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Stuff I didn't know

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Plummer-Vinson Syndrome
postcricoid dysphagia, upper esophageal webs, and iron deficiency anemia (also atrophic glossitis)
Budd-Chiari disease
occlusion of IVC or hepatic veins with centrilobular congestion and necrosis, leading to congestive liver disase - ass'd with polycythemia vera, pregnancy, hepatocellular carcinoma
Most common of all tumors in females.
Leiomyoma (myometrium fibroid)
(also most common obstetrical obstruction)
Gastric heterotopia
small area of normal gastric tissue in an abnl location - typically these occur in small intestine and can produce enough gastric acid to cause a peptic ulcer in adjacent sm. intestine tissue -> GI bleeding
Monckeberg's arteriosclerosis
Arterial sclerosis involving the peripheral arteries, especially of the legs of older people, with deposition of calcium in the medial coat (pipestem arteries) but with little or no encroachment on the lumen
Hyperplastic arteriosclerosis
"onion-skinning"
proliferation of sm muscle cells in arteries - may also have acute vessel wall necrosis w/ fibrin deposition
Hallmark of malignant hypertension - seen esp in kidneys
p450 Inducers
EtOH (chronic)
phenytoin
barbituates (phenobarbitol)
Carbamazapine
Ethosuximide
Rifampin
p450 Inhibitors
macrolide abx
INH
cimetidine
ketoconazole
SMX-TMP
Action (Effect) of p450 Inhibitors?
Decreases metabolism of other drugs, increasing their effect.
20 yo male presents with idiopathic hyperbilirubinemia
Gilbert's Dz (stress-induced jaundice)
-unconjugated bilirubin
-UDP-glucosyl transferase
WTF?
Aminoacidopathy
tend to present in first days of life with feeding difficulties, lethargy, seizures, liver dz, renal dz, coma
Isovaleric acidemia: urine smells like sweaty feet
What organ is most freq involved in AIDS?
Lung - p. jiroveci
What is the #1 cause of PID?
Chlamydia (freq asx, but can -> Chandelier sign)
in men -> non-gonococcal urethritis
Protein-Energy Malnutrition (PEM)
1. Anergy (to common ag) (impaired T cell immunity and dec. Th)
2. Dec total lymphos; impaired phagocytic fn
3. Negative N balance (in healthy people, N balance is near 0)
Aldosterone deficiency:
1. what dz is char by this?
2. Is K retained or wasted?
Addison's Dz is char by aldosterone deficiency. K is retained.
When K is exhausted, H is exchanged w/ Na --> metabolic acidosis.
Is anthrax encapsulated?
Yes.
What kind of capsule does anthrax have?
Polypeptide. Most have a polysaccharide capsule.
Poliovirus - characteristics of the virus (not the sxme)
RNA of the Picorna family (picorna = PERCH)
Naked (RNA nakeds are Picorna, Calici, Reo)
SS+, Icosahedral
Polio (the clinical dz)
Also: which motor neurons? who is more likely to die from it: children/adults?
Anterior horn LMNs
-flaccid paralysis (like W-H floppy baby)
-infxn ass'd with fever, myalgia
-virus proliferates in gut lymphoid tissue
-more likely to cause death in adults than children
Polio vaccines
Killed: Salk (given in US) (salK=Killed)
Live, attenuated: Sabin (can be oral, given worldwide)
What is responsible for immediate hypersensitivity rxns?
Histamine
VSD
usu presents at 4 wks old w/ CHF - poor feeding, sweating, tachypnea
-systolic thrill at LLBorder w/ pan systolic murmur
-if small can close spontaneously
-if large requires surgery
-if uncorrected: heart failure w/ Pulm HTN, pos poor growth/brain dev
-susceptible to infected clots and pulm infxns
-Majority: membranous septum defects, dynamic, 50% close w/in 2 years
Tetrology of Fallot
Embryologic defect where?
1. Pulmonary stenosis
2. VSD
3. Over-riding aorta (shifts rightward and is next to the VSD-getting more deox blood)
4. RV hypertrophy
-d/t defect in infundibular septum
R->L shunts (5)
1. Tetrology of Fallot
2. Truncus Arteriosus persistance
3. Transposition of the great vessels
4. Tricuspid atresia
5. Total anomalous pulmonary venous connection
What are the sx/risks of R->L shunts?
Cyanosis and risk of paradoxic emboli
What produces a L->R shunt?
