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1488 Cards in this Set

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Calcium Pyrophosphate Crystals
Rhomboid Crystals with Positive Birefringence

pseudogout aka Calcium Pyrophosphate Depsoition Dz CPDD:

NB: usually presents Knee >> Foot

Tx: NSAIDs [Steroids, & Colchecine]
NF- κB
transcription factor which induces cytokine prodxn in response to microbial infx
#immunology #molecules
NOD2
[Nucleotide Binding Oligomerization Domain]

intracellular microbial receptor which which triggers NF- κB transcription factor → cyokine prodxn
#immunology #molecules
Pseudogout
aka Calcium Pyrophosphate Depsoition Dz CPDD:

Inflammed Knee, aspirate of PMNs + Rhomboid Crystals with Positive Birefringence

NB: usually presents Knee >> Foot

Tx: NSAIDs [Steroids, & Colchecine]
Galactosyl β-1,4 - glucose
aka Lactose
#biochemistry #molecules
↑ pH ↑ HCO3 ↑ pCO2
↓ Urinary Cloride, Hypovolemic
Saline Responsive Metabolic Alkalosis

3 Causes of Metabolic Alkalosis

1. "Saline Responsive" 2° to loss of Gastric Contents (vomitting) + volume contraxn → maintain HCO3 to retain volume
↓ Urine Chloride, Volume Depleted
Tx: Normal Saline

2. "Contraction Alkalosis" Diuretic → Na delivered to distal collecting duct → Na/H+ antiporter
↑ Urine Chloride, Volume Depleted

3. "Saline Resistant" Conn Sro or Mineralcorticoid Excess: Aldosterone upregulates Na/H+ antiporter
↑ Urine Chloride, Hypervolemic
Thalamic Nuclei
VPL
--incoming from Spinothalamic (pain & temp) tract and Medial Lemniscus (position, proprioception),
---relays to Somatosensory Cortex (Brodman's areas 1-3)

VPM Ventral Posteromedial Nucleus
---incoming from Trigeminal & Gustatory pathways
---relays to same

Lateral Geniculate
--Relay for Vision

Medial Geniculate: relay for audition
--input from superior olivary nucleus & inferior colliculus

NB: smell not relayed through thalamus
#neurology #cns #anatomy
↑ pH ↑ HCO3 ↑ pCO2
↑ Urinary Cloride, Hypovolemic
Contraction Alkalosis

3 Causes of Metabolic Alkalosis

1. "Saline Responsive" 2° to loss of Gastric Contents (vomitting) + volume contraxn → maintain HCO3 to retain volume
↓ Urine Chloride, Volume Depleted
Tx: Normal Saline

2. "Contraction Alkalosis" Diuretic → Na delivered to distal collecting duct → Na/H+ antiporter
↑ Urine Chloride, Volume Depleted

3. "Saline Resistant" Conn Sro or Mineralcorticoid Excess: Aldosterone upregulates Na/H+ antiporter
↑ Urine Chloride, Hypervolemic
VPL Nucleus
Thalamic Nucleus

--incoming from Spinothalamic (pain & temp) tract and Medial Lemniscus (position, proprioception),
---relays to Somatosensory Cortex (Brodman's areas 1-3)

NB: does not relay face/pharynx that is VPM
#neurology #cns #anatomy
↑ pH ↑ HCO3 ↑ pCO2
↑ Urinary Cloride, Hypervolemic
Saline Resistant Metabolic Alkalosis

3 Causes of Metabolic Alkalosis

1. "Saline Responsive" 2° to loss of Gastric Contents (vomitting) + volume contraxn → maintain HCO3 to retain volume
↓ Urine Chloride, Volume Depleted
Tx: Normal Saline

2. "Contraction Alkalosis" Diuretic → Na delivered to distal collecting duct → Na/H+ antiporter
↑ Urine Chloride, Volume Depleted

3. "Saline Resistant" Conn Sro or Mineralcorticoid Excess: Aldosterone upregulates Na/H+ antiporter
↑ Urine Chloride, Hypervolemic
Adult Brain Tumors by Frequency
1. Glioblastoma multiform (Grade 4 Astrocytoma)
--Astrocytes which strain for GFAP
--Pseudopalisading borders around necrosis
--Bad Px

2. Meningioma
--Arachnoid cells
--Psammoma bodies
--Benign
--Surgically Resectable

3. Schwannoma
--Cerebellopontine Angle, S100+

4. Oligodendroma
--Indolent "Fried Eggs" Chicken wire capillaries & calcifications

5. Pituitary adenoma
VPM Nucleus
Ventral Posteromedial Nucleus iof the Thalamus

---incoming from Trigeminal & Gustatory pathways
---relays to Somatosensory Cortex (Brodman's areas 1-3)
#neurology #cns #anatomy
Glioblastoma Multiform
Most common adult brain tumor

Grade 4 Astrocytoma
--Astrocytes which strain for GFAP
--Pseudopalisading borders around necrosis
--Bad Px
Lateral Geniculate Nucleus
Thalamic Nucleus Responsible for Vision
#neurology #cns #anatomy
Brain Tumor stains for GFAP
Glioblastoma Multiform
Grade 4 Astrocytoma
--Astrocytes which strain for GFAP
--Pseudopalisading borders around necrosis
--Bad Px

Most common adult brain tumor
Medial Geniculate Nucleus
Thalamic Nucleus Responsible for Audition

input from superior olivary nucleus & inferior output to temporal lobe
#neurology #cns #anatomy
Adult tumor of Astrocytes
Glioblastoma Multiform
Grade 4 Astrocytoma
--Astrocytes which strain for GFAP
--Pseudopalisading borders around necrosis
--Bad Px

Most common adult brain tumor
Phenoxybenzamine
long acting α blocker used in pheos
#pharmacology #autonomics #drugs
Ephedrine
sympatheticomimentic
#pharmacology #autonomics #drugs
Meningioma
2nd most common adult brain tumor

(Gioblastoma Multiform > Meningioma > Schwannoma)

--Arachnoid cells
--Psammoma bodies
--Benign
--Surgically Resectable
Adult tumor of Arachnoid Cells
2nd most common adult brain tumor

(Gioblastoma Multiform > Meningioma > Schwannoma)

--Arachnoid cells
--Psammoma bodies
--Benign
--Surgically Resectable
oxybutynin
anticholinergic agent used for overactive bladder

does not affect nicotininc receptors
#pharmacology #autonomics #drugs
Adult Brain Tumor of "Fried Egg" Cells
Oligodendroma
--Indolent "Fried Eggs" Chicken wire capillaries & calcifications
phentolamine
α1, 2 antagonist
#pharmacology #autonomics #drugs
Brain Tumor with Psammoma Bodies
Meningioma


2nd most common adult brain tumor

(Gioblastoma Multiform > Meningioma > Schwannoma)

--Arachnoid cells
--Psammoma bodies
--Benign
--Surgically Resectable
ergonovine
α + 5HT stimulator

constricts VSMCs

used to prevent post-partum bleed out

used diagnostically to induced prinzmetal's angina
#pharmacology #autonomics
#cardiovascular #pathology #reproductive #diagnostics #drugs
Parvovirus B19 loves which cells
erythroid precurosors

[esp pronormoblasts and normoblasts]
#microbiology
thiolase
enzyme which conjugates 2 acetyl-CaA → acetoacetyl-CoA

the necessary substrate for HMG CoA Synthase in the formation of cholesterol
#biochemistry #molecules #cardiovascular
DOC: Heparin OD
Protamine

aka protamine sulfate

binds to heparin to form inactive complex
#pharmacology #drugs #toxicities
Protamine Sufate
ie protamine

DOC: Heparin OD

binds to heparin to form inactive complex
#pharmacology #drugs #toxicities
Aminocaproic Acid
inhibits plasminogen activation

used to inhibit fibrinolysis
ie tPA or streptokinase OD

[sibling Rx: tranexamic acid]
#drugs #pharmacology #cardiovascular
Tranexamic Acid
inhibits plasminogen activation

used to inhibit fibrinolysis
ie tPA or streptokinase OD

[sibling Rx: Aminocaproic Acid]
#drugs #pharmacology #cardiovascular
DOC: tPA overload
Aminocaproic Acid or Tranexamic Acid

inhibits plasminogen activation

used to inhibit fibrinolysis
ie tPA or streptokinase OD
#drugs #pharmacology #cardiovascular
The Absorption of B12
1. Salivary Glands Secrete R protein haptocorrin which binds B12 to prevent acid denaturation in Stomach

2. stomach parietal cells (located midway down gastric pits) secrete intrinsic factor

R factor binds B12 in stomach once released from food by Acid

3. Pancreatic proteases cleave R factor which is immediately bound by intrinsic factor (to prevent degredation in SI by pancreatic enzymes)

4. IF-B12 complex abosrbed in distal ileum by IF specific receptor
#biochemistry #nutrition #gastrointestinal
Haptocorrin
R factor

secreted by salivary glands
binds to B12 to prevent hydrolysis by gastric acidity

degraded by pancreatic proteases

(where IF binds to prevents proteolytic degradation of B12)
#biochemistry #nutrition #gastrointestinal
Elderly Patient with Anemia and negative Fecal Occult Blood
Probably B12 deficiency 2° aging → gastric atrophy → [relative] achlorhydria → poor B12 release from eaten foods
#biochemistry #nutrition #gastrointestinal #hematology
Neuroblastoma
N-myc Amplification
medullary adrenal mass: small round blue cells
displaces kidney, causes anorexia

2 yo presents with paraneoplasic "Opsoclonus-Myoclonus Sro"

Opsoclonus: Non-rhythmic conjugate eye movements in various directions (ie not nystagmus)

Px: better w/ younger age (<1) and fewer N-mycs
#pathology #neoplasia
Toddler with spontaneous bursts of non-rhythmic eye movement and occasional myoclonus
Neuroblastoma

N-myc Amplification
medullary adrenal mass: small round blue cells
displaces kidney, causes anorexia

2 yo presents with paraneoplasic "Opsoclonus-Myoclonus Sro"

Opsoclonus: Non-rhythmic conjugate eye movements in various directions (ie not nystagmus)

Px: better w/ younger age (<1) and fewer N-mycs
#pathology #neoplasia
N-myx
Neuroblastoma

N-myc Amplification
medullary adrenal mass: small round blue cells
displaces kidney, causes anorexia

2 yo presents with paraneoplasic "Opsoclonus-Myoclonus Sro"

Opsoclonus: Non-rhythmic conjugate eye movements in various directions (ie not nystagmus)

Px: better w/ younger age (<1) and fewer N-mycs
#pathology #neoplasia
Toddler presents with palpable flank mass
Wilm's Tumor

Histologically: primitive metanephric ts (primtive nephrons)

Malignant

WT1 is a tumor suppressor gene
Chrom 11p

[WAGR: Wilm's Tumor, Aniridia, GU Malformation, MR]
#pathology #neoplasia #nephrology #childhood
Wilm's Tumor
Toddler presents with palpable flank mass

Histologically: primitive metanephric ts (primtive nephrons)

Malignant

WT1 is a tumor suppressor gene
Chrom 11p

[WAGR: Wilm's Tumor, Aniridia, GU Malformation, MR]
#pathology #neoplasia #nephrology #childhood
WT1
WT1 is a tumor suppressor gene
Chrom 11p

WAGR: Wilm's Tumor, Aniridia, GU Malformation, MR
#pathology #neoplasia #nephrology #childhood
WAGR
WT1 is a tumor suppressor gene
Chrom 11p

WAGR: Wilm's Tumor, Aniridia, GU Malformation, MR
#pathology #neoplasia #nephrology #childhood #syndromes
BP 180/70
isolated systolic hypertension 2° age related aortic stiffening

also seen in panic attacks
#cardiovascular #pathology #geriatrics
isolated systolic hypertension
isolated systolic hypertension 2° age related aortic stiffening

common in elderly

also seen in panic attacks
#cardiovascular #pathology #geriatrics
Haptoglobin Levels
Haptoglobin Binds Free Hemoglobin within Blood Vessels

Complexed Hemoglobin-Haptoglobin is phagocytized by Spenic M∅

↓ serum haptoglobin levels ≈ intravascular hemolysis

normal serum haptoglobin levels rules out intravascular hemolysis (ie extravascular = direct splenic phagocytosis)
#hematology #diagnostics #molecules
Differentiating Intravascular from Extravascular Hemolysis
Haptoglobin Levels

Haptoglobin Binds Free Hemoglobin within Blood Vessels

Complexed Hemoglobin-Haptoglobin is phagocytized by Spenic M∅

↓ serum haptoglobin levels ≈ intravascular hemolysis

normal serum haptoglobin levels rules out intravascular hemolysis (ie extravascular = direct splenic phagocytosis)

NB: Extravascular includes Splenic Phagocytosis
#hematology #diagnostics #molecules
Rhomboid Crystals with Positive Birefringence from Inflammed Knee Aspirate
Calcium Pyrophosphate

pseudogout aka Calcium Pyrophosphate Depsoition Dz CPDD:

NB: usually presents Knee >> Foot

Tx: NSAIDs [Steroids, & Colchecine]
#pathology #crystals #inflammation #joints
DOC: anaphylaxis
Epinephrine
#pharmacology #immunology
Pathogenesis Presbyopia
age related lens sclerosis → ↓ elasticity
#geriatrics #pathology #eye
Myasthenia Gravis vs Lambert Eaton Sro
MG:
Begins with Optic Muscles
Worsens at End of Day & after effort
Risk of Thymoma
Anti-ACh receptor antibodies
Edrophonium improves weakness
Nerve Stimulation → decrementalresponse

LE:
Begins with proximal muslces
improves through day & w/ exercise
2° to an already existing malignancy
Anti-Pre-Synaptic Ca2+ channel Antibodies
Edrophonium does not improve
Nerve Stimulation → incremental response
#neurology #neoplasia #pathology
Danger of appetite suppressants
Fenfluramine or Phentermine

↑ 5-HT release

↑ risk pulmonary htn after 3 mo → sudden cardiac death
#pathology #nutrition #pulmonology
Phentermine
appetite suppressent

↑ 5-HT release
like fenfluramine

↑ risk pulmonary htn after 3 mo → sudden cardiac death
#pathology #nutrition #pulmonology #drugs
Fenfluramine
appetite suppressant

↑ 5-HT release
like phentermine

↑ risk pulmonary htn after 3 mo → sudden cardiac death
#pathology #nutrition #pulmonology #drugs
Endomysial Inflammatory Infiltration
characteristic of polymyositis

progresssive symmetrix proximal muslce weakness

Path: CD8 vs myofibers
Findings: ↑ CK, ↑ aldolase, muscle weakness

most often involves shoulders

Similar to Dermatomyositis (∅ shoulders, ✓ Grotton/Heliotrope/perifasicular atrophy)
#pathology #rheumatology
Diarrhea, Weight Loss, Arthralgia
Whipple's Dz

"Foamy" PAS+ M∅

Mn: CAN of Whipped Cream

Cardiac Sx
Arthralgias
Neurologic Sx
#gastrointestinal #microbiology #pathology
Acute Stress Ulcers
Trauma/Shock/Burns

Curling Ulcers: duodenal 2° to hypoxia
Cushing Ulcers: Esophagus, Stomach, Duodenum 2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate
#gastrointestinal #pathology #ulcers
Curling Ulcers
duodenal ulcers 2° to shock hypoxia

NB: not Cushing Ulcers: Esophagus, Stomach, Duodenum 2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate
#gastrointestinal #pathology #ulcers
Cushing Ulcers
Esophageal, Gastric, Duodenal Ulcers

2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate

NB: not Curling Ulcers: duodenal ulcers 2° to shock hypoxia
#gastrointestinal #pathology #ulcers
Mannitol OD
excessive volume depletion → hypernatremia

even worse
rapid administration rapidly draws fluid from interstitial → vascular compartment, ↑ hydrostatic pressure in lungs → pulmonary edema & death

[Mannitol used for ↑ ICP/Cerebral Edema]
#pharmacology #toxicities
DOC: ↑ ICP/Cerebral Edema

OD?
Mannitol

overaggressive → excessive volume depletion → hypernatremia

even worse
rapid administration rapidly draws fluid from interstitial → vascular compartment, ↑ hydrostatic pressure in lungs → pulmonary edema & death
#pharmacology #toxicities #drugs
Bumetanide
Loop Diuretic like Furosimide

[Loop Diuretic toxicities:
Ototixicity, Hypokalemia, Dehydration, Allergic Rxn, Interstitial Nephritis, Gout
Mn: OH DANG!]
#pharmacology #nephrology #cardiovascular
c-myc fnx
nuclear transcription factor
#molecules #pathology #neoplasia
Radius vs Resistance
R = viscosity * length / radius ^4

NB: ^4
#physiology
#cardiovascular
DOC: Refractorily High LDL
First Line Drug: Statin
Competitively (vs Mevalonate) inhibits HMG CoA Reductase
Hepatocytes ↑ LDL receptors to compensate
Tox: Hepatotixic, Rhabdotoxic

Refractory: Add Ezetimibe
Inhibits Brush Border Cholesterol Resorption
Tox: Rare, hepatotoxic
#pharmacology #cardiovascular #lipids
DOC: Refractorily High TAGs
First Line Drug: Fibrates
↑ LPL
Tox: Hepatotoxic, Rhabdotoxic, Gallstones

Refractory: Add Niacin
Inhibits TAG synthesis & VLDL secretion
Tox: Hyperglycemia, Hyperuricemia
#pharmacology #cardiovascular #lipids
DOC: Refractorily Low HDL
Niacin:
Inhibits TAG synthesis & VLDL secretion
Tox: Hyperglycemia, Hyperuricemia

No 2ndry Drug
#pharmacology #cardiovascular #lipids
TGFα mutation
oncogene

astrocytoma, hepatocellular carinoma
#pathology #neoplasia #molecules
Periacinar v Centriacinar Emphysema
Periacinar: air trapped in terminal bronchioles before acini
α1 anti-trypsin deficiency
lower lung fields worse: ↑ perfusion = ↑ PMN's

Centriacinar: air trapped in acini after TB's
smoking
upper fields worse: ↓ perfusion = ↓ α1 anti-trypsin
#pathology #pulmonology
Diathesis Panel
Laboratory Abnormality of HUS
↑ Bleeding Time from Platelet consuming thrombi

oddly no ↑ PT, or PTT

Shiga toxin producing Shigella or E Coli O157H7
#microbiology #pathology #hematology
Pentazocine
opiod partial agonist

will precipitate withdrawal in dependents

sibling: buprenorphine
#pharmacology #drugs #analgesia
Buprenorphine
opiod partial agonist

will precipitate withdrawal in dependents

sibling: Pentazocine
#pharmacology #drugs #analgesia
Opiod Partial Agonists
Pentazocine and Buprenorphine


will precipitate withdrawal in dependents
#pharmacology #drugs #analgesia
Levorphanol
an opioid
#pharmacology #drugs #analgesia
continuous murmur heard best at left infraclavicular regioj
PDA
#cardiovascular #pathology
#anatomy
How do OCP's inhibit ovulation
1° by inhibiting the LH spike

also
thickened cervical mumus plug
#pharmacology #endocrine #reproductive
Warfarin Necrosis
Proteins C & S are natural anticoagulants

Protien C is vitamin K dependent and has much shorter λ than factors 2, 7, 9 and X.

