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143 Cards in this Set
- Front
- Back
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Anterior Pituitary |
- From Rathke's pouch - FLAT PEG -FSH, LH, ACTH, TSH, Prolactin, Endorphins GH |
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Posterior Pituitary |
- From neuroectoderm (brain) - Oxytocin, Vasopressin (ADH) |
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MEN1 |
PPP (3 Ps): - Parathyroid tumors - Pituitary tumors (Gh or prolactin) - Pancreatic endocrine tumors (Zollinger-Ellison syndrome, insulinomas, etc.) Autosomal dominant |
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MEN2a |
MPP - Medullary thyroid carcinoma (calcitonin) - Parathyroid tumor (hyperplasia) - Pheochromocytoma ret gene mutation Autosomal dominant |
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MEN2b |
MPN - Medullary thyroid carcinoma )calcitonin - Pheochromocytoma - Neuromas (oral/intentinal) (+ marfanoid habitus) ret gene mutation Autosomal dominant |
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Basal cell carcinoma |
Most common skin cancer On sun-exposed areas Low metastatic potential Pearly pink nodules w/central depression/ulceration, rolled borders Nests of busload cells and peripheral palisading of nuclei |
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Squamous cell carcinoma |
Associated w/excessive sun exposure, immunosuppression, arsenic exposure Locally invasive, may spread to LNs but rarely metastasizes Ulcerative red lesions w/frequent scale. Keratin pearls Actinic keratosis (scaly plaque) = precursor lesion |
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Akathesia |
Subjective restlessness w/inability to sit still Extrapyramidal side effect of antipsychotics Treat by lowering antipsychotic dose or w/beta blockers |
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Scleroderma/CREST markers |
CREST = anticentromere antibodies (in 40%) Diffuse scleroderma = Anti-DNA topoisomerase I (scl-70) antibodies |
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snRNPs |
"Snerps" = splicing done by splicosomes, made of snRNPs and proteins. snRNPs made in nucleus Antibodies vs. snRNPs in lupus |
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First area damaged during global cerebral schema? |
Hippocampus! |
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Roles of sympathetic receptors |
Alpha1: ↑ vascular SM contraction, ↑ pupillary dilator muscle contraction, ↑ intestinal and bladder sphincter muscle contraction Alpha2: ↓ symp outflow, ↓ insulin release, lipolysis, ↑ platelet aggregation Beta1: ↑ HR, contractility, renin release, lipolysis (1 heart) Beta2: bronchodilation, vasodilation, ↑HR, contractility, lipolysis, insulin release, aqueous humour production. ↓ uterine tone, ciliary muscle relaxation (2 lungs) |
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Roles of parasympathetic receptors |
M1: CNS, enteric NS (brain and bowels) M2: ↓ HR, ↓ contractility of atria (heart) M3: ↑ exocrine gland secretions, gut peristalsis, bladder contraction, bronchoconstriction, pupillary sphincter muscle contraction, cilia muscle contraction (everything else) |
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Roles of dopamine receptors |
D1: Relaxes renal vascular SM D2: Modulates transmitter release, esp in brain |
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Roles of histamine receptors |
H1: ↑ nasal and bronchial mucus production, ↑ vascular permeability, contraction of bronchioles, pruritus and pain H2: ↑ gastric acid secretion |
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Roles of vasopressin receptors |
V1: ↑ vascular SM contraction V2: ↑ H2O permeability and reabsorption in collecting tables of the kidney |
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Bethanechol |
Direct cholinomimetic agonist (PS, M receptors) Activates bowel and bladder SM (ileus, urinary retention) Resistant to AChE "Bethany chol (call) me if you can't pee or poop" |
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Carbachol |
Direct cholinomimetic agonist (PS, M receptors) "Carb"on copy of ACh For: Glaucoma, pupillary constriction, relief of IOP |
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Pilocarbine |
Direct cholinomimetic agonist (PS, M receptors) Potent stimulator of sweat, tears and saliva (for Sjogrens). Also for open/closed angle glaucoma Resistant to AChE "Cry, drool, sweat on your "pilo"(carbine)" |
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Methacholine |
Direct cholinomimetic agonist (PS, M receptors) Challenge test for dx of asthma |
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Neostigmine |
Indirect agonist of PS (M receptors) via anticholinesterase ↑ endogenous ACh For: ileus/urinary retention, myasthenia grabis, reversal of neuromuscular junction blockade (rocuronium) "Neo (No) CNS penetration" |
