UW Deck 1 Flashcards
hepatic abscess
staph aureus through hematogenous spread, enteric bacteria by ascending biliary tract infection or direct invasion
entamoeba histolytica
food borne illness, areas of poor sanitation
penetrating injuries
mixed aerobic and anaerobic
lead poisonining
hypochromic anemia, lead inhibits mitochondrial iron transport, important for heme synthesis
T / B cell relation
T cells needed to active B cell maturation and class switching
temporal arteritis
giant cell arteritis (multinucleated giant cells), polymyalgia rheumatica (neck, torso, shoulder, pelvic girdle pain, morning stiffness), fatigue, fever, weight loss, monocular vision loss, jaw pain and tongue claudication, ESR uniformaly elevated, temporal artery bx to confirm dx, corticosteroids started ASAP to prevent vision loss
constrictive pericarditis
thick fibrosis between parietal and visceral pericardium in pericardial space, kussmaul’s sign (inspiration –> paradoxical increased JVP instead of decreased JVP), pulsus paradoxus
holosystolic murmur
apex: MR, LLSB: VSD
loud p2
pulmonary htn
S3
volume overload, reduced ventricular compliance (diastolic dysfunction)
pericardial knock
constrictive pericarditis (reduced ventricular compliance), right after S2, earlier than S3
Alzheimer
word-finding difficulties, visuospatial, later on: executive, behavioral; atrophy in temporoparietal and hippocampus, strong genetic component
brain tumors in children
MC: pilocytic astrocytoma, 2nd MC: medulloblastoma = both in posterior fossa/cerebellum, differentiate with histology
primitive neuroectodermal tumor
sheets of primitive cells, many mitotic figures, poorly differentiated, poor prognosis
cerebellar tumor
gait instability, limb ataxia, increased intracranial pressure (headache, lethargy, vomiting)
medulloblastoma
undifferentiated/aggressive tumor, small blue cells = scant cytoplasm, basophilic nuclei, often in vermis of cerebellum
mental status exam (MMSE)
orientation to time/space, attention & concentration (spell world backwards), comprehension (3-step command) memory, visuospatial (draw clockface), language (write a sentence)
TOF
asymmetric division of embryonic truncus arteriosus
acyanotic heart diseases
ASD, VSD, PDA –> eisenmenger syndrome –> maybe cyanotic
coarctation of aorta
preductal in infant, ductal dependent systemic perfusion
lung recoil
elastic fibers, surface tension, not affected by PANS
PANS on lungs
increased smooth muscle contraction, increased bronchial mucous secretion –> greater airway resistance, decreased ventilation; muscarinic acetylchoine antagonists block vagally-mediated bronchoconstriction
polyhydramnios
inability to swallow, increased production of fetal urine
APP
amyloid precursor protein –> cleavage –> A beta amyloid (accumulated in AD), more APP in down syndrome (trisomy 21)
myotonia
slow relaxation of muscles
myotonic muscular dystrophy
autosomal dominant, trinucleotide repeat expansion (anticipation) for myotonia protein kinase gene, myotonia, weakness, muscle atrophy, cataracts, gonadal atrophy, frontal balding
peripheral vascular disease
diminished pulses in affected areas (most commonly in legs)
acute aortic dissection
tearing chest pain, radiates to back, unequal pulse strength in upper and lower extremities
pulsus paradoxus
korotkoff sounds intermittently heard during expration –> drop in greater than 10 mmHg –> sounds heard inspiration and expiration; systolic pressure drops more than 10 mm Hg with inspiration
asthma attack: sx
prolonged expiration, pulsus paradoxus (severe obstructive pulmonary disease), wheezing, tachypnea, SOB
albuterol
acute asthmatic control: b2 adrenergic agonist –> increase cAMP –> relax bronchial smooth muscle
cromolyn
mast cell stabilization, helps asthma (but not in acute setting)
asthma pathology
excessive cytokines from Th2; small airway obstruction; mast cells release histamine and leukotrienes –> bronchospasm, increase mucous secretion
corticosteroids
impairs eosinophil degranulation, helps asthma in acute setting (but takes longer than albuterol, hours to days)
histamine
released in hypersensitivity reaction, can lead to bronchial smooth muscle contraction
atopic/extrinsic allergic asthma
high serum IgE
non-immune-mediated asthma
normal levels of serum IgE, “intrinsic” asthma, precipitated by pulmonary infections (espeically viral), aspirin ingestion, cold air, inhaled irritants, stress, exercise
immune mediated and non-immune mediated asthma
bronchial hyperreactivity