Rare complication: in pts w/ already defective Protein C, warfarin creates a transient hypercoagulable state

Tx: Vitamin K + FFP
#hematology #pharmacology #toxicity
What part of airways are attacked in lung transplant rejexn
small airways
#pathology #pulmonology
Rofecoxib
a selective COX2 inhibitor
#pharmacology #drugs #analgesics
Why does systemic granulomatous dz → hypercalcemia
↑ M∅ 1-α hydroxylase

apparently activated M∅ just naturally convert vitamin D to active form
#pathology #chemistry
TNF α inhibitors by name
infliximab, etanercept, adalimumab
#pharmacology #drugs
new onset aortic stenosis in 50 yo
bicuspid aortic valve


recently calcificied
#pathology #cardiovascular
Ehrlichia
zoonotic infx from amblyoma lone star

obligate intracellular inhibits phagolysosomal fusion

a rickettsia
#microbiology
Obligate intracytoplasmic bacterieria
chlamydia and rickettsia

NB: only these survive intracytoplasmically outside of phagosomes
#microbiology
Causes of LV dilation
CAD
Valvular Heat Dz
Dilated Cardiomyopathy
Arrhytmias
#pathology #cardiovascular
Preventing Morbidity of Subarachnoid Hemorrhage
Calcium Channel Blockers

Nimodipine

prevents vasospasm → ischemia, the real cause of morbidity
#neurology #pharmacology
Nimodipine
calcium channel blocker

used both for hypertension and uniquely used to prevent mobidity following SubArachnoid Hemorrhage
#neurology #cardiovascular #pharmacology
The polyol pathway
Aldose Reductase
Glucose → Sorbitol

Sorbitol Dehydrogenase
Sorbitol → Fructose
#biochemistry #energymetzm
Bile Soluble Streptococci
ie cannot grow in presence of bile

all non enterococcal strep
#microbiology
What is the main mechanism for regulating iron stores?
Hepatically produced Hepcidin produced by liver binds ferroportin and causes its degradation

[Ferroportin is basolateral iron transporter on gut epithelium. No ferroportin → iron lost in gut shedding]

Hepcidin prodxn ↑ w/ high [iron] or inflammation
#nutrition #biochemistry #molecules
Hepcidin
Hepatically produced Hepcidin produced by liver binds ferroportin and causes its degradation

[Ferroportin is basolateral iron transporter on gut epithelium. No ferroportin → iron lost in gut shedding]

Hepcidin prodxn ↑ w/ high [iron] or inflammation

Main mechanism of iron regulation
#nutrition #biochemistry #molecules
Erosions vs Ulcers
Erosions do not cross muscularis mucosa
#pathology #gastrointestinal
Antipsychotic associated with retinitis pigmentosa
Thioridazine

Mn: thior-eye-disease

NB: Chlorpormazine ≈ corneal deposits
#pharmacology #toxicity
Toxicity of Thioridazine
retinitis-pigmentosa like retinal deposits

Mn: Thior-eye-disease

NB: Chlorpormazine ≈ corneal deposits
#pharmacology #toxicity
Antipsychotic assocaited with corneal deposits
Chlorpromazine

NB: Thioridazine ≈ Retinal Deposits
#pharmacology #toxicity
Toxicity of Chlorpromazine
Corneal Deposits

NB: Thioridazien ≈ Retinal Deposits
#pharmacology #toxicity
most important strx/molecular defects in Alzhemiers
↓ ACh in Nucleus Basalis and Hippocampus
#pathology #neurology #dementia
Hemangiomas:

Strawberry, Cherry, Cavernous
Benign vascular tumors

Strawberry: infantile
few weeks of rapid growth → regression in elementary school

Cherry: senile
↑ # w/ age, ∅ regress

Vacernous: blue palpable masses
assoc. w/ VHL Dz
may also exist in viscera and CNS as well as dermally
#pathology #dermatology
Eicosonoid responsible for PMN chemotaxis
LTB4
#pathology #inflammation
LTB4
Eicosonoid responsible for PMN chemotaxis
#pathology #inflammation
Hemosiderin
aggregation of ferritin micelles

maker of iron accumulation

golden yellow brown pigment

indicative of chronic iron overload/hemolytic anemia
#pathology #molecules #diagnostics #hematology
Pigment found in chronic iron overload
Hemosiderin

aggregation of ferritin micelles

golden yellow brown pigment

indicative of chronic iron overload/hemolytic anemia
#pathology #molecules #diagnostics #hematology
Cause of Death: Hypertrophic Cardiomyopathy
Mitral Valve leaflets get sucked into the outflow tract
#pathology #cardiovascular
The first portion of the brain damaged during global ischemia
The Hippocampus goes first, within 5 minutes

Then watershet ischemia follow LATER
#neurology #pathology #shock
3-Hydroxy-3-methylglutaryl- lyaseCoA
HMG CoA Lyase

responsible for ketogenesis from HMG CoA (which itself is produced yby degradation of leucine or synthesis via HMG coA synthase)
#biochemistry #molecules
Reid Index
Submucosal Gland thickness/ thickenss of wall from epithlium to cartilage (not including cartilage)

normally 0.4

higher index ≈ severity/duration of chronic bornchitis
#pathology #pulmonology #diognostics
Pemphigus Vulgaris
anti-desmoglein IgG

Flaccid Bullae

Asboe-Hansen sign: bullae spread laterally w/ pressure

Nikolsky Sign: new bullae form with gentile traction

Reticular Immunofluorescence
#dermatology #pathology #rheumatology
Skin covered with Blisters which spread laterally with pressure
Asboe-Hansen sign of Pemphigus Vulgaris

anti-desmoglein IgG

Flaccid Bullae

Reticular Immunofluorescence

also: Nikolsky Sign: new bullae form with gentile traction
#dermatology #pathology #rheumatology
Skin Covered with Blisters, New Blisters formed with Gentle Traction
Nikolsky's Sign of Pemphigus Vulgaris

anti-desmoglein IgG

Flaccid Bullae

Reticular Immunofluorescence

also: Asboe-Hansen sign: bullae spread laterally w/ pressure
#dermatology #pathology #rheumatology
Skin Covered with Blisters, Immunofluorescence shows Reticular Pattern of IgGs
Pemphigus Vulgaris; anti-desmoglein IgG

Flaccid Bullae

Reticular Immunofluoresence

may affect oral mucosa

Asboe-Hansen sign: bullae spread laterally w/ pressure

Nikolsky Sign: new bullae form with gentile traction
#dermatology #pathology #rheumatology
Blistering Skin Dz which Also Affects Oral Mucosa
Pemphigus Vulgaris; anti-desmoglein IgG

Flaccid Bullae

Reticular Immunofluoresence

may affect oral mucosa

Asboe-Hansen sign: bullae spread laterally w/ pressure

Nikolsky Sign: new bullae form with gentile traction
#dermatology #pathology #rheumatology
Bullous Pemphigoid vs Pemphigus Vulgaris
Pemphigus Vulgaris:
anti-desmosomal IgG → flaccid blisters & reticular immunofluorescence
may affect oral mucosa
Positive Nikolsky Sign: new bullae form with gentile traction

Bullous Pemphigoid
anti-hemidesmosomal IgG → tense blisters & linear IF w/ oral sparing & negative Nikolsky's sign
#dermatology #pathology #rheumatology
Skin Covered with Blisters, New Blisters do not formed with Gentle Traction
Bullous Pemphigoid

anti-hemidesmosomal IgG

spares oral mucosa

tense bullae

linear immunofluorescence
(contrast to PV: reticular)

NB: negative Nikolsky's sign (new blisters formwith gentle traction, indicative of Pemphigus Vulgaris anti-desmoglein IgG)
#dermatology #pathology #rheumatology
Skin Covered with Blisters, Immunofluorescence shows Linear Pattern of IgGs
Bullous Pemphigoid

anti-hemidesmosomal IgG

spares oral mucosa

tense bullae

linear immunofluorescence
(contrast to PV: reticular)

NB: negative Nikolsky's sign (new blisters formwith gentle traction, indicative of Pemphigus Vulgaris anti-desmoglein IgG)
#dermatology #pathology #rheumatology
Bullous Pemphigoid
Bullous Pemphigoid

anti-hemidesmosomal IgG

spares oral mucosa

tense bullae

linear immunofluorescence
(contrast to PV: reticular)

NB: negative Nikolsky's sign (new blisters formwith gentle traction, indicative of Pemphigus Vulgaris anti-desmoglein IgG)
#dermatology #pathology #rheumatology
↑ Lipase & Amylase → Dyspnea
Acute Pancreatitis → ARDS
#pathology #pulmonology
Councilman Bodies
acidophilic bodies within apoptitic hepatocytes
#pathology #hepatobiliary
acidophilic bodies within insulted hepatocytes
Councilman bodies indicative of apoptosis
#pathology #hepatobiliary
Blue Babies
5 T's

Tetrology of Fallot (most common)
Transposition fo GReat Vessels
Trucus Arteriosus (persistent, non-divided)
Tricuspid Atresia: hypoplastic RV + ASD + VSD
Total anamalous bulmonary venous return (2 systems)
#pathology #cardiovascular #neonatology
New Onset Cyanosis in Children
Eisenmenger

By Freq:
1. VSD
2. ASD (fixed split S2)
3. PDA
#pathology #cardiovascular
DOC: Nitroprusside OD
Nitroprosside: Ca2+ blocker which acts on both arteries an veins

Cyanide Toxicity

DOC: Sulfur ie Sodium Thiosulfate

provides extra substrate for liver rhodanase to form thiocyanate
#pharmacology #cardiovascular #toxicity
Calcification is indicative of what
prior cell death
#pathology
Toxicity of Hydrocyhloroquine
retinal damage
#pharmacology #antimicrobial #toxicity
electrolyte abnormality following massive packed RBC transfusion
Hypocalcemia

Packed RBC's contain citrate anticoagulant

citrate chelates calcium
#pathology #electrolytes #hematology
nasal transepithelial potential difference
a sensitive test for Cystic Fibrosis (more sensitive than Cl- sweat test)

test is positive if difference is more negative

CFTR both secretes chloride and inhibits Na+ secretion

reduced CFTR fnx → ↓ Cl- secretion ↑ Na+ secretion

more negative nasoepithlial surface

NB: sweat glands are the only glands where CFTR fnx to resporb Cl-
#pathology #molecules #diagnostics #geneticdzs
HIV gp41
gp41 is fusion protein allows entry into cell after adherence

[gp120 allows adherence to CD4]

both cleaved from gp160 from env gene
#HIV #microbiology
HIV gp120
gp120 allows adherence to CD4

[gp41 is fusion protein allows entry into cell after adherence]

both cleaved from gp160 from env gene
#HIV #microbiology
How does mom's blood type determine whether the baby could suffer from hemolytic dz?
Blood Types A & B usually have IgM anti-B & anti-A

Mom w/ Blood Type O often has IgG anti-A and anti-B

Mom with blood type O more likely to have hemolytic dz for baby than otherwise
#pathology #reproductive #immunology
DOC: acute gout
first line Rx is NSAID

glucocorticoid close 2nd
#pharmacology #analgesia
Heparin vs LMWH
enoxapren = LMWH

both activate AT3 to bind Factors 9 X & 2

Only require pentasaccharide to bind AT3 & ↑ affinity

Heparin has >18 sacchardies, allowing it to wrap around AT3 and form a stable bond with factor 2 (ie thrombin)

LMWH cannot and thus has higher affinity for X than 2
#pharmacology #hematology
What is a good mini-mental status test for concentration
reciting months of the year backwards, counting down from 100 by 7's or spelling world backward
#psychology
First sign of uncal herniation

sequelae thereof
ipsilateral dilated pupil from compression of CN3

sequelae:
down & out eye
PCA compression → homonymous hemianopia
contralateral cerebral peuncle → ipsilateral hemiparesis
alternatively isilateral " " → contralateral
brainstem duret hemorrhages 2° rupture of basilar artery → fatal
#neurology #pathology
unilateral dilated pupil
uncal herniation compressing CN3
#neurology #pathology
epigastric pain following food after ~30 min → weight loss

no abnormalities on scope
chronic mesenteric ischemia 2° to atherosclerotic narrowing of Celiac Trunk, SMA or IMA

microscopy would reveal atrophy
#gastrointestinal #pathology
Calcium stones

Frequency, Radiography, Microscopy, Causes
Calcium Stones

Caclium Phosphate or Caclium Oxalate

Frequency: Majority of all Stones
Radiography: all stones radioopaque except uric acid stones
Microscopy: octahedrons (square w/ cross hitching in 2d)
Causes: hypercalcemia; calcium oxalate stones may form from ethylene glycol/methanol or vitamin C abuse
#pathology #nephrology #neprholithalisis
Stones from Vitamin C Abuse
Caclium Oxalate

Frequency: Majority of all Stones
Radiography: all stones radioopaque except uric acid stones
Microscopy: octahedrons (square w/ cross hitching in 2d)
Causes: hypercalcemia; calcium oxalate stones may form from ethylene glycol/methanol or vitamin C abuse
#pathology #nephrology #neprholithalisis
Most common Nephrolithiasis
Calcium Stones

Caclium Phosphate or Caclium Oxalate

Frequency: Majority of all Stones
Radiography: all stones radioopaque except uric acid stones
Microscopy: octahedrons (square w/ cross hitching in 2d)
Causes: hypercalcemia; calcium oxalate stones may form from ethylene glycol/methanol or vitamin C abuse
#pathology #nephrology #neprholithalisis
Struvite Stones

Frequency, Radiography, Microscopy, Causes
Struvite Stones

Ammonium Magnesium or Phosphate
Freq: uncommon, 2nd most common to calcium stones
Radiography: all stones radioopaque except uric acid stones
Microscopy: "coffin lid" rectuangular prism
Causes: bugs: Proteus, Staph, Kleb
Worsened by Alkalinuria
#pathology #nephrology #neprholithalisis
octahedron nephrolithaisis
Calcium Stones

Caclium Phosphate or Caclium Oxalate

Frequency: Majority of all Stones
Radiography: all stones radioopaque except uric acid stones
Microscopy: octahedrons (square w/ cross hitching in 2d)
Causes: hypercalcemia; calcium oxalate stones may form from ethylene glycol/methanol or vitamin C abuse
#pathology #nephrology #neprholithalisis
Ammonium Stones
Struvite Stones

Ammonium Magnesium or Phosphate
Freq: uncommon, 2nd most common to calcium stones
Radiography: all stones radioopaque except uric acid stones
Microscopy: "coffin lid" rectuangular prism
Causes: bugs: Proteus, Staph, Kleb
Worsened by Alkalinuria
#pathology #nephrology #neprholithalisis
Rectangular Prism Stones
Struvite Stones

Ammonium Magnesium or Phosphate
Freq: uncommon, 2nd most common to calcium stones
Radiography: all stones radioopaque except uric acid stones
Microscopy: "coffin lid" rectuangular prism
Causes: bugs: Proteus, Staph, Kleb
Worsened by Alkalinuria
#pathology #nephrology #neprholithalisis
Uric Acid Stones

Radiography, Microscopy, Causes
Radiography: THE ONLY RADIOLUCENT KIDNEY STONE
Microscopy: Rhombus
Causes: uric acidemia (gout, leukemia etc)
#pathology #nephrology #neprholithalisis
Radiolucent Kidney Stones
Uric Acid Stones