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Pyridostigmine |
Indirect agonist of PS (M receptors) via anticholinesterase For: myasthenia gravis No CNS penetration |
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Physostigmine |
Indirect agonist of PS (M receptors) via anticholinesterase Anticholinergic toxicity (e.g. atropine) Crosses BBB |
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Rivastigmine |
Indirect agonist of PS (M receptors) via anticholinesterase For: Alzheimer's |
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Edrophonium |
Indirect agonist of PS (M receptors) via anticholinesterase Historically for dx of myasthenia gravis |
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Atropine |
Muscarinic antagonists (PS) (also homatropine, tropicamide) For: eye --> mydriasis and cycloplegia |
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Benztropine |
Muscarinic antagonist (PS) For: Parkinson's (↓ dopamine, ↑ ACh imbalance, blocks ACh cascade) "Park my Benz" |
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Scopolamine |
Muscarinic antagonist (PS) For: motion sickness "We all live in a yellow scopolamine (submarine)" = yellow barf, nauseous on a submarine |
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Glycopyrrolate |
Muscarinic antagonist (PS) For: pre-op, reducing airway secretions (if just oral use, for drooling or peptic ulcers) |
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Atropine |
Muscarinic antagonist (PS) (so sympathetic unopposed) For: bradycardia and ophthalmologic applications ↑ pupil dilation, ↓ secretions (airway, GI), ↓ gut motility, ↓ urgency in cystitis Toxicity: ↑ body temp (due to ↓ sweating, rapid pulse, dry mouth, dry flushed skin --> "hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter" |
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Epinephrine |
Direct sympathomimetic Beta>alpha Anaphylaxis, asthma, hypotension (alpha effects predominate at high doses) |
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Norepinephrine |
Direct sympathomimetic alpha1>alpha2>beta1 Hypotension |
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Isoproterenol |
Direct sympathomimetic beta1=beta2 electrophysiologic eval of tachyarrhythmias, can worsen ischemia |
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Dobutamine |
Direct sympathomimetic Beta1>beta2, alpha Heart failure (ionotropic>chronotropic), cardiac stress testing |
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Phenylephrine |
Direct sympathomimetic alpha1>alpha2 Hypotension (vasoconstrictor), also ocular procedures, rhinitis |
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Albuterol (also salmeterol) |
Direct sympathomimetic beta2>beta1 albuterol for acute asthmal salmeterol for long-term asthma/COPD control |
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Clonidine |
Sympatholytic (alpha2-agonist) For: hypertensive emergency, ADHD, severe pain, some off-label uses |
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alpha-methyldopa |
Sympatholytic (alpha2-agonist) For: HTN in pregnancy |
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Phenoxybenzamine |
Alpha-blocker (antagonist) IRREVERSIBLE Pre-op for pheochromocytoma |
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Phentolamine |
Alpha-blocker (antagonist) REVERSIBLE If pts on MAO-inhibitors eat foods w/tyramine |
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Prazosin, terazosin, doxazosin, tamsulosin (-osin) |
Alpha1-blocker (antagonist) For: urinary sx of BPH |
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Mirtazapine |
Alpha2-blocker (antagonist) Depression |
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"-LOL"s |
Beta blockers (antagonist) For: angina, MI* (decr mortality), SVT, HTN, CHF* (slows progression), glaucoma Avoid in cocaine users (risk of unopposed alpha-adrenergic receptor agonist activity), can mask hypoglycaemia in diabetics Beta1 selective: Names from A-M (mostly) Nonselective: Names from N-Z (mostly) |
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Eplerenone |
Aldosterone antagonist, new Used in place of Spironolactone (decreased side effects) Can be used for Conn Syndrome (aldo-secreting adrenal tutor, leading to HTN, hypoK+, metabolic acidosis and depressed renin) |
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Tay Sachs |
No Hexosaminidase A Build-up of GM2 ganglioside AR "Tay SAX lacks heXosaminidase" |
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Niemann-Pick |
No Sphingomyelinase Build-up of sphingomyelin AR "No man picks (Niemann-Pick) his nose with his sphinger (sphingomyelinase)" |
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Gaucher |
