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162 Cards in this Set
- Front
- Back
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H&E; H=
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NBC=nuclei, bacteria, calcium
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Prussian blue
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iron
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Congo red
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amyloid
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PAS
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Carbs (BM, Diabetes, Fungi)
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Silver
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Fungus, BM
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Envelope of herpes
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nuclear derived
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Mast cell location
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Skin, GI, Lungs
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Target of Goodpasture
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a3 subunit on collagen type IV
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Deposition in type III hypersensitivity
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kidneys (glomerulonephritis), joints (arthritis), blood vessels (vasculitis), skin (rash)
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CD3
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bring signal into cell so can recognize(t8 cells bind MHC1 or t4 bind MHCII)
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Caspase 3 kills via
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activation of endonucleases, antiproteinases = apoptosis
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Granulomas
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TB, sarcoidosis, Chron’s, fungus, etc
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T4+ turns self on via
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IL-2, then activates macrophage one itself activated via IFN-gamma
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3 component required for granuloma
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T helper lymphocytes, macrophage (epitheliod cell),
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Cyclophosphamide metabolism
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liver P450 into nitrogen mustard plus acrolein (hemorrhagic cystitis)
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MESNA MOA
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binds acrolein, so don’t get cystitis
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Radiation damage
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DNA directly and via free radical formation from water
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Vit A deficiency
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night blindness (rhodopsin-rods), maturation of skin (bumps skin, sclera; squamous metaplasia of urethelium of pelvis/bladder=kidney stones; infection)
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Vit C deficiency
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scurvy; no hydroxylation in collagen; petechiae; bowing of legs
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Niacin can be made via
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tryptophan (as is serotonin, carcinoid tumor long term-pellagra)
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Blood in pancreas
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acute pancreatitis (amylase goes up first, lipase more specific)
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Caseating granuloma
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center dead (no nuclei present)
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Fibrinoid necrosis
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malignant hypertension (artery walls die), acute immune disease (RA, RF (Aschott), vasculitis (Wegners, Kawasaki))
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Rheumatoid nodule
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fibrinoid necrosis of tendon
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Dry gangrene
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Coagulative necrosis
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Wet gangrene
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liquefiable necrosis due to enzymes and neutrophils
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Common gene/protein involved in DNA repair
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BRCA1 (Breast, ovary, prostate)&2 (breast in men and women); MLH1, MSH2=hereditary nonpolyposis CC (lynch)=Colon, endometrial, ovarian; excision endonuclease=xeoderma pigmentosa
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Cytochrome c
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inner membrane mitochondria; leaks into cytoplasms via BAX channels and triggers apoptosis via APAF-1 which activates caspases (9-initiator to 3-executioner)
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What caspase do T8 cells activate
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8-initiator to 2-executioner
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BCL-2
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prevents apoptosis-blocks bax channel to prevent cytochrome c from leaking into cytoplasm; overexpression=follicular lymphoma t(14;18)
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Rituximab
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monoclonal antibody against CD20
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Thymoma
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myasthenia; pure red cell aplasia
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Type 1 muscle
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postural muscles; slow twitch; aerobic (fatty acids in krebs cycle); mitochondria (cytochroms); red fiber (due to iron)=cytochrome and myoglobin
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Type II muscle
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fast twitch; anaerobic (fatigue quickly due to lactic acid); white; atrophies first (myofiber decreased)
