May 11th Flashcards
multinucleated giant cells with intracytoplasmic AND intranuclear inclusions
Warthin-Finkeldey giant cells (fused lymphocytes)
Respiratory secretions
Measles
Most common causes of common cold
1- rhinovirus
2- coronavirus
Immune complex is what type of sensitivity
Type 3
CMV retinitis
Common cause of blindness in AIDS
Cotton-whool exudates, perivascular hemmorhage, retinal detachment
Mitral stenosis
Late diastolic murmur,
Best heard at apex
PAndemic vs epidemic
Pandemic: segmented virus, antigenic shift.
Epidemic, mutations, drift
S3 gallop
Dialated cardiomyopathy
De Quervain thyroiditis
Transient hypothyroidism following viral illness
Tender thyroid, elevated erythrocyte sedimentation and hypothyroid
EBC, Coxackie, flu, adeno
Varicella roster pathology
Cordry A inclusion bodies. Intracellular eosinophilic sorrounded by halo
Bactrim MoA (TMP-SMX)
Inhibits bacterial dihydrofolate reductase
Causes megalobalstic anemia
Premature baby risk
Bronchilitis caused by RSV
Wheezing bc bronchiole (vs pneumonia which is lung parenchyma)
Alcoholics have increased emzyme:
AST vs ALT (but both)
Gamma glutamyl transferase
Spindle shaped tumor
Kaposi sarcoma
Regan-lowe
Bordetella pertussis
Also bordet-gengoug
Ventilator associated pneiu==ymonia
Pseudomonas
CMV vs EBV owl eyes
EBV: reedsternberg, clear cells in lake (higher C:N ratio)
CMV: owl eyes, immediate halo. Owl eye.
Why dont IgG for hep C get rid of diseasse?
Antigenic variation. No proofreading 3’ to 5’
Aniline dyes
Methylene blue (stains orynebacterium diptheriae)
How do sufur granules look in histo
Purple plaque
Von Girk
Deficiency in glucose-6-phosphatase
Seizures, hypoglycemia
Hepatosplenomegaly
Define asterixis
Flapping whne outstretched hands
Suggestive of high ammonia levels
Where is ammonia broken down?
Initial steps: mitochonidrai
Late steps: cytoplasm
Duchennes
Frameshift mutation
Accelerated muscel breakdown, starts pelvis works up.
GOWER’s manuver
X linked
Toxicity of statins
Elevated creatine kinase
Rhabdommyolosis
Myostitis (muscle inflammation)
Cyanide poining
Bright red vessels in eyes
Bitteralmond breath
Fatigue
From fire/constructoin
Isonaiazid
Treatment/prophylaxis for TB
Causes neurotoxicity and heptotoxicity
Kartagener’s
Chornic sinusistis, bronchiectasis, situs inversus (mirror body organs)
Dyenin deficiency
Elevation of leucine, isoleucine, or valine in blood (
I Love Vermont
Maple syrup disease
Alpha ket acid dehydrogenase
Alcohol effect on NADH/NAD
Increased NADH: NAD ratio
NAD is used p.
Vitamin C
Hydroxylation of proline lysine
Facilitates iron obbsorption
Reyes syndrome
Impaired mitochondrial metabolism of fatty acid
Virus + aspirin
Hunter syndrom
Xlinked recessive
Intelectual disability, hearing loss, coarse face, hepatosplenegaly
And NO corneal clouding
Iduronate sulfatase
Ovoid cells within macrophages
Histoplasma capsulatum
Diabetic mononeuropathy
Usually CN III, ischemia of somatic, but spares parasympathetic.
“Down and out” gaze.
Normal reflex
Kidney stone pee
Hematuria
Normocacemia BUT hypercalciuria
Antifungal target:
Mitosis: griseofulvin DNA/RNA synthesis: flucytosine Cell wall: caspofungin Cell membrane: -amphoteracin, nyastatin (bind ergosterol) -azoles inhibit ergosterol synthesis
Type 1 hypersensitivity
Immediate IgE Anaphylaxis/allergies Basophils, mast cells. "Cell surface antibody bridging by antigen"
Type II hypersensitivity
Cytotoxic, IgG, IgM (deposits)
Complement activation.
