
O2 decreased
Pulmonary endothelial dysfunction
Pulmonary Arterial Hypertension –> cor pulmonale
Uterine Fibroids
aka Uterine Leiomyomas - benign
heavy menstrual bleeding due to venous ectasia (dilation) from vasoactive growth factors secreted by the tumors
can also present with an irregular and enlarged uterus
Ischemic Colitis
crampy abdominal pain, tenderness to palpation, bloody stools
early: mucosal hemorrhage and patchy areas of necrosis
late: bowel wall thickening, edema, and transmural infarction
can be caused by hypoperfusion (shock) or decreased CO (thrombosis and embolism)
Why do sclera appear blue in OI?
defective type I collagen –> thin sclerae and visible underlying choroid
Medium Chain Acyl-CoA Dehydrogenase Deficiency
hypoglycemia
hypoketones
hepatomegaly
hypoglycemia after fasting + low ketones = impaired beta-oxidation
most common cause is MCAD deficiency
Protein that functions to transduce signals from the cell membrane to the nucleus by activating other molecules?
Ras (promotes mitogenesis)
GTP binding protein
proto-oncogene with 1 hit GAIN of function
cholangiocarcinoma
pancreatic adenocarcinoma
Osteoarthritis
progressive erosion of articular cartilage
pain is worse with activity and at end of the day
increasing age is biggest risk factor
other risk factors: obesity, female, trauma, abnormal joint alignment
Carcinoid Syndrome
serotonin producing tumor that has metastasized to the liver
flushing, hypotension, diarrhea, bronchospasm, pellagra (all the tryptophan is used to make 5-HT, none left to make niacin)
tx: octreotide
Initiation of translation
5’ cap of mRNA binds small rRNA –> scanning for AUG start codon
@ apoptosis an alternate method is used
IRES (Internal Ribosome Entry Site) allows rRNA binding and translation in the middle of an mRNA
DM medication that induces differentiation of preadipocytes into adipocytes and increased GLUT4 expression on the adipocyte cell membrane
Thiazolidinedione
ex. Pioglitazone
decreased insulin resistance via increased GLUT4 (insulin-responsive glucose transporter @ adipocytes and skeletal muscle)
most frequently involved site for Crohn’s
terminal ileum
most frequently involved site for Celiac
distal duodenum and proximal jejunum
treatment for hyperammonemia
lactulose
acidifies gut lumen, NH3 comes in and gets trapped as NH4+ for excretion
treatment of acute severe asthma attack
Albuterol! beta2-adrenergic agonist
activates G2 –> increased cAMP –> bronchial smooth muscle relaxation
Osteomalacia
decreased mineralization of Osteoid (generally due to decreased calcium and phosphorus)
causes: VitD deficiency, malabsorption, chronic kidney disease, renal tubular acidosis
symp: bone pain, tenderness, muscle weakness, fractures
Li-Fraumeni
autosomal dominant early onset malignancies (breast, bone, soft tissue, brain, adrenocortical)
due to inactivating mutation affecting 1 allele
two-hit hypothesis @ tumor suppressor gene (TP53)
other genes and syndromes like this
Lynch - MSH2, MLH1, MSH6
FAP - APC
VHL - VHL
MEN1 - MEN1
activating gain of function mutation seen at
MEN2A - RET gene
Papillomavirus
HPV
naked circular dsDNA
Poxvirus
Molluscum Contagiosum
enveloped linear dsDNA virus
Polyomavirus
JC Virus - Junky Cerebrum (progressive multifocal leukoencephalopathy in HIV
BK virus - Bad Kidney - transplant pateints
naked circular dsDNA
ASD murmur
fixed splitting of S2
left to right makes the RV receive extra blood, increased pulmonary blood flow, and delayed closure of the pulmonic valve
Esophageal aperistalsis
Achalasia
absence of esophageal peristalsis in the distal esophagus and tonic LES
G6PD deficiency
acute onset anemia in an African/Asian/Mediterranean individual
TMP-SMX, other sulfonamides, fava beans
Lesion to Broca’s area
Broca’s aphasia
inferior frontal gyrus of dominant (usually left) hemisphere
non-fluent, agrammatic, intact comprehension, poor repetition
Normally unmyelinated fibers
slow pain, heat, olfaction.
autonomic postganglionic nerves
Picornavirus
positive linear naked ssRNA
P - polio E - echo (aseptic meningitis) R - rhino C - coxsackie (hand food mouth, meningitis, myocarditis, pericarditis) H - HAV
MHC class II (HLA-D) antigen presentation
Macrophage/Dendritic cell/B-cell = APC
invariant chain brings alpha and beta chains together in the RER
invariant chain @ RER –> golgi –> endocytic compartment –> proteolytic degradation –> exogenous protein is then inserted between alpha and beta chains
Invariant chain is digested by macrophages during antigen presentation
Iron Deficiency Anemia
hypochromic, microcytic anemia
tongue pain/ burning sensation in the mouth, dry mouth, reduced taste due to atrophy of tongue papillae, alopecia
Quellung reaction
capsular swelling - for encapsulated bacteria
PCOS
increased Testosterone
PCOS
increased Testosterone
Pilocarpine
Cholinomimetic - acts like ACh
@ eye causes miosis via contraction of pupillary sphincter muscle
stimulator of sweat, tears, saliva
Pernicious Anemia
autoimmune destruction of parietal cells –> decreased gastric acid production –> increased gastrin release
scrotal mass that is palpable when standing but disappears when lying down?
varicocele
Acanthosis nigricans
insulin resistance and obesity
malignancy @ GI tract (stomach, liver) and lungs
ex. gastric adenocarcinoma
Prophylaxis for mechanical prosthetic valve
warfarin = Vitamin K epoxide reductase inhibitor
Cardiac anomaly for DiGeorge
disturbed truncus arteriosus –> outflow tract defects like persistent truncus arteriosus (both ventricles to aorta AND pulmonary veins) , interrupted aortic arch, ToF
Inositol triphosphate
IP3
@ Gq –> vasoconstriction
Infliximab
TNF-alpha inhibitor –> decreased inflammation
Collapsing glomerulopathy
Focal Segmental Glomerulosclerosis
common HIV-associated nephropathy
collapse and sclerosis of the whole glomerulus + glomerular epithelial cell proliferation and hypertrophy
Hand-Foot-Genital syndrome
mutation in Homeobox gene HOXA13 –> hypoplastic first digit + mullerian fusion abnormalities
Vitamin D supplementation (effects on Calcium, Phosphate, PTH)
increase calcium
increase phosphate
decrease PTH
Citalopram
SSRI
also fluoxetine, paroxetine, sertraline
Growth Hormone Signaling
Jak-STAT