No Glucocerebrosidase (beta-glucosidase) Build-up of Glucoceribroside AR Most common Treated with enzyme replacement! Gaucher = Glucocerebrosidase |
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Candida albicans |
- Systemic or superficial infection: oral/esophageal thrush in immunocompromised, vulvovaginitis, diaper rash, endocarditis in IVDU, etc - Germ tubes (true hyphae) @ 37C - Yeast form (pseudohyphae) @ 20C T-lymphos = prevent superficial infection Neutrophils = prevent hematogenous spread Rx: topical azole for vaginal, fluconazole/nystatin for oral/esophageal, fluconazole/AmphoB/Caspofungin for systemic |
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Aspergillus fumigatus |
- Invasive aspergillosis (esp in immunocompromised and CGD) - Allergic bronchopulmonary aspergillosis (if asthma/CF. May cause bronchiectasis and eosinophilia) - Aspergillomas (in lung cavities, esp after TB infection) Forms ring-enhancing brain lesions and paranasal sinus necrosis Catalase + NOT dimorphic Form acute angles (less than 90°) and septations (A for Acute Angles) Aflatoxins cause hepatocellular CA |
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Cryptococcus neoformans |
Heavily encapsulated Found in soil, pigeon droppings Stains w/india ink and mucicarmine, although latex agglutination test is more specific "soap bubble" lesions in brain |
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Mucor and Rhizopus |
Disease mostly in ketoacidotic diabetic and leukaemia patients (like the ketones and glucose) Penetrate cribiform plate and enter brain Hyphae have wide angles (90°) and are non-septate |
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Histoplasmosis |
Mississippi and Ohio River valleys (bats in caves) Causes pneumonia SMALLER than RBC (macrophage filled w/histo) ("histo hides in macros") Rapid urine or serum antigen test |
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Blastomycosis |
States east of Mississippi River and Central America Causes inflammatory lung disease, can cause osteomyelitis Granulomatous nodules SAME SIZE as RBC ("Blasto has Broad-Based Budding") Detect via urine antigen test |
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Coccidiomycosis |
SW USA, Mexico, South America Causes pneumonia and meningitis, can disseminate to bones and skin ↑ after earthquakes Spherules filled w/endospores (much LARGER than RBC) |
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Paracoccidiomycosis |
Latin America Budding yeast w/"captain's wheel" Much LARGER than RBC |
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Glioblastoma multiforme |
Malignant, high grade tumor of ASTROCYTES Most common primary malignant CNS tutor in adults Can cross corrupt callous ("butterfly" glioma) Pseudopalisading border w/central necrosis and hemorrhage |
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Meningioma |
Common, usually benign From arachnoid cells Usually at convexities of hemispheres and parasagittal region, round lesion external to brain parenchyma Presents w/seizures or focal neuro deficits Resection/radiosurgery Whorled pattern, psammoma bodies |
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Schwannoma |
Benign tumor of Schwann cells Usually at cerebropontine angle, often compresses CN VIII (loss of hearing and tinnitus) S100+ Bilateral tumors in neurofibromatosis type 2 |
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Hemangioblastoma |
Associated w/von Hippel-Lindau Often cerebellar |
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Pilocytic astrocytoma |
#1 tumor in KIDS, usually in cerebellum Benign tumor of astrocytes Cystic lesion GPAF+ Rosenthal fibres - eosinophilic, corkscrew fibres |
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Medulloblastoma |
Highly malignant cerebellar tumor (primitive neuroectodermal tumor - cannot see in adults because neurons don't divide!) can compress 4th ventricle causing hydrocephalus "Drop mets" to spinal cord Small round blue cells, Homer-Wright rosettes |
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Ependymoma |
Highly malignant, ependymal cells Usually in 4th ventricle, can cause hydrocephalus Perivascular pseudorosettes |
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X-linked agammaglobulinemia |
Bruton agammaglobulinemia (in Boys) Defect in BTK gene = defective tyrosine kinase, no B cell maturation and NO Ig Recurrent bacterial and enteroviral infections after 6 months (when maternal IgG decreases) Absent/scant LNs, B markers present, but cells not mature |
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Common variable immunodeficiency |
Defect in B cell differentiation Acquired ↓ plasma cells (and Ig) |
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Selective IgA deficiency |
Most common, most asymptomatic Airway and GI infections, Atopy, Anaphylaxis to IgA containing products (e.g. blood) |
