Week1 Lectures Flashcards
___ (3) are reabsorbed in the kidney
Na+, Cl-, water
___ (1) are excreted in the kidney
H+
___ (2) are reabsorbed and secreted in the kidney
K+ and Uric Acid
hint: creatinine + inulin are unchanged
- porous nephron segment -
- trancellular transport (K+, H20) -
- 85% HCO3- abs -
- site of CAi -
- site for SGLT2 drugs (diabetes)
Proxtimal Tubule
hint: abs carbonate, excretes acid
- Passive water movement based on conc gradient -
- tx site of osmotic diuretic aquaresis after entry (eg mannitol)
segment?
Descending limb LOH
- impermeable segment to water -
- dilutes tubular fluid permb to small solutes (25% Na)
segment?
Thin Ascending Limb LOH
hint: diluting segment
___(enz) restores nephron’s chemical electroneutrality
___(enz) is inh by loop diuretics –> Mg and Ca loss w/ Na, K, Cl
ROMK (electroneutrality);
NKCC2 (loops diuretics)
Renal Autocoids (3)
- Adenosine
- Prostaglandins
- peptides (ANP/BNP vasoD’s)
Renal Hormones (5)
- Renin-Ang sys
- EPO
- Aldosterone (MR rcp Na reabs)
- 1,25 OH Vitamin D3 (via I-𝛂-OHase)
- ADH (V2 rcp water abs)
autocoid responsible for:
- afferent arteriole vasoD
- glomerular blood flow autoregn
- ↓Na reabs in LOH;
- ↓H2O transport in CTs
Prostaglandins
Nephron segment: -
- active NCC co trnsporter -
- impermb to water -
- Apical Mg channel -
- baso Na/Mg transporter
DCT I
hint: 25% NaCL reabs
Nephron segment: -
- active NCC co transporter -
- apical ENaC channel for Na+ -
- baso Cl channel -
- baso Ca/Na + Ca active transporters (PTH reg’d)
DCT II hint: 25% NaCL reabs
____(celltype) in the collecting duct (CD) transports Na, K, H2O; while ____ (celltype) have acid base function in CD (𝛂 for H+ and β for HCO3-)
principle cells;
intercalated cells (𝛂 and β)
Name presentation and causative fungus? -
- hypersensitivity rxn to inftn
- complicates asthma or CF -
- dx on exam -
- treat with itraconazole, sinus surgery , xolar
ABPA from Aspergillosis
Name presentation and causative fungus? -
- colonizing fungus ball after cavitary lung disease -
- air crescent/grape cluster on scan (dx) -
- tw itraconazole vel surgery
Aspergilloma from Aspergillosis
Name presentation and causative fungus? -
- mimics TB air crescent on scan -
- needle-aspirate lung fluid for histo -
- ↑risk for alocoholism , COPD, CGD -
- tw voriconazole + AmphoB
CNPA from Aspergillosis hint: unresponsive to antibiotics
Name presentation and causative fungus? -
- resp distress after prfound PMH of IMNS -
- halo sign on scan (dx) -
- needle/biopsy for histo (Acute Angles*)
Invasive from Aspergillosis
Whats the dx and Tx? -
- Caused by rhizopus -
- deadly invasive vasculitis from env mold -
- non septate right angle* on histo -
- sinus entry –> brain invasion –> infarction -
- Risk: unctrl’d T2DM, Fe overload , IMNS
Mucormycosis (Rhinocerebral, wound, cutanous, lung/GI) tw amphoB + surgery
Whats the dx and Tx? -
- ubiq env mold + rare.fatal inftn -
- seen in HSCT pts -
- eye, lung, and skin sx -
- blood culture + histo dx
Fusarium (mycotoxicosis, local, disseminated) tw amphoB + voriconazole
Whats the dx and Tx? -
- ↓host imm resp -
- late ppt: meningitis; skin; nodules; pulm sx -
- dx: biopsy, CSF, crag
Cryptococcosis tw Fluctyosine –> AmphoB –> fluconazole
how does arteriolar tone affect vascular function curves (esp venous return)
- arterioles hold min vol thf MSFP is not changed -
- blood trapped upstream via vasoC –> ↓venous blood –> ↓venous P + reutrn at any CVP -
- vice versa w/vasoD
vasc pressure when blood flow ceases?
mean systemic filling pressure (MSFP) hint: ∝ blood vol
determinants of systolic fx? (3)
- preload
- afterload
- contractility
COPD, effusion, congestion, or obesity would cause voltage signal to (increase/decrease)
decrease (more distant)
Myocardial hypertrophy would cause EKG voltage to (increase/decrease)
increase (large muscle)
____ (chemical class) ↑ intracell cAMP, Ca+, and contractility
catecholamines
Normal ejection fraction (EF)
55-65%
- ∆ perfusion to body -
