Week 5 + Week 6 Flashcards
Lab Tests:
- for TB
- for HIV
- for Syphilis
- For Lupus
- for TB = PPD
- for HIV = ELISA
- for Syphilis = RPR
- For Lupus = ANA
Left vs Right axillary drainage + clinical significance
Right = only drains upper right side therefore cannot have any malignancy from the legs, colon, neck, etc.
Lymph Node Biopsy: 3 Variables
- Note: do AFTER labs.
- abnormal chest x-ray
- Size > 2 cm
- ENT symptoms: Dysphagia, etc.
Lymph Node Groin
May see single lymph node in women w/ subclinical UTI
Secondary Lymphatic Organs
- 6 different ones
- Lymph Nodes
- Tonsil Lymphoid Tissue
- Spleen
- Peyer’s Patches
- Skin
- MALT
Thymus produce _______ (endocrine function)
Thymosin
Areas of communication between Superficial and Deep Lymphatics
- Inguinal, Axillary, Cervical.
F(x) of lacteals
Lymphatic capillaries that absorb ingested fats: located in villi of small intestine
Right vs Left Lymphatic Drainage
Right: Right lymphatic duct => Right subclavian vein
Left: Thoracic Duct => Left subclavian vein
Venous vs Lymphatic Edema
- Presence of Ulcers
Venous Source
Venous vs Lymphatic Edema
- Pitting Edema
Venous Source
Venous vs Lymphatic Edema
- Non Pitting Edema
Lymphatic Source
Venous vs Lymphatic Edema
- Stemmer’s Sign
Lymphatic Source: Inability to pinch together skin over dorsal aspect of 2nd toe (kind of related to the non pitting aspect of lymphatic)
Lymphedema: Primary
- 3 different types + Ages
- Congenital: Young
- Praecox = presents after birth but before 35 yo
- Tarde (like “Tardy”) = Appears after 35 yo
Lymphedema: Secondary type
- Filariasis
- 90% caused by wuchereria bancrofti (parasitic filarial nematode)
Lymphangitis:
- Description + Most likely agent
- Infectious process spreading along lymphatic channels from site of origin
- Often caused by Group A strep.
Bursa of Fabricus (primary in ____)
- Definition
- Human equivalent (2ndary in humans)
- Derived from the cloaca of birds where the stem cells are induced to mature into B lymphocytes
- In humans: GALT (Tonsils, Peyers Patches of the Ileum, Appendix.
Histology of primary vs secondary lymphoid organs
- Primary = no reticular fibers
- Secondary = rich in reticular fibers, reticulo-endothelial cells.
Thymus:
- Function of Thymic Corpusules
- Aka…
- AKA Hassal’s Corpuscles, unkbown function but they increase with age.
Lymph Node:
- Diffuse Cortex
Diffuse: Predominantly by T-lymphocytes
Lymph Node:
- Nodule
Nodules: B-Lymphocyte Zones = humoral immunity (esp germinal centers)
- B cells => Plasma => Ig => Tagging Ag => complement
B cell: Non-Hodkin Lymphomas
- ALL = ______ B cell
- Stem Cell
B cell: Non-Hodkin Lymphomas
- Burkitt = ______ B cell
- Immature
B cell: Non-Hodkin Lymphomas
- CLL/SLL = ______ B cell (Chronic Lymphocyte Leukemia/Small Lymphocytic Lymphoma = same)
- Pre-antigen exposure
B cell: Non-Hodkin Lymphomas
- Myeloma = ______ B cell
- Antibody producing B-Cell
__________ Lymphoma has increased risk of herpes zoster infections.
-Hodkin’s Lymphoma
“Fish-Flesh”
Description of Lymph Node Pathology in Hodgkin’s disease
Staging of Hodgkin’s Disease (Stage I - IV)
- Stage I: 1 Lymph Node
- Stage II: 2+ lymph nodes on SAME side of Diaphragm
- Stage III: Lymph nodes on both sides of the diaphragm, including spleen.
- Stage IV: Multiple or disseminated foci of involvement of one or more extralymphatic organs w/ or w/o lymphatic involvement.
Sarcoidosis: Multisystemic (most common areas)
- Caseating or Non-caseating
Lungs + Lymph Nodes (L + L)
- Non-caseating!
Red Flag Descriptions for Sarcoidosis (3)
- Potato Nodes on Chest X-ray (Hilar Lymphadenopathy)
- Asteroid Bodies (star shaped crystals) + Schaumann Bodies (calcified lamellar structures) = Histology
Note: Spontaneous Recovery
Ehrlichia Chaffeensis + Anaplasma Phagocytophilum
- Species (+ remember sketchymicro)
- Transmission via..
- Rickettsia Species
- Ehrlichia Chaffeensis = Lone Star Tick (main reservoir = white tailed deer)
- Anaplasma Phagocytophilum = Black legged ticks like Babesia and Borrelia (hence likely co-infection)
Francisella Tularensis
- Disease Types (2)
- Oculograndular tularemia
- Oropharyngeal tularensis: Exudative pharyngitis and cervical lymphadenopathy
yersinia pestis: Virulence Factor (2)
- F1 Capsule: Protects against phagocytosis
- Yops protein: Type III Secretion!