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Thymic aplasia
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22q11 deletion, DiGeorge Failure to develop 3rd and 4th pharyngeal pouches, absent thymus and parathyroids ↓ T cells, PTH, Ca2+ Recurrent viral/fungal infections |
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AD hyper IgE syndrome |
aka Job syndrome STAT3 mutation = decreased recruitment of neutrophils (due to deficiency of Th17 cells) Coarse faces, cold staph abscesses (not inflamed), retained primary teeth, ↑ IgE, derm problems |
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SCID |
Defective T and B cells X-linked = defective IL-2 AR = adenosine deaminase deficiency LOTS of infections (bubble boy) Rx: bone marrow transplant |
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Ataxia-Telangiectasia |
Defects in ATM gene = DNA double strand breaks and cell cycle arrest Ataxia, spider angiomas and IgA deficiency |
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Hyper IgM |
Class switching defect defective CD40L on Th cells (cannot bind to B cells to tell them to switch classes!) XR Opportunistic infections early in life ↑ IgM ↓ everything else |
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LAD1 |
Impaired migration and chemotaxis of leukocytes AR Recurrent skin and mucosal infections, but NO pus, delayed umbilical cord separation (30+ days), impaired wound healing ↑ Neutrophils (because cannot bind to walls!) |
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Chediak-Higashi syndrome |
Defect in lysosomal trafficking gene (LYST) = microtubule dysfunction in phagosome-lysosome fusion AR Partial albinism, peripheral neuropathy, neurodegeneration |
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CGD |
Defect of NADPH oxidase = ↓ ROS and no respiratory burst in neutrophils XR Infection w/catalase + orgs Nitroblue tetrazolim (NBT) dye reduction test is NEG; abnormal dihydrorhodamine test n.b. if MPO deficiency, both tests will be normal |
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DNA laddering |
Endonuclease cleavage into 180 bp fragments during karyorrhexis (apoptosis) |
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Intrinsic pathway apoptosis |
- BAX and BAK = pro-apoptotic - Bcl-2 = anti-apoptotic (Bcl-2 stabilizes mito membrane, prevents cytochrome c release [binds to/inhibits Apaf-1], cell lives = tumorgenesis) |
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Extrinsic pathway apoptosis |
2 pathways: - FasL binds to Fas receptor (CD95), activation of inactive caspases. Defective Fas-FasL = autoimmune disorders - Cytotoxic T cell release of perforin and granzyme B |
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P-glycoprotein |
aka MultiDrug Resistance Protein 1 (MDR1) Expressed by some cancer cells to pump out toxins (incl chemotherapeutic agents) |
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Zero order elimination |
Rate of elimination is constant regardless of target plasma concentration PEA (looks like 0) = Phenytoin, Ethanol, Aspirin |
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Drug efficiency |
Maximal effect a drug can produce |
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Drug potency |
Amount of drug needed for a given effect (high affinity for receptor) |
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Bromocriptine |
Dopamine agonist Inhibits prolactin secretion (used for prolactinoma) |
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17α hydroxylase deficiency |
Funnelled to ALDOSTERONE (glucocorticoids and androgens blocked) HYPERtension, hypoK+, decr DHT Presents as XY pseudohermaphroditism, XX lack of secondary sexual development |
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21-hydroxylase deficiency |
Funnelled to ANDROGENS HYPOtension, hyperK+, high renin activity Most common Salt-wasting in infancy, precocious puberty in childhood XX virilization |
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11β-hydroxylase deficiency |
Funnelled to ANDROGENS HYPERtension (build-up of 11 deoxycorticosterone, so weak mineralocorticoid activity) XX virilization |
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Neurofibromatosis type 1 |
von Recklinghausen disease AD (100% penetrance, variable expression) Mutations on NF1 gene on chromosome 17 Neurocutaneous disorder Café-Au-Lait spots and cutaneous neurofibromas |
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Neurofibromatosis type 2 |
AD Bilateral acoustic schwannomas at cerebropontine angle, juvenile cataracts, meningiomas, ependymomas NF2 gene on chromosome 22 |
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Tuberous sclerosis
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AD Neurocutaneous, multiorgan Benign hamartomas |