ASD, VSD (no cyanosis)
Hypoplastic left heart syndrome
usu incompatible with life; requires surgically keeping ductus arteriosus open (drug that does that is alloprastadil: PGE2 agonist)
Selenium
cofactor for glutathione peroxidase (antioxidant in cytosol)
Molybdenum
cofactor for Xanthine Oxidase (gouty!)
Chromium
enhances insulin activity
Why is bilirubin glucaronyl transferase important in the newborn?
Bilirubin glucaronyl transferase permits bilirubin conjugate to be excreted (in water soluble form). This enzyme is synthesized late in development, so newborns may be jaundiced.
What do acyclovir and gancyclovir do?
Inhibit viral polymerase
How does Ribaviron work and what is it used for?
Used for infxn by RSV
works by interfering with viral mRNA capping
How does amantadine work and when is it best given?
It blocks viral uncoating - so it's best given before infxn.
Picornavirus family
Polio
Echo (aseptic meningitis) and Entero
Rhino
Coxsackie
Hep A
What diseases are caused by Coxsackievirus? (4)
-Aseptic meningitis
-herpangina/febrile pharyngitis (grayish-yellow ulcers)
-hand, foot, and mouth disease
-myocarditis
Mech of Pitting Edema
excess Na and H20 in interstitium (inc Hydrostatic P or dec Oncotic P)
--> pitting edema b/c greater vol of interstitial space vs vascular component, but there is a greater gain in H2O than in Na (dilutional hyponatremia)
-a dec in Tubular Na reabsorption -> dehydration, poor skin turgor
***Nephrotic Sxme***
Leishmaniasis
L. major: moist cutaneous leish (Persian Gulf)
L donovani: visceral leish (kala-azar) (mucocutaneous)
(tx: pentavalent antimony)
Myasthenia Gravis
-Abs to Ach rec
-muscles innervated by cranial N affected most (~100% ocular involvement)
-weakness with use
-smooth muscle spared
-freq presents with bilateral ptosis and horizontal diplopia
-many px have thymoma or thymic hyerplasia
Lambert-Eaton
-Abs to Ca Ch on presynaptic endplate of NMJ
-proximal limb muscles most affected (Cranial N spared)
-repetitive contractions increase strength (temporarily)
-Ass'd w/ small cell carcinoma of lung (ectopic ADH, ACTH)
What kind of receptor is ACh receptor?
Ion channel (Na)
What has the slowest conduction velocity in the heart?
The AV node.
AV conduction delay is necessary for ventricular filling.
How does digitalis work?
Binds Na/K pump--> increased intracellular Na - the Na needs to get out, so the Na/Ca antiport txsporter picks up the slack, bringing more Ca into the cell.
This makes the contraction stronger.
Digitalis also increases the velocity of AV node conduction; decreases refractory period; increases automaticity of heart cells (and AV node)
What is the most common cause of tricuspid regurgitation?
Rt ventricular failure and dilation
-often secondary to Pulm HTN or Left ventricular failure
**S3 sound
How does aortic regurgitation affect pulse?
It widens the pulse pressure.
Tell me about decreased arterial compliance.
ass'd w/ aging and atherosclerosis
-> increased pressure req'd to pump blood by ventricle = increased systolic pressure = wider pulse pressure
Why might the half life of a drug be prolonged in the plasma of an elderly person?
Decreased phase 1 reactions (oxydation, reduction, hydroxylation)
1 decreased liver mass and liver blood flow all slow metabolism.
2 Increased Vd d/t increased body fat and decreased lean mass
3 decreased kidney mass, flow, tubular fn decrease clearance
Bismuth and Sucralfate
bind to ulcer base; increase ulcer healing
AE: sucralfate can bind proteins/other drugs, limiting their effectiveness, so if giving other drugs, must be administered at separate times
Probenecid
Anti-gout drug
treats CHRONIC gout (colchicine for acute)
*inhibits reabsorption of uric acid
*inhibits secretion of PEN, thus decreasing its clearance and increasing its plasma 1/2 life
Nitric oxide
potent vasodilator
activates guanylate cyclase, increasing cyclic GMP levels
*Sildenafil is a cGMP phosphodiesterase inhib)
-Contributes to the pathophysiology of shock
3 constituents of the exotoxin of Bacillus anthracis
1. protective antigen
2. edema factor
3. lethal factor
glutamate dehydrogenase
Can liberate an amino group as free ammonia, which is then passed into the urea cycle (via carbamoyl phosphate).