Radiography: THE ONLY RADIOLUCENT KIDNEY STONE
Microscopy: Rhombus
Causes: uric acidemia (gout, leukemia etc)
#pathology #nephrology #neprholithalisis
Cysteine Kidney Stones

Radiography, Microscopy, Causes
Radiography: all kidney stones are radiopaque except uric acid stones
Microscopy: flat hexagons
Causes: cysteinuria; tx w/ alkalinization
#pathology #nephrology #neprholithalisis
Hexagonal Kidney Stones
Cysteine Stones

Radiography: all kidney stones are radiopaque except uric acid stones
Microscopy: flat hexagons
Causes: cysteinuria; tx w/ alkalinization
#pathology #nephrology #neprholithalisis
"Hotdog" looking inclusions in eosinophils
Major Basic Protein

Kills helminths
damages epithlium
#immunology
#hematology
Cauliflower mass in sigmoid colon causing mucoid diarrhea
villous adenoma

NB: carcinoid tumors also cause diarrhea, but not polypoid (?)
#pathology #gastrointestinal #neoplasia
HBV vs HCV
& Hepatocellular CA
HBV: integrates into genomes
HBx protein encodes for growth promoting and p53 inactivating proteins

HCV induces hepatocellular cancer simply through chronic inflammation, does not encorporate into genome, no specific pro-CA molecules
#pathology #microbiology #neoplasia
what dz is assoc. w/ polyarteritis nodosum
[fibrinoid necrosis of small/medium vessels]

HBV in some not all
#pathology #cardiovascular
Zenker Diverticulum
Esophageal Diverticium 2° inncreased pressure 3* to crichopharyngeal hypertony

crichopharyngeal muscles don't relax, more force required to push food → outpouching

retained food, regurgitation, aspiration all complications
#pathology #gastrointestinal
the pathology of 3* syphilis
obliteration of vasa vasorum
#microbiology
Bosentan
endothelin-receptor antagonist

prevents vasoconstriction and endothelial proliferation

DOC: pumonary artery hypertension
#pharmacology #pulmonology
DOC: pulmonary artery hypertension
Bosentan

endothelin-receptor antagonist

prevents vasoconstriction and endothelial proliferation
#pharmacology #pulmonology
Cause of Death:
Acute Rheumatic Fever
Myocarditis

NB: mitral stenosis req's years to dvlp
#microbiology #pathology
HIV gp24
gp24 and gp7 are nucleocapsid proteins encoded by gag
#HIV
HIV gp7
gp24 and gp7 are nucleocapsid proteins encoded by gag
#HIV
HIV gag
encodes nucleocapside proteins gp24 and gp7
#HIV
HIV nef
downregulates CD4 and MHC 1

↑ virlence
#HIV
HIV rev
faciliates transport of unspliced viral transcripts from nucleus
#HIV
HIV tat
Transcription AcTivator

↑ virulenc
#HIV
Anastrozole
aromatase inhibitor

useful v estrogen dpt breast tumors

anastrozole, letrozole, exemestane
#pharmacology #neoplasia #endocrine
Letrozole
aromatase inhibitor

useful v estrogen dpt breast tumors

anastrozole, letrozole, exemestane
#pharmacology #neoplasia #endocrine
Exemestane
aromatase inhibitor

useful v estrogen dpt breast tumors

anastrozole, letrozole, exemestane
#pharmacology #neoplasia #endocrine
aromatase inhibitors
anastrozole, letrozole, exemestane

useful v estrogen dpt breast tumors
#pharmacology #neoplasia #endocrine
Double Barrel Aorta
Aortic Dissection

Begins as an intimal tear

Hypertension is the most important risk factor
#pathology #cardiovascular
Timeline for correcting B12 deficiency
Immediate ↑ Reticulocyte Count, drops off again

slow ↑ hemoglobin
#nutrition #hematology
Refractory PUD
Gastric Hypertrophy 2° to ?
Gastrin (ZE)
#pathology #gastrointestinal
Buspirone vs BZD's
selective gor 5HT1A

no muscle relaxn
no anticonvulant
greatly ↓ addxn potential
#pharmacology
Source of ↑ AP
Largely from OsteoBlast activity and Liver

--Differentiatable by elecctrophoresis, specific antibodies and boiling
--Bone specific AP easily denatured in heat (Bone = Boil)


Follow-Up test for ↑ AP is γ Glutamyl Transpeptidase (GGTP):
Hepatobiliary Specific
#pathology #diagnostis #bone #hepatobiliary
Urinary product of osteoclastic activity
deoxypyridinoline --most specific

tartrate resistant acid phosphatase --specific but cross reacting with other acid phosphatases

urinary hydroxyproline present but non-specific
#pathology #diagnostis #bone
urinary deoxypyridinoline
the most specific marker of osteoclastic activity

other markers:



tartrate resistant acid phosphatase --specific but cross reacting with other acid phosphatases

urinary hydroxyproline present but non-specific
#pathology #diagnostis #bone
tartrate resistant acid phosphatase
tartrate resistant acid phosphatase --specific but cross reacting with other acid phosphatases

most specific: urinary deoxypyridinoline
#pathology #diagnostis #bone
How is glycogen synthase activated
Insulin → tyrosine kinase → protein phosphatase-1 →

dephosphyrlates glycogen synthase (activating)

also

dephosphorylates Fructose 1,6 bisphosphatase, inactivating and inhibiting gluconeogeneis
#biochemistry #energymetzm #molecules
protein phosphatase-1
Insulin → tyrosine kinase → protein phosphatase-1 →

dephosphyrlates glycogen synthase (activating)

also

dephosphorylates Fructose 1,6 bisphosphatase, inactivating and inhibiting gluconeogeneis
#biochemistry #energymetzm #molecules
Transporter Defect in Cysteinuria
Dibasic Cation Transporter

COAL
Cystine
Ornithine
Arginine
Lysine
#pathology #nephrology #nephrolithiasis #molecules
What is the Nitrogen Source for the Urea Cycle?

How does that molecule originally get its nitrogen?
Nitrogen Source for Urea Cycle is Aspartate (combines with Citrate to form arginosuccinate)

Oxaloacetate + NH3 = Asparatate

The NH3 for that reaction comes from Glutamate via B6

(NB: Glutamate losing NH3 becomes α-ketoglutarate)

And how does glutamate get its NH3+ you ask?

Substrate specific transaminases like AST and ALT (the two most significant):
Alanine → Pyruvate
Aspartate → Oxaloacetate
#biochemistry #energymetzm #molecules
homogenous hyalinization vs onion skinning of arteries
hyaline: low level Htn

onion skinning: malignant htn
#pathology #cardiovascular
describe mechanism of hearing in the inner ear
3 chambers: scala vestibuli: Na+ rich, onnected to oval window
scala media: K+, organ of corti
basilar membrane separates media from tympani
scala tympani: Na+: connected to round window

scala vestibuli and scala tympani meet at helicotremma at top

low freq's cause vibration at top near helicotremma
high freqs at base near oval window
#neurology #physiology
immunolytic effects of corticosteroids
inhibit PLA2
inhibit phagocytosis
inhibit IL1 prodxn
#pharmacology #immunology
Leucovorin
N5 Formyl THF

Rescules MTX toxicity

potentiates 5FU effectiveness

5FU binds THF & Thymidilate Synthase in stable intermediate state
#pharmacology #chemotheraputics
Gemcitabine
pyrimidine analogue

-abine = dNTP analogue
#pharmacology #chemotheraputics
Cytarabine
pyrimidine analogue

-abine = dNTP analogue
#pharmacology #chemotheraputics
Fludarabine
purine analogue

used v CLL

-abine = dNTP analogue
#pharmacology #chemotheraputics
Loss of FAS → SLE

pathogenesis?
impaired "Clonal deletion" of activated T's by CTL's in peripheral ts
#pathology #hematology #immunology
Most common cause of superior vena cava sro?
1. bronchogenic carcinoma

esp 20 years after asbestos exposure
#pathology #pulmonology
Sodium Cyanide Nitroprusside Test for Nephrolithasis
If urine becomes red-purple then you are looking at cystine stones

Cyanide converts cystine → cysteine
Nitroprusside + Cysteine → Blue Molecule

Dibasic AA transporter

Cystine
Ornithine
Arginine
Lysine

Tx: alkalinize the urine
#pathology #diagnostics #nephrology #nephrolithaisis
Confirmatory Test for Cystine Cyrstaluria
Sodium Cyanide Nitroprusside Tes

If urine becomes red-purple then you are looking at cystine stones

Cyanide converts cystine → cysteine
Nitroprusside + Cysteine → Blue Molecule

Dibasic AA transporter

Cystine
Ornithine
Arginine
Lysine

Tx: alkalinize the urine
#pathology #diagnostics #nephrology #nephrolithaisis
Cystic pancreatic lesion 3 weeks post pancreatitis
pancreatic pseudocyst 2° pancreateic enzymatic degradation of pancreas

not a true cyst, lined by fibrosis and granulation ts, no epithlelium

most commonly lesser peritoneal sac posterior to stomach
#pathology #gastrointestinal
Mifepristone
progesterone antagonist abortificant

NB: often combined with misoprostol

5x affinity for progesterone receptor as progesterone
#pharmacology #reproductive
fetus no longer has a heartbeat
dead

risk of DIC

monitor fibrinogen closely
#pathology #reproductive
Cystic degeneration of putamen likely 2° to
Wilson's Dz
#pathology #neurology
What blotting technique should you use to determine if a gene is being transcribed
Northern blot for mRNA
#diagnostics
Medullary Sponge Kidney
common benign disorder
linear dilations of medullary collecting ducts w/ cortical sparing

incidental finding
majority of pts will dvlp kidney stones
10% of all kidney stones 2° to MSK

NB: not medullary cystic kidney dz
fibrosis → inability to concentrate urine → end stage renal dz
#pathology #nephrology
Kidney with cystically dilated medullary collecting ducts
Medullary Sponge Kidney
common benign disorder
linear dilations of medullary collecting ducts w/ cortical sparing

incidental finding
majority of pts will dvlp kidney stones
10% of all kidney stones 2° to MSK

NB: not medullary cystic kidney dz
fibrosis → inability to concentrate urine → end stage renal dz
#pathology #nephrology
Most common Amino Acid in Collagen
Glycine every 3rd position

Strx is always
(Gly-X-Y)x333

Proline also essential, but not as frequent
#biochemistry #molecules
Gestational Diabetes
human placental lactogen hPL from syncytiotrophoblasts induces insulin resistance to provide glucose for baby

if maternal insulin prodxn overwhelmed → gestational diabetes
#endocrine #reproductive #physiology
Cromolyn
Inhibit mast cell degranulation

useful in tx of asthma

sibling: nedocromil
#pharmacology #pulmonology
Nedocromil
Inhibit mast cell degranulation

useful in tx of asthma

sibling: cromolyn
#pharmacology #pulmonology
inhibitors of mast cell degranualtion
cromolyn and nedocromil

useful vs asthma
#pharmacology #pulmonology
Recurrent Bacterial and Viral Infx
indicative of combined T and B cell deficiency (SCID)
#immunology #pathology
The progression of lobar pneumonia
First 24h: Congestion
macro: red, heavy boggy
micro: vascular dilation, bacteria rich exudate

d2-3: Red hepatization
macro: red, firm
micro: RBC, PMN & fibrin infiltrate

d4-6: Grey hepatization
macro: grew brown & firm
micro: PMN's & Fibrin

resolution
macro: normal architecture
enzymatic degradation of exudate
#pathology #pulmonology
Akathisia
side effect of anti-psychotics

anxiety, restlessness

timeline
4h: dystonia
4d: parkinsonianism
4wk: akathisia
4mo: tardive dyskinesia
#pharmacology #toxicity
anti-Mtb Rx most active in acidic environment
pyrazinhamide

ie within phagolysosomes

unknown mechanism of action
#pharmacology #antimicrobials
Pick's Dz: brain region
frontotemoral specificty

inappropriate behavior and speach decline

unknown genetic basis
#neurology #pathology
Conoloscopy Findings:

protuberant mass

Likely Dz?
adenocarcinoma

biopsy: dysplastic mucosa w/ gland formation
#pathology #gastrointestinal
Conoloscopy Findings:

multiple ulcers and mucosal erosions

Likely Dz?
CMV
#pathology #gastrointestinal
Conoloscopy Findings:

nonulcerative inflammation

Likely Dz?
cryptosporidium

biopsy: basophilic clusters seen on surface of intestinal mucosal cells
#pathology #gastrointestinal
Conoloscopy Findings:

numerous discrete flash-shaped ulcerations

Likely Dz?
entamoeba histolytica

biopsy: trophozoites contianing RBC's
#pathology #gastrointestinal
Conoloscopy Findings:

violet flat maculopaular lesions & hemorrhagic nodules

Likely Dz?
Kaposi's sarcoma

HHV-8

biopsy: spindle shpaed tumor cells w/ small vessel proliferation
#pathology #gastrointestinal
Biopsy Findings:

dysplastic mucosa w/ gland formation



Likely Dz?
adenocarcinoma
#pathology #gastrointestinal
Biopsy Findings:

basophilic clusters seen on surface of intestinal mucosal cells

Likely Dz?
cryptosporidium

nonulcerative inflammation
#pathology #gastrointestinal
Biopsy Findings:

trophozoites containing RBC's

Likely Dz?
entamoeba histolytica

numerous flask shaped uilcerative lesiosn
#pathology #gastrointestinal
Biopsy Findings:

spindle shaped tumor cells with small vessel proliferation

Likely Dz?
Kaposi's sarcoma

HHV-8
#pathology #gastrointestinal
HCV v HBV: which more likely from sexual transmission
HBV
#pathology #micobiology #hepatobiliary
DOC: AML
t(15:17) RAR-PML

DOC: all-trans-retinoic acid
induces remission in 90% of pts
#hematology #pharmacology #chemotheraputic #neoplasia #pathology
Murmurs v Respiration
Inspiration induces/increases Right Sided Murmurs

Expiration induces/increases Left Sided Murmurs
#pathology #cardiovascular #diagnostics
Murmurs v Valsalva Maneuver
same as standing

Most murmurs diminish except for

Hypertrophic Cardiomyopathy and Mitral Valve Prolapse

NB: these also the only mumurs to become quieter with passive leg raise/squatting
#pathology #cardiovascular #diagnostics
Murmurs v Standing
same as valsalva maneover

Most murmurs diminish except for

Hypertrophic Cardiomyopathy and Mitral Valve Prolapse

NB: these also the only mumurs to become quieter with passive leg raise/squatting
#pathology #cardiovascular #diagnostics
Mumurs v Squatting
same as passive leg raising

most murmurs become louder except hypertrophic cardiomyopathy and mitral valve prolapse

NB: these are also the only murmurs to become louder with valsalva maneuver/standing
#pathology #cardiovascular #diagnostics
Murmurs v Passive Leg Raise
same as passive leg raising

most murmurs become louder except hypertrophic cardiomyopathy and mitral valve prolapse

NB: these are also the only murmurs to become louder with valsalva maneuver/standing
#pathology #cardiovascular #diagnostics
Murmurs v Handgrip
MR, VSD, and AR become Louder

Hypertrophic Cardiomyopathy murmur becomes queiter
#pathology #cardiovascular #diagnostics
many immature myelogenous cells on blood smear
Not AML: would be "blast cells" rather than immature cells (bands, metamyelocytes, myelocytes)

either CML t(9:22) or leukemoid rxn (ie infx)

depends on AP

low AP: CML
normal or high: leukemoid rxn
#pathology #diagnostics #hematology #neoplasia
D-glutamate capsule
The primary virulence factor of Bacillus anthracis, required for pathogenicity, uniquely does not contain polysaccharide

"wool-workers dz"

grows "medusa head" colonies on media

spores grow once ingested by alvoelar M∅ → mediastinal lymkph nodes → hemorrhagic mediastinitis → septic shock and death

anthrax toxin
#microbiology #pulmonology
Wool Worker with Widened Mediastinum
Bacillus anthracis --"wool workers dz"

spores grow once ingested by alvoelar M∅ → mediastinal lymkph nodes → hemorrhagic mediastinitis → septic shock and death

D-glutamate capsule is the The primary virulence factor of Bacillus anthracis, required for pathogenicity, uniquely does not contain polysaccharide

grows "medusa head" colonies on media

anthrax toxin
#microbiology #pulmonology
"medusa head" colonies on agar
Bacillus anthracis --"wool workers dz"

spores grow once ingested by alvoelar M∅ → mediastinal lymkph nodes → hemorrhagic mediastinitis → septic shock and death

D-glutamate capsule is the The primary virulence factor of Bacillus anthracis, required for pathogenicity, uniquely does not contain polysaccharide

anthrax toxin
#microbiology #pulmonology
Drug Interaxns of Niacin
Potentiates Anti-Hypertensives

Induces Insulin Resistance

also causes hyperuricemia
#pharmacology #cardiovascular #toxicity
Diphenoxylate
opiod used motility diarrhea

often combined with atropine as lomotil
#pharmacology #drugs #gastrointestinal
Desmopressin
aka DDAVP

ADH analogue

used for central diabetes insipidus

and also coagulopathies
→ induces release of vWF & Factor 8 from endothelial cells (where they are produced and stored)
#pharmacology #drugs #hematology #nephrology
DDAVP
aka Desmopressin