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Universal enhancers of P450 |
Rifampin, phenytoin, and phenobarbital Warfarin less effective |
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Universal inhibitors of P450 |
Cimetidine, amiodarone and TMP-SMX Warfarin MORE effective! |
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Lesch-Nyhan syndrome |
XR Defective purine salvage due to decreased HGPRT (hypoxanthine-guanine phosphoribosyl transferase) Hyperuricemia, Gout, Pissed off (aggressive, self-mutilation, Retarded, dysTonia) |
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Hypothalamus functions |
TAN HATS Thirst/H2O balance Adenohypophysis control (anterior pit) Neurohypophysis releases hormones from hypothalamus Huncer Autonomic regulation Temperature regulation Sexual urges OVLT and area pastrami not protected by BBB |
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Thalamus |
Major relay for all ascending sensory info except olfaction |
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Limbic system |
5 Fs: Feeding, Fighting, Fleeing, Feeling and Sex Hippocampus, amygdala, mammillary bodies, fornix, cingulate gyrus |
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Basal ganglia |
Lentiform = Globus pallidus and putamen Striatum = Putamen and caudate nucleus (lines 4th ventricle) D1 = Direct, excitatory D2 = Inhibitory pathway |
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Parkinson's |
TRAPS (tremor [resting], rigidity, akinesia, postural instibility, shuffling gait) Lack of dopamine (pallor of striatum nigra) = ↓ direct and ↑ indirect pathways Presence of Lewy bodies (made of α-synuclein) |
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Huntington's |
Huntingtin gene, chromosome 4 CAG nucleotide repeat CAG = Caudate atrophy, ↓ ACh and GABA Movement, aggression, dementia |
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Homunculus |
(medial to lateral) Foot, hand, mouth, tongue |
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Eyes direction in pathological conditions |
Look TOWARDS a stroke (↓ inhibition) Look AWAY from a seizure (↑ activity = ↑ inhibition |
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Fredrich Ataxia |
Trinucleotide repeat disorder on chromosome 9 in gene for Frataxin (iron binding protein) AR Impairment in mito functioning leading to degeneration of multiple spinal cord tracts. Staggering gait, falling, nystagmus, dysarthria, pets caves, hammer toes, hypertrophic cardiomyopathy "Fredrich is your favourite FRAT brother, always STAGGERING and FALLING but he has a BIG HEART" |
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ACE inhibitor (names) |
End in "-pril" Captopril, enalapril, lisinopril, ramipril |
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Miosis |
Constriction, parasympathetic Neuron 1: Ediger-Westphal nucleus to ciliary ganglion via CN III (PNS fibres on outside, affected by compression; motor fibres on inside, affected by ischemia) Neuron 2: short ciliary nerves to pupillary spincter |
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Mydriasis |
Dilation, sympathetic Neuron 1: Hypothalamus to C8-T2 (ciliospinal centre of bulge) Neuron 2: Exit at T1 to superior cervical ganglion (along sympathetic chain near lung apex, subclavian vessels) Neuron 3: plexus along internal carotid, through cavernous sinus, enters orbit as long ciliary nerve to pupillary dilator |
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CN III |
Outer = PS fibres (constriction. If damaged, dilation) Inner = motor |
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Alzheimer's |
↑ risk in Down Syndrome (early onset: APP on chr 21) Early onset: presenilin-1 (chr 14), presenilin-2 (chr 1) Late onset: ApoE4 (Chr 19) ApoE2 (Chr 19) is protective ↓↓ ACh Senile plaques w/amyloid-β (synthesized w/amyloid precursor protein, APP); Neurofibrillary tangles (hyperphosphorylated tau protein) |
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Lewy body dementia |
Dementia and visual hallucinations, then parkinsonian features α-synuclein defect (like Parkinson's) |
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MS |
(you know it, but the things you don't know...) ↑ protein in CSF (IgG) Oligoclonal bands are diagnostic ** multiple white matter lesions separated in space and time** |
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Guillan Barre |
(you know it, but the things you don't know...) ↑ CSF protein w/normal cell count (albuminocytologic dissociation). ↑ protein causes papilledema |
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Selegiline |
For Parkinson's Selectively inhibits MAO-B (preferentially metabolizes dopamine over norepinephrine and serotonin, thereby ↑ availability of dopamine) (prevents dopamine degredation) |
