test #46 5.6 Flashcards
vertical transmission of hepatitis occurs via..
passage through birth canal, or transplacental infxn
increased risk of vertical transmission marked by..
HBeAg (marks viral replication & infectivity)
rx for all newborns of all mothers w/ active hepatitis B?
-passively via HBIG (hep B Ig)
&
-active immunization w/ recombinant HBV vaccine
window period of hep B detected w/
HbcAb
histology of macula (3)
densely packed cone, few overlying cells, no blood vessels
1 cone -> 1 bipolar cell -> 1 ganglion cell
all = greater visual acuity
scotoma
visual defect surrounded by relatively unimpaired field of vision
causes of scotoma
pathology in retina / optic nerve
- demyelinating disease (MS)
- diabetic retinopathy
- retinitis pigmentosa
- macular degeneration = CENTRAL scotoma
dry vs wet macular degeneration
dry: deposition of fatty tissue (drusen) behind retina
wet: neovascularization of retina
arcuate scotoma
due to damage to a particular region of optic nerve head
resulting defect follows arcuate shape of nerve fiber pattern
deep intramuscular injections to the buttock should be
superlateral quadrant
superomedial injection to the buttock can..
injure superior gluteal n.
path of superior gluteal n.
L4-S1
leaves pelvis via greater sciatic foramen above level of piriformis
inferomedial quadrant to the buttock injection can..
injure sciatic n.
mucinous cystadenocarcinoma
malignant neoplasm arising from ovarian surface epithelium
produce mucin –> pseudomyxoma peritonei
pseudomyxoma peritonei
associated w/ mucinous cystadenocarcinoma & appendiceal tumor
peritoneal cavity fills w/ mucin due to widespread intraperitoneal metastases
demographic for dysgerminoma in females
YOUNGER, 10-30y/o
benign cystic teratoma in females
dermoid cysts
most common germ cell tumors in females
benign cystic teratoma
dermoid cysts
struma ovarii
dermoid cysts / cystic teratoma in ovary – can secrete excessive thyroid hormone
ovarian tumor & hyperthyroidism
struma ovari –> dermoid cysts // benign cystic teratoma of ovaries
presentation of granulosa cell tumor
secrete estrogen –>
young: precocious puberty
older: abnormal endometrial bleeding, endometrial carcinoma
alpha 1-antitrypsin on diffusing capacity
decreased diffusing capacity bc destruction of alveoli and adjoining capillary beds
Curschmann spirals
shed epithelium forming mucus plug in asthma
Charcot-Leyden crystals
breakdown of eosinophils in sputum
asthma characterized by what:
FEV/FVC, TLV, DC
decreased FEV/FVC
increased TLV
increased DC (increased pulmonary blood volume)
selective proteinuria
suggests foot process effacesment
loss of ALBUMIN mostly
(less bulky proteins like IgG and macroglobulin)
components of glomeruliar filtration barrier (3)
- fenestrated endothelium
- glomerular basement membrane
- epithelial cell foot processes
size selectivity in glomerulus conferred by.. most selective?
dimension of pores
- endothelial cell fenestration (40nm)
- GBM pore (4nm)
- slit process between foot processes (also 4nm)
selective: GBM & slit diaphragm
charge selectivity in glomerulus conferred by?
by negatively charged anions (heparan sulfate & proteoglycans) on endothelial cells and GBM
–> repel albumin
how is albumin lost into urine
small enough to fit through GBM pores. normally kept out via charge
in MCD: loose some neg charge in basement membrane
tubular proteinuria
low molecular weight proteins
(Ig light chains, B2 microglobulin, amino acid)
due to PCT disruption
(normally filtered & completely reabsorbed in PCT)
overload proteinuria
when low molecular weight proteins are made in excess (Ig light chain in MM), overloading PCT ability to reabsorb
functional proteinuria
due to change in blood flow through glomerulus
not a big deal, goes away on repeat testing
due to exercise, high fever, emotional stress, cold exposure
orthostatic proteinuria
older, tall, thin, adolescents
increased when upright, decreased when supine
<1g.day
isolated proteinuria
incidental finding in asymptomatic person w/ normal renal fxn and urine sediment
secretin stimulates
bicarb secretion from pancreas
response to acidity in intestine; S cells
composition of pancreatic fluid
isotonic
normally Na+, K+ like plasma
high HCO3
low Cl-
high flow: higher bicarb, low Cl-
what stimulates pancreatic enzyme secretion?