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When does myofibrils get smaller
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contractile unit=smaller when contracts
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Rabies specs
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rhabdovirus; ssRNA negative sense; encapsulated (bullet shaped)
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All viruses than begin with “R”
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RNA virus-most ss
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Symptoms of aortic stenosis indicate surgery
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syncope, angina, SOB
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S3 heart sound
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V overload, heart failure
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HPV
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1-4 (get from the floor), 6 and 11 (from heaven), 16 and 18 (E6 and E7 knocking out p53 and RB)
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3rd spacing
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edema (fluid btwn cells)
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Heroin OD
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pulmonary edema
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Bleomycin, busulfan, amiodarone
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pulmonary fibrosis
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Nutmeg liver causes
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R sides HF; centrilobular (zone 3) most congested
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Palpable purpura
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henoch h. purpura
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4 scenarios for vit K deficiency
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newborn (no gut flora), antibiotics, malabsorption, rat poison (contains warfarin); liver disease looks similar
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Most sensitive pathway when vit K deficient
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extrinsic - factor 7 has shortest half-life=PT most sensitive
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Vit K injection
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takes 1-2 days; with life threatening bleeding=FFP
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Vit K deficiency vs cirrhosis
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liver disease eventually has normal liver enzymes; give vitK and see what happens; low albumin = transplant indication; factor assays
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Desmopressin and bleeding
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release von willebran and V8 from endothelial cells; used in VW and hemA with mild bleeding
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CD18
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adhesion problems
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Only coagulopathy with normal PT/PTT
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factor 13
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Collagen II
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cartilage, vitreous humor
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Collagen III
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granulation tissue (wounds), pliable; fetus, organs that have to stretch
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Collagen 10
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bones in epiphyseal growth plate
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Cross linking of collagen
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Lysol oxidase with cofactor of copper
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Keiser flasher rings deposit where in retina
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desmines membrane
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Wilsons causes atrophy where in brain
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Basal ganglia-lenticular nucleus=putamen + globus pallidus
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Chelators for wilson’s
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D-penacillamine and trientine
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Virchow triad
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damaged endothelium (smoking, atherosclerosis, vasculitis), flow, hypercoagulatable state
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Factor 2
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thrombin-deactivated by ATIII
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Why are nephrotic patients hypercoagulable
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pee out ATIII
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Why cancer causes hypercoagulation
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mucous production and when die release TF
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HIT
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takes ~ week to build antibodies against heparin=binds PF4 (haptin) and activates platelets; ELISA to look for antibodies to screen-confirm w/serotonin release test
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Direct thrombin inhibitors
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argatroban, “-rubin”, lepirubin
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Factor 12
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starts clotting cascade, also activates tPA to break down clots; deficiency = prolonged PTT and thrombosing!
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Thrombosing with prolonged PTT
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lupus antiphospholipids
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What causes skin necrosis SE of warfarin
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protein C deficiency
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5 rules for all trisomies