Reversible: in times of ammonia excess, will transfer free ammonia to alpha-ketoglutarate to make glutamic acid.
What is the relationship between glutamine and ammonia?
Glutamine is the major vehicle for transporting ammonia in a non-toxic form through the blood. (this rxn: ammonia-> glutamine catalyzed by glutamine synthase)
Marker for fetal neural tube defects
aFP
Valproate can cause neural tube defects.
The trapezius is located where and elevates what?
This muscle is located in the posterolateral neck and elevates the acromion.
The cephalic vein can be reliably found between which two muscles in the upper arm?
found between the deltoid and pectoralis major
The chorda tympani is a branch of Cranial Nerve _____ that controls salivation from the ___ and ____ glands.
Cranial Nerve VII
salivation from submandibular and sublingual glands
Potter's syndrome
malformation of ureteric bud leads to bilateral renal agenesis -> oligohydramnios
Baby has limb and facial deformities, pulmonary hypoplasia
Which peritoneal ligaments/boundaries can be cut for surgery, and which have vessels?
Gastrohepatic and Gastrosplenic are empty (CUT the cheese = passing GAS)
Splenorenal has splenic artery and vein
Hepatoduodenal has common bile duct, common hepatic artery, portal vein)
What does the anterior mediastinum contain?
This contains the thymus and fatty tissue.
What does the superior mediastimum contain?
This contains the ascending aorta, aortic arch, and descending aorta, the SVC, brachiocephalic veins, thoracic duct, thymus, trachea, and esophagus.
What is contained in the middle mediastinum?
This contains the heart and roots of the great vessels.
What is contained in the posterior mediastinum?
This contains the descending aorta, azygus and hemiazygus veins, thoracic duct, and esophagus.
Fall on outstreched hands
scaphoid fracture (pain in anatomic snuffbox)
Which nerve crosses the palatine tonsil?
CN IX - glossopharygeal
carries sensation for posterior 1/3 tongue
Which 2 muscles medially rotate the arm?
Subscapularis and teres major (attach to lesser tubercle)
Meckel's diverticulum
2 inches long
2 feet from ileocecal valve (bleeding or obstruction near terminal ileum)
2% population
2 types of epithelia (maybe): gastric, pancreatic
commonly presents in 1st 2 years
Brain structure(s) near the 3rd ventricle
hypothalamus
Brain structure(s) near the 4th ventricle
Pons (floor of 4th ventricle)
Cerebellum (overlies the 4th ventricle)
Brain structure(s) near the lateral ventricles
Caudate nucleus
Hippocampus (adjacent to inferior/temporal horn of lateral ventricle)
Pyriform cortex
primary olfactory cortex
Insula cortex
primary gustatory cortex
Nucleus ambiguus
special visceral (efferent) fibers from IX and X
Postcentral gyrus
primary sensory cortex
Precentral gyrus
primary motor cortex
Area postrema at floor of 4th ventricle
chemoreceptor trigger zone- induced by severe chest pain - projects to medullary vomit center (lateral reticular formation)
Destruction of ventral pons
locked-in syndrome
Meningomyelocele
meninges, CSF, and spinal cord involved
major neurological deficits
Spina bifida aperta
complete failure of fusion of neural plate ass'd w/ malformation of vertebral arches and underdeveloped plate only covered with skin.
-no mass lesion present
-major neurologic deficits
Spina bifida occulta
mildest neural tube defect
small vertebral defect w/ normal spinal cord and meninges
-skin dimple overlying adipose tissue, hair follicles or sinus
corneal reflex
V in VII out
right border of the heart
right atrium
anterior border of the heart
right ventricle
Psoas does what do the hip?
Hip flexion.
Appendicitis often present w/ pt flexing their legs at the hip and extending the leg produces pain.
Dorsal horn of the spinal cord derives from what?
alar plate
(sensory)
anterior horn of spinal cord derives from what?
basal plate
Esophagus - type of muscle and innervation
upper 2/3: striated muscle w/ innervation from vagus
lower 1/3: smooth muscle innervated by splanchnics
Subclavius muscle
protects vessels in the event of a clavicular fracture
Epiphyseal plate on X-ray
looks like a line crossing the bone near the end - may be mistaken for fracture by inexperienced
(epiphyseal plate contains radiolucent cartilage when bone has not yet fully ossified)
The glossopharyngeal n carries somatic, visceral and special sensory information. Describe them all.
What happens if you cut it?
