test #49 5.6 Flashcards
phagocyte dysfxn immunodeficiency present with..
recurrent abscesses
can’t kill what they phagocytose
candida skin test
tests for cell-mediated immunity, since we have all been exposed to candida, we should mount a response to it
via macrophages, CD4+, CD8+, NK cells
absence of response suggests SCID
type 4 HSR
most common causes of spontaneous intracerebral hemorrhage (3)
- arteriovenous malformations
- ruptured cerebral aneursyms
- abuse of sympthatomimetic drugs (cocaine)
cause of death in adult-type coarctation of aorta
HTN-related complications
left ventricle failure, ruptured dissecting aortic aneursym, intracranial hemorrhage (bc increased blood flow tere)
typical site of pathology w/ crohn’s disease
terminal ileum
why may crohn’s have increased gallstones?
bc loss of bile acid reabsorption in terminal ileum
sharp pull on outstretched hand while forearm is pronated and elbow is extended
radial head subluxation (nursemaid elbow)
most common elbow injury in children
tear annular ligament that holds radius to ulna at elbow
will hold in that position
which antipsychotics help treat negative symptoms of schizophrenia
atypicals!
emotional range, poverty of speech, loss of interest, loss of drive
rx for prevention of GBS meningitis in neonate
intrapartum ampicillin
rx earlier still leaves mom susceptible at time of birth
V2 vasopressin increases CD permeability to (2)
- water (aquaporins)
2. urea
two ways of regulating lac operon expression
negatively: bind repressor protein to operon locus
positive: cAMP-CAP binding upstream promoter
receptors w/ Gq activation
a1, m1, m3 oxytocin V1 ADH (vascular) angiotensin II GHRH TRH GnRH
think: 'vasoconstrictors' adh V2, ang II, histamine & hypothalamic reproductive GnRH, oxytocin & TRH
calcipotriene, calcitriol, tacalcitol
topical vitamin D analog
used to treat psoriasis
activate vitamin D receptor nuclear transcription factor, inhibits keratinocyte proliferation & stimulates differentiation
utekinumab
human monoclonal antibody used in psoriasis, targets IL-12 and IL-23.
inhibits differentation and activation of CD4+ Th1 and Th17 cells
aortic regurg murmur
VERY EARLY diastole.
listen carefully, might sound like systole
hypertrophic cardiomyopathy murmur
definitely LVOT
can ALSO have mitral regurg bc of impaired valve closure
both systolic murmurs
alcoholic w/ megaloblastic anemia
likely folate deficiency
- poor intake
- poor absorption, utilization, enterohepatic recycling
(not B12)
rx for acute coronary syndrome, angina
aspirin
clopidogrel (irreversible ADP block)
ticlopidine
considerations before giving metformin
kidney fxn!
worry about lactic acidosis
contraindicate in any condition that might raise lactic acid levels: liver dysfunction, heart failure, alcoholism, sepsis
where does inferior mesenteric vein drain?
into SPLENIC vein, which joins SMA –> portal vein
note: different from arterial supply
what component of meningococcus correlates w/ patient morbidity & mortality
LPS equivalent: outer membrane lipooligosaccharide
in serum
leads to sepsis, petechiae, waterhouse-friederichson
[note: not the capsule]
how do nitrates cause vasodilation
NO, stimulate guanylate cyclase, convert GTP -> cGMP
- decreases intracellcular Ca2+
- decreases myosin lightchain kinase
–> myosin light chain dephosphorylation & smooth muscle relaxation
histology of schwanomma
spindle cells
biphasic:
antoni A pattern: highly cellular
antoni B pattern: myxoid areas of low cellularity
antoni A areas may form “palisading” patterns like a picket fence
S-100 positive
impt S100 tumors
melanoma
schwanoma
both neural crest derivatives
what is the only CN that cannot develop a schwanoma
CN II optic nerve!