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1) all have retardation 2) chromosomal nondysjxn (meiosis I most common) 3) age risk factor 4) if heart defect-hole in endochondrial cushion 5) karyotype
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Down’s (21)
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flat nose bridge, increased nuchal lucency=1st trimester; brushfield spots (areas fibrosis, white speckling of iris); simian crease; duodenal atresia (polyhydraminos, green projectile vomiting, double bubble); <3 AML (M7-mega), 3-7 ALL; decreased AFP and estriol, high bHCG and inhibin A
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Edwards
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decreased AFP, estriol, bHCG, inhibin A; 18; horseshoe kidney; overlapping flexed fingers, rocker-bottom feet (loss of arch)
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Patau
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13; average survival 14 days; midline facial defects (cleft lip and palate); polydactyly; holoprosencepaly (one eye)
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SHH mutation
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holoprosencephaly
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Cri du Chat
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5p deletion; microcephaly; VSD heart defect
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Gene important in neural crest migration (cause hirschsprungs)
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RET
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Seen in alzheimers
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hirano bodies=actin
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Lewy bodies
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Parkinson; alpha-synuclein protein
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Kleinfelters
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XXY or XXXY or XXXXY; testicular atrophy-streaked w/fibrosis=decrease hormones (low T, increase LH/FSH) and infertility, unopposed estrogens (unicoid appearance, high voice, gynecomastia)
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Turners
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45XO; fibrotic ovaries-low estrogen=high LH and FSH; infertile; short (Shox gene in X and low estrogen), osteoporosis, primary amenorrhea, webbing neck (cystic hydroma), bicuspid aortic, preductal coarctation, gonadal dyngenesis
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Hydrops fetalis
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CHF=parvovirus, Rh, turner’s (preductal coarctation)
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Parvovirus
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aplastic crisis in sickle cell; parvo=poor=single stranded DNA and naked (only medically important ssDNA virus, couldn’t afford second strand); slap cheeks-erythema infectiosum
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4 levels that determine sex
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1) phenotype 2) genotype 3) gonadal 4) ductal (mullerian=women, wolfian=male)
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Wolfian duct derivatives
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Y makes MIF via seratoli cells and testosterone via Leydig = epididymis, vas deferens, seminal vesicle, ejaculatory duct
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Mullerian duct derivatives
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filopian tube, uterus, cervix, vagina (upper 1/3)
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Dihydrotestosterone
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makes prostate, gets rid of lower 2/3 vagina, fuse labia, enlarges clitoris
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Finesteride
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5-a-reducatase inhibitor; shrink prostate=takes >6 months-1 yr for significant effect
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True hermaphrodite
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testes and ovary
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Female pseudohemaphrodite
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XX; ovaries, filopian tube, uterus, virulized-clitoralmegaly, fused labia; androgen exposure in utero (CAH or anabolic steroids or ovarian tumor-serotoli leydig)
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Male pseudohemaphrodite
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1) insensitive to androgens=no wolfian duct; XY; testis-make MIF and testosterone; no prostate, female genitalia; blinded 2/3 vagina; testicular cancer; generally Dx at puberty=no cervix or uterus, no menses 2) 5-alpha reductase insufficiency; testis makes testosterone and MIF=wolfian duct made; DHT not produced=blind ended vagina, female external, low DHT, grow hair and 2nd male characteristics at puberty
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CAH
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21, 17, 11; second number 1=clitoralmegaly; first number BP=1 is up arrow, 2 down
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CF
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CFTR (chromosome 7)-cAMP Cl- transporter; 3bp deletion 508 phenylalanine=doesn’t fold properly and gets stuck in RER; most common cause bronchiectasis in US
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Where does mucous get stuck in GI tract in CF
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Peyer’s patches-meconium ileum; smallest diameter
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PKU
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phenylalanine hydroxylase=phenylalanine and ketone metabolites accumulate in brain; tyrosine deficient (becomes essential aa)-need for catecholamines (dop, epi, norepi), TH
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Alkotonuria
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Ochonosis (black cartilage); homogentistic acid oxidase=homogenistic acid accumulates=bluish black nose and ears=early onset arthritis (~30)
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Albino
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tyrosinase absent=squamous and basal cell carcinomas; melanoma with no pigment