1. General somatic sensation from the posterior upper pharynx, eustachian tube, posterior 1/3 tongue
2. Taste from posterior 1/3 tongue
3. Afferent fibers from the carotid sinus baroreceptors and carotid body chemoreceptors. (if you cut it -> reflexive sympathetic outflow -> hypertension and tachycardia!)
(efferent to stylopharyngeus)
Dandy-Walker syndrome
enlarged 4th ventricle/posterior fossa
malignant otitis externa
pseudomonas aeruginosa
-most common in elderly diabetics
Vitiligo
autoimmune destruction of melanocytes
dermatitis herpetiformis
ass'd w/ Celiac dz
-vesicular rash/lesion at dermal/epidermal jct
-type 3 hypersensitivity
Erythema nodosum ass'd w/ ?
Sarcoidosis
(also TB, leprosy, sulfonamides, cocci)
-multiple tender, raised, erythematous nodular lesions over lower extremities
reduction in brain levels of choline acetyltransferase
Alzheimer's Disease
Effect of uncal herniation on CN III
1. ipsilateral CN III palsy
2. ipsilateral dilated pupil
(disrupts pupillary light reflex)
Babies born to mothers with diabetes are Big/Small ?
They are likely to be bigger babies. Maternal hyperglycemia -> fetal insulin release-> increased fat and muscle synthesis
What is the purpose of bile acids?
They are a way to get rid of cholesterol, which the liver can't use. They are either excreted or conjugated by bac to bile salts, which act as detergents that aid fatty acid absorption in the gut and are recyled.
5 causes of bile salt deficiency
1. cirrhosis (dec synthesis)
2. Bac overgrowth in gut (inc degredation)
3. Crohn's disease (dec absorption)
4. Binding agents like cholestyramine (dec absorption)
5. Obstruction of common bile duct (dec delivery to small intestine)
Which immunoglobulin receptor is expressed by B cells?
IgM
What happens during prolonged starvation?
1. Glycogen stores are depleted after 10-18hrs, and gluconeogenesis begins to fuel RBCs.
2. Lipolysis generates fatty acids to fuel muscles.
3. Brain increases its use of ketones for fuel.
4. After urea excretion is initially increased d/t muscle breakdown, proteolysis decreases and so does urea excretion.
What does the presence of secondary follicles in lymph nodes indicate?
Indication of an ongoing humoral response to an infection. Resting mature B cells live in primary follicles until they are exposed to antigen, then they develop secondary follicles and make antibodies.
rhabdomyoma
most common primary heart tumor in children - ass'd w/ tuberous sclerosis
Unstable angina is due to ____
Slowly developing thrombosis w/w/o underlying atherosclerosis
Thrombolytics make good tx
Dressler Syndrome
autoimmune rxn -> fibrous pericarditis w/ friction rub ~ several weeks after MI
Metoprolol is used to treat ______, but is known to have what side effect?
Used to treat hypertension, but has dyslipidemia as a side effect (dec HDL and inc LDL)
Beta blockers (like propanolol) are used to treat what kind of arrhythmia?
ventricular arrhythmias (also supraventriculars and slowing vent. rate during afib and a.flutter)
-Type II antiarrhythmic
-Dec SA node automaticity, dec AV node conduction velocity, inc AV node refractoriness
heart defect ass'd w/ Down's Sxme
endocardial cushion defect
What percent of patients with ischemic heart disease will present with sudden death?
25%
Asthma PFTs:
1. FEV-1
2. FVC
3. FEV/FVC ratio
4. TLC
All PFTs are decreased except TLC (increased d/t air trapping)
Mycobacterium Avium Intracellulare
is NOT the answer.
TB is much more common cause of lung infection in AIDS px.
Most common cause of atypical pneumonia in a teen and its tx
M. pneumonia
Tx w/ erythromycin or tetracycline (pen resistant b/c no cell wall)
neoplasms ass'd w/ tuberous sclerosis (2)
(+1)
rhabdomyoma
astrocytoma
(also w/ cortical hamartomas, aka "tubers")
What sx/findings characterize tuberous sclerosis?