tuberculosis histology
in granulomas: th1-activated macrophages form langhans giant cells = characteristic of caseating granulomas in m tb, multiple nuclei in periphery/horseshoe shape
tuberculosis
inhalation –> ghon complex in middle or lower lobes –> apical lungs + hilar lymph nodes: caseating granulomas + cavitary pulmonary lesions
tuberculosis pathogenesis
macrophage phagocytosis –> t cell activation –> macrophage activation: kill intracellular bugs, form epithelioid cells and langhans giant cells
tuberculosis IFN-g
responsible for granuloma formation and caseous necrosis
afib
no p waves, tachycardia, irregular rate set by AV node refractory period (can’t conduct all atrial electrical activity), without AV node, afib and vfib can be >300 bpm
cardiac hyperpolarization
K channels remain open a little longer after repolarization
K permeability of the heart
highest during repolarization (higher than resting)
spleen, embryology
mesoderm derived (not foregut), but supplied by foregut artery (celiac –> splenic artery), everything else supplied by celiac is from foregut
liver and pancreas, embryology
outpouching of endoderm foregut
transverse colon blood supply
middle colic (SMA) + left colic (IMA)
pancreatic blood supply
superior and inferior pancreaticoduodenal arteries
cholesterol source
intake, production by liver
cholesterol –> bile
cholesterol (insoluble) –> bile acids –> bile salts (soluble) –> secreted into bile
gallstone formation
increased cholesterol (insoluble), decreased bile salts (detergent activity = helps make cholesterol soluble), decreased phosphatidylcholine (phospholipid, helps make cholesterol soluble)
efferent arteriolar constriction
increases GFR up to a point, decreased RPF = always increased FF; GFR starts decreasing because of flow-mediated increase in oncotic pressure in glomerular capillaries
afferent arteriolar constrictoin
decreased GFR, decreased RPF = same FF
Huntington’s disease
abnormal protein huntingtin (gene HD), hypermethylates certain histones –> gene silencing; NMDA receptors depleted in striatum
gene transcription regulation: histones
methylation silences, acetylation increases txn
thymidine dimerization
UV damage to DNA
adenosine deaminase
adenosine –> inosine (first step in elimination of excess adenosine)
adenosine deaminase deficiency
second MC SCID, autosomal recessive, current tx research: retroviral vectors to infect pt stem cells with deficient gene
myeloperoxidase
neutrophil enzyme, helps kill phagocytized bugs, makes hypochlorite (bleach) from H2O2 and chloride
reverse transcriptase
rna-dependent DNA polymerase + dna-dependent DNA polymerase
NADPH oxidase
allows neutrophils to form ROS for oxidative burst, deficient in chronic granulomatous disease
chronic granulomatous disease (CGD)
recurrent infections with catalase-producing bugs (staphylococcus), neutrophils don’t turn blue (need ROS to turn blue) in nitroblue tetrazolium testing, bugs that don’t produce catalyse die of H2O2 accumulation
chronic granulomatous disease (CGD)
decreased NADPH oxidase activity –> defective neutrophil oxidative burse (can’t make H2O2 or ROS), x-linked, failure of myeloperoxidase system
contralateral homonymous hemianopia
lesion in optic tract, lateral geniculate nucleus, optic radiation
pupillary light reflex
retina –> optic nerve –> optic chiasm –> optic tract –> some fibers go to pretectal nucleus in midbrain –> EW nucleus
Marcuss Gunn pupil
nasal retina fibers > temporal retina fibers go to pretectal nucleus; damage to left optic tract = right nasal fibers damaged = right pupillary constricts less with light
frontal eye fields
region in prefrontal cortex, generates conjugate gaze movements to contralateral side; lesion: eye looks to side of lesion
contralateral homonymous hemianopia + intact pupillary response
lesion in lateral geniculate nucleus, optic radiation
contralateral homonymous hemianopia + macular sparing
lesion in visual cortex, pupillary reflexes intact
neural tube defects related to drugs
valproate: inhibits intestinal folic acid absorption
ebstein’s anomly
atrialized right ventricle, downward displacement of tricuspid valve, lithium during early pregnancy
Ach in alzheimer’s
decreased Ach in hippocampus and nucleus basalis of Meynert (deficiency in choline acetyltransferase)
locus ceruleus
panic disorders, area contains a lot of NE
raphe nucleus
contains a lot of serotonin, part of brainstem’s reticular formation, serotonin implicated in anorexia, depression, sleep disorders