ADH analogue

used for central diabetes insipidus

and also coagulopathies
→ induces release of vWF & Factor 8 from endothelial cells (where they are produced and stored)
#pharmacology #drugs #hematology #nephrology
Daptomycin
Rx v MRSA

Mech: creates transmembrane channels → electrolyte flow → depolarization → proteins now nonfnx

Limitation: cannot get through to inner membrane of gram negatives; also inactivated by pulmonary surfactant

Side Effects: Myopathy ( ↑ CPK)
#pharmacology #drugs #antimicrobials
MRSA Rx

non-fnx vs pneumonia
Daptomycin

Mech: creates transmembrane channels → electrolyte flow → depolarization → proteins now nonfnx

Limitation: cannot get through to inner membrane of gram negatives; also inactivated by pulmonary surfactant

Side Effects: Myopathy ( ↑ CPK)
#pharmacology #drugs #antimicrobials
MRSA Rx:

depolarizes cellular membrane
Daptomycin

Mech: creates transmembrane channels → electrolyte flow → depolarization → proteins now nonfnx

Limitation: cannot get through to inner membrane of gram negatives; also inactivated by pulmonary surfactant

Side Effects: Myopathy ( ↑ CPK)
#pharmacology #drugs #antimicrobials
MRSA Rx:

↑ CPK
Daptomycin

Mech: creates transmembrane channels → electrolyte flow → depolarization → proteins now nonfnx

Limitation: cannot get through to inner membrane of gram negatives; also inactivated by pulmonary surfactant

Side Effects: Myopathy ( ↑ CPK)
#pharmacology #drugs #antimicrobials #toxicity
Linezolid
good Rx v MRSA

binds 23S portn of 50S

Toxicities:
Thrombocytopenia
Optic neuritis
5HT Sro
#pharmacology #drugs #antimicrobials
MRSA Rx:

Binds 23S
Linezolid

binds 23S portn of 50S

Toxicities:
Thrombocytopenia
Optic neuritis
5HT Sro
#pharmacology #drugs #antimicrobials
MRSA Rx:

Thrombocytopenia
Linezolid

binds 23S portn of 50S

Toxicities:
Thrombocytopenia
Optic neuritis
5HT Sro
#pharmacology #drugs #antimicrobials #toxicity
MRSA Rx:

Optic Neuritis
Linezolid

binds 23S portn of 50S

Toxicities:
Thrombocytopenia
Optic neuritis
5HT Sro
#pharmacology #drugs #antimicrobials #toxicity
MRSA Rx:

5HT Sro
Linezolid

binds 23S portn of 50S

Toxicities:
Thrombocytopenia
Optic neuritis
5HT Sro
#pharmacology #drugs #antimicrobials #toxicity
rT3
rT3 is nonfnx product of peripheral T4 conversion

T4 can be converted to T3 or rT3

NB: T3 cannot be converted to T4 or rT3
#physiology #endocrine
Libman-Sacks Dz
Libman Sacks Endocarditis of SLE

sterile endocarditis

likely IC deposition

may progress to regurgitation or stenosis
#pathology #cardiovascular #rheumatology
Frequency:
Esophageal Cancers
Adenocarcinoma > Squamous Cell Carcinoma

People are fatter and smoking less
#neoplasia #pathology #gastrointestinal
Dressler's Dz
autoimmune myocarditis which follows MI by months
#pathology #rheumatology #cardiovascular
autoimmune myocarditis which follows MI by months
Dressler's Dz
#pathology #rheumatology #cardiovascular
Relative Conduction Speeds Throughout the Heart
Purkinje
Atrial Muscle
Ventricular Muscle
AV Node

Mn: Park At VENTura AVenue
#physiology #cardiovascular
Cholelithiasis 2° to Cholecystitis
Brown Pigment Stones

Infx → β-glucuronidase spillage → deconjugates bilirubin → Cholelithiasis

Esp E Coli, Ascaris Lumbricoides or Opisthorchis sinesis

Elderly Women in Rural Asia
#pathology #hepatobiliary
Cholelithiasis in Rural Central Asia
Brown Pigment Stones

Infx → β-glucuronidase spillage → deconjugates bilirubin → Cholelithiasis

Esp E Coli, Ascaris Lumbricoides or Opisthorchis sinesis

Elderly Women in Rural Asia
#pathology #hepatobiliary
Brown Pigment Stones
Infx → β-glucuronidase spillage → deconjugates bilirubin → Cholelithiasis

Esp E Coli, Ascaris Lumbricoides or Opisthorchis sinesis

Elderly Women in Rural Asia
#pathology #hepatobiliary
Cause of Death: CF
Pneumonia
#pathology #geneticdzs
anti-PLAR2 IgG
PLAR2 = transmembrane phsopholipase A2 receptor abundant on podocyutes

ideopathic membranous nephropathy

neophrotic sro)
#pathology #nephrology
ideopathic membranous nephropathy
nephrotic sro 2° to anti-PLAR2 IgG

PLAR2 = transmembrane phsopholipase A2 receptor abundant on podocyutes

ideopathic membranous nephropathy

NB: not the same as 2° membranous nephropathy (SLE)
#pathology #nephrology
Most reliable prognostic indicators for liver damage
PT and albumin

NB: AST & ALT only indicative of damage, not of outcome
#pathology #diagnostics #hepatobiliary
Anti-depressant which causes priapism
Trazodone

contraindicated in adolescent boys
#pharmacology #toxicities #drugs
DOC: DKA
regular insulin

oddly not rapid acting insuilins (lispro aspart)
#pharmacology #DOCs #endocrine
HNPCC adenocarcinoma vs Sporadic Adnocarcinoma
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2

Sporadic
>50 yo
left sided
single
arise from adenomatous polyps
genetics: adenoma → CA sequence: APC, K-ras, p53 & finally DCC
#pathology #neoplasia #genticdzs #gastrointestinal
Right Sided Adenocarcinoma
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2
#pathology #neoplasia #genticdzs #gastrointestinal
MLH1
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2
#pathology #neoplasia #genticdzs #gastrointestinal
MLH2
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2
#pathology #neoplasia #genticdzs #gastrointestinal
MSH6
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2
#pathology #neoplasia #genticdzs #gastrointestinal
PMS2
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2
#pathology #neoplasia #genticdzs #gastrointestinal
Colonic Adenocarcinoma in a 30 yo
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2
#pathology #neoplasia #genticdzs #gastrointestinal
Colonic Adenocarcinoma in a 70 yo
Sporadic
>50 yo
left sided
single
arise from adenomatous polyps
genetics: adenoma → CA sequence: APC, K-ras, p53 & finally DCC
#pathology #neoplasia #gastrointestinal
Digoxin: mechanism of action
1. Blocks NaK ATPase → ↑ [Ca2+]

2. ↑ PSNS tone → ↓ AV node condxn
#pharmacology #cardiovascular
S3 indicative of
stiff or partially filled

best heart in left lateral decupitus position at ventricular apex at end of expiration
#cardiovascular #pathology #diagnostics
Gastric Adenocarinomas
2 variants

signet ring: do not form glands, contain mucin
diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica

intestinal type resemble colon cancers: grow as well demarcated masses of well formed glands
#pathology #gastrointestinal #neoplasia
Rugal thickening of stomach
indicative of ZE sro
#pathology #gastrointestinal #neoplasia
"leather bottle" stomach
signet rinng gastric adenocarcinoma: do not form glands, contain mucin
diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica
#pathology #gastrointestinal #neoplasia
linitis plastica
signet rinng gastric adenocarcinoma: do not form glands, contain mucin
diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica
#pathology #gastrointestinal #neoplasia
What good is HMP shunt?
does not produce ATP

produces 2 NADPH's

Required for
--FA, cholesterol & steroid synthesis
--Rx metzm
#biochemistry #energymetzm
Reyes Sro
Child c Fever + Aspirin

Hepatic Failure → Acute Encephalopathy

Biopsy: microvesicular steatosis (yes, there was a question on this) No necrosis or inflammation

all LFT's ↑
cerebral edema
#pathology #hepatobiliary
DOC: anti-depressant with least sexual side effects
Burproprion does not cause sexual dysfnx

DA NE RI

does cause seizures and insomnia
#pharmacology #physciatric
NE activates which receptors
both α and β1

little effect on β2
#pharmacology #autonomic
What signals drive angiogenesis
VEGF: endothelial cell motility and proliferation

FGF: also contributes
#physiology #cardiovascular
Pathogenesis of Crohn's Nephrolithiasis
normally dietary Ca2+ binds dietary Oxalate → insoluble salts → oxalate excretion

Crohns: loss of bile acids → impaired fat absorption → Ca2+ FA Soap formation → excretion → unbound oxalate taken up → Calcium Oxalate Stones

Radiopaque Octahedrons
#pathology #gastrointestinal #nephrology #nephrolithiasis #inflammation
Fever, GI distress, Hepatosplenomegaly, Periumbilical Rose Spots
Salmonella typhi
#microbiology #gastrointestinal #hepatobiliary #pathology
Adrenal Cortex Dz's caused by Hypertrophy and Hyperplasia
Hypertrophy: Conn

Hyperplasia: Cushing
#endocrine #pathology
Histology of Conn & Cushing Sros
Conn: Hypertrophy

Cushing: Hyperplasia
#endocrine #pathology
Signal which gathers Myofibroblasts at wound
MMP's gather myofibroblasts at wound edges
#physiology #molecules
DIC vs TTP vs HUS
DIC:
Pts bleed
Activated Coagulation Cascade
↑ PT & ↑ PTT
↓ fibrinogen, ↑ FDP (D-dimer)

TTP-HUS
usually do not bleed
Only Platelets activated
normal PT, PTT, fibrinogen, ∅ FDP
#hematology #pathology
Rectal Prolapse in Children
CF
#pathology #geneticdzs #gastrointestinal
Osmotic Laxitives
Polyethylene Glycol
& Magnesium Chloride
#pharmacology #gastrointestinal
Microbe: produce diarrhea with small innoculum
Entamoeba Histolytica (1)
Giardia (1)
Shigella (10)
Campylobacter jejuni (500)
#microbiology #gastrointestinal
Dilated Cardiomyopathies
90% of cardiomyopathies are dilated cariomyopathies

Pathogenesis: ↑ End Diastolic Volume
→ Eccentric Hypertrophy → Systolic Dysfnx

All chambers dilated, valvular insufficiencies, heart failure

Etiologies:
Mn: ABCCCD (-PH)
Alcohol, Beriberi
Coxsackie B, Cocaine, Chagas
Doxorubicin/Daunorubicin
Post Partum
Hemochromatosis (may be restrictive)
#pathology #cardiovascular
Alcoholic Cardiac Abnormality
Dilated Cardiomyopathy

↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx

All chambers dilated, valvular insufficiencies, heart failure

90% of cardiomyopathies are dilated cariomyopathies
Etiologies:
Mn: ABCCCD (-PH)
Alcohol, Beriberi
Coxsackie B, Cocaine, Chagas
Doxorubicin/Daunorubicin
Post Partum
Hemochromatosis (may be restrictive)
#pathology #cardiovascular
Thiamine Deficiency Cardiac Abnormality
Dilated Cardiomyopathy

↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx

All chambers dilated, valvular insufficiencies, heart failure

90% of cardiomyopathies are dilated cariomyopathies
Etiologies:
Mn: ABCCCD (-PH)
Alcohol, Beriberi
Coxsackie B, Cocaine, Chagas
Doxorubicin/Daunorubicin
Post Partum
Hemochromatosis (may be restrictive)
#pathology #cardiovascular
Coxsackie Cardiac Abnormality
Dilated Cardiomyopathy

↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx

All chambers dilated, valvular insufficiencies, heart failure

90% of cardiomyopathies are dilated cariomyopathies
Etiologies:
Mn: ABCCCD (-PH)
Alcohol, Beriberi
Coxsackie B, Cocaine, Chagas
Doxorubicin/Daunorubicin
Post Partum
Hemochromatosis (may be restrictive)
#pathology #cardiovascular
Doxorubicin Cardiac Abnormality
Dilated Cardiomyopathy

↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx

All chambers dilated, valvular insufficiencies, heart failure

90% of cardiomyopathies are dilated cariomyopathies
Etiologies:
Mn: ABCCCD (-PH)
Alcohol, Beriberi
Coxsackie B, Cocaine, Chagas
Doxorubicin/Daunorubicin
Post Partum
Hemochromatosis (may be restrictive)
#pathology #cardiovascular
Hemochromatosis Cardiac Abnormality
May be Dilated or Restrictive Cardiomyopathy!

Dilated:
↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx
All chambers dilated, valvular insufficiencies, heart failure

Restrictive:
↓ compliance → diastolic dysnfx heart failure
#pathology #cardiovascular
Cocaine Cardiac Abnormality
Dilated Cardiomyopathy

↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx

All chambers dilated, valvular insufficiencies, heart failure

90% of cardiomyopathies are dilated cariomyopathies
Etiologies:
Mn: ABCCCD (-PH)
Alcohol, Beriberi
Coxsackie B, Cocaine, Chagas
Doxorubicin/Daunorubicin
Post Partum
Hemochromatosis (may be restrictive)
#pathology #cardiovascular
Chagas Cardiac Abnormality
Dilated Cardiomyopathy

↑ End Diastolic Volume → Eccentric Hypertrophy → Systolic Dysfnx

All chambers dilated, valvular insufficiencies, heart failure

90% of cardiomyopathies are dilated cariomyopathies
Etiologies:
Mn: ABCCCD (-PH)
Alcohol, Beriberi
Coxsackie B, Cocaine, Chagas
Doxorubicin/Daunorubicin
Post Partum
Hemochromatosis (may be restrictive)
#pathology #cardiovascular
Restrictive Cariomyopathy
restrictive cardiomyopathy
↓ compliance → diastolic dysnfx heart failure

Causes:
1. Amyloidosis
2. Post-surgical fibrosis
3. Radiation-induced Fibrosis
also Genetics: pompe's dz, hemochromatosis (may also be dilated)
Metastatic Cancers, Genetic abnormalities
childhood fibroelastosis
#pathology #cardiovascular
Amyloidosis Cardiac Abnormality
restrictive cardiomyopathy
↓ compliance → diastolic dysnfx heart failure

Causes:
1. Amyloidosis
2. Post-surgical fibrosis
3. Radiation-induced Fibrosis
also Genetics: pompe's dz, hemochromatosis (may also be dilated)
Metastatic Cancers, Genetic abnormalities
childhood fibroelastosis
#pathology #cardiovascular
Radiation Induced Cardiac Abnormality
restrictive cardiomyopathy
↓ compliance → diastolic dysnfx heart failure

Causes:
1. Amyloidosis
2. Post-surgical fibrosis
3. Radiation-induced Fibrosis
also Genetics: pompe's dz, hemochromatosis (may also be dilated)
Metastatic Cancers, Genetic abnormalities
childhood fibroelastosis
#pathology #cardiovascular
Pompe's Dz Cardiac Abnormality
deficiency of Lysosomal α 1,4 glucosidase (aka acid maltase)

restrictive cardiomyopathy
↓ compliance → diastolic dysnfx heart failure

Causes of Restrictive Cardiomyopathy
1. Amyloidosis
2. Post-surgical fibrosis
3. Radiation-induced Fibrosis
also Genetics: pompe's dz, hemochromatosis (may also be dilated)
Metastatic Cancers, Genetic abnormalities
childhood fibroelastosis
#pathology #cardiovascular
Px of ITP
Ideopathic thrombocytopenic purprua

Bleeding from platelet destrx

Chidlren: acute and self-limited

Adults: insidious and chronic
#pathology #hematology #rheumatology
Best test to monitor for HCC recurrence
Hepatocellular Carcinoma:

Alpha fetoprotein
#pathology #neoplasia #diagnostics
Vitamin K deficiency
Bleeding

Extremely unlikely in adults as colonic bacteria produce vitamin K
#pathology #nutrition
Nails which bow in and bend out
Spoon nails aka Koilonychia
specific for iron deficiency anemia

___________________

Plummer Vincent Sro: Triad of

Iron Deficiency Anemia
Glossitis
Esophageal Webbing (Dysphagia)
#pathology #hematology
Plummer Vincent Sro
Triad of

Iron Deficiency Anemia (Spoon Nails aka Koilonychia)
Glossitis
Esophageal Webbing (Dysphagia)
#pathology #hematology #gastrointestinal
Anemia + Dysphagia
Plummer Vincent Sro

Triad of

Iron Deficiency Anemia (Spoon Nails aka Koilonychia)
Glossitis
Esophageal Webbing (Dysphagia)
#pathology #hematology #gastrointestinal
Spoon Nails + Dysphagia
Plummer Vincent Sro

Triad of

Iron Deficiency Anemia (Spoon Nails aka Koilonychia)
Glossitis
Esophageal Webbing (Dysphagia)
#pathology #hematology #gastrointestinal
Spoon Nails
aka Koilonychia

Specific for Iron Deficiency Anemia

___________________

Plummer Vincent Sro: Triad of

Iron Deficiency Anemia
Glossitis
Esophageal Webbing (Dysphagia)
#pathology #hematology
Koilonychia
aka spoon nails