facial angiofibroma
seizures
MR
bartonella
cat-scratch fever
Lead poisoning
1. constipation, colickly abd pain, HA, irritability -> neuropathy
2. microcytic anemia w/ basophilic stippling and elev erythrocyte protoporphyrin
3. tx: EDTA (edetate calcium disodium)
Most common cause of thrombocytopenia
Heparin therapy, esp if longer than 10 days
embryo hematopoiesis
Young Liver Synthesizes Blood
yolk sac, liver, spleen, BM
von Willebrand factor does 2 things:
1. links platelets to collagen exposed by damaged endothelium
2. binds platelets to newly formed fibrin strands in blood clot
Increased ESR
anything that -> more antibodies (autoimmune, cancer, pregnancy, infxn)
mech: the RBCs stick to each other better and settle faster
Decreased ESR (3)
Sickle cell anemia
Polycythemia vera
CHF
Ristocetin test
detects von Willebrand disease
Eosinophilic granuloma, Hand-Schuller-Christian, and Letterer-Siwe are all subsets of what disease?
Histiocytosis X
Histiocytosis X
idiopathic immune disorder
1. prolif of histiocytes
2. inflmn of bronchioles and sm vessels
3. fibrosis and alveolar destruction
-may also have lytic bone lesions and exophthalmos (H-S-C variant)
TX: corticosteroids
What will happen to PO2 and PCO2 values if arterial blood is accidently exposed to air?
arterial O2 concentration will be falsely increased, and arterial CO2 concentration will be falsely decreased
Colon cancer, bacteremia/septicemia, and endocarditis
s. bovis
Pt with history of RA is at risk for what kind of heart disease?
Restrictive cardiomyopathy
(amyloid!)
Most common presentation of carcinoma in the head of the pancreas
Jaundice (direct/conjugated bilirubin, and increased alk phos) d/t compression of common bile duct
Most common kind of colon polyp?
Hyperplastic
-small and rounded
-glands and sawtooth crypts
-goblet and columnar epithelial cells
-no atypia
-no malignant potential
Cause of annular pancreas
Abnl rotation of ventral pancreatic bud around the duodenum
(nl: bud rotates around the right side; abnl: bud rotates around rt and left side)
Menetrier's Disease
Protein-losing gastroenteropathy
-thickened gastric folds, hyperplasia of mucus cells w/ scant gastric glands
-increased mucus -> protein loss, hypoalbuminemia, edema
Campylobactor pylori
most common food-borne
**curved rods, polar flagella, gram-neg, oxidase +
-poultry or poultry products
Cisapride
some kind of GERD drug that can cause torsade de pointes if given w/ p450 inhibitor)
Gallstones ass'd w/ chronic hemolytic disease
Calcium bilirubinate (pigment bile stones from degredation of heme)
Gallstones
usu made of cholesterol
Fat Forty Female Fertile
oral cancer (scc)
usu found on floor of mouth
-ass'd w/ HPV 16
-alcohol and smoking/tobacco use
Kidney Stones - most commn kind?
Calcium (80-85%)
-result of hypercalcemia
-ca oxalate or ca phosphate or both
-tend to recur
-Radiopaque
Kidney stones - struvite
2nd most common
-Ammonium magnesium phosphate
-radiopaque
-urease+ bugs: proteus vulgaris or staphylococcus
-esp in px w/ indwelling catheters
"Staghorn" kidney stone
struvite
-can form large struvite calculi that can be a nidus for UTI
Classic presentation for kidney stones
-sudden onset colicky pain
-radiates to the groin
-UA shows numerous RBC
(think dehydration)
Kidney stones - uric acid
Ass'd w/ what diseases?
ass'd w/ hyperuricemia (gout)
-radioLUCENT
-often ass'd w/ dz w/ inc cell proliferation (leukemia, myeloproliferative)
Kidney stones - cysteine
Cystinuria
-hexagonal
-radiolucent, but can co-ppt w/ ca -> staghorn, radiopaque
Jaundice, fever, RUQ pain
Charcot's triad
=obstruction of common bile duct (cholangitis)
What is the most important risk factor for duodenal peptic ulcer disease?
H. pylori
(100% of duodenal ulcers vs 70% of gastric ulcers)
Aminoglycoside toxicities (2)
1. Nephrotoxicity
2. Ototoxicity
(hydration may help prevent)
Halothane toxicity
Idiosyncratic liver failure
Shigella
-bacillary dysentery
-diarrhea may have blood, pus, mucus
-fluid replacement critical (TMP-SMX optional)
-epidemics commonly in crowded pop., poor sanitation; or day care
Oxybutynin
Anti-muscarinic and anti-spasmodic for bladder instability
Papillary necrosis
tips of renal papilla are pale gray w/ parenchymal loss; coagulative necrosis limited to distal renal pyramids, no glomerular/interstitial changes
-ass'd w/ diabetes
-also ass'd w/ analgesic abuse, sickle cell, urinary tract obstruction
Acute interstitial necrosis
-acute renal failure, fever, maculopapular rash, eosinophilia (may also see periorbital edema, wheezing)
-hypersensitivity reaction to drugs (NSAIDs, beta-lactams, sulfonamides, diuretics, phenytoin, cimetidine)
Which part of kidney most susceptible to sickle cell damage?