rabies
bats, restlessness, agitation, dysphagia (painful spasms with swallowing) then coma, killed virus vaccine, rapid spread and replication through/in nerves/CNS
delusional disorder
non-bizarre delusions (vs. bizarre delusions in schizophrenia), function not impaired (impaired in schizophrenia)
familial hypercholesterolemia
LDL receptor defect –> decreased LDL uptake by liver –> increased LDL and total cholesterol
strep pneumo vaccine
capsule polysaccharide of many strains (but not all), recommended for >65, COPD, immunosuppressed, asplenic pts, unconjugated vaccine (no Th response, only IgM)
live attenuated bacterial vaccine
live vaccines more common for viruses, for bacteria: BCG vaccine (TB), typhoid (salmonella typhi), francisella tularensis
live attenuted viral vaccines
measles, mumps, rotavirus, Sabin polio
killed bacterial vaccines
pertussis, yersinia pestis (plague), cholera, bacillus anthracis
killed viral vaccines
rabies, influenza, Hep A, salk polio
hep b vaccine
recombinant surface protein
inactivated toxin vaccines
diphtheria toxoid, tetanus toxoid
polysaccharide capsule vaccines
strep pneumo, h flu, neisseria meningitidis
cephalic, gastric, intestinal phases
cephalic and gastric phases increase gastric acid secretion, intestinal phase decreases it
tetrodotoxin
puffer fish, blocks vg-Na channels in cardiac and neural tissues, sx: weakness, paresthesias, loss of reflexes, n/v
apex
left mid clavicular line, 5th ICS, LV (covered by lung)
azygous vein
posterior mediastinum, immediately to the right of midline, drains posterior intercostal veins –> SVC
lung position relative to heart
lungs overlie majority of anterior heart, cardiac impression in both lungs
right ventricle, position in thorax
majority of inferior border of heart
just below the diaphragm
liver, stomach, spleen
MAP kinase signal transduction pathway
autophosphorylation of tyrosine residues –> activation of Ras = G protein, GDP (inactive state), needs GTP to be active (mutated/always active Ras: cancer) –> activate MAP kinase –> MAP kinase enters nucleus and modifies transcription
cAMP signal transduction pathway
cAMP activates protein kinase A
inositol-lipid pathway
IP3 messenger –> release Ca from ER
lung problems that involve hilar LN
TB granulomas (perihilar lymph node involvement), SLE (hilar adenopathy), sarcoidosis (bilateral hilar lymphadenopathy), silicosis (eggshell calcification of hilar LNs), squamous cell carcinoma (hilar mass arising from bronchus)
mycoplasma pneumonia
walking PNA, nonproductive cough, only mycoplasma genus requires cholesterol to grow (bc cell membrane has a single cholesterol-rich phospholipid bilayer), bug lacks peptidoglycan cell wall, envelope, or capsule
streptococcus pneumoniae
lobar consolidation, MCC CAP
klebsiella pneumoniae
debilitated, hospitalized, alcoholics; current jelly
h influenzae
chocolate agar, factor X, factor V
legionella pneumophila
requires L-cysteine in agar
coxiella burnetii
q fever, mild PNA, spores inhaled from animal hides, obligate intracellular
coccidioides immitis
southwest US, northern mexico, san joaquin valley fever, frequently asx, can also cause severe disseminated dz in immunocompromised
histoplasma capsulatum
similar dz as cocci, mississippi and ohio
pneumocystis jiroveci
fungus, severe PNA in HIV+ CD4<200, ground glass, silver stain fluid collected with bronchoscopy
aspiration PNA in alcoholics
alcohol intoxication impairs gag and cough reflexes, infection with anerobes (bacteroides, prevotella, fusobacterium, peptostreptococcus) and aerobes. Lung abscesses. Tx: clindamycin: most activity against oral anaerobes + gram positive bugs (strep pneumo)
metronidazole
anerobes but not GP bugs
vancomycin, ciprofloxacin, cefazolin
no anaerobes
acute otitis media
h influenzae, strep pneumo
h influenza epidemiology
different types based on polysaccharide capsule, nontypable strains = ones that don’t have a capsule, part of normal flora in upper respiratory tract, but can cause otitis media, sinusitis, bronchitis; vaccine is for type b (Hib)
cold agglutinins
mycoplasma pneumonia, EBV infection, hematologic malignancy, antibodies against RBCs (antigenic mimicry) that only agglutinate at low temperatues, can cause transient anemia
PPV/NPV vs. sensitivity/specificity
PPV/NPV depend on disease prevalence in population, sensitivity/specificity only depend on the test
alveolar hyaline membranes
decreased lung compliance
asthma triggers
viral URI, allergens, smoke, cold weather
HOCM etiology
