Path shelf - deck 1 Flashcards
Profound diarrhea, unicellular acid fast creating oocytes. Infectious cysts can be passed in watery stool
Cryptosporidum / HIV, IC
Transmitted via spores, DKA predisposes to infection. Hyphae are non-septated with 90’ degree angle branching. Can cause black eschar and necrosis of nasal cavity/eyes with neuro defects -> death.
Murcor – Rhizopus
DM, IC
Strawberry cervix, cervicitis – burning, itching, malodorous with yellow/green discharge. Diagnosed via wet mount showing motile trophozoits – Treatment Metronidazole
Trichomonas
Sexually Transmitted
Psuedohyphae at 25C, germ at 37C (opp of mold in the cold, yeast in the heat), Catalase +; increased susceptibility in CGD, Diaper rash, inhaler for corticosteroids, KOH prep oral candida, AIDs defining illness MAX CD4 100 -
Candida
IC, CGD, HIV, DM
ssDNA, naked virus (smallest virus). Transmitted via respiratory droplets causing “slap cheek” or 5th disease – starts on face and moves down. Adults – joint pain, arthritis, soreness. En Utero baby can cause hydrops fetalis.
Sickle cell patient can cause aplastic anemia due to shut down of BM.
Thalassemia B Major: Aplastic crisis
Spherocytosis: Can cause aplastic crisis
Parvo B19
Sickle Cell, Hydrops
Spirocytes – can cause lyme disease, erlichosis, bubesiosis. Do not gram stain. Wright/Giemsa used for diagnosis.
Stage 1: Target lesions with Bulls eye rash – chronic migrains, fever, papule -bite
Stage 2: Heart block – myocaridits, bilateral bells palsy
Stage 3: Joint pain, arthritis, migratory arthritis, meningitis, encephalopathy
Treatment: Doxycycline (stage 1), Ceftriaxone
Borrelia Burgdorferi
Tick Exposure
Coughing, macrophages with intracellular oval bodies. Histoplasma much smaller than RBCs. Can cause granulomas which look similar to TB – have calcification of hilar lymph nodes. IC can cause hepatosplenomegaly. KOH used for diagnosis .With nucleus = histoplasma (without = coccid)
Histoplasma
Bird/Bat droppings
IC
Severe hemorrhagic colitis by O157 H7 most commonly from undercooked beef. Symptoms: bloody diarrhea. Does not ferment sorbitol. Shiga like toxin can cause hemolytic uremic syndrome which damages endothelial cells of capillaries and glomerulus -> Thrombocytopenia and platelet clumps
EHEC
Raw Hamburger
Cysts of giardia (flagellated) from feces in unfiltered water – bloating, flactulence, and foul smelling diarrhea (steatorrhea). Deficiency in DEAK due to this. Treatment: Metronidazole
Giardia Travels/Campers unfiltered water
Grows green colonies - Induces M cells in peyers patcheert6 s to phagocytose them and escape. Then use host actin cytoskeleton to create a tail and propel itself from one another. Damages tissues to release cytokines that will watery -> bloody diarrhea. Leads to Hemolytic uremic syndrome in children <10 y/o with acute renal damage and schistocytes. Treatment: Macrolide/Fluoroquinolone.
Shigella
Fecal/Oral
Gram – non-lactose fermenter, motile, H2S positive with black colonies. Undercooked chicken -> inflammatory diarrhea.
Typhi: Typhoid Mary – Harbored in gallbladder, stayed longer in stool with antibiotic use. #1 cause of osteomyelitis
Salmonella Raw chicken OR
Human Source
Osteomyelitis Sickle cell
Ammonium magnesium phosphate stone – Ammonia urease + which makes staghorn calculi to struvite stones causing pain and kidney stones. Symptoms: fishy odor, UTI, pain. H2S +
Proteus
Staghorn Kidney
Attracts neutrophils along with IL-8, C5a
LTB4 Chemotaxis
Underdeveloped 3/4th pharyngeal pouch - Thymic hypoplasia, recurrent infection and hypocalcemia due to decreased parathyroid. LOW T cells.