Vasa recta
-the high osmolality of the renal medulla favors sickling (can -> papillary necrosis, proteinuria)
Minimal change disease
may be ass'd with foot process FUSION, thought to be d/t a weird T cell response
-AKA lipoid nephrosis
Which part of the renal tubule is always hypotonic?
Early distal tubule (think where thiazides work)
"diluting segment"
Which diuretic is CONTRAINDICATED in renal failure?
Spironolactone/ K sparing
Serous or Mucus?
1. Parotid gland
2. Submandibular gland
3. Sublingual gland
1. serous
2. mixed
3. mucus
"chalky white deposits"
fat necrosis or saponification d/t acute pancreatitis/amylase in peritoneal cavity
"frothy urine"
albuminuria
(this + edema = nephrotic sxme)
Myoglobin can be filtered into the urine, and it will produce what odd sign?
The dipstick will be positive for blood, even though there is no blood in the sample.
liver with chronic inflmn, continuing necrosis of hepatocytes surrounding portal tract (limiting plate) and piecemeal necrosis
Chronic active hepatitis
ground glass nuclei = hepatitis B infxn
which part of renal tubule has a brush border?
proximal convoluted tubule
In pregnancy, GFR is usually increased or decreased?
increased (creatinine values of less than 1)
What is responsible for keeping the Na level in serum stable when you ingest large amounts of salt?
ADH (increases perm. to water in the distal tubule and allows concentrated urine to be excreted)
traveller's diarrhea
ETEC
enterotoxic e. coli
toxin activates intestinal adenlyate cyclase -> overexpression of cAMP -> mild secretory diarrhea
Damage to what -> loss of hair cells and hearing loss?
Organ of Corti
(OC has hair cells, which rest on the basilar membrane)
shoulder injury with abnormal depression below the acromion
shoulder dislocation
phenylephrine
pure alpha agonist
mydriasis, nasal decongestant
(alpha rec for radial muscle, but not ciliary, so mydriasis w/o cycloplegia)(ciliary muscle has B2 rec)
Causes paradoxical splitting of heart sounds (2)
1. aortic stenosis
2. LBBB
Vitamin A toxicity
Arthralgia, alopecia, headache, skin changes, sore throat, fatigue
B6 deficiency
sx: convulsions, irritability - inducible by INH and OC
(fn: transamination cofactor)
Which antibody crosses the placenta?
IgG
What is the difference between Direct Coombs and Indirect?
Direct: see if anti-serum agglutinates the patient's RBCs (does Anti-B agglutinate RBC sample? - if so, sample is type B blood)
Indirect: detects presence of IgG (warm agglutinin) antibody in serum (if serum from pt has anti-B and is mixed with B cells - it will agglutinate and the patient has type A blood)
What does RPR test for?
Syphilis
(SLE gives false+)
Anti-smooth muscle antibodies
AI hepatitis
Leucovorin
to diminish/prevent toxicity ass'd w/ antineoplastic folic acid antagonists (methotrexate)
Pencillamine
chelator-promotes renal excretion of copper (Wilson's)
-also used for lead poisoning and tx of RA (last resort)
Hemorrhagic cystitis
sudden onset dysuria and freq, in the absense of bacteriuria
-px taking ifosfamide and cyclophosphamide (nitrogen mustards)
-can be prevented w/ MESNA
Rosenthal fibers
pilocytic astrocytoma
(or reactive gliosis)
-corkscrew-shaped, v. eosinophilic
(good prognosis in post fossa)
tumor appears as cyst w/ mural nodule and rosenthal fibers
pilocytic astrocytoma
ependymal tumor histology
rosettes (either pseudo around small vessels or true around small lumina)
HLA-A3
Hemochromatosis
Kwashiorkor
lack of protein: MEAL
Malabsorption
Edema
Anemia
Liver is fatty
Microtubules and drugs that act on them (4 things, 5 drugs)
-Microtubules
(Mebendazole/thiabendazole)
-have Tubulin
(Taxol)
-bind GTP
(Griseofulvan)
-are Cylindrical
(colchicine)
-collapse Very fast
(Vincristine/vinblastine)
Pyruvate dehydrogenase deficiency
(nl fn: Pyruvate -> Acetyl CoA)
backup of pyruvate and alanine -> lactic acidosis
-in alcoholics, d/t B1 def
TX: increase intake fo fat (ketogenic nutrients
preeclampsia before the 20th week of pregnancy indicates what?