Specific for Iron Deficiency Anemia

___________________

Plummer Vincent Sro: Triad of

Iron Deficiency Anemia
Glossitis
Esophageal Webbing (Dysphagia)
#pathology #hematology
B6 deficiency anemia
required for first step of heme synthesis

microcytic hypochromatic B6 responsive anemia

same morphology as X linked Sideroblastic Anemia, but B6 responsive
#pathology #nutrition #hematology
Neutral Aminoaciduria
Hartnup Dz

Defective Neutral AA transporters in both Kidneys and Intestine

Tryptophan is the only essential AA,
necessary for (BH4 dpt) 5HT and (B6 dpt) Niacin synth

mostly aSx, though som pts present with pelagra:
Diarrhea
(Photosensative) Dermatitis
Dementia (Ataxia)

These pts benefit from Niacin supplementation
#pathology #geneticdzs #nutrition
Ataxia + Photosensitive Skin Lesions + Loose stools
Pellagra 2° to Niacin Deficiency
Diarrhea, Dermatitis, Dementia

causes:
Corn Based Diets
Carcinoid Tumor (uses up all the 5HT)
Hartnup Dz: defective transport of neutral AA's in intestine and nephrons → no Tryptophan absorption → no Niacin prodxn
#pathology #nutrition #neoplasia #geneticdzs
Pellagra
Diarrhea,
(Photosenstive) Dermatitis
Dementia (Ataxia)

causes:
Corn Based Diets
Carcinoid Tumor (uses up all the 5HT)
Hartnup Dz: defective transport of neutral AA's in intestine and nephrons → no Tryptophan absorption → no Niacin prodxn
#pathology #nutrition #neoplasia #geneticdzs
Tocopherol
Vitamin E
#nutrition #molecules
Vitamin E molecule name
Tocopherol
#nutrition #molecules
E Coli & Sorbitol
Most E coli Strains ferment sobitol Rapidly

Most EHEC O157H7 cannot ferment sorbitol
#micriobiology #diagnostics
Test for EHEC from other E coli
Sobitol Containin McConkey's Agar

Most E coli Strains ferment sobitol Rapidly

Most ETEC O157H7 cannot ferment sorbitol
#micriobiology #diagnostics
Cause of Death: TCA OD
Fast Na+ Channel inhibition → slowed conduction + prolonged QRS → fatal arrhytmias

else

↓ CO (arrthmias) + α blockade → Refractory Hypotension
#pharmacology #toxicity
Rapid Lactose Fermenters
Kleb: Citrate + Urease +
Enterobacter: Citrate + Urease Neg
E Coli: Citrate, Urease Double Neg
#microbiology #diagnostics
Biochemical Profile of Kleb
Rapid Lactose Fermenter
Citrate +
Urease +
#microbiology #diagnostics
Biochemical Profile of Enterobacter
Rapid Lactose Fermenter
Citrate +
Urease Neg
#microbiology #diagnostics
Biochemical Profile of E coli
Rapid Lactose Fermenter
Citrate Neg
Urease Neg
#microbiology #diagnostics
Biochemical Profile of Shigella
Oxidase Negative
Lactose Nonfermenter
Which does not produce H2S on TSI Agar
#microbiology #diagnostics
Biochemical Profile of Salmonella
Oxidase Negative Lactose Nonfermenter
Which Produces H2S on TSI Agar

Identical Profile to Proteus
#microbiology #diagnostics
Biochemical Profile of Proteus
Oxidase Negative Lactose Nonfermenter
Which Produces H2S on TSI Agar

Identical Profile to Salmonella
#microbiology #diagnostics
Biochemical Profile of Pseudomonas
Oxidase Positive Lactose Nonfermenter
#microbiology #diagnostics
Gram Negative Rod
Which Ferments Lactose Slowly
Both Citrobacter and Serratia
#microbiology #diagnostics
Urease + Citrate +
Rapid Lactose Fermenting
Gram Negative Rod
Kleb
#microbiology #diagnostics
Urease Neg Citrate +
Rapid Lactose Fermenting
Gram Negative Rod
Enterobacter
#microbiology #diagnostics
Urease Neg Citrate Neg
Rapid Lactose Fermenting
Gram Negative Rod
E coli
#microbiology #diagnostics
Oxidase Negative Lactose Non-Fermenting
Gram Negative Rod
Which Does Not Produce H2S on TSI Agar
Shigella
#microbiology #diagnostics
Oxidase Negative Lactose Non-Fermenting
Gram Negative Rod
Which Produces H2S on TSI Agar
Either Salmonella or Proteus
#microbiology #diagnostics
Oxidase Positive
Lactose Non-Fermenting
Gram Negative Rod
Pseudomonas
#microbiology #diagnostics
Lactose Non Fermenting
Oxidase Negative
Gram Negative Rod
TSI Agar:

∅ H2S Prodxn: Shigella

H2S Prodxn: Salmonella or Proteus
#microbiology #diagnostics
Maltose Fermenting
Gram Negative Cocci
N meningitidis

NB: Maltose Non-Fermenting = N gonorrhoeae
#microbiology #diagnostics
Maltose Non-Fermenting
Gram Negative Cocci
N gonorrhoeae

NB: Maltose Fermenting = N meningitidis
#microbiology #diagnostics
ANS innervation of the Uterus
beta 2 causes relaxation

beta 2 agonists used to defer premature labor:
ritodrine, terbutaline
allows time for cortisol to work
#pharmacology #autonomics #reproductive
Ritodrine
beta 2 agonist

used to relax the uterus and defer labor
allowing time for cortisol to work
#pharmacology #autonomics #reproductive #drugs
Terbutaline
beta 2 agonist

used to relax uterus and defer labor
allowing time for cortisol to work
#drugs #pharmacology #autonomics #reproductive
deferring labor
beta 2 agonists

ritodrine and terbutaline
allowing time for cortisol to work
#drugs #pharmacology #autonomics #reproductive
Kussmaul's Sign
normally JVP decreases with inspiration

Kussmaul's sign is an increase in JVP w/ inspiration

indicative of constrictive pericarditis

-Kussmaul's Sign
-Pericardial Knock (earlier than S3 which normallly indicates rapid filling from dilated/weak ventricle)
-Pulsus Paradoxus
#cardiology #pathology #diagnostics
Increase in JVP on inspiration
normally JVP decreases with inspiration

Kussmaul's sign is an increase in JVP w/ inspiration

indicative of constrictive pericarditis

-Kussmaul's Sign
-Pericardial Knock (earlier than S3 which normallly indicates rapid filling from dilated/weak ventricle)
-Pulsus Paradoxus
#cardiology #pathology #diagnostics
Decrease in JVP on inspiration
Physiologic
_________________________
Kussmaul's sign is an increase in JVP w/ inspiration

indicative of constrictive pericarditis

-Kussmaul's Sign
-Pericardial Knock (earlier than S3 which normallly indicates rapid filling from dilated/weak ventricle)
-Pulsus Paradoxus
#cardiology #pathology #diagnostics
Pericardial Knock
Heart Sound heard before S3 indicative of extremely restricted filling

Restrictive Pericarditis
--Kussmaul's increase in JVP on inspiration
--Pericardial Knock
--Pulsus Paradoxus
#cardiology #pathology #diagnostics
Heart sound immediately following S2
Pericardial Knock

before S3 (ventricular splash from dilation)

indicative of restrictive pericarditis
--Kussmaul's increase in JVP on inspiration
--Pulsus Paradoxus
--Pericardial Knock
#pathology #cardiovascular #diagnostics
Small Cell Lung Cancer

Risk Factors, Histology, Location, Behavior/Px, Genetics, Staining, PNP Sros, Tx
Histology: Kulchitsky cells: Small Dark & Blue beneith intact epithelium
Arises Centrally
Px: Very Aggressuve, Mets Early & Widely
Genetics: c-myc
Stains: chromogranin, synaptophysin, CD56, neuron specific enoslase
Risks: Smoking
Tx: Chemo

Many PNP Sros: Cushing, Lambert Eaton, SIADH
#pathology #neoplasia #pulmonology
Bronchial Adenocarcinoma

Risk Factors, Histology, Location, Behavior/Px, Genetics, Staining, PNP Sros, Tx
Risk Factors: most common non-small cell cancer
non-smoking females at sites of scarring
Histology: Glandular differentiation with mucin prodxn
Location: Peripheral
Behavior/Px: Slow & Small but with Early & Wide Mets
Genetics: EGFR overexpression, Kras mutation
Staining: TTF-1, CEA
PNP Sros: Clubbing, Hypertrophic Osteoarthropathy
Tx: Surg
#pathology #neoplasia #pulmonology
Bronchioalveolar Carcinoma

Risk Factors, Histology, Location, Behavior/Px
Risk Factors: not assoc. with smoking
Histology: lepidic growth w/o invasion
Location: Periphery, Terminal broncheolavoli
Behavior/Px: Aerogenous Seeding, Death from Suffox → consolidatn
#pathology #neoplasia #pulmonology
Squamous Cell Carcinoma of the Lung

Risk Factors, Histology, Location, Behavior/Px, PNP Sros
Risk Factors: Males, Smoking
Histology: Cavitating; Keratin Pearls & Intracellular Bridges
Location: Central (Bronchus/Hilar Mass)
Behavior/Px: Large & Slow, Late Mets
PNP Sros: PTHrP induced Hypercalcemia
#pathology #neoplasia #pulmonology
Methylene Blue
Antidote for methemoglobin

reduces iron Fe3+ to Fe2+
Antidote for poisoned pt with garlic breath
Dimercaprol

Antidote for acute arsenic poisoning.

Note: garlic odor.

Displaces Arsenic ions from sulfhydryl groups.

Side effects of antidote: nephrotoxic & hypertension
Large Cell Lung Cancer

Histology, Location, Behavior/Px, Genetics, Staining, PNP Sros, Tx
Histology: Highly anaplastic: large cells with large nuclei
Location: Peripheral
Behavior/Px: Extensive Local Growth
PNP Sros: Gynecomastia, Galactorrhea
Tx: non responsive to chemotheray
#pathology #neoplasia #pulmonology
Antidote for Acute Lead Poisoning
Antidote for Acute Lead and Mercury Poisoning. Forms complexes with mono, di, and trivalent ions.CaNa2EDTA
Antidote for Acute Mercury Poisoning
Antidote for Acute Lead and Mercury Poisoning. Forms complexes with mono, di, and trivalent ions.CaNa2EDTA
Lung Cancer:

Dark Blue Cells
Small Cell Lung Cancer

Histology: Kulchitsky cells: Small Dark & Blue beneith intact epithelium
Arises Centrally
Px: Very Aggressuve, Mets Early & Widely
Genetics: c-myc
Stains: chromogranin, synaptophysin, CD56, neuron specific enoslase
Risks: Smoking
Many PNP Sros: Cushing, Lambert Eaton, SIADH
Tx: Chemo
#pathology #neoplasia #pulmonology
Antidote for Iron Poisoning
Deferoxamine

most common after multiple blood transfusions

facilitates urinary excretion
Lung Cancer:

C-Myc
Small Cell Lung Cancer

Histology: Kulchitsky cells: Small Dark & Blue beneith intact epithelium
Arises Centrally
Px: Very Aggressuve, Mets Early & Widely
Genetics: c-myc
Stains: chromogranin, synaptophysin, CD56, neuron specific enoslase
Risks: Smoking
Many PNP Sros: Cushing, Lambert Eaton, SIADH
Tx: Chemo
#pathology #neoplasia #pulmonology
Antidote for Cyanide Poisoning
Amyl Nitrite

Forms methemoglobin that binds cyanide, distracting it from binding to mitochondiral enzymes
Lung Cancer:

TTF-1 positive Stain
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer
non-smoking females at sites of scarring
Histology: Glandular differentiation with mucin prodxn
Location: Peripheral
Behavior/Px: Slow & Small but with Early & Wide Mets
Genetics: EGFR overexpression, Kras mutation
Staining: TTF-1, CEA
PNP Sros: Clubbing, Hypertrophic Osteoarthropathy
Tx: Surg
#pathology #neoplasia #pulmonology
Antidote for methemoglobin
Methylene Blue

reduces iron Fe3+ to Fe2+
Destroying Hep A
Boiling for to 85* for 1 min

Chlorination
Bleach,
Formalin
UV Rad
Female Child with Ambiguous Genitalia

Hyponatremia, Hyperkalemia, Hypotension
21β hydroxylase deficiency

↓corticosteroids & mineralcorticoids
↑ testosterone
Lung Cancer

CEA positive Stain
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer
non-smoking females at sites of scarring
Histology: Glandular differentiation with mucin prodxn
Location: Peripheral
Behavior/Px: Slow & Small but with Early & Wide Mets
Genetics: EGFR overexpression, Kras mutation
Staining: TTF-1, CEA
PNP Sros: Clubbing, Hypertrophic Osteoarthropathy
Tx: Surg
#pathology #neoplasia #pulmonology
Female Child with Ambiguous Genitalia

Hypertension
11β hydroxylase deficiency

↓ cortisol, aldosterone

↑11-deoxycorticosteone (weak mineralcorticocoid)

↑ testosterone
Male child with female genitalia

Hypertension
17α hydroxylase deficiency

↑ mineralcorticoids

↓ sex hormones and corticosteroid

fluid and salt retention
Lung Cancer

Hypertrophic Osteoarthropathy
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer
non-smoking females at sites of scarring
Histology: Glandular differentiation with mucin prodxn
Location: Peripheral
Behavior/Px: Slow & Small but with Early & Wide Mets
Genetics: EGFR overexpression, Kras mutation
Staining: TTF-1, CEA
PNP Sros: Clubbing, Hypertrophic Osteoarthropathy
Tx: Surg

Bronchioalveolar Carcinoma
Risk Factors: not assoc. with smoking
Histology: lepidic growth w/o invasion
Location: Periphery, Terminal broncheolavoli
PNP Sros: Clubbing, Hypertrophic Osteoarthropathy
Behavior/Px: Aerogenous Seeding, Death from Suffox → consolidatn
#pathology #neoplasia #pulmonology
21β hydroxylase deficiency
↓corticosteroids & mineralcorticoids
↑ testosterone

Ambiguous Genitalia in Females

Hyponatremia, Hyperkalemia, Hypotension
11β hydroxylase deficiency
↓ cortisol, aldosterone
↑11-deoxycorticosteone (weak mineralcorticocoid)
↑ testosterone

Ambiguous Genitalia in Females
fluid and salt retention → hyeprtension
Lung Cancer: EGFR
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer
non-smoking females at sites of scarring
Histology: Glandular differentiation with mucin prodxn
Location: Peripheral
Behavior/Px: Slow & Small but with Early & Wide Mets
Genetics: EGFR overexpression, Kras mutation
Staining: TTF-1, CEA
PNP Sros: Clubbing, Hypertrophic Osteoarthropathy
Tx: Surg
#pathology #neoplasia #pulmonology
17α hydroxylase deficiency
↑ mineralcorticoids

↓ sex hormones and corticosteroid

all patients phenotypically female
fluid and salt retention → hypertension
What blood has the lowest oxygen content in the body
blood in the coronary sinus

myocardium extracts 80% of all O2 normally, 90% when stressed, consuming 5% of all CO
Pt treated for depression

↓ BP, ↑ HR, ↑ QRS, & PVC's

What is wrong?
How do you treat?
TCA overdose
quinidine like effect: inhibition of fast Na+ channels

most effective tx: NaHCO3
Describe the perfusion of the Heart
Left and Right Coronary Arteries

Left becomes Left Anterior Descending and Circumflex Arteries, supplies the anterior and left lateral surfaces of heart

Right gives rise to Posterior Descending Artery which supplies most of the inferior wall of the left ventricle including the diaphragmatic surface of the heart, as well as the SA and AV node arteries.