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Vitilligo
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autoimmune, loose pigment, lack of monocytes
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Cherry red spot
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pale macula with red fovea centralis; Nieman pick and Tay sacs
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3 rules for lysosomal storage diseases
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1) all ash. Jewish 2) lipid accumulation in lysosome 3) deficiency of lysosomal acid hydrolase
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Tay Sachs
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hexosaminodase A chromosome 15; lipid accumulation = GM2 ganglioside in CNS; Foamy cells in CNS (whirls, onion pattern)
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Nieman Pick
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chromosome 11; spingomyelinase; accumulates in lysosome of CNS and RE system (enlarged liver, spleen, and bone marrow); zebra body lysosomes
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Gaucher
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chromosome 1-most common; glucocerebrocidase; accumulate only in RE system=type 1-macrophages in sinusoids-tissue paper like-fibrulary cytoplasm
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Glycogen storage disease rules
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1) glycogen accumulates 2) accumulates in liver, skeletal muscle, cardiac muscle in cytoplasm
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Von gierke
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1 organ=liver; glucose-6-phosphatase (PAS positive); fasting hypoglycemia
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Pompe
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die by cardiac failure by 2; lysosomal enzyme=alpha 1, 4, glucosidase (aka acid maltase); glycogen accumulates in liver, cardiac, and skeletal muscle within lysosomes
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McArdles
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muscle glycogen phosphoylase deficiency=myophosphorylase; muscles cramp up, pee red via myoglobinuria; no lactic acid
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Mucopolysaccaridoses (GAGs-the sulfates)
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1) Hunters-macrophages and CT accumulation 2) Hurler’s-clouding of cornea; PAS positive; short stature, joint abnormalities-carpal tunnel 3) Fabry’s
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Marfan’s
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chromosome 15 fibrillin gene-structural protein, lense subluxation (up and lateral); mitral prolapse, cystic medial degeneration leading to aortic dissection
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Homocystinuria
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marfanoid-like-characteristics; elevated homocysteine and methionine, cysteine low (and essential in these patients)
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Ehler’s Danlos Type 4
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collagen 3-poor wound healers (granulation tissue); organ rupture (uterus, colon, aorta)
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Ehler’s Danlos Type 6
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lysol hydroxylase, not collagen defective-cross linking
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NF1
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17; Tumor suppressor gene=neurofibromin defective-turns off RAS normally; Ras=oncogene=G protein (gRas=grass=grass grows); café o’le spots>6, lisch nodules in iris (pigmented spots-harmartomas)
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NF2
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neurofibroma, café o’le, acoustic neuromas (schwanoma=ectoderm=neural crest cells)-S100 positive; chromosome 22-merlin=normally contact inhibition; meningioma (psamomma bodies)
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Meningiomas
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females in later reproductive life-estrogen receptors (and progesterone); whirled calcifications; NF-2 knocked out usually
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Von-Hipple landau
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3p-normally inhibits/breaks-down hypoxia inducing factor 1 (HIF-1); blood vessel growth=hemangioblastoma (retina, cerebellum, brainstem, spinal cord), commonly make EPO=polycythemia; renal cell carcinoma-multiple bilateral; urine VMA (breakdown of epi and norepi)=pheochromocytoma
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RB
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chromosome 13-G1/S check control gene; retinoblastomas and osteosarcoma; true rosette=flexer-winter-steiner true rosettes (true empty space); invades optic nerve
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P53
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li fraumeni; chromosome 17 (Li upsidedown)
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Small round blue cell tumors of childhood
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All malignant (highly); potentially curable; often line up around space (be like nerves-pink processes into space)=homer-wright pseudo rosettes; retinoblastomas, medulloblastoma (CSF spread), neuroblastoma (adrenal medulla, like pheo=VMA, HMA, free metanephrins; N-myc>2 copies; bad prognosis if >18 months); Ewing sarcoma (t(11;22)-Ews and fli1; onion skinning; CD99 positive); primitive neural ectodermal tumor (like medulloblastoma outside the cerebellum; ewing translocation)
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Genomic imprinting
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Prader-Willi (15; paternal deletion, maternal imprinting; morbid obesity, hypogonadism-impotence, hypotonia) and Angelman (15; maternal deletion, paternal imprinting; seizures, ataxia, laugh)
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SSa (Ro) antibodies in pregnancy
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IgG that crosses placenta; prevents conduction system formation=3rd degree heart block; seen in lupus and SS