autosomal dominant disease of cardiac sarcomere (mutation in cardiac sarcomere protein, most common: beta myosin heavy chain)
laryngeal carcinoma associated with
associated with cigarettes, alcohol
acquired bronchiectasis associated with
infection, impaired drainage, airway obstruction, inadequate host defense
asthma: allergic triad
allergic rhinitis, atopic dermatitis
type 1 pneumocytes cell type
squamous cells
PKU mutation
mutation in hepatocyte intracellular enzyme phenylalanine hydroxylase –> protein misfolding
sickle cell mutation
mutation in b-globin gene (Hb S)
avoid sunlight in
photodermatosis (cutaneous porphyria or lupus photosensitivity)
minute ventilation vs. alveolar ventilation
minute: TV (L/breath) RR (b/minute), alveolar: (TV-dead space)RR
Kartagener syndrome
autosomal recessive, microtubular defect –> immotile cilia –> male infertility, recurrent sinusitis, bronchiectasis; associated with situs inversus
Marfan’s genetic defect
autosomal dominant, defect in connective tissue glycoprotein (fibrillin-1) –> abnormal monomers –> can’t polymerize –> no normal microfibrils in connective tissue
Marfan’s associated with
(aortic) cystic medial necrosis –> risk for aortic root dilation, aortic valve incompetence, dissecting aortic aneurysm, MVP, high arched palate, crowded teeth, narrow face, lens displacement
pyruvate kinase deficiency
common cause of hemolytic anemia
stool guaiac test
trace bleeding in GI
pulmonary embolism
pleuritic (associated with deep breathing) chest pain; associated with dyspnea, cough, hemoptysis
IVDU right heart endocarditis –> pulmonary septic emboli
IVDU endocarditis: S aureus, then P aeruginosa –> hemorrhagic pulmonary infarcts (pulmonary infarcts are almost always hemorrhagic due to dual blood supply – pulmonary and bronchial arteries)
staph endocarditis
penicillin (nafcillin) + aminoglycoside (gentamycin). If MRSA: vancomycin + rifampin/aminoglycoside.
ethylene glycol
antifreeze, forms toxins to renal tubules, forms calcium oxalate crystals (folded envelopes) –> ARF (ballooning and vacuolar degeneration), anion-gap acidosis
ATN
oliguria, muddy brown casts
laplace’s law
distending pressure (to keep sphere distended) = 2T (surface tension) / r
surfactant
surfactant reduces variation in distending pressure among alveoli of different sizes (greater concentration in smaller alveoli = less surface tension in smaller alveoli = prevent smaller alveoli from collapsing)
acute (calculous) cholecystitis pathogenesis
stone + GB contraction –> inflammation, irritation –> ischemic/injured/necrotic tissue –> bacterial invasion/infection –> complications: peritonitis, abscess
acute cholecystitis clinical
RUQ pain, radiates to back or neck, triggered by large meal, fever, n/v, female, fat, forty
biliary colic
when inflammed or obstructed gallbladder contracts; stimulated by fatty meal (fatty acids –> cholecystokinin stimulates GB contraction)
causes of cholestasis
intrahepatic (PSC, PBS, cholestasis of pregnancy, drug-induced: erythromycin, contraceptives), extrahepatic (choledocholithiasis, malignancy - pancreatic, gallbladder), hepatocellular dysfunction
cholestasis histology
green-brown plugs in dilated bile canaliculi
cholestasis clinical
malabsorption, nutritional deficiencies (ADEK) –> osteomalacia
nuclear medicine hepatobiliary scan (HIDA)
definitive dx acute calculous cholecystitis by showing cystic duct obstruction (failed gallbladder visualization on radionuclide biliary scan = no radionuclide is filling the gallbladder because it’s obstructed); nonobstructing biliary stones on US are suggestive but not diagnostic; many gallstones are asx
labs for cholecystitis
increased serum AST, ALT (not diagnostic)
left-sided colon cancer
obstruction: cramping, change in stool caliber, constipation, distention, n/v
right-sided colon cancer
iron deficiency anemia, systemic sx
pre-eclampsia
maternal HTN + proteinuria, can progress to eclampsia (seizures) or HELLP syndrome
placental previa
placenta implanted over cervical os, common cause of vaginal bleeding during pregnancy
maternal hyperglycemia
sign of gestational diabetes, associated with increased rates of stillbirth, macrosomia, postnatal hypoglycemia in infant
megaloblastic anemia
vitamin B12 or folate
partial moles
dispermy or duplication of paternal chromosomes –> triploid genome
antibiotic use causes disease
c diff colitis, vaginal candidiasis
prevent neonatal tetanus