In 10% of pts the Left Circumflex artery gives rise to the posterior descending arteries.
Lung Cancer: Kras
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer
non-smoking females at sites of scarring
Histology: Glandular differentiation with mucin prodxn
Location: Peripheral
Behavior/Px: Slow & Small but with Early & Wide Mets
Genetics: EGFR overexpression, Kras mutation
Staining: TTF-1, CEA
PNP Sros: Clubbing, Hypertrophic Osteoarthropathy
Tx: Surg
#pathology #neoplasia #pulmonology
Describe the K+ distribution in DKA

describe the causes
↓ total body K+
↓ intracellular [K]
↑ extracellular [K]

2° to
-osmotic loss
-acidosis pulls K from intracellular to extracellular
-lack of insulin which normally promotes cellular influx of K
Lung Cancer:

Gyneocomastia
Large Cell Lung Cancer
Histology: Highly anaplastic: large cells with large nuclei
Location: Peripheral
Behavior/Px: Extensive Local Growth
PNP Sros: Gynecomastia, Galactorrhea
Tx: non responsive to chemotheray
#pathology #neoplasia #pulmonology
Progressive weakening with repeated use
the hallmark of myasthenia gravis
Amino Acids with Titratable Protons
Bases:

H Histidine
R Arginine
K Lysine

Acids:
D Aspartic Acid
E Glutamic Acid

Neutral:
C Cysteine (-SH)
Y Tyrosine (-OH)
2 most common causes of focal brain lesions in HIV+ pts
Toxoplasmosis

Lymphoma esp 2° to EBV
Lung Cancer:

Galactorrhea
Large Cell Lung Cancer
Histology: Highly anaplastic: large cells with large nuclei
Location: Peripheral
Behavior/Px: Extensive Local Growth
PNP Sros: Gynecomastia, Galactorrhea
Tx: non responsive to chemotheray
#pathology #neoplasia #pulmonology
Phenytoin
DOC: partial seizures and tonic clonic seizures

blocks sodium channels

↑ CYP
DOC: tonic clonic seizures
Phenytoin
also for partial seizures

blocks sodium channels
↑ CYP450
Peripheral Lung Cancers
Bronchial & Bronchioalveolar Adenocarcinoma
Large Cell Lung Cancer
#pathology #pulmonology #neoplasia
Anti-seizure drug which blocks sodium channels
phenytoin
carbamazepine
lamotrigine
valproic acid-also blocks NDMA receptors in hippocampal neurons
Central Lung Cancers
Small Cell & Squamous Cell Carcinomas
#pathology #pulmonology #neoplasia
Anti-seizure drug which blocks calcium channels in the thalamus
Ethosuximide

first line tx for absence
Lung Cancer:

Non-smoking Women
Bronchial Adenocarcinoma
_____________________
Risk Factors: most common non-small cell cancer
non-smoking females at sites of scarring
Histology: Glandular differentiation with mucin prodxn
Location: Peripheral
Behavior/Px: Slow & Small but with Early & Wide Mets
Genetics: EGFR overexpression, Kras mutation
Staining: TTF-1, CEA
PNP Sros: Clubbing, Hypertrophic Osteoarthropathy
Tx: Surg
#pathology #pulmonology #neoplasia
Anti-seizure drug which ↑ Cl- flow
Benzos, Barbituates, ETOH, enhance inhibitory action of GABA on GABAa and thus ↑ Cl- flux
Anti-seizure drug which blocks NMDA receptors in hippocampal neurons
Valproic acid
also has some sodium channel blocking effect
DOC partial seizures
carbamazepine

blocks Na+ channels

↑ CYP450
Ethosuximide
Anti-seizure drug which blocks calcium channels in the thalamus

first line tx for absence
Lung Cancer

Definitively Not Caused by Smoking
Bronchioalveolar Carcinoma
____________________________
Risk Factors: not assoc. with smoking
Histology: lepidic growth w/o invasion
Location: Periphery, Terminal broncheolavoli
PNP Sros: Clubbing, Hypertrophic Osteoarthropathy
Behavior/Px: Aerogenous Seeding, Death from Suffox → consolidatn
#pathology #pulmonology #neoplasia
DOC: Absence Seizures
Ethosuximide

blocks calcium channels in the thalamus
Lung Cancer

Slow Growth
Early Mets
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer
non-smoking females at sites of scarring
Histology: Glandular differentiation with mucin prodxn
Location: Peripheral
Behavior/Px: Slow & Small but with Early & Wide Mets
Genetics: EGFR overexpression, Kras mutation
Staining: TTF-1, CEA
PNP Sros: Clubbing, Hypertrophic Osteoarthropathy
Tx: Surg
#pathology #pulmonology #neoplasia
Sertaline
Zoloft, an SSRI
Phentolamine
competitive αantagonist
Labetalol
competitive antagonist of α1 and β1 with partial agonism at β2
Lung Cancer

Fast Growth
Early Mets
Small Cell
Large Cell
_____________________

Small Cell Lung Cancer
Histology: Kulchitsky cells: Small Dark & Blue beneith intact epithelium
Arises Centrally
Px: Very Aggressuve, Mets Early & Widely
Genetics: c-myc
Stains: chromogranin, synaptophysin, CD56, neuron specific enoslase
Risks: Smoking
Many PNP Sros: Cushing, Lambert Eaton, SIADH
Tx: Chemo


Large Cell Lung Cancer
Histology: Highly anaplastic: large cells with large nuclei
Location: Peripheral
Behavior/Px: Extensive Local Growth, Early Mets
PNP Sros: Gynecomastia, Galactorrhea
Tx: non responsive to chemotheray
#pathology #pulmonology #neoplasia
Phenoxybenzamine
nonselective, irreversible α1 and 2 antagonist
Pramipexole
a non-ergot dopamine agonist

sibling to rppinerole
Lung Cancer

Slow Growth
Late Mets
Squamous Cell
________________________
Risk Factors: Males, Smoking
Histology: Cavitating; Keratin Pearls & Intracellular Bridges
Location: Central (Bronchus/Hilar Mass)
Behavior/Px: Large & Slow, Late Mets
PNP Sros: PTHrP induced Hypercalcemia
#pathology #pulmonology #neoplasia
ropinerole
a non-ergot dopamine agonist
Lung Cancer

Hypercalcemia
Squamous Cell Carcinoma
___________________________
Risk Factors: Males, Smoking
Histology: Cavitating; Keratin Pearls & Intracellular Bridges
Location: Central (Bronchus/Hilar Mass)
Behavior/Px: Large & Slow, Late Mets
PNP Sros: PTHrP induced Hypercalcemia
#pathology #pulmonology #neoplasia
non-ergot DA agonists
pramipexole and ropinerole
ergot DA agonists
bromocriptine, pergolide
Lung Cancer

Mucin Producing Glands
Bronchial Adenocarcinoma
_____________________
Risk Factors: most common non-small cell cancer
non-smoking females at sites of scarring
Histology: Glandular differentiation with mucin prodxn
Location: Peripheral
Behavior/Px: Slow & Small but with Early & Wide Mets
Genetics: EGFR overexpression, Kras mutation
Staining: TTF-1, CEA
PNP Sros: Clubbing, Hypertrophic Osteoarthropathy
Tx: Surg
#pathology #pulmonology #neoplasia
bromocriptine
an ergot DA agonist

like pergolide
pergolide
an ergot DA agonist like bromocriptine
tirhexyphenidyl
anticholinergic
benztropine
anticholinergic
Lung Cancer

Cavitating
Squamous Cell Carcinoma
_____________________
Risk Factors: Males, Smoking
Histology: Cavitating; Keratin Pearls & Intracellular Bridges
Location: Central (Bronchus/Hilar Mass)
Behavior/Px: Large & Slow, Late Mets
PNP Sros: PTHrP induced Hypercalcemia
#pathology #pulmonology #neoplasia
Amantadine
primarily an anti-flu agent

indirect and direct dopaminergic agent used initially in parkinsons
Lung Cancer

Intercellular Bridges
Squamous Cell Carcinoma
_____________________
Risk Factors: Males, Smoking
Histology: Cavitating; Keratin Pearls & Intracellular Bridges
Location: Central (Bronchus/Hilar Mass)
Behavior/Px: Large & Slow, Late Mets
PNP Sros: PTHrP induced Hypercalcemia
#pathology #pulmonology #neoplasia
Auer Rods
Stain for peroxidase

inducative of AML t(15:17) Retinoic Acid Receptor α + Promylogenous Leukemia

RARα-PML

bone marrow repalcement produces anemia, thrombocytopenia and neutropenia
Major Basic Protein
found in eosinophil granules, used against parasites
Terminal deoxynucleotidyl transferase
adds nucleotides to V D and J regions

makrer of immature lymphocytes as seen in ALL

mainly affect children
Acyclovir v Herpesviruses
Guanosine Analogue

must be converted to acyclovir monophosphate by virally encoded Thymidine Kinase before being incorporated (rate limiting step)

HSV-1 & VZV produce thymidine kinase

EBV and CMV do not
[some fnxality at extremely high concentrations]
#pharmacology #microbiology #antimicrobials
Tartarate resistant Acid PHosphatase
Stain for Hairy Cell Leukemia

CD20+ B cell precursors

splenomegaly, fatigue, pancytopenia
Peroxidase Stain in Leukemia
detects Auer Rods

Stain for peroxidase

inducative of AML t(15:17) Retinoic Acid Receptor α + Promylogenous Leukemia

RARα-PML

bone marrow repalcement produces anemia, thrombocytopenia and neutropenia
platelet derived growth factor receptor mutations
Chronic myelomonocytic leukemia
Pure Red Cell Aplasia

Pathogenesis
Parvovirus B19

or

Thymoma
#pathology #hematology #microbiology #noplasia
p27
protein cell cycle inhibitor which acts to inhibit cyclin depdent kinases from allowing G1-G2 crossing
Rb's job
binding E2F, the transciption factor necessary for G1 → S transition

Cyclin D, E and CDK4 and 6 hyperphosphyrlate Rb to relase EF2
Fnx of Nucleolus
Synthesis of rRNA
#biochemistry
Bacterial DNA polymerases
I: the only bacterial DNA polymerase with exonuclease activity
Cystic Fibrosis and Sweating
sweat is produced isotonic to plasma

it is the CFTR channels which reabsorb Chloride and Sodium.

CF pts secrete high sodium high cloride sweat and thus experience hypovolemia
relationship of λ, CL and Vd
λ = (Vd * 0.7)/CL
#pharmacology #pharmacokinetics
Azole antifungals & CYP450
CYP450 Inhibitors

Cimetidine
Ciprofloxacin
Erythromycin
Azole antifungals
Grapefruit Juice
Isoniazid
Ritonavir/Protease Inihbitors
#pharmacology #pharmacodynamics
What part of the brain does Huntington's Damage and how
NMDA receptors bind gluatamate and cause NMA associated toxicity and neuronal death in the caudate nucleus and putamen

Chrom 4

Decreases ACh, GABA and Substantce P in caudate nucleus and putamen
Ethnicity and Bone Mass
African American Women have better bone mass than Caucausian Women

Caucasian race assoc with ↓ bone mass
Delta Nerve endings
Thing myelinated

Acute pain and temp, contribute to reflex withddrawal
Grapefruit Juice & CYP450
CYP450 Inhibitors

Cimetidine
Ciprofloxacin
Erythromycin
Azole antifungals
Grapefruit Juice
Isoniazid
Ritonavir/Protease Inihbitors
#pharmacology #pharmacodynamics
Pacinian corpuscels
rapidly adapting mechanoreceptors


like Ruffini's end organs(slowly adapating), mediate touch, proprioception and virbratory sensation

myelinated A β fibers
Ruffini's end organs
slowly adapting mechanoreceptors

like Pacinian (rapidly adapating), mediate touch, proprioception and virbratory sensation

myelinated A β fibers
Isoniazid & CYP450
CYP450 Inhibitors

Cimetidine
Ciprofloxacin
Erythromycin
Azole antifungals
Grapefruit Juice
Isoniazid
Ritonavir/Protease Inihbitors
#pharmacology #pharmacodynamics
MAP Kinase Pathway
RTK autophosphorylation
SOS
Ras GTPase
Raf Kinase
MAP Kinase Kinase
MAP Kinase (Mitogen Activated Protein Kinase) enters nucleus and influences gene granscription
Hemoglobin which does not bind 2,3-BPG
Fetal Hemoglobin
HbF 2α2γ

Production begins around 2nd trimester
Majority of Hb at time of birth
Slowly drops off to zero by 6 mo

Lack of interaction with 2,3 BPG accounts for stronger affinity for oxygen than maternal hemoglobin

Charged Histidine in β subunit responsible for 2,3 BPG interaction
Alcoholic excreting fat in feces
pancreatic insufficiency
Ritonavir & CYP450
CYP450 Inhibitors

Cimetidine
Ciprofloxacin
Erythromycin
Azole antifungals
Grapefruit Juice
Isoniazid
Ritonavir/Protease Inihbitors
#pharmacology #pharmacodynamics
Azithromycin
Chalmydia
Mycoplasma
H influenza
Moraxella
CYP450 inducers
CYP450 Inducers

Carbamazepine
Phenobarbital
Phenytoin
Rifampin
Griseofulvin
#pharmacology #pharmacodynamics
S-100
Neural Crest Derivative Marker
Schwannoma & Melanoma
Intracranial mass with mixed areas: some densely cellular, some sporatically cellular
Antoni pattern of schwannoma

Antoni A Pattern is density
Antoni B Pattern is sporatic

S-100+
(also S-100+: melanoma)
urinary trends in DKA
excess H+ excreted
Bicarbonate retained in exchange for Na+
titratable acids excreted
H2PO4- and NH4+
CYP 450 inhibitors
CYP450 Inhibitors

Cimetidine
Ciprofloxacin
Erythromycin
Azole antifungals
Grapefruit Juice
Isoniazid
Ritonavir/Protease Inihbitors
#pharmacology #pharmacodynamics
Male
Recurrent infections
Induration vs Skin Challenge (TB, Candida, etc)
Bruton's X linked agammaglobulinemia

B lymphocyte maturation defect

[Induration = Fnx T cells]
Carbamazepine & CYP450
CYP450 Inducers

Carbamazepine
Phenobarbital
Phenytoin
Rifampin
Griseofulvin
#pharmacology #pharmacodynamics
Tetrology of Fallot
VSD
Overriding Aorta
Pulmonary Stenosis
RV Hypertrophy

Initially acts as a left to right shunt, but progressive increase in pulmonary hypertension leads to shunt reversal with increase in cyanotic sx releived by increasing systemic pressure (squatting)

Problem is with abnormal migration of neural crest cells which form the aorticopulmonary septum

may manifest cyanosis at birth
Endocardial cushion defects
acyanotic left-too-right shunt → pulmonary hypertesnion → shunt reversal (Eisenmenger Sro) → cyanosis

will NOT manifest cyanosis at birth
southwestern blot
identify and isolate proteins that bind to DNA
jun
DNA binding protein
proto-oncogene
will show up via southwestern blot (DNA binding proteins)
pigmented spots on trunk, headaches, ruberry cutaneous tumors
Neurofibromatosis Type 1
cafe-au-lait macules
gliomas
neurofibromas of Schwann Cells
Phenobarbitol & CYP450
CYP450 Inducers

Carbamazepine
Phenobarbital
Phenytoin
Rifampin
Griseofulvin
#pharmacology #pharmacodynamics
Renal Failure: Calcium Status
no renal 1-α-hydroxylase → no 1,25-dihydroxy vitamin D → no gut Ca2+ absorption

↓ renal flow → ↑ phosphate retention → calcium binding

↓ serum [Ca2+]

compensatory ↑ [PTH]

2° hyperparathyroidism
Insulin & Glucagon
Insulin decreases Glucagon secretion

[Glucagon does not decrease Insulin Secretion--right?]
What are the major factors affecting coronary blood flow
Coronary blood flow almost entirely controlled by local metabolites

almost no input from nervous system

NO: arteries
adenosine: arterioles
Phenytoin & CYP450
CYP450 Inducers

Carbamazepine
Phenobarbital
Phenytoin
Rifampin
Griseofulvin
#pharmacology #pharmacodynamics
DOC: Tic Douloureaux
Carbamazepine

like phenytoin, inhibits Na+ channel recovery following discharge, inhibiting high frequency signalling

may cause aplastic anemia
powerful CYP450 inducer
What is the major mechanism by which hormones/cytokines induce insulin resistance
TNFα, catecholamines, glucocorticoids and glucagons

all activate serine kinase which phosphorylates serine and threonine residues on insulin receptor

normally insulin receptor RTK phosphorylates tyrosines

phosphorylating serines/threonines inhibits phosphorylation of tyrosines and inhibits downstream signalling.
Competant Bacteria
can uptake DNA for transformation

Strep pneumo
H influenzae
N meningitidis
Rifampin & CYP450
CYP450 Inducers

Carbamazepine
Phenobarbital
Phenytoin
Rifampin
Griseofulvin
#pharmacology #pharmacodynamics
Acid Fast Stain
Analine dye (carbolfuscion)
Hydrochloric Acid (dissolves outer membranes)
Counter stain: methylene blue

Stains mycolic acid

Mycoplasma: Acid Fast
Nocardia: Weakly acid fast
Griseofulvin & CYP450
CYP450 Inducers

Carbamazepine
Phenobarbital
Phenytoin
Rifampin
Griseofulvin
#pharmacology #pharmacodynamics
Oral Thrush, Interstitial Pneumonia, Severe Lymphopenia during first year of life
HIV+ maternal → fetal transmission

prevent with zidovudine nucleoside analogue RTI
DOC: Serotonin Sro
Cyproheptadine

antihistamine with anti-serotonergic properties
Cimetidine & CYP450
CYP450 Inhibitors

Cimetidine
Ciprofloxacin
Erythromycin
Azole antifungals
Grapefruit Juice
Isoniazid
Ritonavir/Protease Inihbitors
#pharmacology #pharmacodynamics
Inheritence pattern of G6PD
X linked
Cirpofloxacin & CYP450
CYP450 Inhibitors

Cimetidine
Ciprofloxacin
Erythromycin
Azole antifungals
Grapefruit Juice
Isoniazid
Ritonavir/Protease Inihbitors
#pharmacology #pharmacodynamics
Fx at hook of hamate: neurologic consequence?
Ulnar nerve injury

passes btw hook of hamate and pisiform bone in Guyon's fibroosseus tunnel

Dysesthesias on ulnar side of hand and weakness of intrinsic mucles of the hand
dysthesias on ulnar side of hand and weakness of intrinsic mucles of the hand
Fx at hook of hamate: Ulnar nerve injury

passes btw hook of hamate and pisiform bone in Guyon's fibroosseus tunnel
Erythromycin & CYP450
CYP450 Inhibitors

Cimetidine
Ciprofloxacin
Erythromycin
Azole antifungals
Grapefruit Juice
Isoniazid
Ritonavir/Protease Inihbitors
#pharmacology #pharmacodynamics
Fx at Radeal head:
neurologic consequence?
radial nerve innervates muscles of the extensor compartment of the upper arm, passes through lateral epicondyle and divides into superficial and deep branches.

superficial branch: sensory innervation to dorsal half of hand, radial side.