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Sterile vegetation both side cardiac valve
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lupus
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Class 4=diffuse proliferative glomerulonephritis
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most common and severe form in lupus; RBC in urine (nephritic); wire-loops=immune complexes everywhere=subendothelial
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Class 5=membraneous
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nephrotic
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Progressive systemic sclerosis (scleroderma)
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activating fibroblasts via immune system (IL-1, TNF-a, TGF-b, PDGF)=scar formation; Diffuse (progressive sclerosis=entire skin, internal organs, Scl-70 aka topoisomerase) and limited (CREST=calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasia; anti-centromere)
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x-linked agammaglobulinemia of Bruton
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extracellular bacterial infections (staph, strep, pseudomonas, hemophilus) in respiratory area; no germinal centers in lymph nodes (no mature B cells or plasma cells); IVIg every month
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Digeorge
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viral and fungal infections; 22q11 (can also lead to Velocardiofascial syndrome=cleft lip and palate, heart problems (tetralogy of Fallot, truncus arteriosus)
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SCIDS
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no immune system; X-linked (most common, chemokine receptor (IL receptor)) and AR (adenosine deaminase-breaks down deoxyadenosine (toxic to stem cells))
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IL-7
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makes T-cells grow up (IL-2 turns it on)
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Wiscott-aldrich
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X-linked; TIE=thrombocytopenia, infections, eczema (atopy); lymphoma=NHL; W upsidedown is M (low), IgA high, IgE high, IgG normal
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Gp 120
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attachment of HIV
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Gp41
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fusion and entry of HIV; CCR5 and CXCR4 is where it attaches
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CMV in lungs
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loves blood vessels; intranuclear inclusion surrounded by halo (owl eye inclusion); likes tubules in kidneys-can see in urine; tropism: lungs (atypical), kidneys, adrenals (addisons), eye (retinitis), GI tract (ulcer endothelial bv inclusions); gancyclovir (2nd line foscarnet=renal SE); congenital=retinitis, encephalitis (periventricular white matter calcifications)
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Toxo gestational
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retinitis, encephalitis (basal ganglia calcifications)
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Pneumocystis jiroveci
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silver stain=black-cyst with dot in middle (trophozoite)
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Ziel-nielson stain
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acid fast stain; TB makes niacin and cord factor
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Capsaicin topical pain relief
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stops substance P
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Recessive PKD
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PKHD1-fibrocystin protein; kidney and liver
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Dominant PKD
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1/1000; asymptomatic until midlife-hematuria, hypertension, renal insufficiency; PKD1&2-polycystin1 and 2=cilia on surface and adhesion on base=CT weakness
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Wegner’s 5 C’s
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C-saddle shaped nose, Cavitating lung granulomas, Crescents in kidney, cyclophosphamide, sinusitis, c-anca
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Alport’s
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X-linked; collagen 4 alpha 5 subunit; hearing loss (hair cells) and eye (lens shape curvature=lenticonus) and nephritis (basket weave BM)
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CA 15-3
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breast cancer marker; 3 sideways=breasts; ERB-2 (epidermal growth factor receptor) = amplification, more makes worse prognosis=makes HER2-neu receptors-trastuzumab blocks
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CA19-9
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pancreatic cancer; 9 sideways=pancreas
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CA-125
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ovarian cancer; 25=2ovaries
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RET
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endocrine tumors; Remember Endocrine Tumors=RET; tyrosine kinase that causes growth
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Bcr-abl
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t(9;22); Philadelphia chromosome=CML; tyrosine kinase always turned on in fusion protein; Imatinib (blocks ATP binding site of tyrosine kinase; I’M A Tyrosine kinase INhIBitor; also used in GI stromal tumors (c-kit) and acrolentiginous melanoma)
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3 myc genes
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c-myc=t(8;14) Burkitts Ig heavy chain; l-myc=little lung cancer (small cell) on chromosome 1; n-myc=neuroblastomas
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Leukemias 2 main categories
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1) Acute = must have blasts in blood/marrow (large, immature), >20-30% in marrow(myelodysplasia <20%), rapid onset 2) Chronic = mature; gradual onset (months to years)