- ↑ fluid in lungs (congestion) -
- SOB + pulm edema
characterizes…
Left heart failure
- ∆ perfusion to lung -
- ↑ fluid in periphery -
- ascites + periph edema
characterizes…
right heart failure
whats the dx? -
- ∆ NCC in distale tubule (SLC12A3) -
- hypoMg* + hypoK + alkalosis + ↑plasma renin + aldo
- ± low BP -
- caused by LOOP diuretics
Gitelman’s syndrome (low serum Ca+)
hint:
- Bartter’s + hypoMg
- dump bicarb –> ↑water into lumen
whats the dx? -
- ∆ NKCC2 symporter in Thick Asc LOH (SLC12A1) -
- hypoK + alkalosis + ↑plasma renin + aldo -
- ± low BP
- caused by THIAZIDE diuretics
Bartter’s Syndrome (high urine Ca+)
hint: water (vol) drops –> renin/aldo↑
what Rx combo is used for nephron paralysis? (3)
CAHi + loop + distal diuretics
what’s this rare AD dz? and how do you tx? -
- gain of fx: EnAC channels -
- clinica; ppt: htn, ↑Na+ reabs, K wasting
Liddle’s Syndrome
tw
- K-sparing diuretics:
- amiloride (or triamtereneif allergic )
2 yrs dapsone + rifampin is tx for ___
Tuberculoid Hansen’s (M. Leprae)
Hansen’s disease form chr by:
- Paucibacillary,
- vigorous, but ineffective CMI (CD4+, Th1) –> PPD⊕
- nerve damage (clawed hands + toes, foot drop)
Tuberculoid
Hansen’s disease form chr by:
- multibacillary ,
- weak CMI (useless Th2 w/ Abs) –> PPD⊖
- extensive cutaneous sx
lepromatous
hint: lionine facies
____ has no in vitro culture system, slowest growing human pathogen, only affects 5-10% of humans*, prefers 30-37C
M. Leprae
common ppt: asymptomatic seroconversion*
Scrofula in kids indicates ___ inftn; while in adults indicates ____
Atypical Mycobacterial inftn; TB
key histo features for M. Leprae inftn? (2)
- foam cell mø’s
- granulomatous epiths + lymphos
hint: skin smear/punch biopsy
Labs for M. Leprae in the US and Abroad
PPD (abroad):
Serology (US):
- LMIT for tuberculoid
- phenolic glycolipid-1 for lepromatous
- health care worker exposed to Mleprae
- pt with tuberculoid form
- previous lepromatous form responding to tx
these are indicative of (neg/pos) lepromatin PPD?
POSTIVE PPD
- naive pt
- lepromatous leprosy
these are indicative of (neg/pos) lepromatin PPD?
NEGATIVE PPD
Name that drug:
- Unknwon MOA
- SEs: N/V; hepatotox; HS rxns
Pyrazinamide
Large proteins, cells, and complexes that can be centrifuged* out is a job for ____ (procedure)
Apharesis
hint: exchange (replace) vs true pheresis (substract)
Separating plasma contents small enough for a semipermb membrane through diffusion/convection would be a job for ___ (procedure)
Dialysis
hint: AEIOU = Acid/base, Electrolytes, Intoxication, Overload of fluid, Uremic Sx
types of Dialysis (2) and their subtypes (2 each)
- Hemodialysis
- cont CRRT vs intermittent IHD
- Peritoneal Dialysis
- manual vs auto
Why is sodium citrate used for dialysis?
- sodium citrate binds Ca+
- Ca+ is vital for coagn via intrinsic pathway (F9,10,V and thrombin)
- ↓ Ca+ –> bleeding risk
___ moves solute; ____ moves water; is also known as solvent drag or the movement of water with stuff in it
- diffusion;
- hydrostatic F (osmosis)
- convection = solvent drag
Why does hereditary hemochromatosis and transfusion lead to iron overload myocardial dz?
ventriclular iron deposition –> ∆ metal dep enz systems + O2* injury –> systolic dsfx (∆ pumping)
dilated heart and ↑hemosiderin laden mø’s (on Prussian blue stain) is chr histopathology for ___
Iron Overload (myocardial dz)
these are signs of what tupe of thryoid disfx?
- nonspecific ischemic hypertrophy
- tachycardia, palpitations, and cardiomegaly
HypERthyroidism
these are signs of what type of thryoid disfx?
- ↓stroke vol –> ↓CO
- myofibers swelling w/↓ striations + basophilic staining
- flabby, dilated heart
hypOthyroidism
what the dx?
- AD inheritance
- ∆ desmosomes –> thinned R ventr wall (fatty + fibrotic change)
- leads to heart failure, vtach, and vfib
Arrhythmogenic R Ventricular Cardiomyopathy/Dysplasia
Whats the Dx?
- AD congenital dz
- spongy ventricular myocardium –> arrythmias + heart failure
- tx sx + heart tranplasnt