indicates hydatiform mole
Homer-Wright pseudorosettes
1. Ewing's sarcoma
2. medulloblastoma (PNET)
How are receptors that are expressed on the cell surface manufactured?
Synthesis begins in cytosol on free ribosomes - completed on ribosomes bound to RER, w/ help from chaperones (calreticulin)
What does calreticulin do?
binds to misfolded proteins in RER and prevents them from being promoted to the golgi (they get degraded instead)
-this is for proteins bound for the cell surface only
mosaicism
When some cells have different genetics than other cells in same person
-can happen in Down Sxme if nondisjunction of 21 occurs during mitosis rather than during meiosis
Which MHC class is responsible for organ rejection?
MHC II
C3 nephritic factor
an IgG autoantibody that binds to C3 convertase, making it resistant to inactivation -> consistantly low completment levels
-ass'd w/ Type II Membranoproliferative glomerulonephritis
Edwards syndrome
trisomy 18
-club feet / rocker-bottom feet
-second digit overlaps 3rd and 4th
-multiple congenital anomalies
-may have small placenta, single umbilical cord
-small mouth/jaw, prominance of occiput
-low-set ears
-clenched hands
Patau syndrome
Trisomy 13
-may also have rocker bottom feet (less common) and multiple congential anomalies, but defects are more likely to be midline: cleft lip/palate, holoprosencephaly, eye and scalp defects, dermal sinuses
-least common viable trisomy
-small head, eyes
may have polydactyly
-congenital heart defects
HNPCC
defect in mismatch repair gene (MLH1, hMSH)
-microsatellite instability (dinucleotide repeat)
Where are elastic fibers found? (3)
1. aorta
2. vocal cords
3. ligamentum flava (connect the vertebrae)
Clathrin polymerization
clathrin pits for receptor-mediated endocytosis
-polymerization responsible for budding in the vesicles of rec-med endocytosis
-these vesicles deliver lysosomal proteins from golgi to endosomes/lysosomes
-also responsible for formation of secretory vesicle involved in regulated secretion
Laron dwarfism
congenital absence of growth hormone receptors
-GHBP is identical to extracellular portion of GH rec, so no GHBP confirms this dz
-IGF-1 levels low b/c no rec on hepatocytes=no IGF-1 secreted from liver
Glucocorticoids: increased or decreased sensitivity to insulin?
decreased sensitivity to insulin
(insulin resistance)
Reiter syndrome is associated with what kind of infection 70% of the time?
chlamydia
Which arthritis is DISTAL interphalngeal joints?
Osteoarthritis
Heberden's Nodes
Osteoarthritis
Myofibroblast
with contractile proteins, fn in wound closure
Dupuytren contracture (palmar fascia) is myofibrils working with collagen fibrils of the fascia
basophilic rhomboid crystals
calcium pyrophosphate in pseudogout
-tends to affect older people, big joints
Pick's disease
like Alzheimer's, but w/ atrophy of frontal and temporal lobes
-ballooned neurons (Pick cells) or cytoplasmic inclusions (Pick bodies)
-slowly progressive dementia w/ language disturbances and beh changes
-may eventually -> mutism
Where is the brain atrophy in Alzheimer's?
diffuse brain atrophy
Motor charac of Parkinson's Dz
cogwheel rigidity, resting tremor, festinating gait
resting tremor
Parkinson's
Intention tremor
cerebellal problem
Trousseau's syndrome
migrating thrombophlebitis ass'd w/ visceral cancer (like pancreatic cancer)
-for example, may present with episodes of unilateral leg swelling, involving both legs at different times
antibiotics best used in pregnancy
azithromycin
erythromycin
cephalexin
Amoxicillin, ampicillin, augmentin
Lipoma vs liposarcoma
Lipoma: microscopically identical to fat, composed of adipocytes; nucleus displaced to the periphery
Liposarcoma: a common soft tissue tumor, middle-aged/elderly; thigh, retroperitoneum common sites - composed of pleomorphic lipocytes (looks embryonal) - cytoplasm filled w/ lipid vacuoles that char. indent the nuclear membrane - prognosis depends on location, age
Karyolysis
pale chromatin ass'd w/ cell necrosis
-also, chromatin may form irregular clumps and nucleus may shrink into a dense pyknotic body
CD5+ cell
Path: Mantle Cell Lymphoma
and lymphocytic leukemia
nl: ass'd w/ T cells
theophylline
by inhib cAMP, blocks mast cell degranulation
-excellent long-term drug for treating allergies (and asthma) in kids
Inhibition of C1 (1st step of complement) produces what condition?