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Acute leukemias
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ALL: 3-7 yrs, huge w/large nucleus and has nucleolus, Tdt blast marker, CD10 (aka cALLa=common ALL antigen); AML (adult mid-life): 15-40 yrs
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Chronic leukemias
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CLL: elderly >=60, too many normal looking lymphocytes (looks like viral infection); CML: 30-60, too many myeloid cells (granules-neutrophils; looks like bacterial infection); Hairy cell: 30-60 men
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Pre-B ALL
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cytoplasmic mu=heavy chain Ig; lymphadenopathy; sanctuary sites (CNS-astrocytes, testes-sertoli); good prognosis-95% remission and 50% cure after 1 round chemo; tumor lysis syndrome = prevent with large amount IV fluids, allopurinol; t(9;22) = bad prognosis, 5% ALL; t(12;21)=good prognosis
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AML
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most aggressive; multiple nucleoli, myeloperoxidase granules-Auer rods (M3)-fused lysosomes (Sudan B Black stain); M0-M7 (M3-neutrophil, DIC aka PML (t(15;17)-PML and a-retinoic acid receptor gene); M5-monocyte-into CNS, gingiva, skin (chloroma-green), marker NE (nonspecific esterase-monocytes); M6-Diguglielmo-erythroblast, PAS positive, poor prognosis; M7-megakaryoblast = myelofibrosis via PDGF, tear-drop RBC); risk factors=radiation, benzene (smokers), alkylating agents
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CLL
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most common leukemia in adults; smudge cells; flow cytometry-CD5, 20 coexpression; Evan’s syndrome-antibodies against self; excellent prognosis; Rickter’s-transform (~5%) B NHL
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CML
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Band cells, myelocyte; L shift plus; lack normal enzymes like leukocyte alkaline phosphatase; karyotype for Philly transformation; enlarged spleen; B-symptoms (fever, night sweats, weight loss); WBC>100,000 (infections at most 50,000)=leukostasis (stroke); Blast crisis-turns into AML, die within 3 months
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Hairy cell
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lymphocytes with hair; TRAP stain (tartrate resistant acid phosphatase positive); CD20, CD11c (like 2 hairs), CD103 (grow hair around butthole and ear); enlarged spleen, pancytopenia, dry tap; bone marrow biopsy for diagnosis; 2-CDA to treat (deoxyadenosine analog)
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Non-Hodgkins lymphoma-Follicular
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Most common NHL; too many follicles that fuse and coalesce; CD20 (rituximab); t(14;18)=heavy chain and BCL-2; low grade-not proliferating, just not passing away
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Small non-cleaved NHL (Burkitts)
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Starry sky; sheets of tumor (no follicles)-macrophages eating dead tumor cells; EBV positive; t(8;14)=Ig heavy chain and c-myc; high grade ~1 yr survival without treatment; 80% cure; kids, AIDS, abdominal (US), jaw (Africa), ovary
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Mantle cell NHL
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mantle=area around follicle; middle age guy-painless, enlarging node; CD5+, B-cell numbers (19-22) except CD23-; t(11;14)=Ig heavy chain and BCL-1 (cyclinD1-increase cell cycle); intermediate grade (~3yrs untreated)
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Marginal zone NHL
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mucosal associated (MALToma)=stomach due to H. pylori; treat w/antibiotics; low grade; chronic smoldering inflammation-like Hashimoto’s, Sjrograns
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Multiple Myeloma
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tumor of plasma cells; increased total protein with normal albumin-electrophoresis shows spike in IgG or A; bence jones=kappa and lambda light chains-can form amyloid; bone marrow biopsy >10% plasma cells (normal ~1%); Russell bodies=accumulated IgG in cytoplasm (excess amounts=Mott cell); Flame cell=accumulated IgA in cytoplasm; osteoclast activating factors made by plasma cell=IL-1, IL-6 (bad prognosis if high=self-stimulation); B2M-prognosis factor-volume of tumor (use to follow all lymphomas); die by infection and renal failure; Tx-analogs of thalidomide
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Lymphoplasmacytic NHL (Waldenstrom’s macroglobulinemia)
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electrophoresis with IgM spike; mid-age 30-60 male; hyperviscosity syndrome (blurring vision, weak, confusion); IgM cold agglutination (Raynauds)
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Mycosis fungoides
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T-cell tumor of skin; usually catch early-good prognosis; 40-50 males; presents as rash-doesn’t improve with steroids, ulcerates-antifungals doesn’t improve, biopsy-band like infiltration of t-cells in dermis, go into epidermis=pautriei’s microabscess; metastasize to blood-cerebriform nucleus=Sezary cell
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Hodgkin’s lymphoma
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Reed-sternburg cell = normal lymphocytes surrounding along with plasma cells and eosinophils-HUGE with 2 nuclei, prominent nucleolus, EBV infected 30%, CD15+, CD30+; lymphocyte predominant=excellent prognosis; mixed cellularity=good prognosis; lymphocyte depleted=bad prognosis, older ppl; Nodular sclerosing=young ppl, all lymphocytes-excellent prognosis, most common, nodules grossly when looking at lymph nodes, broad bands of fibrosis, empty lacunar space with RS cell; nodes hurt when drinking alcohol
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Staging of lymphomas
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1) 1 LN group 2) >2 LN groups on same side diaphragm 3) LN both sides 4) metastasis; radiate with 1&2 w/ high cure rate; chemo for 3 &4; non-Hodgkin’s always 3&4
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