Non-compaction cardiomyopathy
- On histology _____ (dx) shows intersitital lymphocytic infiltrate + focal necrosis –> focal or patchy inflamm/progressive fibrosis. Clinical sx incl dyspnea, palps, precordial discomfort + fever w/± normal/dilated heart
- WHat is the most common cause for this dx in US?

- myocarditis;
- viral inftn = most common cause in US
hint: ppt = precordial discomfort + fever
on clinical exam, pt complains of dyspnea and excerise intolerance, and appears to have right sided heart signs. On echo myocardium appears thick, w/↑ atrial size and normal ventr size. On EKG, voltage is low with condduction abnormalities (afib + arrhtymia). Biopsy is seen below. Dx?
bonus? what contributes to dyspnea and exercise intolerance?

Amyloidosis leading to Restritive Cardiomyopathy (Diastolic dysfx)
bonus: ↑ filling pressure (which –> ↓CO)
Least common type of cardiomyopathy. Chr by myoc infiltr –> ↓ ventr compliance –> ↓diastolic ventr filling
Restrictive Cardiomyopathy
What’s your dx?
- 100% genetic (sarcomeric prots)
- ↑ IVS thickness (obstruction) w/ banana shaped LV
- Myocyte disaaray + replacement fibrosis on histo
bonus: why does sarcomeric change lead to gross heart changes?
Hypertrophic cardiomyopathy (diastolic dysfx)
Bonus: sarcomeric dyfx/change –> defective E transfer from mt to sarcomere
What does the pt have? how would you dx (2)
- Sx:
- Dyspnea on exertion (↑HR and contractility)*
- chest pain
- syncope*
- signs:
- loud S4
- systolic ejection murmur ± mitral regurg
- 2 upstrokes –> ↑↑↑carotid pulse rate
Hypertrophic cardiomyopathy
dx by echo + family hx
hint: dyspnea + syncope dt outflow obstruction
Explain how systolic ejection murmur changes with:
- squatting/lying/hand grip/straight leg raise
- standing/Valsalva
- where is its best heard?
- decreases dt ↓outflow obstruction
- increases dt ↓ventr filling
- best heard @ L lower sternal border (tricuspid posn)
- Most common type of cardiomyopathy
- 50% cases are idiopathic
- both ventricles are affected
- death w/i 5 years
Dilated Cardiomyopathy (systolic dysfx)
hint: Toktsubocardiomyopathy (broken heart syndrome)
Treatment for Dilated CMP (4) + anticoagn
- Digoxine (improves contractility)
- diuretics (ACE inh)
- VasoDs (βBs)
- Cardiac Transplant
hint; remove offending agent if possible
Clinical features point to what dx?
- L and R sided CHF sx
- S3, S4 + murmurs*
- Cardiomegaly (balloon~ on CXR)
- sudden death*
bonus: Explain the reasons behind the *
Dilated Cardiomyopathy
bonus:
- mitral/tricuspid insuffc –> murmurs
- cardiomegaly –> ↑thrmobotic risk
These are etiologies for what cardiomyopathy?
- Alcohol abuse,
- wet Beriberi,
- Coxsackie B viral myocarditis,
- chronic Cocaine use,
- Chagas disease,
- Doxorubicin