Digeorge Syndrome:
XLR Male – LOW T cells. Deficiency of CD43 on T lymphocytes and platelets causing eczema, thrombocytopenia – petechiae, recurrent bacterial infections. Increased risk for pneumococcal infections. T cell depletion.
Wiscott Aldrish Syndrome:
6 months old male – recurrent pyogenic bacteria. B cells don’t mature. No ab in the blood. Absent germinal centers due to no plasma cells. Increased infection with Strep, staph, giardia, enteroviruses.
X-Linked Agammaglobulinemia or Brutons:
boy or girl with low levels of B cells. Increased risk of autoimmune diseases – Increased risk for giardia infection.
Common Variable Immunodeficiency:
Most common. Most patients are asymptomatic. Involve GI, urinary, and respiratory. BLOOD transfusions -> anaphylactic reaction
Isolated IgA deficiency:
Defect in humeral/T cell immunity – Hypoplasia of LN and thymus – Risk of bacterial, fungal, and viral infection. NEED A BM TRANSPLANT for survival. 50% have X linked inheritance.
Severe Combined Immunodeficiency:
Mutation of CD40/L leading to low signals and no differentiation – Low to no IL-4/IL-5. Low IgA, IgG, IgE – recurrent pyrogenic infections at mucosal sites
Hyper-IgM Syndrome:
Increased risk of Neisseria infection
C5-9 Deficiency:
Hereditary angioedema (periorbital edema)
C1 inhibitor deficiency
AIRE mutation – failure of central tolerance. Autoimmunity to endocrine glands. Hypoparathyroidism, adrenal failure, chronic candida infections of skin and oral mucosa
Autoimmune Polyendocrine Syndrome
(ALPS) Mutation FAS/L – breakdown in peripheral tolerance. Self reactive lymphocytes -> Cytopenia, lymphadenopathy, hepatosplenomegaly. Can progress to lymphoma
Autoimmune Lymphoproliferative Syndrome
Mutated FOXP3. Thyroiditis, type I DM, Diarrhea, eczema
IPEX
- Increased vascular permeability, pain, vasodilation, bronchoconstriction
- Mediators of pain: Bradykinin, PGE2
Bradykinin – Pain
IL-6 Secreted by Mo. Important mediator of fever and acute phase response. Is capable of crossing BBB and initiating PGE2 causing activation in hypothalamus. Increased production of No in the bone marrow.
IL-6
• Produced by many different lymphocytes in the body. Found in epithelial cells causing increased diapedesis at site of need. Can cause fever and activation of hypothalamus. Also can cause increased sensitivity to pain, vasodilation, and hypotension. Seen most often in shock.
IL-1, TNFa
Transmembrane protein of Toll-like receptor family – activation of NFkB and inflammatory cytokine production for activation of the immune system. It is well known for recognizing lipopolysaccharide of gram – bacteria. LPS bind CD14. Causing binding of TLR4-MD2 protein -> dimerization. LPS recognition causes conformational change of TLR4 receptors results in recruitment of intracellular domains. Causes release of pro-inflammatory cytokine signaling -> IL-1, TNF, IL6.
TLR4
collagen Type 1: Type 2: Type 3: Type 4:
- Type 1: Bones – most common increased in tensile strength
- Type 2: Cartilage
- Type 3: Granulation tissue, embryonic tissue, uterus – stretchy material
- Type 4: Basement membrane
collagen Scar formation steps
• Scar: Granulation tissue causes increased 1) Fibroblasts (Collagen 3), 2) Capillaries (increased nutrients), 3) Myofibroblasts (contraction of wound making scar smaller). Scar formation Type I collagen -> Type III collagen via collagenase requiring Zinc as a cofactor. Stimulation of collagen formation via FGF/VEGF angiogenesis.
collagen delayed wound healing
infection, vitamin C deficiency, Cu (lysl oxidase) deficiency, Zinc deficiency.
collagen hypertrophic scar
Increase in Type 1 collage.
