Uw 1

Description indicates pheochromocytome, usually associated with MEN syndromes:

MEN 1: Pth, Pan, Pit

MEN 2A: M.C.Th, Pheo, Pth

MEN 2B: M.C.Th, Pheo, Muc. Neuromas

Chromaffin cells and parafollicular cells (c-cells) of the thyroid originate from neural crest

Non selective, irreversible a1, a2 adrenergic antagonist that reduces the number of receptors available for norepinephrine binding

Decrease insulin resistance by binding to PPARy, alter gene expression and protein synthesis, can result in a delayed in action to several days

Up regulates:

Glut 4: increase glucose uptake

Adiponectin: increase insulin response of adipocytes

Increase insulin release from the pancreatic B cells

Close K+ channel in B cell, insulin release via increase Ca++ influx

Non competitive inhibitor of mitochondrial glycerol 3 phosphate dehydrogenase, important for maintaining hepatic redox state. Inhibition of this enzyme causes a significant reduction in hepatic glucose production

Perchlorate and Pertechnetate ions absorbed into the thyroid gland via Na- Iodide symporter

Autosomal recessive, mutation chromosome 9, increase number of trinucleotide repeats, Friederich Ataxia, patient most likely will die of cardiomyopathy, also complicated with DM

Stool for bacterial toxins, looking for C. botulinum spores

In adults the same disease can results for consumption of canned foods

(GVHD) Graft vs host disease mediated by T- lymphocytes of the donor tissue that are sensitized against MHC antigens of recipient. Skin, liver and intestine are commonly involved.

Within minutes, pre existing recipient antibodies react to donor antigen (type II reaction), activate complement

Widespread thrombosis of graft vessels- ischemia/ necrosis

Graft must be removed

Weeks to months, Cellular: CTL's activated against donor MHC's

Humoral: similar to hyper acute, except antibodies develop after transplant

Vasculitis of graft vessels wit dense interstitial lymphocytic infiltrate

Prevent/ reverse with immunosuppresants

Months to years

Recipient T cells perceive donor MHC as recipient MHC and react against donor antigens presented

Cellular and humoral

Irreversible. T cell antibody- mediated damage

Heart atherosclerosis, Lung bronchiolitis obliterans, Liver vanishing bile ducts, Kidney vascular fibrosis, glomerulopathy

Herpes simplex virus type 1, Enveloped double stranded DNA, gingivostomatitis

Stress: loss of urethral support, IAB pressure exceeds urethral sphincter pressure, due to coughing, sneezing, laughing, lifting

Urge: Detrusor overactivity, sudden, overwhelming or frequent need to empty the bladder

Overflow: Impaired detrusor contractility, bladder outlet obstruction, constant involuntary dribbling and incomplete emptying.

Nitric oxide, large arteries, pre arteriolar vessels, synthesized from argininine and O2 by endothelial cels, causes vascular smooth muscle relax ion by a guanylate cyclase mediated cGMP second messenger system.

Adenosine, a product of ATP metabolism, acts as vasodilatory in small coronary arterioles

DNA, RNA, Protein, DNA binding protein

Purkinje system, Atrial muscle, Ventricular muscle, AV node

Park At Ventura Avenue

Play a role in the initiation of translation (mRNA binding to ribosomes), a mutation 3 bases upstream from the start codon (AUG) in this sequence is associated with thalassemia intermedia.

1) Enhanced metabolic rate (seizures, exercise)

2) Reduced oxygen delivery (cardiac or pulmonary failure, shock, tissue infarction)

3) Diminished lactate catabolism due to hepatic failure or hypo perfusion

4) Decreased oxygen utilization (cyanide poisoning)

5) Enzymatic defects in glycogenolysis or gluconeogenesis

In septic shock there is an impaired tissue oxygenation, leading to the shunting of pyruvate to lactate after glycolysis, increasing the lactic acid formation

1) ATP depletion

2) Cellular/mitochondrial swelling (decrease ATP-> decrease activity of NA/K pump)

3) Nuclear chromatin clumping

4) Decrease glycogen

5) Fatty change

6) Ribosomal/Polysomal detachment (decrease 7) protein synthesis)

8) Membrane blebbing

1) Nuclear pyknosis, karyorrhexis, karyolysis

2) Plasma membrane damage ( degradation of phospholipid)

3) Lysosomal rupture

4) Mitochondrial permeability / vacuolization

Phospholipid- containing amorphous densities within mitochondria

Activation of NMDA receptors by glutamate, increasing phosphorylation of opioid receptors and increasing nitric oxide levels

NDMA blockers like ketamine, block the actions of glutamate and decrease morphine tolerance

Most common due to maternal sensitization to Rh during a prior pregnancy with an Rh(D)+ fetus.

In subsequent Rh(D)+ pregnancies, maternal anti-Rh(d) IgG antibodies cross the placenta and cause fetal hemolysis

Clinical findings: anemia, jaundice, generalized edema (hydrops fetalis), nucleated erythrocytes, extramedullary hematopoiesis.