Dilated Cardiomyopathy
hint: ABCCCD
what leads to sudden death in young athletes?
ventricular arrythmia –> syncope –> suddetn death dt Hypertrophic Obstructive Cardiomyopathy
These are etiologies for what cardiomyopathy?
- Postradiation fibrosis,
- Löffler endocarditis (hypereosinophicic syndrome)
- Endocardial fibroelastosis in kids (thick fibroelastic tissue in endocardium)
- Amyloidosis
- Sarcoidosis
- Hemochromatosis (although dilated cardiomyopathy is more common)
Puppy LEASH*
Restrictive Cardiomyopthaty
hint: Puppy LEASH* is restrictive
6 stages of plaque formation
- endoth cell damage
- monocyte/lø adhesion (ox LDL + leukotriene chemotaxis)
- mø maturation
- lipid uptake by mø (foam cells)
- Sm mucle cell migration (media –> intima)
- advance lesion
Whats your dx?
- mostly asympto but AD
- mitral valve ballooning during systole –> mitral insuffc –> incidental mid systolic click + murmur
- emboli
- mixoid change –> ∆ conductionsystem –> sudden death
Mitral Valve Prolapse (MVP)
hint: floppy valves in 3-5% of Americans; Marfan + Ehlers Danlos syndrome assc
Whats your dx?
- degenerative change in the elderly
- stenotic leaflets + valve ring regurgitation

Mitral Valve annular calification
Whats your dx?
- Cardiac sx of seratonin sydnrome
- R heart lesions (subendo gray yellow plaques)

Carcinoid Valve Dz
Click and murmur become ___ (softer/louder) w/ squatting in mitral valve prolapse bc?
softer bc ↑ systemic resistance –> ↓ventr emptying
Complications of MVP include (3)
- infectious endocarditis
- arrythmia
- severe mitral regurg
hint: valve replacement
The difference bwn acute and subacute endocarditis (virulence, valve, predispn, eg bug)
Subacute
Acute
- Low virulence + small vegetations
- Mitral valve involvmt
- Previously dmg valves infted
- E.g. strep viridans
- High virulence
- Tricuspid valve (why?)
- Normal valves infted
- E.g. staph aureus
triscupid valve involvement dt to R heart drainage
Name the assc etiology:
- strep viridans (subacute)
- staph aureus
- staph epidermidis
- strep bovis
- chronic RHD, mitral valve prolapse
- IV drug abuse
- prosthetic valves
- colorectal carcinoma –> endocarditis
Name the HACEK organisms and key assc with endocarditis
- Haemophilus
- Actinobacillus
- Cardiobacterium
- EIkenella
- Kingella
assc with NEGATIVE blood cultures
Clinical features of bact endocarditis (4)?
- Fever (bactermia)
- Murmur (∆flow)
- veg emboli –> skin involvemnt: Janeway lession (palms and soles); Osler nodes (ouch); splinter hemorrhages; roth spots (retina)
- Anemia of chronic dz (microcytic + inflamm)
what’s the dx?
- small, sterile vegetations dt SLE
- undersurface of mitral > tricuspid valves
- ANA changes (eosinophilic necrotic debris) + mitral regurgitation