Post bath pruritus indicate __________
Polycythemia rubra vera (Note, due to basophils and mast cells secreting histamine)
Malaria: __________ invade(s) only young red blood cells + severity of symptoms.
- P. vivax and P. ovale only invade young RBCs.
- Hemolytic anemia does occur, may be severe.
Malaria: __________ invade(s) cells of all ages + severity of symptoms.
- Both P. Malariae and P. falciparum invade red cell of all ages.
- P. Malariae = Very mild symptoms
- P. Falciparum = severe symptoms
Risk of splenic rupture: Prominent splenomegaly
Infectious mononucleosis
Patient takes ampicillin or amoxicillin and develops a maculopapular rash. This patient has ________ disease
kissing disease = infectious mononucleosis
- Also has cervical lymphadenopathy.
Thrombosis of the hepatic vein is called __________ and causes ______________
1) Budd-Chiari Syndrome = Cirrhosis, hepatosplenomegaly, collateral veins, jaundice, ascites.
Deficiency of glucocerebrosidase is called ________. Possible ______ and _______ symptoms
Guacher’s Disease; anemia and thrombocytopenia
________ leads to build up of shingomyelin due to lack of _______ leading to mainly ___________
- Niemen-pick
- sphingomyelinase
- thrombocytopenia.
Spleen develops from __________ and begins it’s development in the ______________
- Dorsal mesentery
- Dorsal mesogastrium
Dorsal mesogastrium rotates ________ which includes ________ ligament.
- Laterally
- leinorenal (spleno-renal)
Anterior mesogastrium rotates __________ which includes __________ ligament.
- Medially
- gastro-splenic
spleen is a(n) _____peritroneal structure
-intraperitoneal
Splenorenal ligament contains _________ and _________
- splenic vessels + tail of pancreas
gastrosplenic ligament contains ________ and _________
- short gastric vessels + left gastro-epiploic branches of splenic artery.
portal triad contains these 3 structures
- Hepatic artery, hepatic portal vein, and bile duct.
Branches of celiac axis to know (3)
- left gastric artery, hepatic artery, and splenic artery.
- Note: Splenic artery raises from the celiac axis, RIGHT of the midline. (relative to what?)
Distributed Splenic Artery vs Bundled Splenic Artery
- Distributed = prefers partial splenectomy (difficult to do complete splenectomy)
- Bundled = easier to do complete splenectomy
Occlusion of this branch may cause pancreatitis
Pancreatica magna = most important aberrant branch
Splenic artery branches
- Superior terminal = short gastric vessels
- Medial terminal = hilum of the spleen
- Inferior terminal = left gastroepiploic artery
Function of Marginal Zone
- Area between Red and White Pulp
- Directs old RBCs to the Red Pulp and Blood antigens to White Pulp.
SMV (Superior mesenteric vein) drains blood from __________, _________ and empties into the____________
- Right colon up to the middle portion of tranverse colon
- hepatic portal vein
IMV (Inferior mesenteric vein) drains blood from ________, ________, _______ and anastomose with ______
- Large bowel, splenic flexure, and descending colon
- splenic vein then returns blood back into the hepatic portal vein.
Splenic plexus consists of _____, _______, and ______
- branches of celiac plexus, left celiac ganglion, and the right vagus nerve.
Splenic plexus accompanies the __________
splenic artery
Splenic plexus are mainly _________
sympathetic + uses norepinephrine
The following embryological structure(s) recanalize during portal hypertension:
- Round ligament of the liver (ligamentum teres): formally umbilical veins. (this is the one he emphasized.)
- Technically any venous structure can serve as collateral pathway such as epigastric veins etc.
3 Immunizations needed before splenectomy: think encapsulated
- Haemophilus Influenza (type B)
- Meningococcus (serogroup C)
- Polyvalent pneumococcal vaccine)
Note: Haemophilus influenza is a bacterium but the influenza vaccine is caused by a virus therefore you should recommend the annual viral vaccine to splenectomized patient.
OPSI: Symptoms of _____, _____, and ______
Septic Shock, DIC, and Multiple Organ Failure
OPSI: Highest risk in _______ and ____ years out of splenectomy. Most worried about the bug, _______.
Children and 2 years out of splenectomy. Most worried about Strep pneumonia.
- Also H. influenzae type B, Strep Type B, and Staph Aureus
Breakdown of RBCs: Hemoglobin breaks down into ____, ____, and _____.
Biliverdin, carbon monoxide, and Ferrous iron 2+.