covered by oligodendrocytes
what are CN myelinated by? exception
normally schwann cells (PNS)
except CN II optic: oligodendrocytes
histology of psoriasis
hyperparakeratosis acanthosis (increased spinosum) elongation of rete ridges mitotic activity above epidermal basal cell layer reduced/absent stratum granulosum
epidermal layer above dermal papillae = thinned & contained dilated vessels –> pinpoint bleeding– AUSPITZ sign
neutrophils may form clusters in superficial dermis & parakeratotic stratum corneum –> MUNRO MICROABSCESSES
signs of portal HTN w/ normal liver biopsy suggests
presinusoidal process (aka not budd chiari)
must be portal vein thrombosis
unlikely to see ascites bc obstruction is presinusoidal
differentiating portal HTN due to budd chiari vs portal vein thrombosis
liver biopsy.
if it was budd-chiari (occlusion of hepatic vein, which drains hepatic & portal circulation into systemic circulation), would see centrilogular congestion & fibrosis in liver.
see nothing w/ portal vein thrombosis
acetaminophen overdoses causes what type of liver histology
centrilobular hepatic necrosis and failure in 24-48 hrs after ingestion
kussmaul sign
paradoxical increase in JVP with insipiration
suggests constrictive pericarditis
causes of constrictive pericarditis
usu chronic
- idiopathic/viral
- cardiac surgery/radiation therapy
- tuberculosis (in endemic areas)
hemodynamic signs of constrictive pericarditis
- increased JVP
- kussmaul sign
- pulsus paraoxous
- pericardial knock
pericardial knock vs. S3
S3: sudden deceleration of incoming blood as it reaches an elastic limit (reduced INSTRINSIC) ventricular compliance
pericardial knock: reduced ventricular compliance via an EXTERNAL force. sharper, more accentuate sound heard earlier in diastole
most common liver neoplasm
metastasis
if see multiple hypodense masses in liver
think mets
causes of hepatic adenoma
uncommon, benign epithelial tumors
associated w/ oral contraceptives, or anabolic steroid use
presentation: upper abdominal pain, or incidental
can rupture and cause intraabdominal hemorrhage
hepatic angiosarcoma associated w.
exposure to vinyl chloride, thorotrast, or arsenic
aggressive and associated w/ poor prognosis. most die within 1 year.
hepatoblastoma
most common liver neoplasm in kids.
associated with FAP and beckwith-Wiedemann syndrome
fatal within a few years if not surgically resected.
cholangiocarcinoma
rare, from intra / extrahepatic bile ducts.
intrahepatic: grossly like tree-like mass along biliary system. typically resulting in extensive intrahepatic metastasis.
risk: primary sclerosing cholangiitis, fibropolycystic liver disease, infxn w/ liver flukes in endemic areas.
poor prognosis
superior sulcus
lung groove formed by subclavian vessels
location of pancoast tumors
another location name for pancoast tumors
superior sulcus tumors
local invasion of pancoast tumor can cause..
- pain in shoulder that radiates to axilla / scapula: most common, brachial plexus. also paraesthesia, etc
- horner’s
- upper extremity edema: compression of subclavian
- spinal cord compression/paraplegia if extend into intervertebral foramina
mediastinal mass can cause..
superior sulcus mass can cause..
mediastinal: SVC syndrome: headache, face plethora
superior sulcus: compression of subclavians: arm edema
2 centrally located lung cancers
squamous cell
small cell
warty brown plaques that look like can be peeled off
seborrheic keratosis
discoid lupud erythematous
thick scaly discoid plaques that erupt on unexposed skin, may result in scarring.
no systemic disease is present in 90%
when are macroscopic changes first seen post ischemic infarct to brain
12 hours
red neurons
sign of irreversible damage
during first 48 hours
demyelination of peripheral nerves
Guillan-Barre
acute demylelinating disease after infxn, immunization, allergic rxn
pathogenesis of guillan-barre
some infectious agents contain ganglioside-like substance in LPS.
antibodies form, cross-react w/ ganglioside in myelin. segmental demyelination & endoneural inflammation on light microscope.
ascending muscle weakness after a respiratory or GI illness.
no DTR
esp camplyobacter jejuni
guillan barre
can ascend to cranial n.
worry: paralysis of respiratory muscles -> fatal
werdnig-hoffman
anterior horn cell damage
lower motor neuron signs “floppy child”
b12 deficiency neuro presentation
subacute combined degeneration
degeneration of DORSAL COLUMN and LATERAL corticospinal (can also be spinocerebellar) tracts
neuro beri beri
can cause demylelination too, but NO perineural inflammation.