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Alzheimer drugs |
Memantine = NBDA receptor antagonist Rivastigmine, galantamine, donepezil = AChE inhibitors |
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Stethoscope bell |
Low pitched sounds S1, S3, S4, low freq murmurs |
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Stethoscope diaphragm |
High pitched sounds S2, ejection sound, opening snap, mid-systolic click, high freq murmurs (most) |
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Paroxysmal Nocturnal Hematuria |
Mutation of PIGA gene (involved in synthesis of glycosylphosphatidylinositol (GPI) - glycolipid needed to anchor several cell surface proteins) CD55 and CD59 not anchored (normally inactivate complement and prevent MAC from attacking Complement-mediated hemolysis Thrombotic complications Often presents w/pancytopenia and aplastic anemia Dx w/flow cytometry |
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Inulin |
= GFR; freely filtered and neither secreted nor absorbed Cr clearance is approximate measure of GTR - slightly overestimates b/c moderately secreted by tubules |
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PAH (para-aminohippuric acid) |
= effective renal plasma flow both filtered and actively secreted in the proximal tubule (underestimates flow by 10% |
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Filtration fraction |
GFR/Renal plasma flow Inulin (or Cr clearance)/PAH clearance Usually between 0.15-0.20 |
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In kidney: - ATII - Loop diuretics - Thiazides - Aldosterone - ADH - Amiloride, triamterene |
- ATII: (in PCT) stimulates Na+/H+ (contraction alkalosis) - Loop diuretics: (in ascending loop) blocks Na+/K+/2Cl- reabsorption - Thiazides: (in DCT) blocks Na+/Cl- reabsorption - Aldosterone: (in CT) insertion of Na+ channel on lumen (reabsorption) - ADH: (in CT) acts at V2 receptor, insertion of H2O aquaporins on lumen (reabsorption) - Amiloride/Triamterene: (in CT) block ENaC (so less Na+ reabsorption and therefore less K+ leaving) |
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Renal tubule defects |
Fanconi (PCT, wasting) Bartter (Thick ascending loop, blocks Na+/K+/2Cl-, AR) Gitelman (DCT, blocks NaCl, AR) Liddle (DCT and CT, ↑ ENaC, AD) "FaBulous Gold Liquid" |
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Angiotensin II |
Vasoconstriction (vascular SM) Constricts efferent arteriole Aldosterone release (adrenals, to ↑ Na absorption) [volume] ADH release (anterior pit, to ↑ H2O absorption) ↑ PCT Na+/H+ activity [osmolarity] Stimulates hypothalamus (thirst) |
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RTA |
Type 1 = DCT, intercalated cells can't secrete H+ (new HCO3- not generated); hypoK+ Type 2 = PCT, can't reabsorb HCO3-, instead excreted; hypoK+ Type 4 = Hypoaldo, aldo resistance, K+ sparing diuretics; hyperK+ |
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Nephrotic |
> 3.5 g protein/day, frothy urine, hyperlipidemia, fatty casts, edema, associated w/thromboembolism, ↑ risk of infection (loss of Ig) "O F My Mom And Dad" NephrOtic - FSGS - Minimal change - Membranous - Amyloidosis - Diabetes |
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FSGS |
Effacement of foot processes; focal and segmental sclerosis and hyalinosis IF - AAs and Hispanics, idopathic, HIV, sickle cell, heroin, etc. Steroids = inconsistent response, may progress to chronic |
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Minimal change |
Normal-looking glomeruli, IF-, effacement of foot processes on EM CHILDREN ["mini"] (infection, immunization, immune stimulus, Hodgkin) Only lose albumin Steroids = excellent response |
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Membranous |
Capillary and GBM thickening, GRANULAR deposits on IF (immune complex deposition, can be SLE), "spike and dome" sub-endothelial deposits Idiopathic, drugs, infections, SLE, solid tutors Steroids = poor response, risk of chronicity |
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Amyloidosis |
Congo-red stain shows green birefringence ("Apple-oidosis") |
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Diabetic |
Mesangial expansion, GBM thickening, Kimmelstiel-Wilson nodules (eosinophilic nodular glomerulosclerosis) Non-enzymatic glycosylation of: 1) GBM = ↑ permeability and ↑ thickening, 2) efferent arterioles = ↑ GFR and mesangial expansion ACE-Is slow progression of hyper filtration-induced damage |
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Membranoproliferative |
Type I - Subendothelial immune complex deposits, granular IF, "tram track" appearance (GBM splitting from mesangial growth) - HBV, HCV, idiopathic (classic complement) Type II - Intramembranous immune complex deposits, "dense deposits" - C3 nephritic factor |