collagen keloid
usually located behind ear in AA, increased Type 3 collagen
Vasodilation, fever (PGE2), inhibits platelet aggregation – produced by vascular endothelium
• Prostaglandin
Vasodilation – produced by vascular endothelium
• Prostacyclin
Inhibits platelet aggregation, vasoconstriction
• Thromboxane A2
Bronchoconstriction, LTB4 attracts neutrophils
• Leukotrienes
rejection = minutes to hours, type II HSR. No accumulation causing kidney cortex damage – pale infarct.
hyperacute
days – 3-4 months (uncommon years rejection
acute rejection
o Cellular: Most common; extensive inflammation with lymphocytes, plasma cells. Responds to steroids.
o Humeral: Kidney cortex damage same as hyperacute. DOES NOT respond to steroids.
rejection = 6months – years, atrophy of blood vessel with endothelial cell hyperplasia. Compromise of lumen. SLOW NARROWING – chicken fat like. SLOW rise of BUN/Creatinine.
chronic rejection
Graph tissue is attacking the host (BM transplant»_space;). Host is going to be immunocompromised. Graph attacks – skin, GI, liver. Liver damage – abdominal pain, jaundice, edema ect. Bilirubin will build up in the liver. Increased AST/ALT with pruritus due to increased bile salts.
graph vs host
• IL-1/TNF from macrophage causes increased COX2 expression leading to increased PGE2 expression. Activation of perivascular cells of the hypothalamus leading to fever
Prostaglandin
Butterfly rash worsens with sunlight, hematuria, HTN, glomerulonephritis, lumpy bumpy pattern on IF, pericarditis, Libman Sacks endocarditis, arthritis
whats the autoantibody and disease?
SLE
Anti-DsDNA and Anti-Smith
Isoniazid, Hydralazine, Procainamide
whats the disease related and auto antibody ?
Drug Induced Lupus
=Anti-Histone
Proximal weakness of muscles, elevated CK
Disease related and AB?
Polymyositis
Anti-Jo-1
Proximal weakness of muscles, rash, periorbital heliotrope rash (similar to SLE) elevated CK
Disease related and AB?
Dermatomyositis Anti-Jo-1
Overlap of all disorders – commonly Joint pain, swelling, Raynaud phenomenon, sclerodactylyl, dry mouth/eyes
disease related and AB?
Mixed Connective Tissue Disease
Anti-U1-RNP
Anti-Smooth Muscle, Anti-LKM
Autoimmune Hepatitis
Anti-CCP
Rheumatoid Arthritis
Raynauds, respiratory distress – restrictive lung disease, dysphagia – gastric reflux, kidney involvement malignant HTN, pericarditis with fibrosis, arrhythmia, Sclerodactyl
Scleroderma (diffuse)
Anti-Scl-70
C: Calcinosis – Calcium deposits R: Raynauds E: Esophageal dysphagia S: Sclerodactyl T: Telangiectasia – dilation of small blood vessels
CREST Scleroderma (limited)
Anti-Centromeric Ab
Fibrosis of lacriminal and sweat glands.
Increased risk lymphoma
Sjogrens Anti SS-A/SS-B
ANCA
Autoimmune Vasculitis
Chromosomes: C-myc? cyclin D? RB? Ig Heavy chain? p53?
C-myc? 8 cyclin D? 11 RB? 13 Ig Heavy chain? 14 p53? 18
• IgA deficiency has anti IgA Ab in their serum. Which can cause anaphylactic reaction after blood transfusion. Use washed RBCs to avoid anaphylactic reaction
IgA/ABO Blood Transfusion
• S100+ Tanning bed has highest increased risk, Radial growth -> vertical growth. »_space;6mm, irregular borders, color changes. Vertical growth important for metastasis. Types melanoma en situ, superficial spreading (radial growth) and lengio maligna have good prognosis. Acral (hands and feet) and nodular have poor prognosis
Melanoma
• Also known as Buerger disease associated with smoking. Necrotizing vasculitis of the digits leading to ulceration, gangrene, and auto-amputation of the digits. Can also present with Raynauds phenomenon.
Thrombosis Obliterans:
• Granulomas with involvement of lung and heart. Often present with asthma, p-ANCA, and eosinophilia.