Angioedema
-b/c it inhibits Factor XII (intrinsic path) and kallikrein (kallikrein contributes to formation of plamin (which makes fibrin) and bradykinin)
What happens to Factor VIII in liver disease?
Factor VIII goes up
Bleeding disorders:
Vit K deficiency vs Vit C def
Vit K: inc PT, nl bleeding time
Vit C: normal PT, inc bleeding time
What do you give for heparin overdose?
protamine sulfate
Type I collagen
this + elastin makes most things
-ground substance: proteoglycans and glycoproteins (stabilize fibrillar network)
-high tensile strength
Type II collagen
hyaline cartilage
-articular joints
-frosted glass appearance
-ground substance may obscure the type II fibers
Type III collagen
lymphatics/reticular system
Type IV collagen
Basement membrane
-less fibrillar than type I
Prothrombin time
PT
extrinsic pathway
warfarin
Partial Prothrombin Time
PTT
intrinsic pathway
heparin
Sx of salicylate toxicity
dizziness, tinnitus, hearing impairment; later nausea, vomiting, hypervent, tachycardia, flushing, sweating, pos CV collapse
-caused by agents that acidify urine dec clearance of salicylic acid
-example: Ammonium chloride could do this
patient presents with rash, fever, lymphadenopathy, arthralgias
-recent hx of drug therapy
Serum sickness (type III hypersensitivity)
most common cause is PEN
intercalates DNA, blocking replication
bleomycin, doxirubicin
Antihistimines commonly have what kind of side effects?
What is diphenhydramine?
Which antihistamines have lower side effects?
1. anti-cholinergic SEs are common (anti-SLUDG)
2. Diphenhydramine is benadryl and commonly has such side effects
3. Zyrtec, allegra, claritin (Cetirizine, fexofenadine, loratadine) have fewer anti-cholinergic side effects)
C3a and C5a
anaphylatoxins, triggered by IgE-mediated type I hypersensitivity response
INF-gamma
T cell-mediated activation of macrophages -> epithelioid cells and mulinucleated giant cells in granulomas
Prostaglandin E
Mediates temperature control mechanisms in the brain
-Inc PGE in brain as part of acute phase responses of inflmn -> fever
Neuroblastoma
childhood tumor of sympathetic nerves (commonly parasympathetic chain or adrenal medulla)
-N-myc (chrom 2) - greater amplification = poorer prognosis
-better prognosis: aneuploidy, younger age (under 1 yr), ganglion cells (=better differentiation)
Arsenic poisoning
(may be ass'd w/ old rat poison)
SX: vomiting, rice water stools, hypotension, GARLIC odor on breath
TX: succimer (po) or dimercaprol (iv) (both are chelators and have following tox: htn, n/v, HA) - succimer is worse
lecithinase
clostridium
Scarlet fever
strep. pyogenes (beta-hemolytic) that has been infected with a phage
-sx: sore throat w/ swollen red tonsils w/ white spots, enlarged cervical lymph nodes, diffuse, erythematous rash that blanches and has sandpaper-like texture
Leigh disease
Mitochondrial DNA defect - cytochrome oxidase
SX: (young adult) progressive intellectual deterioration, weakness, ataxia, seizures
-typically fatal w/in a few years after sx develop
Tumor cachexia
d/t TNF-alpha and probably IFN and IL-1: increase catabolism of proteins and fat
Methimazole
tx for Graves Dz: inhibits tyroidal peroxidase and prevents incorporation of iodine into thyroglobulin
anuclear cell "ghosts"
coagulative necrosis-
seen in MI
Ataxia-telangiectasia: DNA repair defect due to what kind of a mutation?
Inactivation of tumor suppressor genes
-high incidence of malignancy, esp lymphoreticular (hodgkin, non-hodgkin, lymphomas, leukemias)
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