Damage to radial nerve injury at radial head (including subluxation) damages deep branch: wakenss of forarm extensors with wrist drop
Radial nerve
radial nerve innervates muscles of the extensor compartment of the upper arm, passes through lateral epicondyle and divides into superficial and deep branches.

superficial branch: sensory innervation to dorsal half of hand, radial side.

Damage to radial nerve injury at radial head (including subluxation) damages deep branch: wakenss of forarm extensors with wrist drop
Aspirin Induced Kidney Damage
Chronic Interstital Nephritis
#pharmacology #toxicity #pathology #nephrology
Fx at the surgical neck of the humerus
axillary nerve damage

paralysis of deltoid and teres major muscles, loss of sensation to lateral upper arm
paralysis of deltoid and teres major muscles, loss of sensation to lateral upper arm

Fx?
surgical neck of humerus
Coracobrachialis

adjacent strx,
innervation
overlies median nerve and brachial artery

innervated by musculocutaneous nerve.
Vitamin E deficiency
anti-oxidant which preserves cell membranes

most affected:
neurons (large surface area)
RBC's (poor antioxidant fnx)

manifestation:
Friederick's ataxia-like neuropathy w/ ataxi a & loss of proprioception and vibration +
hemolytic anemia
#pathology #nutrition #neurology #hematology
Hibernating Myocardium
repetitive ischemia of myocytes or persistent hypoperfusion → chronic but reversible loss of contractile fnx "hibernation"

Repetitive "stunning" (mild <30 min ischemic episodes) can result in hibernation
Myocardial stunning
mild ischemia induced reversible loss of contractile function

Repetitive Stunning can lead to hibernation
<30 min
full recovery w/in days
Compare Subclasses of Class I antiarrhytmics
1A (DQP)
prolonged QRS
intermediate inhibition of phase 0

1B
Shortened QRS
Weak inhibition of Phase 0

1C
∅Δ QRS
Strong inhibition phase zero
#cardiovascular #pharmacology
Ischemic preconditioning
cardiac myocytes which develop resistence to infarction via non-lethal ischemia

sub-lethal ischemia protect myocardium vs later ischemic events
Chronic reversible loss of cardiomyocyte contractile fnx
Hibernating myocardium

repetitive ischemia of myocytes or persistent hypoperfusion → chronic but reversible loss of contractile fnx "hibernation"

Repetitive "stunning" (mild <30 min ischemic episodes) can result in hibernation
Short term reversible loss of cardiomyocyte contractile fnx
Myocardial Stunning

mild ischemia induced reversible loss of contractile function

Repetitive Stunning can lead to hibernation


NB: ischemic preconditioning = cardiac myocytes which develop resistence to infarction via non-lethal ischemia

sub-lethal ischemia protect myocardium vs later ischemic events
Teardrop RBC's
indicative of myelofibrosis or metastatic cancer

RBC's which had had to squeeze through fibrous strands

(not sliced like schistocytes)
#hematology #pathology #diagnostics
Sequelae of sublethal ischemia on myocardium
ischemic preconditioning
cardiac myocytes which develop resistence to infarction via non-lethal ischemia

sub-lethal ischemia protect myocardium vs later ischemic events
Pantothenic Acid
actively transported into the cell and then ATP-dependently phosphorylated to become Coenzyme A

particularly important for first step of TCA cycle: binds with oxaloacetate to form citrate and then succinyl-CoA

also important in the syntehsis of vitamin A, D, cholesterol, steroids, heme A, fatty acids, amino acids and proteins

Deficiency rare, severley malnourished with "burning feet" paresthesias and GI distress
Acanthrocytosis
indicative of abetalipoproteinemia
or liver dz

no fat absorption
(no vitamin E absorption)
#hematology #pathology #diagnostics
Spur cells
extreme form of acanthrocytosis
or liver dz

indicative of abetalipoproteinemia
#hematology #pathology #diagnostics
Most common location of colon cancer
rectosigmoid colon
#pathology #neoplasia #gastrointestinal
anatomic landmarks of ureters to bladder
start retroperitoneally on top of psoas

pass under gonadal vasculature

cross over the common or external illiac arteries (depending on laterality)

stay laterl to internal ilac vessels and medial to gonadal vessels before entering uterosacral ligament and gaining access to bladder
#anatomy #genitourinary
Helmet Cell
Schistocyte
ie mechanical trauma
#hematology #pathology #diagnostics
Most Likely Outcomes:

Acute Hep B and C
Hep B: Complete Resolution

Hep C: Chronic Stable Hepatitis
#microbiology #hepatobiliary #pathology
Ki 67
protein expressed in S phase

maker for proliferation

near 100% in cancers
#pathology #neoplasia #molecules #diagnostics
Familial QT prolongation
predisposes to TdP

accompanied by neurosensory deafness
#pathology #cardiovascular #neurology #geneticdzs
Familial Neurosensory Deafness

Likely Accompanying Condition?
Familial QT prolongation

predisposes to TdP
#pathology #cardiovascular #neurology #geneticdzs
Pathogenesis of aortic aneurysm
myxomatous changes in media of large arteries 2* gragementation of elastic ts

may be caused by marfan sro
β-aminopropionitrile (sweat peas) inhibits lysyl oxidase which cross links elastin
#pathology #cardiovascular
SERM: agonist in bones antagonist in breast and uterus
Raloxifene
#pharmacology #endocrine #neoplasia
Raloxifene
SERM: agonist in bones antagonist in breast and uterus
#pharmacology #endocrine #neoplasia
Uremia v. Hemostasis
only ↑ Bleeding Time

∅Δ platelet count

just makes platelets non-fnx
#pathology #henmatology #nephrology
azoospermia
not having measurable sperm in semen

think CF bilateral absence of vas deferens
#pathology #reproductive #geneticdzs
bilateral absence of vas deferens
CF
#pathology #reproductive #geneticdzs
Cutoff for Sweat Chloride Test
above 60 mM/L is diagnostic
#pathology #geneticdzs #diagnostics
Thiazide Diuretics
and
Serum Constituents
Causes Hyper
-Uricemia, Calcemia, Glycemia, Lipidemia
"GLUC"
Hypo
Kalmia & Tension
#pharmacology #toxicity
Heart Abnormality of DiGeorge Sro
Tetrology of Fallot
#pathology #cardiovascular #geneticdzs
Heart Abnormality of Down Sro
Endocardial Cushion Defects:
--ASD
--Regurgitant AV vales
#pathology #cardiovascular #geneticdzs
ApoA

Lipoproteins
Fnx
Dysfnx manifestation
ApoA1

Present on Chylomicrons and HDL's
(not Chylomycron Remants interestingly)

LCAT activation induces cholesterol esterification

Dysnfx: not a clinical entity
#biochemistry #energymetzm #lipids
Apolipoprotein: LCAT Activation

Lipoproteins, Dysnfx
ApoA1

Present on Chylomicrons and HDL's
(not Chylomycron Remants interestingly)

LCAT activation induces cholesterol esterification

Dysnfx: not a clinical entity
#biochemistry #energymetzm
ApoB-48

Lipoproteins
Fnx
Dysfnx manifestation
ApoB-48

Present on Chylomicrons and CM Remnants

Fnx: Chylomicron assembly and secretion by small intestine

Dysnfx: not a clinical entity
#biochemistry #energymetzm
Apolipoprotein: Chylomicron assembly and secretion

Lipoproteins, Dysnfx
ApoB-48

Present on Chylomicrons and CM Remnants

Fnx: Chylomicron assembly and secretion by small intestine

Dysnfx: not a clinical entity
#biochemistry #energymetzm
ApoB-100

Lipoproteins
Fnx
Dysfnx manifestation
ApoB-100

Present on VLDL, IDL and LDL

Binds LDL receptor

Dysnfx: inherited overexpression = Type 2b combined familial hyperlipidemia

HyperTAGemia + Hypercholesterolemia c high [LDL] and [VLDL]

∅xanthoma
✓ ↑ CVD Risk
Tx: aggressive lifestyle modification + Rx's
#biochemistry #energymetzm
Apolipoprotein which binds LDL receptor

Lipoproteins, Dysnfx
ApoB-100

Present on VLDL, IDL and LDL

Binds LDL receptor

Dysnfx: inherited overexpression = Type 2b combined familial hyperlipidemia

HyperTAGemia + Hypercholesterolemia c high [LDL] and [VLDL]

∅xanthoma
✓ ↑ CVD Risk
Tx: aggressive lifestyle modification + Rx's
#biochemistry #energymetzm
HyperTAGemia + Hypercholesterolemia c ↑ LDL & VLDL
ApoB-100

Present on VLDL, IDL and LDL

Binds LDL receptor

Dysnfx: inherited overexpression = Type 2b combined familial hyperlipidemia

HyperTAGemia + Hypercholesterolemia c high [LDL] and [VLDL]

∅xanthoma
✓ ↑ CVD Risk
Tx: aggressive lifestyle modification + Rx's
#biochemistry #energymetzm
ApoC-II

Lipoproteins
Fnx
Dysnfx
ApoC-II: Lipoprotein lipase activation

Lipoproteins: HDL, CM, VLDL

Dysnfx:
Type I Familial Chylomicronemia
--identical to LPL deficiency

Isolated HyperTAGemia c ↑ CM & Normal VLDL
Xanthoma, Pancreatitis, Hepatosplenomegaly
Presentation: Abdominal Pain 2° Acute Pancreatitis

NB: No Tendinous Xanthomas, Xanthelasmas, or ↑ CVD (all from cholesterol)
#biochemistry #energymetzm
Apolipoprotein:
Activates Lipoprotein Lipase

Lipoproteins
Dysnfx
ApoC-II: Lipoprotein lipase activation

Lipoproteins: HDL, CM, VLDL

Dysnfx:
Type I Familial Chylomicronemia
--identical to LPL deficiency

Isolated HyperTAGemia c ↑ CM & Normal VLDL
Xanthoma, Pancreatitis, Hepatosplenomegaly
Presentation: Abdominal Pain 2° Acute Pancreatitis

NB: No Tendinous Xanthomas, Xanthelasmas, or ↑ CVD (all from cholesterol)
#biochemistry #energymetzm
Isolated HyperTAGemia c ↑ CM & Normal VLDL
ApoC-II: Lipoprotein lipase activation

Lipoproteins: HDL, CM, VLDL

Dysnfx:
Type I Familial Chylomicronemia
--identical to LPL deficiency

Isolated HyperTAGemia c ↑ CM & Normal VLDL
Xanthoma, Pancreatitis, Hepatosplenomegaly
Presentation: Abdominal Pain 2° Acute Pancreatitis

NB: No Tendinous Xanthomas, Xanthelasmas, or ↑ CVD (all from cholesterol)
#biochemistry #energymetzm
Type I Familial Chylomicronemia
ApoC-II: Lipoprotein lipase activation

Lipoproteins: HDL, CM, VLDL

Dysnfx:
Type I Familial Chylomicronemia
--identical to LPL deficiency

Isolated HyperTAGemia c ↑ CM & Normal VLDL
Xanthoma, Pancreatitis, Hepatosplenomegaly
Presentation: Abdominal Pain 2° Acute Pancreatitis

NB: No Tendinous Xanthomas, Xanthelasmas, or ↑ CVD (all from cholesterol)
#biochemistry #energymetzm
Type 2b combined familial hyperlipidemia
ApoB-100

Present on VLDL, IDL and LDL

Binds LDL receptor

Dysnfx: inherited overexpression = Type 2 combined familial hyperlipidemia

HyperTAGemia + Hypercholesterolemia c high [LDL] and [VLDL]

∅xanthoma
✓ ↑ CVD Risk
Tx: aggressive lifestyle modification + Rx's
#biochemistry #energymetzm
ApoE (3 & 4)

Lipoproteins
Fnx
Dysnfx
ApoE3 & ApoE4

CM CMR, VLDL, IDL (not LDL or HDL)

VLDL and Chylomicron remnant uptake by liver cells

Dysnfx: Type III Hyperlipidemia Dysbetalipoproteinemia

mostly manifests as poor clearance of IDL

Combined HyperTAGemia + Hypercholesterolemia with ↑ IDL

Xanthoma and ↑ RIsk CVD
#biochemistry #energymetzm
Apolipoprotein: Hepatic Remanant Clearance

Lipoproteins, Dyfnx
ApoE3 & ApoE4

CM CMR, VLDL, IDL (not LDL or HDL)

VLDL and Chylomicron remnant uptake by liver cells

Dysnfx: Type III Hyperlipidemia Dysbetalipoproteinemia

mostly manifests as poor clearance of IDL

Combined HyperTAGemia + Hypercholesterolemia with ↑ IDL

Xanthoma and ↑ RIsk CVD
#biochemistry #energymetzm
Combined HyperTAGemia + Hypercholesterolemia with ↑ IDL
ApoE3 & ApoE4

CM CMR, VLDL, IDL (not LDL or HDL)

VLDL and Chylomicron remnant uptake by liver cells

Dysnfx: Type III Hyperlipidemia Dysbetalipoproteinemia

mostly manifests as poor clearance of IDL

Combined HyperTAGemia + Hypercholesterolemia with ↑ IDL

Xanthoma and ↑ RIsk CVD
#biochemistry #energymetzm
Type III Hyperlipidemia Dysbetalipoproteinemia
ApoE3 & ApoE4

CM CMR, VLDL, IDL (not LDL or HDL)

VLDL and Chylomicron remnant uptake by liver cells

Dysnfx: Type III Hyperlipidemia Dysbetalipoproteinemia

mostly manifests as poor clearance of IDL

Combined HyperTAGemia + Hypercholesterolemia with ↑ IDL

Xanthoma and ↑ RIsk CVD
#biochemistry #energymetzm
Isolated Hypercholesterolemia c ↑ LDL
Type IIa Familial Hypercholesterolemia

Isolated Hypercholesterolemia c ↑ LDL

Deficiency of LDL receptor

Xanthomas, Corneal Arcus, ↑ Risk CVD
#biochemistry #energymetzm
Corneal Arcus
Type IIa Familial Hypercholesterolemia

Isolated Hypercholesterolemia c ↑ LDL

Deficiency of LDL receptor

Xanthomas, Corneal Arcus, ↑ Risk CVD
#biochemistry #energymetzm
Deficiency of LDL receptor
Type IIa Familial Hypercholesterolemia

Isolated Hypercholesterolemia c ↑ LDL

Deficiency of LDL receptor

Xanthomas, Corneal Arcus, ↑ Risk CVD
#biochemistry #energymetzm
Type IIa Familial Hypercholesterolemia
Type IIa Familial Hypercholesterolemia

Isolated Hypercholesterolemia c ↑ LDL

Deficiency of LDL receptor

Xanthomas, Corneal Arcus, ↑ Risk CVD
#biochemistry #energymetzm
Isolated Hypertagemia c ↑ VLDL
Type IV Familial HyperTAGemia

Isolated Hypertagemia c ↑ VLDL

VLDL over-expression

↑ Risk of CVD
#biochemistry #energymetzm
VLDL overexpression
Type IV Familial HyperTAGemia

Isolated Hypertagemia c ↑ VLDL

VLDL over-expression

↑ Risk of CVD
#biochemistry #energymetzm
LPL deficiency
ApoC-II: Lipoprotein lipase activation

Lipoproteins: HDL, CM, VLDL

Dysnfx:
Type I Familial Chylomicronemia
--identical to LPL deficiency

Isolated HyperTAGemia c ↑ CM & Normal VLDL
Xanthoma, Pancreatitis, Hepatosplenomegaly

NB: No Tendinous Xanthomas, Xanthelasmas, or ↑ CVD (all from cholesterol)
#biochemistry #energymetzm
Type IV Familial HyperTAGemia
Type IV Familial HyperTAGemia

Isolated Hypertagemia c ↑ VLDL

VLDL over-expression

↑ Risk of CVD
#biochemistry #energymetzm
Tubular Xanthomas
aka Tendinous Xanthomas

the hallmark of type 2a familial hypercholesterolemia

Type IIa Familial Hypercholesterolemia
Isolated ↑ LDL 2° to LDL receptor deficiency
Xanthomas, Corneal Arcus, ↑ Risk CVD

Type 2 B
ApoB-100 (binds LDL receptor)
overexpression = HyperTAGemia + Hypercholesterolemia c high [LDL] and [VLDL]
∅xanthoma, ✓ ↑ CVD Risk
Tx: aggressive lifestyle modification + Rx's
#biochemistry #energymetzm
Tendinous Xanthomas
aka Tuberous Xanthomas

the hallmark of type 2a familial hypercholesterolemia

Type IIa Familial Hypercholesterolemia
Isolated ↑ LDL 2° to LDL receptor deficiency
Xanthomas, Corneal Arcus, ↑ Risk CVD