NK, eosinophil, neutrophil, macrophage
Goodpasture, autoimmune hemolytic anemia
Type III hypersensitivity
Immune complex
Neutrophil
Complement activation
Type IV hypersensitivity
Delayed type
T cell, Macrophage (no humoral).
TB skin test
Leukocyte ahesion cascade
Margination: bloodflow
Rolling: P/E selectin (cell) + Integrin/sialyated glycoprotein (cell)
Activation: ICAM-1 (integrin ligand)
Tight adhesion: CD18
Transmigration: PECAM1 (platelet endothelial adhesion molecule
What cell can’t use ketones
RBCs. No mitochondria
How do you treat muscle stiffness/tremor associated with antipsychotics?
Anticholinergic AND stop meds
Most common cause of death after MI
V-Fib
CO/End diastolic volume curve
X intercept = mean systemic pressure
Decreased total peripheral resistance = Increased slope of both Cardiac functiona nd venous return curve.
L2
Sensory loss: upper thigh
Weakness: hip flexion
L4
Patellar Reflex
S1
Achilles reflex
Third nerve crosses
Between posterior cerebral and Superior cerebral arteries
Aneurysm from posterior cerebellar or posterior cerebral
Ipsilateral headache, diplopia, nonreactive pupil, ptosis, and down and out eye.
Smoking and hypertension
Estrogen on thyroid
Less clearance of thyroid binding protein
Low free T4 for a little, then TSH makes more so free is equal.
Long term = increased TOTAL thyroid
Diagnosing cholecystitis
Prefereed: ultrasound
Nuclear medicine scanning: more specific
Age related macular degeneration (AMD)
Smoking makes wors.
Dry: gradual vision loss in one or both eyes. Difficulty reading/driving. Drusen depsoits (yellow spots on fundescopic). VEGF
Wet: acute vision loss, metamorphosia (distrotion of straigt lines). (Ray/green subretinal discoloration.
Abortion
Misoprostol: prostaglandin E1 agonist
Mifepristone: progesterone/glucocorticoid antagonist
Methotrexate: Folic acid antagonist
Effect modification
Effect of an exposure on an outcome is modified by another variable (Drug)
Vs. confounding, when coincidentally something was not thoguht of.
alpha 1 antitrypsin deficinency (AAT)
Destruction by macrophages of alveolar walls.
Unsecretted AAT is seen within periportal hepatocytes as reddish-pink with acid-schiff.
Trisomy 21 in utero
Low alpha feto protein (AFP) and unconjugated estriol
Increasedb-hCG and inhibin A
Cardiac output calculation
CO = stroke vl X heart rate
Or
CO= rate of O2 consumption/ AV O2 difference
Serotonin amino acid precursor
tryptophan
How to treat serotonin syndrome
Antagonist (crypoheptadine)
Xanthelasma
Yellow macule/laque on eyelid
Hyperlipidemia
Hypoketotic hypoglycemia
Acyl CoA dehydrogenase deficiency (Acyl CoA to acetyl CoA from fatty acids)
Ketones: acetoacette
Centriacinar emphysema
Smoking history Exertional dyspnea Dialated airspaces on CT Wheezes Infiltrating neutrophil
Kidney embryo origin
Ureteric bud: collecting system (ureter, calyces, collecting tubules/ducts)
Metanephric mesoderm: glomerulus, distal and proxuimal tubules.
IL12 deficiency
Can’t make Th1, must treat with IFN-y
Benzodiazepine MoA
Bind to bendodiazepine binding site, allosterically modulates biding of GABA.
Increases frequency of ion channel opening.
Marker in Glomerulonephritis
Serum IgG antibodies to PLA2R (found in glomerular podocites).
Paroxysmal nocturnal dyspnea
Marker of no DAF (CD55).
Heme cells attacked by IgG and complement
Why dont calcium channel blockers block skeletal muscle?
Does not require extracellular calcium influx for excitation/contraction coupling
Why is elastin rubber-like?
Because of elastin monomer cross-linking
Lysyl oxidase (requires copper). lysine common.
Desmosine cross-liinks
Homocysteinuria
No methionine synthase (B12) or cyastathionine synthase (B6).
Can’t make cystine from homocystine. Elevated methionine.