Corresponds to the minimum number of organisms required to cause disease in 50% of affected individuals

Shigella (10-500 cells), Campylobacter jejuni (500 cells), E.Histolytica (1-10 organisms), Giardia lamblia (1-10 organisms)

To test the association between 2 categorical variables, patients are divided in 2 groups based on exposure, and the number of patients that experience each outcome is recorded in 2x2 table.

To compare 2 group of means, not categorical variables, ex. fibrinogen levels as numerical values mg/dL instead of categorically

To compare the means of 2 or more groups. Ex. ANOVA analysis could be used to assess for differences in mean blood pressure among 3 sample populations grouped by exercise status (never exercise, occasionally, frequently)

Inhibit conversion of HMG-CoA to mevalonate (a cholesterol precursor)

Causes hepatocytes to increase their LDL receptor density as a means of increasing their uptake of circulating LDL

* LDL decreases, HDL increases, Triglycerides decreases

Hepatotoxicity (increase LFT's)

rhabdomyolysis (esp with fib rates and niacin)

Prevent intestinal reabsorption of bile acids; liver must use cholesterol to make more

*LDL decrease, HLD increase, TGL increase

GI disconfort

Decrease absorption of fat soluble vitamins

Cholesterol gallstones

Inhibit lipolysis in adipose tissue; reduces hepatic VLDL synthesis

*LDL Decrease, HDL increase, TGL decrease

Red, flushed face, which is decreased by aspirin or long term use.

Hyperglycemia (acanthosis nigricans)

Hyperuricemia (exacerbates gout)

Prevent cholesterol absorption at small intestinal brush border

*LDL decrease, HDL no change, TGL no change

Rare, increase LFT's, diarrhea

Upregulate LPL

Increase TG cleareance

Activates PPARa to induce HDL synthesis

* LDL decrease, HDL increase, TGL decrease a lot

Myositis (increase risk with statins)

Hepatotoxicity (increase LFT's)

cholesterol gallstones (esp with bile acid resins)

Cause: Adrenal hyperplasia or aldosterone secreting adrenal adenoma (Conn syndrome)

Hypertension, hypokalemia, metabolic alkalosis, LOW PLASMA RENIN.

Normal Na+ due to aldosterone escape = no edema

May be bilateral or unilateral

Tx: Surgery to remove the Tu and or spironolactone

Cause: Renal perception of low intravascular volume results in an overactive renin- angiotensin system

Due to Renal artery stenosis, CHF, cirrhosis, nephrotic syndrome.

HIGH PLASMA RENIN

Tx: Spironolactone (K+ sparing, aldosterone agonist)

Folic acid analog that inhibits dihydrofolate reductase, decrease dTMP, decrease DNA, and protein synthesis

Myelosuppression (reversible with leucovorin (folinic acid))

Macrovesicular fatty change in liver

Mucositis

Teratogenic

Stomatitis

Secondary to the presence of a cord factor a mycoside (2 mycolic acid), establish virulence through neutrophil inhibition, mitochondrial destruction and release of TNF

H1 receptor blockers decrease the activity of this receptor increasing the proportion of inactive H1 receptors (reverse blockade)

1st generation antihistaminics (Clorpheniramine, diphenhydramine) have antimuscarinic, anti a adrenergic, anti serotonergic properties

Anticholinergic: pupillary dilation (blurry vision) muscarinic, dry mouth, urinary retention, constipation.

Deep vein thrombosis that cause a pulmonary embolism

Inadequate recanalization of the ureteropelvic junction, the junction between the kidney and the ureter

Digest the offending pathogens, and tissue debris, chemotactically summon additional neutrophils or macrophages to the area. Occasionally the enzymes will also damage the surrounding parenchyma, setting the stage for abscess formation

To treat P.vivax, P ovale in roder to eradicate the intrahepatic stages of these 2 malarial species and prevent relapsing.

Acute lymphoblastic leukemia

Acute myelogenous leukemia

Ulnar nerve injury "claw hand" deformity, can be injured either near the medial epicondyle of the humerus or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

Radial nerve provides sensory innervation to the skin of the posterior arm, forearm, and dorsal lateral hand, motor innervation to all of the extensor muscles of the upper limb below the shoulder.

1) Proximal tubule

2) Descendind limb of Henle's loop

3) Thick ascendinf limb of Henle's loop

4) Distal convoluted tubule

5) Collecting duct (Na+ channel blocker)

6) Collecting duct (Aldosterone receptor antagonist)

DM1 can cause overflow incontinence due to inability to sense a full bladder and incomplete emptying. Post void residual testing with ultrasound or catheterization can confirm inadequate bladder emptying

1) Proximal tubule, descending limb of Henle loop- HIGH

2) Ascending limb of Henle loop, early convoluted tubule- NON

3) Late distal convoluted tubule, collecting duct system- ADH VARIABLE

DRESS syndrome 2-8 weeks after exposure to a drug, anticonvulsivants, allopurinol, sulfonamides, antibiotics

Affected organs: Liver (hepatomegaly, jaundice), kidney (acute interstitial nephritis), lung (cough, dyspnea)

Labs: Eosinophilia, atypical lymphocytosis, elevated ALT

Improve with suspension of the drug

DIgestive disorders such as cholestasis can cause malabsorption and nutritional deficiencies, of the fat soluble vitamins, one of them Vit D

Impaired bile acid absorption in the terminal ileum leads to loss of bile acids in feces with subsequent fat malabsorption.