vaccinate mom with tetanus toxoid –> mom transfers protective IgG antitoxin across placenta –> no risk for infxn of umbilical cord stump
tetanus
skeletal muscle spasms and rigidity
prevent neonatal disease
immunize mom, not baby, give baby passive immunity, neonate immune system can’t mount proper response to vaccine
peripartal antibiotics
only for GBS, HIV
passive immunity to infants
IgA mucosal antibodies from breast feeding
meniere’s disease
disorder of inner ear, defective endolymph resorption –> increased endolymph volume and pressure in vestibular apartus –> distention of endolymphatic system –> damage to vestibular and cochlear components of inner ear –> tinnitus, vertigo, sensorineural hearing loss, NL Rinne test, Weber test: healthy side
rinne test
nl = air conduction superior to bone conduction
weber test
reveals lateralization to healthy side
passive aggressive behavior
express aggression by passively refusing to meet their needs, act out hostility in non-confrontational manner
friedreich’s ataxia
spinocerebellar degeneration (predominantly spinal ataxia), loss of dorsal column (position, vibration, sensation), associated with diabetes, HOCM leads to arrhythmias, CHF
parkinson’s
extrapyramidal hypokinetic movement disorder: tremor, rigidity, akinesia, postural instability
ingestion + intestinal attachment
salmonella, shigella, EIEC, entamoeba histolytica
posterior pituitary
oxytocin (stimulates uterine contractions in late pregnancy, facilitates breast milk ejection postpartum), vasopressin/ADH
duodenal mucosal cells
gastrin, secretin, cck
silicosis
birefringement silica particles surrounded by fibrous tissue
pulmonary asbestosis
ferruginous bodies (fusiform or beaded rods, translucent asbestos center, coated with iron-containing proteinaceous material), calcified pleural plaques
coal worker’s
perilymphatic accumulation of coal dust-laden macrophages = coal macules
hypersensitivity pneumonitis
inhalation of organic dusts, noncaseating granulomas (berylliosis and hypersensitivity pneumonitis)
Dx ZES
serum gastrin
Dx UC/Crohn’s, screen CRC
colonoscopy
schilling test
detect cause of abnormal B12 absorption (see improvement of B12 absorption after intrinsic factor administration = pernicious anemia)
chronic pancreatitis, CT
abdominal CT = calcificaiton
evaluate chronic hepatitis and cirrhosis
liver bx
spectrin
structural component of RBC membrane, abnormalities –> hereditary spherocytosis (susceptible to hemolysis)
DM1
T cell infiltration and fibrosis of islets of langerhans
ulcerative colitis
bloody diarrhea +/- abdominal pain = hallmark; most dangerous complication = megacolon (can lead to performation); low grade fever
crohn’s
if bloody diarrhea, abdominal pain always present
whipple dz
rod-shaped bacilli
malar rash + pleural effusion in yount pt
SLE, circulating immune complex nephritis, most are ANA positive (sensitive test)
pauci immune
no anti-GBM antibodies or IC deposition
rheumatic fever
antibodies against streptococci M proteins, in situ immune complexes on the heart (vs. circulating immune complexes for the kidney), affects heart, brain, and joints; occurs after pharyngitis
poststreptococcal glomerulonephritis
circulating immune complexes (deposit and fix complement), high ASO titers, low C3, anti-DNAase B, 2-3 weeks after upper respiratory or skin infection, occurs even if you treat pharyngitis/skin infxn
duodenal ulcers
most in duodenal bulb, if unusual (ulcer in distal duodenum or other atypical location, multiple ulcers, ulcers refractory to therapy) = ZES
zollinger-ellison syndrome
acid inactivates pancreatic and intestinal enzymes –> diarrhea
erosive gastritis
erosions = do not penetrate muscularis mucosa
antral sparing
autoimmun egastritis
antral predominant
h pylori
PUD
ulcers in duodenal bulb, lesser curvature of stomach
trinucleotide repeats/expansion
Friedreich’s ataxia, myotonic dystrophy, Huntington’s, fragile X
pleiotropy
one gene mutation –> affects many organs (ex: Huntington’s)
mosaicism occurs in
turner’s, klinefelters, down syndrome
down syndrome dx
karyotyping of fetal cells (screen: AFP)
MHC I
heavy chain + b microglobulin; combines with antigen in ER; antigen processing in cytoplasm
MHC II
alpha and beta polypeptide chain
TH cells
CD4 T cells
area postrema
contains chemoreceptor trigger zone, dorsal medulla, caudal end of 4th ventricle, fenestrated capillaries allow it to sample chemicals in blood, causes n/v after systemic chemotherapy
thalamus
sensory and motor
dorsal to midbrain
3rd ventricle (dorsal to superior and inferior colliculi)