Big sideffect of ganciclovir
Neutropenia (bone marrow suppression). Worse if you give zidovudine or trimethroprim-sulfamethoxolate
Define dysarthria
Weak muscles, resulting in slurred speech.
Wallerian degeneration
Breakdown of axon distal to site of injury.
B/c BBB, macrophage recruitment is slow
Plaque forms, prevents axonal growth. Glial scar. Persistant myelin debris
Chemicals in insulin metabolic acidosis URINE
Decreased pH (b/c HCO3 is removed to balance pH)
Decreased HCO3
Increased H2PO4- (to trap H+ for excretion)
Hydrocele occurs where?
Inside tunica vaginalis
S3 in adults
Limitation of ventricular movement during passive filling
Ventricular enlargement
When can S3 be heard best?
Left lateral decibitus at END expiration
Attrition bias
Form of SELECTION bias
people leaving study
Dangerous consequence of Adenosine and dipyridamole?
Cardiac steal (bc they are vasodilators) from ischemic sections. Blood flows in least resistance.
Hyaluronic acid
Present in strep pyogenes
NOT IMMUNOGENIC
Bc also present in connective tissue
How do you better facilitate phagocytosis of strep pyogenes?
Add antibodies to protein M (virulence factor).
Pulmonary embolism in breathe tests
Ventilation/perfusion mismatch
Leads to hypoxemia
Ipratropium MoA
Blocks acetylcholine at muscariinc receptors
Prevents bronchoconstriciton, reduces parasympathetic stimulation
Feeds descending colon
Inferior mesentaric artery
Feeds all hindgut (distal 1/3 of transverse, descending, sigmoid, rectum)
Risk for galstone formation
High cholesterol
Low bile salts or phosphatidylcholine (both increase solubility)
Pigmented gallstones
Calcium and unconjugated bilirubin
Usually secondary to bacterial (salmonella) or helminthic (chlonorchis sinesis) infection OR hemolytic anemia
Causes release of beta-glucuronidase by injured hepatocytes (increased unconjugated bilirubin)
Gemfibrozil MoA
Fibrate, reduces cholesterol solubility (so it’s not absorbed)
Risk: can cause gallbladder stones (don’t give w/ history)
Drug use for seizures
Absence: valproic acid/ethosuximide
Combined absence and tonic cloinic: valproate.
Stop drinking drugs
Stop pleasure: Naltrexone
Once you stop drinking to stay sober (disulfram)
Gonadal arteries arise from
Abdominal aorta, right under renal arteries
HIrschprung
Failure of neural crest migration to intestinal wall.
No meissner or myenteric plexus.
Check submucosa of the rectum (narrowed part)
Pheochromocytoma presentaton
Episodic headache Tachycardia Diaphoresis HTN, severe. (Catecholamine secreting tumor from chromaffin cells)
Completely opacified hemithorax
Looks like pleural effusion BUT shortness of breath mixed with tracheal deviation TOWARD problem = collapse.
Likely mainstrem bronchi lesion/occlusion leading to collapse
How to treat carcinoid syndrome
Octreotide
diagnosed by increased 5-HIAA urine excretion
Most common kidney issue in SLE
Diffuse progressive glomerulonephritis
Proteinuria
Treatment for SLE
Skin/muscle: hydroxychloroquine Organ involvement (nephritis): cyclophosphamide
Langerhans cell histoicytosis
Disorder of dendritic cells (langerhan cells)
Present in kids 1-3 as lytic bone lesion, skin rash or recurrent otitis media. Jaw mass.
Tennis racket sapedBirbeck granules on EM
Leukocyte adhesion defieicency (LAD)
No neutropihl going into periphery. High in blood, no pus in infection.
Absence of CD18 integrin.
Anti IgG antibodies are pathomneumonic for what?
Rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid factor (anti IgG)
Fatigue, chroinic joint pain not made better by tylenol.
Bilateral hands and knees
Stiffness that improves with movement.
Acute lymphocytic leukemia
3-7
Fever, atigue, decreased appetite, night sweats
Cervical lypmohadenopathy, anemia, petichial rash
>20% leukemic blasts
Job syndrome
Hyper IgE (Th17 can't make IL18, no neutrophil) FATED Faces weird (coarse, leathery) Abscess (cold) T: Baby teeth retained E: IgE is high D: derm (excema)