Libman-Sacks/Lupus Endocarditis
What’s the dx?
- sterile thrombotic vegs on mitral valve –> regurg
- hypercoagb state/underlying adenocarcinoma/marantic endocarditis

Non bact thrombotic endocarditis (NBTE)
Triad for chronic RHD
- Leaflet thickening (mitral fish mouth)
- Commissural fusion (aortic valve involement)
- thickened cordae tendinae
What’s the dx?
- Dyspnea on exertion, slowly ↑ with age
- Fainting spell + vision loss in one eye (aortic valve sx)
- Blood tinged sputum (pulm edema + hemosiderin cells)
- history of acute rheumatic illnesses (firbotic changes)
Chronic RHD
WHats the Dx with this type of pancarditis? assign each sx to a layer :
- mitral verrucae + regurg
- Ashoff bodiess + Anitschkow cells
- friction rub and chest pain
ACUTE rheumatic Fever
- endocarditis - mitral verrucae + regurg
- myocarditis (sudden death) - Ashoff bodiess + Anitschkow cells
- pericarditis - friction rub and chest pain
what does this dx point to?
- ↑ASO/Anti-DNase B titers
- minor criteria: fever and ↑ESR
- major criteria: J❤NES (what does this stand for?)
ACUTE rheumatic fever
hint: J❤NES
- Joints (polyarth)
- ❤ heart (pancarditis)
- Nodules on skin
- Erythema marginatum (trunk + limbs)
- Syndenham Chorea
why does strept throat (Pharyngitis) cause ARF?
bact M protein in Aβ-hemolytic strep mimics human tissue (Ab cross reactivity)
hint: S. pyogenes + anti streptolysin O titer
Check Valve
Whats your dx?
- Chronic wear + tear (age > 60)
- Hx of Healed RHD or congential biscupid valve –> fibrosis
- A fib and LV hypertrophy on ECG
- Cardiomegaly + calcification @ aortic valve on CXR
Calcified aortic stenosis
the ∆F508 mutation is class ___ (2). Describe the problems in each class.
- Class II - no traffic –> need to correct prot folding
- Class VI - less stable –> need to promote statbility

5 steps in CF pathophys:
- CFTR gene defect
- ∆ ion tranpsort
- ↓airway surface liq
- ∆ mucciliary clearance
- inftn + inflamm + mucus obstruction
explain why dosage reqs are much higher with short interval/cont admin (3)?
how would you dose tobramycin or Ceftazidime?
high/short dosage rationale:
- ↑metabs
- ↑excretion
- ↑vol of distribution
IV Tobramycine: 14 mg/kg/day
Ceftazidime: cont infusion of 200 mg/kg/day (10-14 g)
THe most common pathogen in CF pts is ____. Why are outcomes so bad?
Pseudomonas
- Polymicrobial Biofilms
- Co-dependancy
- ∆ virulence
2 non TB atypical mycobacterials that affect IMNS CF pts
- M. Avium (MAC)
- M. abscessus/M. chelonae
what is the dx? explain the asterisks
- ↓NaCl alkalosis
- infertility*
- manutrition + vit defc
- pancreatitis + diabetes*
- steatorrhea and billiary cirrhosis*
- neonatal jaundice + meconium plug
Cystic Fibrosis
* hint: ø vas deferens in males; pancreatic burnout of islet cells –> diabetes; mucus obstruction in biliary tree –> fat mal-abs
Whats the dx?
- onset of dyspnea/difficulty breathing hours within exposure to welding (self limited)
- fever, chills, cough, wheezing,chest pain (normal CXR)
- metallic taste in mouth
Metal Fume Fever
hint: zinc/cadmium oxide + teflon
Large Vessel Vasculitis Dzs (2)
- Takayasu Arteritis
- Giant Cell Artertitis

Medium Vessel Vasculitis Dzs (2)
- POlyarteritis Nodosa
- Kawasaki Dz

ANCA-assc Small Vessel Vasculitis Dzs (3)
- MIcroscopic Poyangiitis
- GPA (Wegener’s)
- Churg Strauss (Eosionophil GPA)