Type 2 B
ApoB-100 (binds LDL receptor)
overexpression = HyperTAGemia + Hypercholesterolemia c high [LDL] and [VLDL]
∅xanthoma, ✓ ↑ CVD Risk
Tx: aggressive lifestyle modification + Rx's
#biochemistry #energymetzm
What should you monitor when giving Lithium?
T3 and T4
#pharmacology #toxicities
What should you monitor when giving Amiodarone?
PFT's: Pulmonary Fibrosis
LFT's
TFTs
#pharmacology #toxicities
What should you monitor when giving INH?
LFT's
#pharmacology #toxicities
What should you monitor when giving Carbamazapine?
LFT's
#pharmacology #toxicities
For what drugs should you monitor thyroid hormone levels?
Lithium
Amiodarone (LFT, PFT, TFTs)
#pharmacology #toxicities
For what drugs should you vigilently monitor LFT's?
INH
Carbamazapine
Amiodarone (LFT, PFT, TFTs)
#pharmacology #toxicities
Which heart chamber is closest to the esophagus?
left atrium makes up the majority of heart's posterior surface

RA makes up the right border of X-ray
LV makes up the left border and paex
RV is the front of the heart and inferior border on X ray
#anatomy #cardiovascular
Why doesn't blood flow back into lungs during atrial systole?
cardiac muscle in proximal few cm of pulmonary veins fnx like sphincters
#phsyiology #cardiovascular
5' 3'

3' 5'

which way does DNA polymerize?
DNA adds onto the 3' end
the 3' end is out front and then the next piece clips a 5' onto that

5' → 3'
#biochemistry #DNA
3' 5'

5' 3'

which way does DNA polymerize?
DNA adds onto the 3' end
the 3' end is out front and then the next piece clips a 5' onto that

5' → 3'
#biochemistry #DNA
bisphosphoglycerate mutase
bisphosphoglycerate mutase
present only in RBC's & Placenta
alternative glycolytic pathway which produces no ATP

BPG mutase: 1,3 BPG → 2,3 BPG

Phosphatase: 2,3 BPG → 3 Phosphoglycerate

Bypasses one step by Phosphoglycerate kinase which would have produced ATP

2,3 BPG allosterically induces a right shift → O2 dumping

[I guess BPG mutase fnx is upregulated by hypoxia]
#biochemistry #hemoglobin #molecules #energymetzm
1,3 BPG → 2,3 BPG
bisphosphoglycerate mutase
present only in RBC's & Placenta
alternative glycolytic pathway which produces no ATP

BPG mutase: 1,3 BPG → 2,3 BPG

Phosphatase: 2,3 BPG → 3 Phosphoglycerate

Bypasses one step by Phosphoglycerate kinase which would have produced ATP

2,3 BPG allosterically induces a right shift → O2 dumping
#biochemistry #hemoglobin #molecules #energymetzm
2,3-bisphosphoglycerate
bisphosphoglycerate mutase
present only in RBC's & Placenta
alternative glycolytic pathway which produces no ATP

BPG mutase: 1,3 BPG → 2,3 BPG

Phosphatase: 2,3 BPG → 3 Phosphoglycerate

Bypasses one step by Phosphoglycerate kinase which would have produced ATP

2,3 BPG allosterically induces a right shift → O2 dumping
#biochemistry #hemoglobin #molecules #energymetzm
Factors which induce K+ secretion in the proximal tubule
Dietary K
Aldosterone
Alkalosis
K non sparing diuretics.
#physiology #nephrology
CD55
Paroxysmal Nocturnal Hemoglobinuria
Neither Paroxysmal nor Nocturnal
Constant w/ ↑ visualization in first urine of day

mutation in PIG-A gene which codes for glycosylphosphatidylcholine (GPI) anchor necessary for CD55 and CD59 attachment

CD55 & 59 important to inactivate complement

a disorder of the stem cells → pancytopenia

chronic hemolysis → recurrent venous thromboses

>>deficiency of CD55 and CD59 diagnostic of PNH<<
#pathology #hematology
Paroxysmal Nocturnal Hemoglobinuria
Paroxysmal Nocturnal Hemoglobinuria
Neither Paroxysmal nor Nocturnal
Constant w/ ↑ visualization in first urine of day

mutation in PIG-A gene which codes for glycosylphosphatidylcholine (GPI) anchor necessary for CD55 and CD59 attachment

CD55 & 59 important to inactivate complement

a disorder of the stem cells → pancytopenia

chronic hemolysis → recurrent venous thromboses

>>deficiency of CD55 and CD59 diagnostic of PNH<<
#pathology #hematology
CD59
Paroxysmal Nocturnal Hemoglobinuria
Neither Paroxysmal nor Nocturnal
Constant w/ ↑ visualization in first urine of day

mutation in PIG-A gene which codes for glycosylphosphatidylcholine (GPI) anchor necessary for CD55 and CD59 attachment

CD55 & 59 important to inactivate complement

a disorder of the stem cells → pancytopenia

chronic hemolysis → recurrent venous thromboses

>>deficiency of CD55 and CD59 diagnostic of PNH<<
#pathology #hematology
Mycoplasma v Mycobacterium

Species, DOC's
Mycobacterium: tuberculosis, leprosy, M avium
Mycolic acid cell wall: acid fast
INH (B6 analogue) inhibits mycolic acid synth


Mycoplasma: M pneumo & ureaplasma urealyticam
single cell membrane composed of cholesterol containing pospholipid bilayer
DOC: erythromycin or tetracycline
#microbiology #antimicrobials #pharmacology
ACEI's → ↑ Cr
Slight ↑ Cr physiologic 2° to ↓ Renal Filtration

(relaxed efferent arteriole)
#pharmacology #toxicities #nephrology
Renal damage from heroine
focal segmental glomeruloscelrosis

same as pamidronate
#pharmacology #toxicities #nephrology
Renal damage from pramidronate
focal segmental glomeruloscelrosis

same as heroin
#pharmacology #toxicities #nephrology
Renal damage from Gold
membranous nephropathy
#pharmacology #toxicities #nephrology
Renal damage from Sulfonamides
precipitation in renal tubules → failure

sulfonamides, MTX, acyclovir, triamterene
#pharmacology #toxicities #nephrology
Acid-Base State of Pulmonary Ebolus Pt
Respiratory Alkalosis

PE → V/Q mismatch → hypoxia → hyperventilation → ↓ pCO2
#pathology #pulmonology
Renal damage from MTX
precipitation in renal tubules → failure

sulfonamides, MTX, acyclovir, triamterene
#pharmacology #toxicities #nephrology
Renal damage from acyclovir
precipitation in renal tubules → failure

sulfonamides, MTX, acyclovir, triamterene
#pharmacology #toxicities #nephrology
What Amino Acid is essential in PKU
Tyrosine
#biochemistry #pathology
Crescenteric Glomerulonephritis:

what could you stain for?
Monocytes, M∅& fibrin

as it progresses ↑ sclerosis: mroe and mroe fibrin

if and only if goodpasture
IgG & C3
#pathology #diagnostics #nephrology
Renal damage from triamterene
precipitation in renal tubules → failure

sulfonamides, MTX, acyclovir, triamterene
#pharmacology #toxicities #nephrology
Renal damage from foscarnet
drug induced tubular necrosis

aminoglycosides, radiocontrast media, cisplatin, amphotericin B, foscarnet
#pharmacology #toxicities #nephrology
Varicose Veins: most problematic complication
skin

thrombi do occur, but no thromboemboli

all PE's from deep veins of leg (sic: DVT)
varicosities occur in superficial veins
#cardiovascular #pathology
Mechanism of Action: NO
primarily a venodilator

↓ preload → ↓ cardiac O2 demand


large doses can affect arterioles → HA, flushing
#pharmacology #cardiovascular
phlegmaisa alba dolens
painful white leg

ilofemoral venous thrombosis which occurs in peripartum women 2° uterus pressure on deep pevic veins + hypercoagulaable state

non-ischemic state

if superficial flow lost also "Phlegmasia cerulea dolens"→ ischemia & gangrene
#reproductive #pathology #cardiovascular
Flunisolide
inhaled glucocorticoid
prophylaxis vs bronchial asthma

DOC vs bronchial asthma for anti-inflam effects
#pharmacology #pulmonology
Regulation: precapillary sphincters
pericytes

location dpt response to NE & E
dilate irt histamine, ↓ O2, ↑ CO2, ↓ pH
#physiology #cardiovascular
Palpable But Non-Tender Gallbladder
Courvoisier Sign

indicative of adenocarcinoma of head of pancreas compressing bile duct

Biggest environmental contributor: smoking
#pathology #gastrointestinal
#neoplasia
Theophylline
Methylxanthines: theophylline & aminophylline

phosphodiesterase inhibitor, increases [cAMP] → bronchodilation

also block adensoine receptors
#pharmacology #pulmonology
aminophylline
Methylxanthines: theophylline & aminophylline

phosphodiesterase inhibitor, increases [cAMP] → bronchodilation

also block adensoine receptors
#pharmacology #pulmonology
Low Fiber Diet v CA
Colonic Adenocarcinoma

#pathology #gastrointestinal
#neoplasia
"Starry Sky" Lymphoma
Burkitt's Lymphoma

appearance from M∅ &apoptotic bodies

almost all assoc. w/ c-MYC translocations on chrom 8 usually w/ Ig on 14 t(18;14)
#pathology #neoplasia #hematology
Phosphodiesterase Inhibitors vs Asthma
Methylxanthines: theophylline & aminophylline

phosphodiesterase inhibitor, increases [cAMP] → bronchodilation

also block adensoine receptors
#pharmacology #pulmonology
Most common cause of asthma
inhaled allergens like animal dander >> other stuff like cold air & exercise
#pathology #pulmonology
What does intracellular [citrate] affect?
↑ Acetyl CoA carboxylase (FA synth)
↓ Posphofructokinase 1 (Glycolysis)
#bicohemistry #energymetzm
DOC: Mac
clarithormycin or azithromycin + others
#antimicrobials #pharmacology #microbiology
To where is blastomyces native
Mississippi River & Great Lakes regions
#microbiology
DOC: kaospi's sarcoma
IFN α (roferon)
#antimicrobials #pharmacology #microbiology
Flecainide
IC antiarrhytmic

blocks sodium channels and primarily acts by slowing phase 0 depolarization
no effect on duration of QT

contrast to
IA: Qunidine, Procainimide, Disopyramide
blocks K channels ↑ QT

IB: Lidocaine, Mixiletine, Tocainide
shortens QT by ↓ Funny Current (Background Na)
#drugs #cardiology #pharmacology
DOC: Pneumocystis pneumonia
pentamidine

also for tyrpanosoma brucei
#antimicrobials #pharmacology #microbiology
Dofetilide
Class III antiarrhthmic

blocks K⁺ channels

dofetilide, ibutilide, amiodarone, sotalol
#drugs #cardiology #pharmacology
Ibutilide
Class III antiarrhthmic

blocks K⁺ channels

dofetilide, ibutilide, amiodarone, sotalol
#drugs #cardiology #pharmacology
pentamidine
DOC: Pneumocystis pneumonia & Tyrpanosoma brucei

[unknown mech]
#antimicrobials #pharmacology #microbiology
Major causes of Hepatocellular Carcinoma
Hep B, Hep C, Chronic EtOH, Afloatoxins
#pathology #neoplasia #hepatobiliary
Mutations in the HIV genome which enhance its virulence/survival
pol genes: resistance to HIV reverse transcriptase inhibitors & other antiretroviral drugs (reverse transcriptase inhibitor)

env: escape host neurtalizing antibodies (codes glycoproteins)
#microbiology #resistance
Ticlopidine
Ticlopidine
ADP antagonist like Clopidogrel

2nd line drug for pts who are allergic to clopidogrel

serious side effects: neutropenia → fever & mouth ulcers
#pharmacology #cardiovascular #toxicities
Why inverted nipple w/ breast ca?
suspensory ligament infiltration
#pathology #diagnostics #reproductive #neoplasia
Best Diagnostic Test for Distended, Tympanic Abdomen
Potential Toxic Megacolon

Flat Plain X Ray

Anything that invades (scope, enema) may induce perforation
#pathology #diagnostics #gastrointestinal
Pt on Rx after TIA dvlps fever & oral ulcers
Ticlopidine
ADP antagonist like Clopidogrel

2nd line drug for pts who are allergic to clopidogrel

serious side effects: neutropenia → fever & mouth ulcers
#pharmacology #cardiovascular #toxicities
Most cardioselective calcium channel blocker
Verapamil
#cardiovascular #pharmacology
Pt cannot clear Giardia infx
IgA deficiency
#microbiology #immunology #gastrointestinal
anti-arrhythmic which ↑ PR & QT intervals
Sotalol

Class II: β1 blockade ↑ PR
Class III: K+ blockade ↑ QR

uniquely so
#pharmacology #cardiovascular
Where are ulcers not likely to be malignant
Vast Majority of Ulcers Duodenal

Even when H pylori induced, not likely malignant

Esewhere assoc. w/ malignancy
Stomach: adenocarcinoma, maltoma
Esophagus: adenocarcinoam
Colon: annular "napkin rings" or UC (still ↑ risk)
#neoplasia #pathology #gastrointestinal
Hydrocephalus, Intracranial Calcifications, Chorioretinitis
Classic Traid of Congenital Toxoplasmosis

1st exposed when pregnant
#pathology #neonatology #microbiology
Layers of the Gastric Mucosa
Surface: simple columnar epithelium which secretes mucus to protect lining

Gastric Pits short things

Midway down Gastric PIts:
parietal Cells: HCl & Intrinsic Factor

Botton of the PIts: Cheif Cells: Pepsinogen
#physiology #gastrointestinal
Congential Toxoplasmosis
Classic Triad:

Hydrocephalus
Intracranial Calcifications
Chorioretinitis

1st exposed when pregnant
#pathology #neonatology #microbiology
Neurophysiology of Urination
Sacrial mMicturation center S2-4

Pontine center: coordinates sphincter relaxn

Cerebral corteex: inhibits sacral center

normal pressure hydrocephalus (elderly) ↑ ventricular area stretches descending cortical fibers → urinary incontenence
#neurology #physiology
Pt presents with bruised looking eyes and grey scaling papules on extensor surfaces of hands
Dermatomyositis

↑ CK, ↑ aldolase, muscle weakness

Heliotrope Rash: bruised looking eyes
Grotton's Papules: grey scaling papules on extensor surfaces of hands

Path: CD8 vs myofibers

Dx: perifasicular atrophy on muscle biopsy

positive ANA, anti-Jo-1

Similar to Polymyositis (∅ Grotton/Heliotrope, ✓ shoulders)
#pathology #rheumatology
Urinary incontenence of demention: pathophysiology
Sacrial mMicturation center S2-4

Pontine center: coordinates sphincter relaxn

Cerebral corteex: inhibits sacral center

normal pressure hydrocephalus (elderly) ↑ ventricular area stretches descending cortical fibers → urinary incontenence
#neurology #pathology
anti-Jo-1
Dermatomyositis or Polymyositis

Path: CD8 vs myofibers
Findings: ↑ CK, ↑ aldolase, muscle weakness
positive ANA, anti-Jo-1

Dermatomyositis
Heliotrope Rash: bruised looking eyes
Grotton's Papules: grey scaling papules on extensor surfaces of hands
Dx: perifasicular atrophy on muscle biopsy


Polymyositis
∅ Grotton/Heliotrope/perifasicular atrophy
Mostly affects shoulders
#pathology #rheumatology
Size cutoff:
mucociliary elevator vs M∅
>2.5 mucociliary elevator
≤2mm Alveolar M∅

[Pneumoconiosis = interstital lung fibrosis 2° to M∅ stimulation & growth factor prodxn]
#physiology #pulmonology
perifasicular atrophy on muscle biopsy
Dermatomyositis

Heliotrope Rash: bruised looking eyes
Grotton's Papules: grey scaling papules on extensor surfaces of hands

Path: CD8 vs myofibers
Findings: ↑ CK, ↑ aldolase, muscle weakness
positive ANA, anti-Jo-1

Dx: perifasicular atrophy on muscle biopsy


Similar to Polymyositis (∅ Grotton/Heliotrope/perifasicular atrophy, ✓ shoulders)
#pathology #rheumatology
Primary biliary cirrhosis: primary pathology
antimitochondrial antibody
#pathology #hepatobiliary
Dermatomyositis
Dermatomyositis

Heliotrope Rash: bruised looking eyes
Grotton's Papules: grey scaling papules on extensor surfaces of hands

Path: CD8 vs myofibers
Findings: ↑ CK, ↑ aldolase, muscle weakness
positive ANA, anti-Jo-1

Dx: perifasicular atrophy on muscle biopsy

Similar to Polymyositis (∅ Grotton/Heliotrope/perifasicular atrophy, ✓ shoulders)
#pathology #rheumatology
serum marker of chronic alcoholism
elevated gamma glutamylthransferase (GGT)

NB: the whole ALT/AST > 2:1 thing is for alcoholic hepatitis, not chronic alcoholism
#pathology #diagnostics
Coronary Steal Effect
Vessels in Ischemic Regions are often maximally dilated

addition of adenosine and dipyridamole (coronary-selective vasodilators) may dilate surrounding vessels and divert flow away from ischemic areas.
#pharmacology #cardiovascular #toxicity
Polymyositis
progresssive symmetrix proximal muslce weakness

Path: CD8 vs myofibers
Endomysial Inflammatory Infiltration
Findings: ↑ CK, ↑ aldolase, muscle weakness

most often involves shoulders

Similar to Dermatomyositis (∅ shoulders, ✓ Grotton/Heliotrope/perifasicular atrophy)
#pathology #rheumatology
dipyridamole
a coronary-selective vasodilator like adenosine

also inhibits thromboxane synthesis and prevents platelet thrombus formation