usu: weakness, areflexia, pain & parathesia. usu distal lower limb
most common cause of spontaneous nipple discharge
intraductal papilloma
bloody or serosanguinious
breast cancer associated w/ peau de orange?
inflammatory breast cancer
lymphatic obstruction and tissue swelling –> collections of neoplastic cells plugging dermal lymphatic channels
presentation of inflammatory breast cancer
-breast tenderness
-skin discoloration
(pale pink to deep red brown to purple)
-rapidly progressive underlying mass
peau d;orange: putting edema in subcutaneous break tissue w/ skin thickening around exaggerated follicles.
plugging of lymphatic channels
3 phases of wound healing
- inflammatory:
- within 1 day: neutrophils
- 2-3day: macrophages - proliferative:
- 3-5days: fibroblasts and endothelial vascular cells -> vascular granulation tissue - maturation phase:
- after 1 wk: active fibroblasts make collagen, elastin, etc. replace type III w/ type I collagen.
6-8 wks: scar complete, 30-40% of tensile strength. mature for several months, increasing tensile
70-80% in 3 months
keloid vs. hypertrophic scar
excessive collagen formation during tissue repair.
keloid:
- extend beyond borders,
- don’t regress,
- recur after resection
- collagen fibers DISORGANIZED
hypertrophic:
- limited to area of wound,
- can regress.
- collagen fibers PARALELL
what vessels are affected by atherosclerosis
large elastic: aorta, carotid iliac
large/medium muscular:coronary, popliteal
rank:
- ABDOMINAL AORTA, near renal ostia
- coronary
- popliteal
- internal carotid
- circle of willis
hypoxemia defined as
drop in PaO2 below 80mmHg
normal A-a gradient
< 20mmHg
(10-15) normal
causes of hypoxemia with normal A-a gradient (2)
- hypoventillation
- low pO2 (high altitude)
hypoventilation: suppressed respiratory drive, i.e. sedative overdose, sleep apnea, or decreased inspiratory capacity: myasthenia, obesity
how does decreased alveolar ventillation affect PaO2
will have LOWER alveolar gas
normal A-a gradient
hypoxemia
how does a right-to-left shunt affected PaO2
will have increased A-a gradient (>15-20)
alveolar gas = normal
but hypoxemia
how does V/Q mismatch affect PaO2?
poor ventilation of perfused alveoli -> physiologic right-left shunt.
increased A-a gradient
pneumonia, obstructive pulmonary disease, PE
what part of gI tract is affected in Crohn’s
anything from mouth to anus!
classically: ileocecal region
sarcoidosis produces elevated
vitamin D –> HYPERCALCEMIA
&
ACE
what types of patients frequently develop hypercalcemia / hypercalciuria
granulomatous disorders!
sarcodosis, TB, hodgkin’s disease, non-hodgkins
granuloma giant cells have 1-alpha-hydroxase, activating vitamin D
carcinoid syndrome is associated w/ decreased
niacin!
tryptophan all consumed to make sertotonin, less for niacin production
TB tissue damaged caused by
T-cell delayed HSR
Th1 stimulation of both CD8+ T cells and macrophages
bacteria itself does not cause tissue damage
histology of s. pneumoniae pneumonia
- congestion: fluid extravasation into alveolar space
- red hepatization: extravasated PMN and RBC in alveolar space
- grey hepatization: deposition of fibrinous material in alveolar space
- elimination, histologic resolution
intracellular fungus in macrophage
histoplasma
features of disseminated histoplasmosis (3)
- hepatosplenomegaly
- loves mononuclear phagocyte system - ulcerated lesions of tongue
- usu pulmonary disease
chest x-ray of disseminated histoplasma
hilar adenopathy
can resemble pulmonary TB (cavitary lesions in upper lobe, calcified nodes)
histology of coccidiodes immitis
thick walled spherules containing endospores
don’t confuse w/ histo: macrophage filled w/ yeast
vitamin E deficiency presentation
neuromuscular disease
DORSAL COLUMN, SPINOCEREBELLAR
-skeletal myopathy, spinocerebellar ataxia, pigmented retinopathy
hemolytic anemia