Churg Strass Syndrome
Most common vasculitis in children – due to IgA deposits. Symptoms: palpable purpura on buttock and legs s/p URI with hematuria. Often following B19 infection.
Hench Schonlein Purpura
rening/ angiotensin 2
Low blood pressure, stenosis of renal artery, decreased Na delivery to macula densa, increase sympathetic tone -> release of angiotensinogen. Converted to Angiotensin I in the liver. Angiotensin II in the lung by ACE. Angiotensin II causes
o Increased aldosterone secretion: Na retention, K+ excretion
o Vasoconstriction of efferent arteriole
causes of renal stenosis
Renal Artery Stenosis
• Can result in narrowing of the renal artery -> decreased blood flow to the kidney -> HTN.
• Causes:
o Atherosclerosis: hardening of renal arteries and narrowing with plaque.
o Fibromuscular Dysplasia: Females <40, abnormal growth within the wall of the artery. 2’ HTN with abdominal bruit on auscultation.
causes of right sided heart failure?
Right Sided Heart Failure (RSHF)
• Causes: Left heart failure (most common), pulmonary HTN, left -> right shunt, chronic lung disease (cor pulmonale)
• Symptoms: JVD, painful hepatosplenomegaly, pitting edema or pedal edema
Holosystolic high pitched blowing murmur greatest at apex which radiates
what is the murmur and what are some causes?
Mitral Regurgitation Holosystolic Murmur
• Causes: Rheumatic fever, Infective endocarditis, LV dilation, papillary muscle rupture after MI
o Rheumatic fever: S. Pyrogenes – M proteins against tissues (molecular mimicry). Chronic RF -> M. Stenosis
o Subacute infective endocarditis: S. Viridans
Holosystolic, harsh sounding murmur – loudest at the tricuspid area
what is the murmur and what are some causes?
VSD
• Most common congenital heart defect. Associated with fetal alcohol syndrome.
• Fever, night sweats, weight loss, new or exacerbated murmur – can cause septic embolism, Janeway lesions – on hands and toes, Ouch ouch osler – painful nodes, anemia of chronic disease
endocarditis
High virulence – large vegetation’s. Most often tricuspid valve. Gram + cocci, coagulase +, ferments mannitol
S. Aureus IVDA
ALWAYS CHECK – with this more likely to have colorectal carcinoma
S. Bovis =Colorectal carcinoma
Gram + cocci, coagulase -, does NOT ferment mannitol
S. Epidermatis Indwelling catheter
Most common overall cause – infects previously damaged valves. Low virulence. Gram + cocci, Coagulase -.
Strep. Viridans Subacute: underlying valve disease
Gram + cocci, bile salt tolerant, efflux pump, Lancefield D+
Enterococcus Indwelling catheter
Gram – rods
Negative blood cultures
HACEK Hemophilus Acintobacillus. Cardiobacterium Elkenella Kingella
Oral Flora
Yeast producing pseudohyphae
Candida Albicans Nosocomial, Indwelling Catheter
Feces from Reduvid bug causing dilated cardiomyopathy, arrthymia, elevated CRP
Typanosoma Cruzi Reduvid bugs – Kissing bug
Vegetation’s on both sides of the valve
Libman Sacks Endocarditis LPS – Lupus
- Symptoms: decreased CO, diastolic dysfunction – unable to fill the heart, Syncope during exercise
- Histology: Myofibril disarray
Hypertrophic Cardiomyopathy
• Genetic mutations in the sarcomere proteins (AD) – leading to massive hypertrophy
• Primary tumor of the heart in children/infants associated with tuberous sclerosis usually in the ventricle
•
Rhabdomyoma:
• Histology: Striated muscle with mass
• Symptoms: Fever, chills, pleuritic chest pain – expansion of lung, elevated WBCs
Pneumonia
• Damage to mucociliary escalator can cause increased risk of pneumonia, mucous plugging.
• Symptoms: Fever, chills, pleuritic chest pain – expansion of lung, elevated WBCs
• Types: Lobar, Bronchopneumonia (dots) – bacteria; Interstitial (increased lung marking) – Virus
• Type II pneumocyte – will help regenerate damaged lung tissue
95% of lobar pneumonia – most common cause of community acquired.