Lipids then bind Ca++ and the resulting soap complex is excreted.

Free oxalate is absorbed and forms urinary calculi

Bacterial mRNA can be polycistronic, one mRNA codes for several proteins

mRNA is the bacterial lac operon, wich codes for the proteins necessary for lactose metabolism, transcription, translation, all regulated by a single promoter, operator

1) Disruption of cell membranes, denaturation of proteins

2) Disruption of cell membranes, coagulation of cytoplasm

3) Produces destructive free radicals that oxidize cellular components

4) Halogenation of proteins- nucleic acids

Exchange of entire genome segments

Orthomyxoviruses (Influenza)

Rotaviruses

1) Pyramidal cells of the hippocampus

2) Neocortex and the Purkinje cells of the cerebellum

The hippocampus is the first area damaged during global ischemia

Chemical structure similar to pyrophosphate and attach to hydroxyapatite binding sites on bony surfaces to inhibit bone resorption by mature osteoclasts

Jimson Weed (datura stramonium) poisoning, also called "Gardener mydriasis)

Belladona alkaloids (anticholinergic properties)

Jimson weed and Atropine poisoning are similar

Can be reverted with cholinesterase inhibitors (physostigmine)

Arsenic, Throrotrast, polyvinyl chloride

Tu cells express CD31, an endothelial cell marker

Serotonin, because BH4 is a cofactor used by hydroxyls enzymes in the synthesis of tyrosine, dopa, serotonin, NO.

Serotonin is synthesized from tryptophan, initial step is catalyzed by enzyme uses BH4 as a cofactor

Dihydrobiopterin reductase deficiency causes defective regeneration of BH4 and is an uncommon cause of PKU.

1) Body, tail, most of the head

2) Wirsung (major pancreatic duct)

Failure of the dorsal and ventral pancreatic buds to fuse leads to pancreas divisum.

Accessory duct drain the majority of the pancreas

Osteoarthritis

Be aware that for Ddx rheumatoid arthritis typically affects the metacarpophalangeal and proximal inerphalangeal joints

Saline responsive: Vomiting/nasogastric suctioning and thiazide/loop diuretic use cause volume and Cl- depletion (low urine chloride)

Saline unresponsive: Hyperaldosteronism (high urine chloride)

Parenteral agent, seective D1 receptor agonist

Causes arteriolar dilation and natriuresis

Improve renal perfusion, used for hypertensive crisis

D: Diarrhea- Diaphoresis

U: Urination

M: Miosis

B: Bronchospasm- Bronchorrhea- Bradycardia

E: Emesis

L: Lacrimation

S: Salivation

Also muscular excitation, only symptom that atropine cannot reverse

Hot as a hare

Dry as a bone

Red as a beet

Blind as a bat

Mad as a hatter

Irritability, poor feeding, increased head circumference, enlarged ventricles on CT

Long term sequelae of hydrocephalus: lower extremity spasticity due to stretching of periventricular pyramidal tracts, visual disturbances, and learning disabilities

Growing with S.Aureus demonstrate the satellite phenomenon where this bacteria produce needed X and V factors for H. Influenza

Nuclear medicine hepatobiliary scanning (cholescintigraphy)

Primary hyperaldosteronism

1) Normal

2) Low

3) High

India ink staining in the CSF

Mucicarmine staining of lung tissues and bronchoalveolar washings

APC for interaction with T-lymphocytes

Failure to acidify lysosomes would lead to to deficient expression of MHC II bound to foreign antigen and subsequent lack of interaction between APC's and T-cells

TH1

1) Cell mediated

2) Activate macrophages and cytotoxic T- cells

3) IL-2, IFN-y, lymphotoxin B

4) Cytotoxicity, delayed hypersensitivity

1) Humoral (antibody- mediated)

2) Activate B-cells, promote class switching

3) IL-4, 5, 10, 13

4) Secretion of antibodies

Tricyclic antidepressants (amitriptyline)

CO= Stroke volume x Heart rate

CO= O2 consumption/ arteriovenous O2 difference

1) Echinocandins (caspofungin, micafungin) inhibits glucan from cell wall

2) Triazoles (Keto,fluco,itra,vori) inhibit ergosterol synthesis

Polyenes (Anfot B, nystatin) Bind ergosterol molecules in fungal cell membranes, creating pores and lysis

Allylamines (terbinafine) synthesis ergosterol [squalene epoxidase]

3) Pyrimidines (Flucytosine) converted to 5-fluoracil within the fungal cell and interferes with RNA and protein synthesis

Follicular lymphoma (B lymphocytes) translocation between chromosomes 14 and 18 which causes Bcl-2 over expression (protoncogene)

Thymoma, lymphocytic leukemias, parvovirus B19 infection

High number of tumor cells in S phase, that are present, high grade, poor prognosis

I form a Zenker diverticulum, presents in elderly patients with oropharyngeal dysphagia, halitosis, regurgitation , recurrent aspiration