IMmune COmplex Small Vessel Vasculitis
- Cryoglobulemic Vasc
- Henoch-Schōnlein (IgA Vasc)
- AntiC1q Vasc (hypocomplementemic Urticarial Vasc)
- Anti-GBM Dz

Immune complex mediated Vasc is assc with what 2 dz?
- Rheumatoid vasc
- Lupus Vasc
Whats the dx?
- early, self limited childhood dz
- risk of renal involvement ↑with age
- purpura on buttocks and LE + abdominal pain (GI bleeds) + hematuria+ arthritis

HSP
Henoch-Schōnlein (IgA Vasc)
hint: small vessel; tx with steroids if severe; abdominal pain (GI bleeds); IgA nepropathy → hematuria (glomerular/mesangium bleeding)
ANCA assc small vessl vasculitis dz with extravasc granulomas (2)?
- Wegener’s Granulomatosis (cANCA; PR3)
- Churg Strauss (pANCA; MPO)

ANCA ass small vessl vasculitis dz withasthma and eosionophia (1)?
Churg Strauss
hint: pANCA + MPO; also has extravasc granulomas

Small vessel ANCA vasculitiis with neither extravasc granulomas/eosinophilia
Micro Polyangiitis
hint: pANCA or cANCA

Whats the dx?
- eosino-med necrotizing granulomas (lung, heart, GI*)
- pANCA ∝ severity
- progressive, steroid dep asthma + peripheral eoinophilia

Churg Strauss

Whats the Dx? How would you treat?
- necrotizing vasulities w/o granulomas (lung + kidney)
- ø nasopharyngeal involvment
- ⊕ pANCA (perinucear)
- Microscopic Polyangiitis
- tw: cyclophosphamide + steroids
hint: relapse is common
what’s the Dx? How would you tx?
- Necrotizing granulomas + vasculitis (nasopharynx, lungs, kidneys)
- sinusitis, hemoptysis, hematuria
- ⊕cANCA (cytoplasmic)
- 82% mortality @ 1 yr

GPA (granulomatous Polyangiitis; Wegener’s Granulomatosis)
tw:
- Cycophosph/Rituximab
- steroids (prednisone)
- bactrim prophx (for S.aureus)
subglottic stenosis is usually assc with what dx?

GPA
what’s the dx? How do you tx?
- Gran vasc in women > 50
- signs + sx: as ∆vision, headache w/jaw claudn, flu like sx , arthr-/my-algia + ↑ESR
- vasc biopsy: segnantal lesions w/ giant cells + intimal fibrosis
- Giant Cell/Temporal Vasculitis
- tw: steroids otw blindness!
hint: segmental lesions → false⊖ biopsy; major branches of carotid artery → blindness (opthalmic), HA/jaw (temporal); polymalgia rheumatica –> arthr-/my-algia + ↑ESR

(2) what’s the dx? How do you tx?
- Gran vasc in Asian women < 50 (classically)
- signs + sx: ∆vision + neuro, weak/absent pulses in UEs + ↑ESR
- Takayasu Arteritis
- tw CCSs
hint: branches of the aorta → “pulseless” dz
(2) whats the dx? how would you treat?
- fibrinoid necr vasculities that spares the lung
- HbsAg⊕ w/ pears on string renal arterial
- young adults with htn, mesenteric melena, CNS + sx
- Polyarteritis Nodosum
- tw with CCSs + cyclophosph
what’s the dx? how would you tx?
- Asian kids < 4
- erythema on palms and soles
- nonspecf fever + conjunctivitis
- coronary arteries at risk for 1)thrombosis + MI and 2)aneurysm
- Kawasaki Dz
- tw ASA + IVIG; otw self-limited
hint: the only case that you’d give ASA to a child with fever (usually causes Rye Syndrome)
(2) What’s the Dx? How would you tx?
- necro vasulitis in digits
- sx: ulcerative, gangrenous → autoamputation of fingers + toes
- Raynaud’s
- smokers*
- Buerger Dz
- tw smoking cessation
hint: vasospasm → Raynaud’s