S. Pneumoniae Lobar Pneumonia
Affects malnourished, elderly, alcoholics, DM – gelatinous sputum (thick current red). Thick mucoid capsule. Most commonly complicated by abscess.
Klebsiella Lobar Pneumonia
Most common cause of 2’ pneumonia – often complicated by abscess
S. Aureus Bronchopneumonia
pneumonia Common in COPD
H. Influenza Bronchopneumonia
pneumonia Common in CF
Pseudomonas Bronchopneumonia
pneumonia Common community acquired and COPD exacerbation
Moraxella Bronchopneumonia
pneumonia Common community acquired, COPD exacerbation – transmitted from water source which is an intercellular organism visualized on silver stain
Legionella Bronchopneumonia
pneumonia Most common cause – young adults, military recuits – Complications autoimmune hemolytic anemia IgM
Mycoplasma Interstitial Pneumonia (atypical)
pneumonia HIGH fever Q fever – spores from cattle which causes PNA
Coxiella Burnetii Interstitial Pneumonia (atypical)
pneumonia Common in elderly -> S. Aureus -> bacteria pneumonia
Influenza Interstitial Pneumonia (atypical)
penumonia infants
RSV Interstitial Pneumonia (atypical)
• Painful swallowing, erythema throat, LN, exudate (S. Pyrogenes)
pharyngitis
Painful swallowing, erythema throat, LN, exudate
Gram + cocci, Catalase -, Lancefield A, M Proteins – JONES
S. Pyrogenes Exudate, erythemia, high fever
painful swallowing Most common cause 90% - can present with conjunctivitis – dsDNA linear naked
Adenovirus
No Exudate
painful swallowing PiCoFlaCoCa – ssRNA+ virus naked – respiratory droplets
Picorna CoxA Herpangina - vesicular ulcerations on hands and feet
painful swallowing Lemierre Syndrome – Lungs – systemic emboli – anerobic gram – rod
Fusobacterium Necrophorum Abscess internal Jugular vein
complications of bronchiectasis ?
Secondary amyloidosis – SAA -> AA with deposition of AA amyloid
predisposing factors of Bronchiectasis?
CF, Kartagener Syndrome – Primary ciliary dyskinesia (dynein arm) causing sinus adverus, tumor/foreign body, necrotizing infection, allergic bronchopulmonary aspergillosis, alcoholic, immunodeficiency
mental retardation, coarse facial features, joint stiffness
corneal clouding, growth retardation, death 6-10y/o
Mucopolysacchardoses
• Deficiency in different GAGS
• Hurlers: AR alpha iduronidase
mental retardation, coarse facial features, joint stiffness
no corneal clouding
Mucopolysacchardoses
• Deficiency in different GAGS
• Hunters: XLR iduonate 2 sulfatase
Chin, Giant Gonads – Large ears, mental retardation
Fragile X CCG
Chin, Giant Gonads – Large ears, mental retardation
Fragile X -CCG repeat
Loss of motor control, dementia, increased
Huntington’s disease CAG
AD - Gradually worsening muscle loss and weakness, cataracts, intellectual disability, heart conduction problem
Myotonic Dystrophy CTG
5-15 y/o (but can occur 20-30) with progressive loss of coordination and muscle strength -> wheel chair bound. Cardiomegaly, nystagmus, cerebellar dysfunction, slurred speech, DM
Fredrich’s Ataxia GAA
tongue increased in size (macroglossia), HTN, 2nd DM
bitemporal hemianopsia, hypopituitarism, headache
GH Adenoma
• Pituitary adenoma –
• Children = Gigantism – linear growth of bone due to no closure of bones prior
• Adults = Acromegaly
• GH decreases glucose uptake into cells – glucose is not taken into cells causing secondary cause of DM
• Treatment: Ocreotide – somatostatin analog which blocks the production
Cretism – mental retardation, short stature, coarse facial features, large tongue
• Iodine Deficiency, Lithium
Hypothyroidism
• Decreased T3/T4
• Children