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Nephritic |
Inflammatory, hematuria and RBC casts in urine Azotemia, oliguria, HN, proteinuria (<3.5 g/day) |
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Acute PSGN |
Enlarged glomeruli, hypercellular Granular appearance "starry sky" due to IgM, IgG and C3 deposition = subepithelial IC humps Children 2-weeks post-GAS infection of pharynx or skin - M-protein virulence factor Type III hypersensitivity reaction Edema, coca-cola-coloured urine, HTN |
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RPGN |
Crescent moons of fibrin and plasma proteins (C3b) w/glomerular parietal cells, monocytes and macros Can be caused by: - Goodpastures (TII hypersensitivity); antibodies to GBM and alveolar BM = linear IF - Wegener's (c-ANCA) - Microscopic polyangiitis (p-ANCA) |
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Diffuse proliferative GN |
SLE or membranoproliferative GN Wire-looping of capillaries, sub endothelial and sometimes intramembranous IgG-based IC w/ C3 deposition, granular IF |
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IgA nephropathy (Berger disease) |
Mesangial proliferation, mesangial IC deposists, IgA-based IC deposits in mesangium Seen w/Henoch-Schonlein purpura Often w/mucosal infections (URI or acute gesture), Excess IgA gets stuck! 1-3 days later |
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Alport |
Mutation in type 4 collagen Thinning and splitting of BM GN, deafness, sometimes eye problems |
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Kidney stones |
- Calcium (80%) - radiopaque (can see); Ca oxalate or phosphate - Ammonium magnesium phosphate (struvite) (15%) - radiopaque, infection w/urease+ bugs, staghorn calculi - Uric acid (5%) - RadioLUCENT - Cystine (1%) - radiopaque, cystinuria |
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Bladder cancer |
Transitional cell carcinoma - RFs: Smoking, cyclophosphamide, Aniline dyes, etc. - Flat (early P53 mutations) or papillary (later P53 mutations) Squamous cell carcinoma - Chronic irritation - RFs: schistosoma, chronic cystitis, smoking, chronic nephrolithiasis Adenocarcinoma - From urachal remnant, cystitis or extrophy |
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ATN |
Granular "muddy brown" casts Stage 1: inciting event Stage 2: maintenance phase, oliguric; 1-3 weeks, risk of hyperK+, met acidosis Stage 3: recovery phase: polyuric, BUN and Cr fall, risk of hypoK ↓ GFR, ↓ reabsorption of BUN (serum BUN:Cr < 15), ↓ reabsorption of Na (FENa > 2%), inability to [] urine (urine osm < 500 mOsm/kg) Ischemic (PCT and thick ascending limb) or nephrotoxic (substances, crush, hemoglobulinuria) (PCT) |
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Structures perforating diaphragm |
"I ate (8) 10 eggs at 12" T8 = IVC T10 = Esophagus + Vagus CN10 T12 = Aorta, thoracic duct, azygos vein |
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Virchow triad
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Stasis Hypercoagulability Exposed endothelial collagen |
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Ratio for lung maturity in neonates |
Lecithin:sphingomyelin > 2 indicates lung maturity <1.5 predictive of neonatal RDS Tx: maternal steroids before birth, artificial surfactant for infant (O2 can cause retinopathy of prematurity and bronchopulmonary dysplasia) |
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ARDS |
↑ alveolar capillary permeability (noncardiogenic pulmonary edema) Formation if intra-alveolar hyaline membrane Initial damage due to release of neutrophilic substances toxic to alveolar wall, activation of coal cascade and oxygen-derived free radicals |
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Collagen synthesis and formation |
IN fibroblasts: - Synthesis (Gly-X-Y, usually proline or lysine) - Hydroxylation (+OH to proline/lysine, vit C needed. Scurvy) - Glycosylation (pro collagen formed via hydrogen and disulfide bonds = triple helix. Osteogenesis imperfecta) - Exocytosis OUTSIDE fibroblasts - Proteolytic processing (cleavage of disulfide rich terminal regions = insoluble tropocollagen) - Cross-linking (reinforcement by cross-linkage to make fibrils. Elhers-Danlos) |
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Heteroplasmy |
Presence of both normal and mutated tDNA (maternal DNA) resulting in variable expression in mitochondrial inherited disease |
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Vit Bs 1 2 3 5 6 7 9 12 |
1 = thiamine 2 = riboflavin 3 = niacin 5 = pantothenate 6 = pyridoxine 7 = biotin 9 = folic acid 12 = cobalamin |
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Scurvy |
Swollen gums, bruising, hemarthrosis, anemia, poor wound healing, corkscrew hair Cannot hydroxylate proline/lysine = defective collagen synthesis |