Follicular B cells vs Marginal Zone B cells
- Results in terms of antibodies
- Follicular B cells => protein antigen + helper T cells => germinal center reaction => Isotype-switching therefore IgG, IgA, and IgE. (Long lived plasma cells)
- Marginal Zone B cells => Mainly IgM, short lived plasma cells
“Onion Skin”
- Reactive Splenomegaly: Systemic Lupus
Note: Technically also seen in Tay Sachs disease
Hand-Schuller-Christian Disease: Splenomegaly scheme
- Pathogenesis + Triad of disease
(Type of Langerhan Cell Histiocytosis)
- malignant proliferation of Langerhan Cells: 2-5 yo kids
- Triad: Radiolucent lesions of the skull, Diabetes Insipidus, Exophthalmos
- Other Sx: Deafness
Litterer-Siwe Disease (Not as important as Hand-Schuller-Christian Disease it seems like)
- Part of Splenomegaly scheme
(Type of Langerhan Cell Histiocytosis)
- Sx: hemorrhagic skin lesions are common. Massive hepatosplenomegaly, + progressive bone marrow involvement (typical symptoms of -penias)
Birbeck Granules
- Racquet shaped tubular structure
Histologic Features of Langerhan Cell Histiocytosis (Eosinophilic Granuloma, Hand-Schuller-Christian Disease, and Litterer-Siwe Diease)
Necessary for Dx.
Eosinophilic Granuloma Sx.
- (Type of Langerhan Cell Histiocytosis)
- solitary or multiple. Can see lytic lesions on the skull/vertebrae.
- accounts for 70% of LCH cases, eventual recovery but bone lesion may have to be curetteted.
Hx of Benzene exposure or previous radiation exposure is a clue for __________. Can see _____ in blood smear
Myelofibrosis, tear drop cells.
Dx: for Infectious Mono
Monospot Test = heterophile antibodies that cross reacts with and agglutinates sheep or horse RBCs.
Presentation of Enlargement of tongue points towards _________
Amyloidosis: Usually a lot of different organs involved.
Diagnosis of Amyloidosis:
Congo Red Stain + Apple Green color birefringence.
Amyloid is made of ______ and ______ arranged in ________
95% fibrillar proteins
5% glycoproteins
beta-pleated sheets
AL Amyloid vs AA Amyloid
L = Light Chain while AA = Amyloid A.
- AL Amyloid formed by neoplastic B cells via cancerous source
- AA Amyloid is derived from the liver via reaction to infection, inflammations, neoplasms, or IV drug use.
Most common cause of death in amyloidosis patients
Renal failure = glomerulus shows large eosinophilic pale spheres with total obliteration = non-selective proteinurea.
Virchow’s Triad
- Venous Stasis
- Hypercoaguable State
- Vascular injury
Most common acquired thromophilia + strong correlation w/ pregnancy loss
Antiphospholipid antibody syndrome
Work up for Possible Clot (2 assessments)
- Venous Compression Ultrasound = Rule out DVT
- D-dimer assays = sensitive but not specific for thrombosis, therefore more of a screening test. Negative assay helps rule out but positive test does not rule in.
Serological (laboratory work up) is done after ____________ because _________
- Done post acute thrombotic event because active thrombosis may alter level of some proteins.
Vasoconstricters released during vascular spasm
Endothelin-1 + Thromboxane A2
Vasodilators released during vascular spasm
PGI2 and NO
the “troponin” of the blood vessels is _______ which activates _______
Excitation-contraction coupling
- calmodulin, Ca2+ binds to it, myosin light chain kinase
__________ stops the cross-bridge cycling
Myosin phosphatase
_____ state is the reason why tension can be maintained without ATP use.
Latch State
Serum is plasma minus ________
clotting factors
Plasma proteins consist of _______, ______, and _______
Albumin, Globulins, and Fibrinogen
Last area of electrophoresis where circulating antibodies form
gammaglobulin (which includes circulating antibodies)
Platelet granules contain _______, a potent vasoconstrictor
Serotonin
Aspirin MOA
Block COX-1 which interferes with TXA2 production
Vorapaxar MOA
Blocks thrombin receptor (PAR-1)
Abciximab, tirofiban, eptifibitide MOA
Blocks IIb/IIIa receptor (fibrinogen receptor)
Clopidogrel MOA
Blocks ADP receptor (P2Y12)
Prothrombinase complex is composed of:
Calcium, Xa, Va, Prothrombin (II). => output: Thrombin IIa
Initiation of coagulation pathway is inhibited by _________
TFPI: Tissue Factor Pathway Inhibitor
Amplification of coagulation factors is due to ______ which goes and effects _____ and ______
- Thrombin Burst (IIa) => XIIIa, and fibrinogen.
Fibrinolysis inhibitors are ______ and _______. While it is activated by ________
- PAI (Plasminogen activator inhibitor) and Alpha 2-antiplasmin
- tPA
Antiphospholipid antibody syndrome (autoimmune, therefore seen with other autoimmune diseases like SLE)
- Definition
- Inherited type vs acquired type
- Definition: Autoantibodies directed against numerous negatively charged phospholipids
- Inherited Type = coagulation on VENOUS SIDE
- Acquired Type = coagulation on ARTERIAL + VENOUS SIDE
During the Initiation and Priming stage, Thrombin affects activation of ______, ________, _______, and ______
5a, 8a, 9a, and platelet activation
Thrombin Burst = amplification of ______ and _______
Fibrin + XIIIa.