CCK
fractional excretion of Na+ into urine
<1%
99% of filtered = reabsorbed
reabsorption of urea
40-50% inPCT
more in CD depending on ADH expression
eye presentation of MS
- optic neuritis
- visual disturbances (central scotoma)
- painful eye movements - internuclear opthalmoplegia: impaired eye adduction during lateral gaze (MLF)
(nystagmus, but thats cerebellar)
cerebellar dysfunction in MS
tremor, ataxia, nystagmus
sensory & motor dysfxn in MS
bowel & bladder dysfxn
presentation of MS
chronic demyelinating disease
white matter of CNS
highly variable, exacerbation & remission
most common nonspecific: FATIGUE
SIIIN
scanning speech, intention tremor, incontienence, internuclear opthalmoplegia, nystagmus
what exacerbates MS symptoms
HEAT or STRENUOUS ACTIVITY
(decreased axonal transmission w. heat)
heat also exacerbates neuro symptoms -> heat insensitivity
TIA
transient focal neurolgoic symptoms, last less than 24 hours
amaurosis fugax
transient monocular blindness
associated w/ TIA
why does polycythemia present w/ puritus post shower
release of histamine from basophils
xanthelasma associated w/
primary biliary cirrhosis
secondary hypercholesterolemia
Wermer syndrome
MEN I (menin gene, not ret)
what’s in the pseudomembrane of diptheria infxn
c. diptheria bacteria
leukocyte
fibrin
necrotic mucosal epithelial cells
systemic diptheria infxn (TOXIN absorbed in blood stream)
cardiac & neural toxicity
myocarditis, arrhythmia, heart failure, neuropathy, paralysis, coma
note: bacteria is not absorbed, only toxin
role of IgA
PREVENT infxn by inhibiting bacterial itxn w/ epithelial cells
diptheria toxin subunits
AB
B: (binding) allows penetration of A:active subunit into thecell to inhibit ribosome fxn
ADP ribosylation of EF-2
which cells make EPO
interstitial cells in renal cortex
familial dysbetalipoproteinemia (type III)
defective ApoE3 & E4
on chylomicrons & VLDL
bind hepatic apolipoprotein receptors “recycle”
elevated cholesterol & triglycerides
xanthona, premature coronary & peripheral vascular disease
what do chylomicrons get from HDL?
apoC-II and apo-E
ApoA-1
LCAT activation (cholesterol esterification in HDL)
ApoB-48
chylomicron assembly & secretion by intestine
ApoB-100
LDL particle uptake by extrahepatic cells
VLDL marker
which Apo protein binds to LDL?
ApoB100
intermittent claudication
muscle pain w/ exercise that remits w/ rest
often: peripheral vascular disease due to atherosclerosis of larger arteries
onion-like thickening of arteriolar walls
due to laminated CMV and reduplicated basement membrane
hyperplastic arteriolosclerosis
arterioles
hyaline arteriolosclersosis
deposition of hyaline in intima and media of small arteries / arterioles
intima thickened, lumen narrowed
3 major presentation of sickle-cell
- hemolysis (intra & extra vascular)
- vasooclusive: bone infarct, dactylitis (hand & foot syndrome), acute chest
- infxn (splenic infarct -> fxnl asplenia)
sickle dactylitis
hand & foot syndrome
- small infarctions within marrow, trabeculae, inner cortical layers of bone in hand, wrist, feet, ankle
leads to swelling, tenderness, & warmth
common in first years of life –> bc affected bones still contain hematopoetic marrow
vaso-occlusion in children vs. adult
generally: bone / marrow infarcts
young: sickle-cell dactylitis in hand, wrist, feet, ankle, bc still have marrow there!
older kids & adult: pain crises, acute chest syndrome, leg ulceration, priapism, autosplenectomy, stroke
alendronate
rx for osteoporosis
pyrophosphate analogue (impt component of hydroxyapatite)
- makes hydroxyapatitie more insoluble
- interfere w/ osteoclasts
[absorption is really bad, must be taken in fasting state w/ plenty of fluids, and must stay upright for 30min bc caustic to esophagus]
specific MAO-B inhibitor?
selegiline
phenelzine
MAOi
tranylcypromine
MAOi
isocarboxazid
MAOi
pergolide
dopamine agonist D2.
modest improvement of parkinsons symptoms
amantadine (3)
antiviral (prevent uncoating
& anti-cholinergic
& promote dopamine release
rx for parkinsons
BALSA
bromocriptine amantidine levadopa/carbidopa segeline (+ COMT inhibitors) anticholinergics (benztropine etc)
nausea / vomiting w/ levadopa
due to peripheral conversion to dopamine
limited w/ carbidopa addition
galactose processing
galactose -> galactose 1-phosphate
-via galactokinase
galactose 1-phosphate -> UDP-galactose
w/ UDP-glucose -> glucose 1-phosphate
- via galactose 1-P uridyl transferase
2 fates:
1. UDP galactose epimerized to UDP glucose
-via UDP-galactose-4-epimerase
(then act as glucose)
OR
in mammary glands:
- UDP-galactose + glucose -> lactose
- via lactose synthase
lactose -> galactose
- via b-galactosidase
note lactose = galactosyl b-1,4 glucose
galactosemia deficiency
deficiency in..
- GALT (galactose 1-P uridyltransferase)
- galactokinase
- UDP-glucose 4-epimerase
what converts galactose to galactitol?
aldose reductase
- glanzman thrombasthenia
- abciximab, eptifibitide, tirofiban
- ITP
alll….
block GbIIbIIIa!
Abciximab, eptifibatide, tirofiban
unstable angina
acute coronary syndrome
(esp undergoing percutaneous coronary intervention)
cilostazol, dipyridamole
PDE III inhibitors
- increase cAMP in platelets,
- -> inhibiting aggregation.
also vasodilation
rx: intermittent claudiation, coronary vasodilation, preventing stroke or TIA w/ aspirin, angina prophylaxis
peripheral smear with no platelet clumping
think glanzman thombasthenia
inhibited defect in GbIIbIIIa
present: mucocutaneous bleeding
ouabain
blocks Na/K+ pump at K+ binding site
digoxin toxicity is exacerbated w…
hypokalemia! bc Na/K+ pump already less functional
digoxin toxicity causes..
hyperkalemia!
block Na/K+ pump
digoxin toxicity presents as..
nausea, vomiting, anorexia, confusion, CHANGED VISUAL PERCEPTION, bradycardia, etc etc
immune complex mediated RPGN caused by..
post-strep glomerulonephritis
SLE
IgA nephropathy
anti-neutrophil cytoplasmic antibody
ANCA
decreased serum C4 levels seen in..
hereditary angioedema
lack C1 esterase inhibitor
C1 esterase breaks C4 down.
pathogenesis of wilson’s disease
autosomal recessive
mutation in ATP7B chr. 13
- reduces formation & secretion of ceruloplasmin.
- decreased secretion of Cu2+ into bile
Cu2+ = pro-oxidant, injures hepatic tissue & deposits in cornea & basal ganglia
skin hyperpigmentation w/ ACTH?
ACTH directly stimulates melanotropin receptors due to sequence homology w/ a-MSH
even w/ small cell carcinoma producing ACTH
splenic artery compression would most severely affect what gastric artery / tissue
gastric supplied by short gastric artieries
bc even though splenic gives left gastroepiploic, we have collateral circulation from right gastricepiploic (from gastroduodenal)
arteries coming off of splenic
splenic short gastric left gastroepiploic (greater curvature
right gastric artery
comes off of proper hepatic artery
what part of kidney tubules is most susceptible to ischemic injury
PCT & TAL
- in outer medulla, less blood flow
- ATP consuming transport of ions
also affect DT and CD, but not as sensitive
Papillary necrosis associated w/
DM
analgesic nephropathy
sickle cell
not related to ischemia:
(so sAAD) sickle cell obstruction analgesic acute pyelo diabetes
vitelligo caused by..
autoimmune destruction of melanocytes
usu kicks in 20-30s
albinism
have melanocytes, but don’t make melanin bc lack of tyrosinase
myasthenia gravis associated w/
thymoma
tensilon test
edrophonium. brief acetycholinesterase inhbitir
improves myasthenia gravis
onset of dermatitis herpetiformis?
etiology?
3rd-4th decade of life
vesicular
cross-reaction between IgA and IgG against gliadin –> RETICULIN in basement membrane
microabscesses containing fibrin and neutrophils at dermal papillae tips. overlying basal cells become vacuolated and blisters form at tips.
pale retina w/ cherry red spot in macula of older man
think: retinal artery occlusion
macula blood supply: choroid artery
rest of retina: central retinal artery (branch of opthalmic artery or internal carotid)
occlusion of retinal artery: makes macula look red
blood supply to macula
choroidal artery
NOT central retinal artery
antibody to alpha3-chain of collagen type IV
goodpastures
anti-GBM
type 4 collagen
basement membrane
measles presentation
paramyxovirus
CCCK
- cough
- coryza (rhinitis, infl of muccosal membranes)
- conjunctivitis
- koplik spots - small white/blue/gray specks on buccal mucosa
then maculopapular rash
major proliferative stimuli for cellular components of atherosclerotic plaques
platelets: PDGF and TGF-B
stimulate SMC prolif & migration & interstitial collagen production
secreted by platelets, endothelial cells, infiltrating macrophages
dimercaperol & EDTA for..
lead poisioning
all rest: penicillamine
deferoxamine
iron chelator: hemochromatosis
rx for wilson’s
pencillinamine
energy for myocardial cellular fxn from (3) sources
- glycolysis (5%)
- glucose oxidation (30%)
- fatty acid oxidation (60%)
% source of energy
fatty acid oxidation: makes more ATP, but costs more oxygen.
still, is main source
reduction in fatty acid oxidation in heart will..
reduce oxygen demand!
potential rx for angina due to atherosclersosis
how do oral contraceptives reduce risk of ovarian cancer?
reduce number of ovulations
fewer ovulatory cycles: less need to repair ovarian surface, less chance for abberrant repair -> cancer
what gynecologic cancer has highest mortality rate
ovarian cancer! bc no effective screening, present w/ advanced disease
2nd most common cause of mental retardation
1st most common inherited form
fragile X
appears broken when cultured in folate-deficient medium
highly mitotic tumor suggests
high grade (low differentiating)
staging system
measures spread:
often via TNM synstem
TNM system
measure of spread
T: size of primary tumor
N: nodal involvement
M: metastasis
grading system
differentiation aka malignant potential
radiosensitivity correlation w/ grade
high grade - usually radiosenstivity, bc rapidly dividing –> target of radiation
